Emergence and spread of antimicrobial resistance of Streptococcus pneumoniae in Korea.
(9/2333)
Pneumococcal resistance has become a global issue during the past three decades. One of the major foci of pneumococcal resistance worldwide is the Asian region including Korea, Japan, and Hong Kong. Korea had not been recognized as a focus of pneumococcal resistance until 1995, when serial reports documented the alarmingly high prevalence of penicillin resistance among clinical isolates. Serial reports on penicillin resistance among pneumococcal isolates in Korea ranged from 68% to 77% as of 1995. Multidrug resistance was also noted in 34% of Korean isolates. Penicillin-binding protein profile analysis, pulsed-field gel electrophoresis, ribotyping, and fingerprinting analysis of pbp genes showed that antibiotic-resistant pneumococci isolated in Korea were genetically related. Data documented the extensive spread of a resistant clone within Korea and between different countries. Besides the injudicious use of antimicrobial agents or the high prevalence of serotypes 23 and 19, the spread of a resistant clone may play an important role in the rapid increase of penicillin resistance in Korea. (+info)
The role of private medical practitioners and their interactions with public health services in Asian countries.
(10/2333)
This paper aims to review the role of private practitioners and their interactions with public health services in developing countries, focusing largely on the Asian region. Evidence on the distribution of health facilities, manpower, health expenditures and utilization rates shows that private practitioners are significant health care providers in many Asian countries. Limited information has been published on interactions between public and private providers despite their co-existence. Issues related to enforcement of regulations, human resources, patient referrals and disease notifications, are examined. (+info)
The role of private providers in maternal and child health and family planning services in developing countries.
(11/2333)
This paper uses data from the Demographic and Health Surveys program (DHS) in 11 countries in Asia, Africa, and Latin America to explore the contribution of private health care providers to population coverage with a variety of maternal and child health and family planning services. The choice of countries and services assessed was mainly determined by the availability of data in the different surveys. Private providers contribute significantly to family planning services and treatment of children's infectious diseases in a number of the countries studied. This is as expected from the predictions of economic theory, since these goods are less subject to market failures. For the more 'public goods' type services, such as immunization and ante-natal care, their role is much more circumscribed. Two groups of countries were identified: those with a higher private provision role across many different types of services and those where private provision was limited to only one or two types of the services studied. The analysis identified the lack of consistent or systematic definitions of private providers across countries as well as the absence of data on many key services in most of the DHS surveys. Given the significance of private provision of public health goods in many countries, the authors propose much more systematic efforts to measure these variables in the future. This could be included in future DHS surveys without too much difficulty. (+info)
Clinical and subclinical vitamin D deficiency in Bradford children.
(12/2333)
A survey of the vitamin D status of Bradford schoolchildren was carried out in April 1973, employing conventional biochemistry, radiology, and measurement of 25-hydroxycholecalciferol levels. Biochemical evidence of rickets was present in 45% of the Asians. When re-examined in September, several children showed spontaneous biochemical resolution; nevertheless, radiological abnormalities were present in 12% of the original sample. No evidence of rickets was detected in the smaller White sample. Minor biochemical abnormalities were present in 9 of the 40 West Indian children. A study of admissions of Bradford hospitals in the 4 years 1969-1972 inclusive confirmed that clinical vitamin D deficiency was confined to Asians except for a few cases of infantile rickets in White children. The probability that one Asian child in 40 may require admission during the period from birth to adolescence emphasizes the urgent need for the introduction of prophylactic measures. (+info)
Ethnicity, nationality and health care accessibility in Kuwait: a study of hospital emergency room users.
(13/2333)
In mid-1994, non-Kuwaiti expatriates constituted 61.7% of the total population of Kuwait (1.75 million). Despite this numerical majority, non-Kuwaitis exist as a social minority. Non-Kuwaitis may be grouped into three broad categories along ethnic/nationality lines into Bidoon (without nationality), Arabs, and Asians. The objective of this paper was to compare the relative accessibility of the various groups to health care services in Kuwait. The study is based on data collected as part of a survey of 2184 Emergency Room (ER) users in January-February 1993. All patients attending the hospital ERs between 7:30 am and 9:00 pm were interviewed about their reasons for coming to the ER instead of going to the primary health care (PHC) centres, as required. The major reason given was low accessibility of the PHCs. Compared to Kuwaiti nationals, 92% of whom were registered at the PHC centres, only 62% of the Arabs and 39% of the Asians were registered. Multiple logistic regression of the factors in registration indicated that nationality was the most important reason for lack of registration, with Asians only about one-quarter as likely to be registered as Kuwaitis. Also, people who had been in Kuwait for shorter durations (< 5 years) were less likely to be registered than the Kuwaiti nationals or expatriates who had been here for 10 years or longer. In the absence of registration at the PHC centre, the civil identification card (ID) may be used as a valid means to enter the health system. Among the Arabs and Asians, 22% and 29% did not have a civil ID card. Thus, for many expatriates, the hospital ER, which does not provide the necessary follow-up care is often the only source of health care available. (+info)
Evidence for effective suppression of recombination in the chromosome 17q21 segment spanning RNU2-BRCA1.
(14/2333)
Characterization of associations between polymorphic sites located throughout the approximately 200-400-kb variable-length region spanning RNU2-BRCA1 reveals nearly complete linkage disequilibrium. This segment spans the RNU2 array, which includes 6-30 tandem copies of the U2 snRNA gene, and an adjacent region containing NBR1, the LBRCA1 pseudogene, NBR2, and BRCA1 in a tandemly duplicated structure. A series of biallelic polymorphisms define two common haplotypes that do not vary significantly, in structure or frequency, between populations of primarily European (n=275) or Asian (n=34) ancestry. Lower-frequency variants occurring at distantly located sites within this region also show very strong associations. The rarer haplotype classes appear to be distinguished by mutational alteration and are not recombination products of the two major classes. The two major haplotypes also exhibit significantly different allele-length distributions for local simple tandem-repeat markers. The conservation of extensive distinct chromosomal haplotypes during a long period of human population expansion and divergence indicates that selective forces or specific chromosomal mechanisms result in effective recombination suppression. The extreme degree of long-range linkage disequilibrium at this locus may be exceeded only by that reported for the human MHC locus, where allele-specific functional interactions are believed to be significant. These findings have implications for the estimation of the time of origin of BRCA1 mutations having a founder effect, the interpretation of the significance of rare allelic variants, and the study of the origins of modern populations. (+info)
Retrospective analysis of risk factors for late presentation of chronic glaucoma.
(15/2333)
BACKGROUND: Why some individuals present to the ophthalmologist in the early stages of chronic glaucoma but others present with very advanced visual field loss is a question which has received little attention. This study is an attempt to identify some basic characteristics of people who present with late glaucoma. METHODS: A retrospective case-control study by medical record review was employed. 100 cases and 100 controls were identified from the notes of patients presenting to Moorfields Eye Hospital glaucoma service between July 1993 and July 1995. Cases were defined as new patients presenting with absolute field loss within five degrees of fixation and a cup to disc ratio of greater than 0.8 in one or both eyes. Controls were new patients with no absolute field loss within 20 degrees in either eye, but otherwise typical glaucomatous field loss and a cup to disc ratio of greater than 0.5 or a difference of 0.2 or more between the discs. RESULTS: The ethnic origin, sex, referral source, presenting IOP, and age of the subjects studied were independently associated with late presentation. An African Caribbean patient is estimated to be four and a half times more likely to attend with advanced field loss than a white patient of similar age, sex, IOP, and referral source (adj OR: 4.55, 95% CI [1.57, 13.18]). A female patient is estimated to be one third (0.34, [0.15, 0.74]) as likely to attend late than a male patient of the similar age, IOP, ethnic origin, and referral source. A patient referred via any source other than an optometrist with the correct diagnosis is estimated to be greater than four times (4.32 [1.89, 9.88]) more likely to be a late attender than a patient of the same sex, ethnicity, and similar age but referred with a diagnosis of glaucoma. There was a trend of increasing odds of late presentation with increasing age (adj OR per 10 years, baseline 40-49 years 1.68 [1.22, 2.20]). A patient whose presenting IOP is 21-25 mm Hg is estimated to be a quarter (0.24, [0.09, 0.64]) as likely to attend with advanced field loss than a patient of the same ethnic origin, sex, age, referral source, but with presenting IOP of greater than 31 mm Hg. CONCLUSIONS: These data strongly suggest that certain subgroups of patients with glaucoma are likely to be at greater risk of presenting with advanced and irremediable field loss. (+info)
Ergonomic strategies for improving working conditions in some developing countries in Asia.
(16/2333)
Ergonomic action is growing in Asia in response to increasing local needs. Recent studies in some developing countries in Asia commonly developed and applied widely-applicable measures for assessing local needs in field conditions including small enterprises and agriculture. For this purpose, carefully examining the actual workplace conditions of the local people was essential. Consequently, a number of field studies could contributed to improving the working conditions of the local people in materials handling, workstation design, work organization and work environment by using available local resources. Building on local capacity and practice, action-oriented ergonomics training has also been developing and spreading into many workplaces. Various non-expert human resources including local government units, trade unions, industrial associations and the agricultural sectors have been mobilized to act as participatory trainers in the action-oriented ergonomic training programmes. Training tools such as action checklists, good local examples and group work dynamics have been developed and applied to such training activities. Learning from local achievements and focusing on locally available resources, ergonomists have facilitated these local action processes by developing action-oriented training tools and training local trainers. It was confirmed that a number of ergonomic improvements could be formulated by the self-help initiative of the local people when participatory action tools and training were provided. Developing flexible and dynamic ergonomic research and training methods to meet the diversifying needs of the local people will continuously be important. Ergonomists' efforts to cover the wider population and workplaces need to be strengthened and accelerated. (+info)