Patterns of trematode infections of Opisthorchis viverrini (Opisthorchiidae) and Haplorchis taichui (Heterophyidae) in human populations from two villages in Savannakhet Province, Lao PDR.

The liver fluke, Opisthorchis viverrini, and the minute intestinal fluke, Haplorchis taichui, are prevalent in many Asian countries. This study analysed the patterns of infections of O. viverrini and H. taichui in Lahanam and Thakhamlien villages (Savannakhet Province, Lao PDR), in two cross-sectional investigations. Out of a total of 207 human participants, post-anthelmintic treatment positivity rates for expelled worms were 170 (82.1%) for H. taichui and 65 (31.4%) for O. viverrini. Both these species co-exist in the study villages. When each parasite was analysed separately, H. taichui infections reached a plateau among people aged >20 years. Opisthorchis viverrini infection rates were highest in the age group 21-30 years, with decreasing infection rates after the age of 30. Our findings indicated that fish-borne trematode infections were more prevalent among adults. Fish, common intermediate hosts, were acquired in the study area for analysis. The examination of 35 species of fish as intermediate hosts found O. viverrini metacercariae in only six species, and these were found mostly during the month of November. Many farmers who live on the rice fields obtain their food from their immediate environment, including these intermediate-host fish, potentially putting them at greater risk of O. viverrini infection. By contrast, H. taichui metacercariae were found in three species of fish obtained from the market, meaning that anyone could consume them and become infected. If people who work in rice fields limit the species of fish they consume, or avoid consuming raw fish during the month of November, they may reduce their risk of O. viverrini infection.

Short- and long-term impact of health education in improving water supply, sanitation and knowledge about intestinal helminths in rural Bangladesh.

OBJECTIVE: To investigate the long-term impact of health education in intestinal helminth infection control in rural Bangladesh. STUDY DESIGN: Longitudinal study to compare knowledge, awareness and practice for intestinal helminths between four communities: two receiving health education and two not receiving health education. METHODS: Parents of 1497 children aged between 2 and 8 years [781 (52.2%) received health education] were investigated by interview at baseline, endline (18 months) and follow-up (5 years). RESULTS: Health education had a significant effect on the installment of tubewells and latrines, but only had a temporary effect on health knowledge. CONCLUSION: This long-term follow-up study showed the lack of sustainability of knowledge and awareness in the long-term after health education interventions.

Suppressive effect of partially hydrolyzed guar gum on transitory diarrhea induced by ingestion of maltitol and lactitol in healthy humans.

OBJECTIVES: To estimate the suppressive effect of partially hydrolyzed guar gum (PHGG) on transitory diarrhea induced by ingestion of a sufficient amount of maltitol or lactitol in female subjects. DESIGN: The first, the minimal dose level of maltitol and lactitol that would induce transitory diarrhea was estimated separately for each subject. Individual subject was administered a dose that increased by 5 g stepwise from 10 to 45 g until diarrhea was experienced. Thereafter, the suppressive effect on diarrhea was observed after each subject ingested a mixture of 5 g of PHGG and the minimal dose level of maltitol or lactitol. SETTING: Laboratory of Public Health Nutrition, Department of Nutrition and Health Sciences, Siebold University of Nagasaki. SUBJECTS: Thirty-four normal female subjects (21.3+/-0.9 years; 49.5+/-5.3 kg). MAIN OUTCOME MEASUREMENT: Incidence of diarrhea caused by the ingestion of maltitol or lactitol and the ratio of suppression achieved by adding PHGG for diarrhea. RESULTS: The ingestion of amounts up to 45 g of maltitol, diarrhea caused in 29 of 34 subjects (85.3%), whereas the ingestion of lactitol caused diarrhea in 100%. The diarrhea owing to maltitol was improved in 10 of 28 subjects by the addition of 5 g of PHGG to minimal dose-induced diarrhea, and that owing to lactitol was in seven of 19 subjects. Adding 10 g of PHGG strongly suppressed the diarrhea caused by maltitol, and the cumulative ratio was 82.1% (23/28). CONCLUSION: The transitory diarrhea caused by the ingestion of maltitol or lactitol was clearly suppressed by the addition of PHGG. These results strongly suggest that diarrhea caused by the ingestion of a sufficient amount of non-digestible sugar substitute can be suppressed by the addition of dietary fiber.

Oligoclonal expansion of cd8+ T-lymphocytes in cultured peripheral lymphocytes derived from asymptomatic HTLV-I carriers.

Peripheral blood mononulear cells (PBMC) derived from 10 asymptomatic human T lymphotropic virus type I (HTLV-I) carriers were cultured for a short term (10-14 days) in the absence of exogenous antigens. In 5 carriers, when compared with 5 HTLV-I non-carriers an apparent increase in the proportion of CD8+ DR+ cells was observed. The clonality of cultured lymphocytes was then examined by analyzing the usage of Vbeta families of T cell receptor genes. In three of the 5 carriers with an increased CD8+ population, two to four Vbeta genes were dominant in the CD8+ population but not in the CD4+ population. No dominance of Vbeta gene usage was observed in lymphocytes derived from the 5 noncarriers. The sequence of cDNA from Vbeta families which were especially dominant revealed their oligoclonal characteristics. These results were quite similar to our previous findings from HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients in whom the same oligoclonal CD8+ cells were expanded cytotoxic T lymphocyte clones for HTLV-I genome products. We posed the question of whether the dominance of TCR Vbeta usage in cultured PBMC was associated with the HTLV-I genome dose in the PBMC or with anti-HTLV-I antibody titers. The three carriers who showed an increased CD8+ population mentioned above all showed a rather high HTLV-I genome dose, which again was similar to HAM/TSP patients. These three carriers however, did not necessarily show high anti-HTLV-I antibody titers in contrast with HAM/TSP patients, who generally do.

Selenium levels and glutathione peroxidase activities in blood in an andean high-altitude population.

Selenium (Se) levels in blood (whole blood, erythrocytes and serum) and blood glutathione peroxidase (GSH-Px) activity were investigated in people living at high altitude in Bolivia (4,000 m above sea level). These parameters were compared to those of people living at low altitude (300 m above sea level). The Se levels in whole blood of the high-altitude subjects did not differ significantly from those of the low-altitude subjects. However, the Se levels in erythrocytes were significantly lower in the high-altitude subjects than in the low-altitude subjects, whereas serum Se levels were higher in the high-altitude subjects than in the low-altitude subjects. GSH-Px activity (Unit/g Hb) was significantly lower in the high-altitude subjects than in the low-altitude subjects. The mean corpuscular Hb concentration (MCHC), an indicator of the age of erythrocytes, in the high-altitude subjects was significantly higher than in the low-altitude subjects. These results show that the GSH-Px activity in the blood of the high-altitude subjects is relatively low. This may be due to their aged erythrocytes and/or to relatively low Se intake in the high-altitude population compared with low-altitude population.

Hand-arm vibration in tropical rain forestry workers.

Working conditions and health hazards including vibration syndrome related to forestry work using chain-saws were studied in Papua New Guinea and Indonesia. The subjects comprised 291 workers including 97 chain-saw operators. The health examination consisted of peripheral circulatory and sensory tests in the upper extremities. The vibration spectrum measured at the handle of the chain-saw indicated that these acceleration levels would lead to a moderately high risk of hand-arm vibration syndrome (HAVS). The peripheral circulatory function tests revealed dysfunction after more than five years vibration exposure. However, in general, the results of the function tests and subjective complaints showed fewer health problems compared to those of Japanese forestry workers. The reason of such differences of vibration effects seem to be the following: (1) warmer climate (more than 25 degrees C throughout the year), (2) young workers and short work experience. (3) short time vibration exposures on working days in the natural forests, (4) seasonal changes in logging work (5) healthy workers effects. Thus, we found no clear evidence that the workers of our study suffered from HAVS. A principal component analysis was applied. The factor score of the components of the reactive dynamics of peripheral circulation differed significantly after more than five years' exposure. On the other hand, we cannot deny the possibility that subclinical dysfunction of peripheral circulation may be caused by chain-saw operation in the tropics in future. Further investigations on the HAVS among forestry workers in the tropic environment are needed.

[Prevalence of disabilities of the upper and lower extremities among community-dwelling middle-aged and elderly women].

OBJECTIVE: In order to obtain baseline data for designing programs aimed at promoting physical function among elderly people in Japan, we determined the prevalence of disabilities affecting upper and lower extremities and their impact on function in community-dwelling middle-aged and elderly Japanese women. METHODS: Subjects were 580 women aged 40 years and over, living in Oshima town, Nagasaki, Japan. Information on disabilities affecting all four extremities was collected by questionnaire. Subjects were asked about the extent of disability in each extremity (no disability, some, moderate, cannot or very difficult to use extremity) and the reason for the disability. The functional level was defined using a disability score, calculated by summing the disabilities for upper or lower extremities (no disability, 0; some, 1; moderate, 2; cannot or very difficult to use, 3). Women who scored 0 were classified as 'good', women who scored 1-2 'fair', and who scored 3-6 as 'poor'. RESULTS: Prevalence of disability affecting the upper extremities increased significantly with age (11.9% with some or greater, and 4.3% with moderate or worse). Disabilities of the lower extremities also increased significantly with age (27.2% with some or greater, and 12.9% with moderate or worse), affecting a larger proportion of individuals. With regard to the upper extremities, the women classified a 'fair' and 'poor' increased significantly with age (9.5% with 'fair', and 2.4% with 'poor'), and function decreased (p = 0.003). The same was the case for the lower extremities (19.0% with 'fair', and 8.3% with 'poor') (P < 0.001). The most frequently cited cause of disability was arthritis, both in the upper (20%) and lower (40%) extremities, followed by stroke (10%), fracture (10%) and trauma not associated with fracture (10%). CONCLUSIONS: In middle aged and elderly women, disabilities of the upper and lower extremities become more prevalent and are associated with further functional impairment with aging. Such disabilities are more common in the lower extremities, and arthritis seems to be the most frequent cause.

[Validity of various indices of obesity calculated from height and weight data for adult males use of the underwater-weighing method as a reference].

PURPOSE: We evaluated associations between excess body fat (%Fat) and various indices of obesity calculated from height and weight data. METHODS: In 147 adult males, %Fat was measured by the underwater-weighing method, and obesity indices were generated by the following 5 approaches: the Broca-Katsura (Katsura method), the Kato-Wataya (Kato method), Japan Society for the Study of Obesity (BMI method; based on the body weight at which the BMI is 22), and the Meiji Life Insurance Co. methods, and the Tables and Figures for Assessment of Obesity and Leanness published by the Ministry of Health and Welfare (MHW method). RESULTS: %Fat was 20% or more (obese) in 67 males (45.6%), 15-20% in 39 (26.5%), 10-15% in 35 (23.8%), and less than 10% in 6 (4.1%). The correlation coefficients between the obesity indices and %Fat were 0.612 for the Katsura method, 0.590 for the Kato-method, 0.611 for the BMI method, 0.612 for the Meiji Life Insurance Co. method, and 0.550 for the MHW method, being significant in each case (P < 0.01). When the cut-off point was set as 110% for each obesity index, sensitivity was highest with the Kato-method (82.1%), and specificity was highest with the Meiji Life Insurance Co. method (93.8%). With the MHW method, the receiver operating characteristic (ROC) curve was slightly farther from the point of sensitivity of 100% and 1-specificity of 0% than the others. CONCLUSION: Excess fat accumulation can not be accurately assessed by obesity indices calculated from body height and weight data. Validity was similar among obesity indices examined.

[Validity of various obesity indices calculated from height and weight in adult females using the underwater-weighing method as a reference].

We evaluated association between excess percent body fat (%Fat) and various obesity indices calculated from height and weight in 322 adult females. %Fat was measured by the underwater-weighing method, and obesity indices were based on the following 5 methods; Broca-Katsura method (Katsura method), Kato-Wataya method (Kato method), Japan Society for the Study of Obesity method (BMI method; based on the body weight at which BMI is 22), Meiji Life Insurance Co. method, and Table and Figure for the Assessment of Obesity and Leanness by the Ministry of Health and Welfare (MHW method). %Fat was 30% or more (obese) in 73 females (22.7%), 25-30% in 97 (30.1%), 20-25% in 88 (27.3%), and less than 20% in 64 (19.9%). The correlation coefficient between the obesity indices and %Fat were 0.71 for the Katsura method, 0.70 for the Kato-method, 0.72 for the BMI method, 0.70 for the Meiji Life Insurance Co. Method, and 0.63 for the MHW method, being significant for all methods (P < 0.01). When the cut-off point was set as 110% for each obesity index, sensitivity was the highest for the Katsura method (67.1%), and specificity was the highest for the Meiji Life Insurance Co. method (95.2%). Receiver operating characteristic (ROC) curves were similar in figure for the Katsura method, Kato-method, BMI method, and Meiji Life Insurance Co. method. For the MHW method, however, the curve was slightly farther from the point of sensitivity of 100% and 1-specificity of 0% than the others. Excess fat accumulation could not be accurately assessed by the obesity indices calculated from body height and weight. Validity was similar among the obesity indices except for the MHW method.

[Body density assessment utilizing skinfold thickness and age in Japanese women].

A study was conducted to investigate the validity of skinfold-based prediction equations for body density (g/ml) by Nagamine and Suzuki (1964), and to formulate more convenient and more useful equations for predicting body density from skinfold and age in women. Subjects of the study were 512 healthy women aged 18-66 years in or near Nagasaki City. The dependent variable in the multiple regression equation, body density, was determined by hydrostatic weighing. Independent variables included eight skinfolds, the sum of two skinfolds (triceps, subscapular), the sum of three skinfolds (triceps, subscapular, and abdominal), age, and body surface area. Skinfolds were measured with an Eiken-model skinfold caliper. Age (mean 30.1, range 18-66 yrs.), weight (mean 52.6, range 38.0-83.3 kg), height (mean 157.0, range 142.0-172.0 cm), and body density, (mean 1.04125, range 0.98806-1.08650 g/ml) were also recorded. Percent body fat was calculated using the formula by Brozek et al. and ranged from 6.4% to 48.3%. Multiple correlation coefficients (MR) and standard error (SE) of 10 regression equations (A-J) for predicting body density in women were compared. The best-fitting and the most convenient prediction equation for body density was equation-E. The regression equation developed for predicting body density was: body density = 1.07931-0.00059 x sum of three skinfolds(mm)-0.00015 x age (MR = 0.77 and SE = 0.0089). The equation was cross-validated on a different sample of 46 women. The correlation coefficient between predicted and hydrostatically determined body density was 0.813 (p < 0.001). Equation-E (Tahara's equation) appears to be useful in body density analysis particularly when the subjects are Japanese women, aged 18-50 yrs, with percent body fat 17 to 34%.

Sexual behavior and condom use in female students in Dar-es-Salaam, Tanzania: differences by steady and casual partners.

OBJECTIVE: In Tanzania female youth are increasingly becoming at greater risk of sexually transmitted HIV infection, whereby more than 80% cases occur through un-protected sex. The objective of this study was to examine related-factors which influence female students to have risky sexual contacts with casual partners including condom use and sex with sugar daddies. METHODS: A cross section study involving face-to-face interview was conducted regarding sexual behavior among 219 sexually-debuted female students aged between 18 and 24 years who were attending high schools and colleges in Dar-es-salaam, Tanzania. RESULTS: Eighty-three percent had at least one boyfriend in the past 12 months, 57% had engaged in sex with a "sugar daddy", and 24% had engaged in sex with a casual partner other than a sugar daddy. Sixty-nine percent had ever used a condom, and 66% had used a condom during their most recent sexual encounter. Thirty-two percent reported always using a condom during sex with their boyfriends, whereas only 2% always used a condom with a sugar daddy. Decision-making about condom use during sex with boyfriends was made by couples together (48%) or by the girls alone (34%), whereas the decision during sex with a sugar daddy was predominantly made by the male partner (79%). Data were analyzed using Statistical Package for Social Sciences (SPSS) version 9.5 for frequencies, cross-tabulations and chi-squired test and statistical significance set at p<0.05. CONCLUSION: The study highlighted risk factors for female students towards HIV infection. Receiving money and/or presents were the major motivations for having sex irrelevant with types of sex partners. Although most female's students disagreed in principle to have sex in exchange for money or presents, sex with sugar daddies was common among female students and was a major risk factor for HIV infection. Based on the findings, recommendations for improvement in prevention programs among female youth within Tanzanian context are discussed.

Educational intervention for preventing bloodborne infection among medical students in China.

Although medical students are known to be at risk for bloodborne infections, there have been no systematic studies, effective intervention programmes, or guidelines for them in China. We developed prevention guidelines, implemented an intervention, and evaluated the effectiveness of knowledge among medical students. This study was designed as a cluster randomised controlled trial. All those who completed a consent form were randomly assigned either to an intervention or to a control group. The intervention group underwent an educational intervention programme consisting of a series of lectures and videos following a baseline survey. The control group completed the same intervention programme after the study was completed. A questionnaire of 25 items was sent to participants three months and nine months after the initial intervention programme. Outcomes measured before and after intervention included knowledge of transmission route, first-aid care, and post-exposure prophylaxis. Pearson's chi(2)-test was used, and the efficacy of students was analysed to control for bias. Intervention in the form of a one-time bloodborne pathogen educational prevention programme for Chinese medical students had little effect on knowledge.

Parasite egg contamination of vegetables from a suburban market in Hanoi, Vietnam.

Helminth egg contamination of vegetables purchased at suburban market in Hanoi, Vietnam was examined. A total of 317 vegetables were examined and 82 (26%) were revealed to be positive for parasite eggs. Of the 15 varieties, 13 were positive except for horseradish and cucumber. Contamination was highest in leafy vegetables (31%), followed by root vegetables (17%) and fruit vegetables (3%). Throughout the survey, five species of parasite eggs were found: Ascaris sp., Trichuris sp., Toxocara sp., Taenia sp. and Ascaridia galli. In the interview with the villagers, 121 (81%) of 149 adult villagers stated that they usually use not only animal feces but also human feces as a fertilizer. Throughout the survey, a total of 453 eggs were recovered. Number of eggs recovered from vegetables was higher in the dry season (355 eggs) than in the rainy season (98 eggs). The study revealed that vegetables purchased at a market in suburban Hanoi (Vietnam) were highly contaminated with parasite eggs excreted by humans and animals. Considering the eating habits of the Vietnamese and the 17% embryonation rate of detected parasites, vegetables seem to play an important role in soil-transmitted helminth infection in this country.

Factors affecting choice of sterilisation among low income women in Paraíba, Brazil.

Despite the absence of a family planning programme, the prevalence of sterilisation in Brazil has increased substantially, such that it is used by relatively young women in poor areas of the country. Sterilisation is influenced more by the characteristics of the health service than by socioeconomic characteristics of the population.

Changes in cortical thickness of the clavicle and serum bone gamma-carboxyglutamic acid-containing protein in the elderly in an island community in western Japan.

The cortical thickness of the clavicle (CTC), concentrations of bone gamma-carboxyglutamic acid-containing (Gla) protein (s-BGP, osteocalcin), alkaline phosphatase (s-ALP), calcium (s-Ca) and inorganic phosphorus (s-P) in serum, and calcium/creatinine (u-Ca/Cr) and inorganic phosphorus/creatinine (u-P/Cr) ratios in urine were examined in 211 subjects aged over 40 years in Oshima Island in Nagasaki prefecture. CTC decreased and s-BGP increased with age in both sexes, especially in women. Serum BGP was significantly higher in women than in men at the ages of 50's and over. Serum ALP in women increased until the ages of 60's. Serum Ca at the ages of 50's and s-P at the ages of 60's and over were higher in women than in men. As the increase in s-BGP is reported to be coincident with active bone formation, our findings do not support the view that age-related bone loss, especially in women, primarily results from decrease in bone formation.

Difference of the 28-item general health questionnaire scores between Japanese high school and university students.

The General Health Questionnaire (GHQ) with 28 items was tested in Nagasaki city on 138 senior students in a prefectural high school and 685 freshmen in a national university to evaluate the degree of students' mental stress due to the highly competitive entrance examination for university. The average GHQ score tested on high school students was 5.33 for males and 7.07 for females, and 3.99 for males and 4.42 for females on university students. It showed that high school students were under greater pressure than university students and female students were in a higher tension compared with male students. The factor analysis showed that the primary and secondary factor of high school students were "severe depression" and "anxiety and insomnia," while "somatic symptoms" were the primary factor causing stress in university students.

Intra-individual variation of skin temperature recovery rate after cold water immersion among Japanese bush-cutter operators.

Recovery rates of skin temperature after cold water immersion tests and other measurements were recorded from 1978 to 1989 to assess the effects of vibration due to the use of bush-cutters on the health of 42 road-maintenance workers having an average age of 51.7 years. Their work and health conditions were controlled and checked systematically, and the incidence of white finger in 1989 was 2%. The recovery rate as well as the initial skin temperature was influenced greatly by ambient temperature and thus direct assessment of the changes in recovery rate had little value. The intra-individual variation in recovery rates among 6 examinations ranged widely from 6.7 to 55.7%. Subjects with large variation in the recovery rate showed better results in recovery rate, skin temperature, and vibratory sensation than those with little variation. Individuals with large variation tend to respond well to changes in ambient temperature and to suspension and resumption in the use of bush-cutters, indicating the elasticity of their peripheral circulatory system.

Urban growth and health in Nagasaki after the atomic air raid.

According to development of the city, it has been revealed that demographic characteristics and living condition, as well as health status, have been differentiated among areas within it. On the causal relationships between urban growth and health, the present study shows no evidence, but a significant correlation between population density and demographic characteristics, and health, especially in maternal child health, have been observed in the same city (Takemoto et al., 1988). Considering the regionalization of characteristics in man and his environment within a city, public health activities based on the assessment of health needs in each community should be developed in urbanized society.

Physical growth of Aymara children in a herding community of the Bolivian Altiplano.

In a small agropastoral Aymara community called Wariscata in the Andean Altiplano of Bolivia, anthropometric measurements were made in 1988. In comparison with those of published data for the other rural and urban Andean populations (Aymara, Quechua and Mestizo at high and low altitudes), the Aymara children of Wariscata were taller and heavier than other rural high altitude native children, but similar in height to urban high altitude children. This is possibly due to secular change of growth accompanied with nutritional improvement that has taken place in recent years. Chest width and depth had similar values to those in other Aymara children. But, Aymara children in Wariscata of both sexes had smaller chest dimensions (depth and width) than those of Quechua children. However, these ethnic differences in chest dimensions were not reflected in the adult Aymara and Quechua, suggesting different process of chest growth in Aymara and Quechua populations.