Ficus septica exudate, a traditional medicine used in Papua New Guinea for treating infected cutaneous ulcers: in vitro evaluation and clinical efficacy assessment by cluster randomised trial.

BACKGROUND AND OBJECTIVES: Infected cutaneous ulcers are major health problems for children living in rural areas of Papua New Guinea. The inaccessibility of affected populations and lack of access to basic healthcare, make a local plant-based therapy an attractive treatment option. We assessed Ficus septica exudate in biological assays relevant to wound healing. We then carried out a clinical trial to determine the exudate's efficacy in healing small cutaneous ulcers compared with Savlon antiseptic cream, and soap and water washing. METHODS: Pre-clinical in vitro assessment of the exudate was carried out using assays to monitor the pro-inflammatory responses of M1 macrophages and neutrophils, antibacterial assays using known ulcer pathogens, an Ames test for mutagenicity and LC-MS chemical analysis of the exudate. An open label cluster-randomised clinical trial was performed, enrolling participants from three different clusters with skin lesions less than 1 cm in diameter. Each cluster comprising 50 participants was randomly assigned to one of three treatment arms namely topical exudate, topical Savlon antiseptic cream, and standard care (soap and water treatment), all administered daily for 2 days. The primary outcome was clinical healing/improvement measured at days 7 and 14, assessed by three dermatologists using blinded photographs. The primary analysis was assessed as non-inferiority of F. septica treatment based on the risk difference for healing/improvement. RESULTS: In vitro, the exudate which is rich in the alkaloid ficuseptine, was found to be non-mutagenic whilst also inhibiting pro-inflammatory responses and exhibiting antibacterial activity. When administered to participants enrolled in the clinical trial, no significant differences were observed between the healing efficacy of F. septica exudate and the two comparator treatments (Savlon antiseptic cream and soap/water treatment). At day 14, but not at day 7, the efficacy of F. septica exudate for healing/improving the ulcers was non-inferior to Savlon antiseptic cream or water/soap treatment. CONCLUSIONS: F. septica exudate is non-mutagenic and has both bactericidal and anti-inflammatory properties. When applied topically to small cutaneous ulcers, the exudate has a healing effect that is non-inferior to Savlon antiseptic cream and standard treatment with soap and water at day 14. Our findings, which should be confirmed in larger clinical trials, have important public health implications.

Medical Students at the School of Medicine and Health Sciences, University of Papua New Guinea: Predictors of Performance and Student Backgrounds.

BACKGROUND: Papua New Guinea, a lower middle income country with a population of around 8.5 million, the majority of whom live in rural areas, produces far fewer than the number of medical graduates required to meet the WHO-recommended doctor/population ratio. The School of Medicine and Health Sciences is under pressure to increase its output and ensure the graduates are able to function in rural settings. Through two studies, we aimed to determine the predictors of student performance and their socioeconomic and educational background to assist in determining admission policies and improve completion rates. METHODS: A retrospective study analysed data relating to student performance from six annual cohorts. A cross-sectional study among currently enrolled students sought information about their socioeconomic and educational background. RESULTS: Of the 300 students enrolled in the six cohorts, 176 (59%) completed the programme in the scheduled 4 years. There were no differences in completion rates by gender or route of entry to the programme. Grade point average at medical school entry predicted academic performance. Sixty-four per cent of the students who failed to complete in four years attributed their poor academic performance to social issues. Overall attrition was only 8%. Seventy-six per cent (162/214) of the enrolled students completed the cross-sectional survey. Most (79%) of students' fathers and 58% of mothers had postsecondary education. Seventy-three per cent of respondents indicated that they had been to preschool or elementary school. Thirty-six per cent had attended primary school in a village or government/mission station. Just over half (53%) of the students indicated that English had been the language most used in primary school. Males were more likely to have made a specific career choice than females. The majority (141/162, 88%) of the students indicated that they had experienced some academic difficulty during the years. CONCLUSION: Prior academic performance predicted timely completion of the MBBS programme. Just over a third of students had attended rural village primary schools. Social and domestic issues were common and adversely affected academic performance.

Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group.

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.

Rapid assessment of avoidable blindness and diabetic retinopathy in people aged 50 years and older in the National Capital District of Papua New Guinea.

BACKGROUND/AIMS: To conduct an assessment of avoidable blindness, diabetes mellitus and diabetic retinopathy (DR) in adults aged 50 years and older in the National Capital District (NCD) region of Papua New Guinea (PNG). METHODS: A cross-sectional population-based survey was performed for which 25 clusters of 50 people aged ≥50 years were randomly selected from the NCD region. The standardised rapid assessment of avoidable blindness (RAAB) with diabetic retinopathy (+DR) methodology was used. Blindness was defined as presenting visual acuity <3/60 in the better eye. Participants were classified as having diabetes if they were known to have diabetes or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed. RESULTS: In total, 1192 out of 1250 eligible participants (95.4%) were examined. Of these, 7.8% had known or newly diagnosed diabetes. Seventy-one per cent of participants with known diabetes had a blood glucose level ≥200 mg/dL, and 82.9% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 46.4%. The age-adjusted and sex-adjusted prevalence of diabetes was estimated at 8.1% (95% CI 5.7% to 10.4%) in the population aged 50 years or older in the NCD region of PNG. CONCLUSIONS: Prevalence of diabetes in adults aged 50 years and older was lower than reported elsewhere in the region, and lower than other RAAB+DR surveys. Despite this, the prevalence of DR is high compared with other RAAB+DR surveys and demonstrates the need for increased awareness and accessibility to eye services for people with diabetes.

Dietary Guidelines for the Asia Pacific Region.

Nutrition is a major determinant of health throughout all stages of life and together with smoking is the most important risk factor for morbidity and mortality in the Asia Pacific Region. The workshop participants examined Dietary Guidelines and Food Guides that are in use in our region, together with additional materials from the World Health Organization, UNICEF and the World Cancer Research Foundation. The resulting set of guidelines is meant as a reminder of the main issues to be covered in a general public health education program. It may also be of value in reminding public health practitioners, educators, administrators, and policy makers of current nutrition issues. It may additionally be useful as a checklist of the issues to be considered in public health programs and regulations. The main areas of nutrition that are included in the Guidelines are eating a variety of foods, including vegetables, fruits, whole grain cereals, and nuts. Choose fish, poultry, and meats grown in a sustainable way. Appropriate growth, including avoiding obesity, and physical activity are important. Breastfeeding is the basis of infant nutrition and nutrition of mothers is an important public health measure. Negative factors in the Asian diet include salt, refined sugar, alcohol and fats. The APACPH Dietary Guidelines will need to be kept under review and modified to meet regional differences in food supply. The Guidelines will be useful as a checklist of the issues to be considered in public health programs, addressing both acute and chronic diseases.

The associations of sociocultural attitudes towards appearance with body dissatisfaction and eating behaviors in Hong Kong adolescents.

OBJECTIVES: Western culture has great influences on body dissatisfaction and related eating behaviors in adolescents. This study aimed to assess the sociocultural influences on eating attitudes and motivations among Hong Kong Chinese adolescents. METHODS: In 2007, 909 adolescents (mean age = 14.7 years, 55.3% boys) completed a survey with Stunkard's Figure Rating Scale (FRS), Motivation for Eating Scale (MFES), Eating Attitudes Test (EAT), Revised Restraint Scale (RRS), and Sociocultural Attitudes Towards Appearance Scale (SATAQ). In addition, their body mass index (BMI) was objectively measured. RESULTS: Our results indicated that Hong Kong adolescents, particularly girls exhibited a remarked level of body dissatisfaction, external, emotional, restrained and disordered eating behaviors. Hierarchical regression analyses indicated that age, sex and BMI were the most common contributing factors to individual eating styles. SATAQ significantly accounted for an additional variance of body dissatisfaction (2%), physical eating (2%), external eating (1%), emotional eating (3%), restrained eating (5%), and disordered eating (5%). CONCLUSIONS: In Hong Kong, the sociocultural influences on body image and eating disturbance were supported.

The emergence of separation protest is robust under conditions of severe developmental stress in rural Bangladesh.

The response of 185 infants to their mothers' departure was assessed in a rural area of Bangladesh. Despite their poor health and nutritional status, this group of infants showed the same peak in separation protest around the end of the first year that has been documented for healthier samples in several cultural contexts; correlational analysis suggests that the healthier infants were more likely to display protest. In addition, there was an earlier rise and decline in distress at maternal departure in the first half year of life, not seen in other reports. In this case, poor health appeared to dispose toward upset, indicating that the most fragile infants were least able to cope with the regulatory demands imposed by maternal departure. Overall, the results are evidence for a very strongly canalized transformation of cognitive and emotional functioning toward the end of the first year of life.

Asian children's obesogenic diets-time to change this part of the energy balance equation?

Food intake and dietary behavior, along with physical activity, are key environmental determinants of both energy imbalance as well as achieving and maintaining a healthy weight. Increasingly globalized, obesogenic diets and dietary behaviors have created a mainly urban Asian childhood obesity epidemic, which, coupled with persistent undernutrition, present a complex double burden of malnutrition. Some dietary patterns associated with Asian childhood overweight include snacking and eating out; consumption of fast food, sweetened beverages, and excessive meat; unhealthy macronutrient energy proportions; and a preference for refined grains. Strong evidenced-based measures must be created or identified that can adjust these ongoing obesogenic dietary shifts in more healthful directions, targeting lower-income subgroups in some of these societies. Measures must sensitively prevent and control the complex, interrelated diet problems presenting the nutritional double burden that, if not controlled, may overwhelm societies and health systems, undermining further Asian progress in health and socioeconomic development.

Associations of the growth hormone receptor (GHR) gene polymorphisms with adiposity and IGF-I activity in adolescents.

OBJECTIVE: To explore the genetic effect of the GH receptor (GHR) on obesity and related metabolic parameters in Hong Kong Chinese adolescents. CONTEXT: Obesity is a growing global epidemic. Increasing evidence suggests that the GH-IGF-I axis plays an important role in regulating adiposity and insulin sensitivity. DESIGN: We examined the associations of genetic variants of GHR with serum IGF-I and IGFBP-3 levels as well as obesity-related metabolic traits in Hong Kong Chinese adolescents. PATIENTS: Nine hundred and eighty-one randomly selected Hong Kong Chinese adolescents from 14 schools. MEASUREMENTS: We genotyped 17 single nucleotide polymorphisms (SNP) at GHR and measured serum IGF-I and IGFBP-3 levels as well as obesity-related metabolic traits including fasting plasma glucose, insulin and lipid levels. RESULTS: There were significant associations between rs4410646 and the body composition (P = 0.0044) and blood pressure factor scores (P = 0.00017). Carriers of the CC genotype had lower body mass index, percentage body fat, waist and hip circumferences than AC and AA genotype carriers (P = 0.00030-0.0094). There was also association between rs7703713 and the IGF-I activity factor score (P = 0.0033). The GA and AA carriers of rs7703713 had higher serum IGF-I, higher serum IGFBP-3 and higher IGF-I/IGFBP-3 molar ratio (P = 0.00069-0.025). Haplotype analysis did not increase the significance of associations. CONCLUSION: Our results support the role of GHR gene polymorphisms in modulating adiposity and IGF-I activity in adolescents. Examination of interactions of these SNPs with lifestyle, environmental and perinatal factors may provide further insights into their long-term effects on obesity and metabolic risks.

Secular changes in height, weight and body mass index in Hong Kong Children.

BACKGROUND: Large population growth surveys of children and adolescents aged 6 to 18 y were undertaken in Hong Kong in 1963 and 1993. The global epidemic of obesity is a major public health concern. To monitor the impact of this epidemic in Hong Kong children and to identify secular changes in growth, a further growth survey was undertaken in 2005/6. METHODS: Cross-sectional height and weight measurements of 14,842 children and adolescents aged 6 to 18 y from Hong Kong's 18 districts were obtained during the 2005/6 school year. Percentile curves were constructed using LMS method and sex-specific percentile values of weight-for-age, height-for-age, and BMI-for-age were compared with those data from 1963 and 1993. RESULTS: Secular changes in height, weight and BMI were noted between 1963 and 1993 and between 1993 and 2005/6. In the latter period, greater changes were observed at younger ages, and particularly in boys. On an annual basis, the 1993-2005/6 changes were less than those during 1963-1993. Using the International Obesity Task Force cut-offs, 16.7% of children were overweight or obese in 2005/6, which was a 5.1% increase since 1993. CONCLUSION: These data provide policy-makers with further evidence of the secular changes in child growth and the increasing obesity epidemic among Hong Kong children.

[Factors associated with responses of telephone screening interview in a validity and reliability study of telephone interview to assess dietary intake in urban China].

OBJECTIVE: To describe the first phase of a multi-phase study exploring the possibility of conducting telephone dietary intake interviewing in Beijing, Shanghai and Hong Kong in urban China in 2002. METHODS: Three hundred healthy urban Chinese women aged 20 to 49years were sampled by random telephone screening interviews. RESULTS: Examination of the factors associated with their responses to the telephone screening showed that the completion rates differed by day of the week and time of the day. The completion rates were higher onWednesday and Thursday than other weekdays, and higher on Sunday than Saturday at the weekend. There was a trend for the completion rates to peak from 18 :00 to 21:30 during weekday evenings and between 11:00 and 12:00 AM and 19:00 and 20:00 PM during weekends. There was no significant interviewer difference in the completion rates except for one interviewer in Hong Kong, indicating that interviewer performance did not influence completion rates. Of all numbers dialed, 25% of the responding persons refused, with almost all (94.3%) occurring at or near the beginning of the screening interviews, either before or at invitation. Key reasons for refusal included "hung up without any interaction" (35.1%), "not available to participate" (28.6%) or "not interested in survey" (19.0%). Most of the refusals were firm and not possible to reverse.

A prospective study of the effects of 1-year calcium-fortified soy milk supplementation on dietary calcium intake and bone health in Chinese adolescent girls aged 14 to 16.

The Chinese diet is low in calcium, including among adolescent girls, with an average intake around 500 mg per day. In this study, we compared the percentage change in bone mineral density and content of the spine and hip region in a 1-year follow-up study between 104 adolescent girls aged 14 to 16 years receiving 375 ml calcium-fortified soymilk supplementation and 95 girls in the control group. The mean percentage changes of bone mineral density/content (BMD/BMC) and standard deviation (SD) at 1 year for the supplementation and control groups were as follows: neck of the femur BMD 2.7+/-2.94%, 1.8+/-3.49% (P = 0.08); trochanter BMD 3.3+/-3.27%, 1.6+/-2.94% (P < or = 0.001); intertrochanter BMD 3.6+/-3.05%, 2.32+/-2.95% (P = 0.002); total hip BMD 3.1+/-2.39%, 2.05+/-2.22% (P = 0.001); total hip BMC 3.8+/-3.05%, 2.6+/-2.96% (P = 0.006). The percent difference between the percentage of bone changes in the supplementation and control groups [100x (soymilk-control)/control] ranged from 45 to 113%. We observed no differences in the spine BMD/C and no differences in changes of height and weight between the soymilk supplementation and control groups, which yielded similar results. Stepwise multivariate regression analysis including height, weight, growth stage, dietary energy, protein, calcium from usual diet and physical activity also showed that supplementation was significantly associated with a percentage increase in BMD/C at the hip. We conclude that 375 ml calcium-fortified soymilk supplementation, or an equivalent of about two glasses, is among the effective strategies for bone acquisition and the optimization of peak bone mass in adolescent girls.

[Feasibility of telephone screening interview in a validity and reliability study of telephone interview to assess dietary intake in Beijing, Shanghai and Hong Kong].

OBJECTIVE: To understand the feasibility of telephone interviews to achieve recruitment of subjects to assess the validity and reliability of the telephone interview in eliciting dietary intake. METHODS: A multi-phase study was conducted in Beijing, Shanghai and Hong Kong in 2002. RESULTS: Three hundred eligible women aged from 20 to 49 years old were recruited in those cities. In the screening interview, 2462 random telephone numbers were dialed with 95% of dials completed within 5 times of attempts. The average number of dial for the completion was two calls, the rates of completion and refusal conversion were not improved remarkably by the increase of calls although some calling attempts reached 20 times. Regarding the processing of the sampling pools in those three cities, Beijing had a lower efficiency rate but a satisfactory completion rate, Shanghai was good in both indicators, and Hong Kong had a good efficiency rate but lower completion rate. The overall telephone screening interview completion rate was 42%, with Hong Kong having the lowest rate (32%) compared with Beijing and Shanghai (47% and 50%, respectively, P < 0.001). CONCLUSION: The telephone interview method could successfully reach the target of urban Chinese women and earn their cooperation with a satisfactory completion rate.