Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women.
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Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over-reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework. (+info)
Nasopharyngeal cancer and the Southeast Asian patient.
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Because of a documented increased incidence, nasopharyngeal cancer should be considered when signs or symptoms of ear, nose and throat disease are present in patients from southern China (in particular, Hong Kong and the province of Guangdong) or Southeast Asia. Environmental factors, the Epstein-Barr virus and genetic factors have been associated with the development of nasopharyngeal cancer. Patients with this malignancy most often present with a cervical mass from metastatic spread to a lymph node. Other possible presentations include ipsilateral serous otitis, hearing loss, nasal obstruction, frank epistaxis, purulent or bloody rhinorrhea, and facial neuropathy or facial nerve palsies. Radiotherapy is often curative. The addition of chemotherapy has produced high response rates in local and regionally advanced disease. (+info)
Emerging viral diseases of Southeast Asia and the Western Pacific.
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Over the past 6 years, a number of zoonotic and vectorborne viral diseases have emerged in Southeast Asia and the Western Pacific. Vectorborne disease agents discussed in this article include Japanese encephalitis, Barmah Forest, Ross River, and Chikungunya viruses. However, most emerging viruses have been zoonotic, with fruit bats, including flying fox species as the probable wildlife hosts, and these will be discussed as well. The first of these disease agents to emerge was Hendra virus, formerly called equine morbillivirus. This was followed by outbreaks caused by a rabies-related virus, Australian bat lyssavirus, and a virus associated with porcine stillbirths and malformations, Menangle virus. Nipah virus caused an outbreak of fatal pneumonia in pigs and encephalitis in humans in the Malay Peninsula. Most recently, Tioman virus has been isolated from flying foxes, but it has not yet been associated with animal or human disease. Of nonzoonotic viruses, the most important regionally have been enterovirus 71 and HIV. (+info)
The crystal structures of glutathione S-transferases isozymes 1-3 and 1-4 from Anopheles dirus species B.
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Glutathione S-transferases (GSTs) are dimeric proteins that play an important role in cellular detoxification. Four GSTs from the mosquito Anopheles dirus species B (Ad), an important malaria vector in South East Asia, are produced by alternate splicing of a single transcription product and were previously shown to have detoxifying activity towards pesticides such as DDT. We have determined the crystal structures for two of these alternatively spliced proteins, AdGST1-3 (complexed with glutathione) and AdGST1-4 (apo form), at 1.75 and 2.45 A resolution, respectively. These GST isozymes show differences from the related GST from the Australian sheep blowfly Lucilia cuprina; in particular, the presence of a C-terminal helix forming part of the active site. This helix causes the active site of the Anopheles GSTs to be enclosed. The glutathione-binding helix alpha2 and flanking residues are disordered in the AdGST1-4 (apo) structure, yet ordered in the AdGST1-3 (GSH-bound) structure, suggesting that insect GSTs operate with an induced fit mechanism similar to that found in the plant phi- and human pi-class GSTs. Despite the high overall sequence identities, the active site residues of AdGST1-4 and AdGST1-3 have different conformations. (+info)
Hydrological investigations of forest disturbance and land cover impacts in South-East Asia: a review.
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Investigations of land management impacts on hydrology are well developed in South-East Asia, having been greatly extended by national organizations in the last two decades. Regional collaborative efforts, such as the ASEAN-US watershed programme, have helped develop skills and long-running monitoring programmes. Work in different countries is significant for particular aspects: the powerful effects of both cyclones and landsliding in Taiwan, the significance of lahars in Java, of small-scale agriculture in Thailand and plantation establishment in Malaysia. Different aid programmes have contributed specialist knowledge such as British work on reservoir sedimentation, Dutch, Swedish and British work on softwood plantations and US work in hill-tribe agriculture. Much has been achieved through individual university research projects, including PhD and MSc theses. The net result is that for most countries there is now good information on changes in the rainfall-run-off relationship due to forest disturbance or conversion, some information on the impacts on sediment delivery and erosion of hillslopes, but relatively little about the dynamics and magnitude of nutrient losses. Improvements have been made in the ability to model the consequences of forest conversion and of selective logging and exciting prospects exist for the development of better predictions of transfer of water from the hillslopes to the stream channels using techniques such as multilevel modelling. Understanding of the processes involved has advanced through the detailed monitoring made possible at permanent field stations such as that at Danum Valley, Sabah. (+info)
Effectiveness of postmigration screening in controlling tuberculosis among refugees: a historical cohort study, 1984-1998.
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OBJECTIVES: This study assessed the effectiveness of postmigration screening for the control of tuberculosis (TB) among refugee migrants. METHODS: We conducted a historical cohort study among 24 610 predominantly Southeast Asian refugees who had arrived in Sydney, Australia, between 1984 and 1994. All had been screened for TB before arrival and had radiologic follow-up for 18 months after arrival. Incident cases of TB were identified by record linkage analysis with confirmatory review of case notes. RESULTS: The crude annual incidence rate over 10-year follow-up was 74.9 per 100 000 person-years. Only 29.6% of the cases were diagnosed as a result of routine follow-up procedures. CONCLUSIONS: Enhanced passive case finding is likely to be more effective than active case finding for the control of TB among refugees. (+info)
Drug-based helminth control in Western Pacific countries: a general perspective.
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Helminthiases still have a relevant detrimental role in the health of large groups of human population. Where poor hygiene and lack of access to education, health services and essential care characterize living conditions, parasitic infections dramatically affect essential aspects of individual life, such as nutrition, cognitive performance, susceptibility to infections and micronutrient deficiency. Severe illness is associated with schistosomiasis, lymphatic filariasis and food-borne trematode infections. Drugs are the cornerstone of control strategies for such infections, the World Health Organization (WHO) list of essential drugs contains several highly efficacious anthelmintics which are all safe, single-dose and cheap. If given regularly to infected communities, these drugs effectively control the morbidity related to the major endemic helminth infections. New strategies for mass drug administration to human populations have been tested, and several endemic Western Pacific countries have achieved excellent results in reducing morbidity in spite of continuous transmission. In this region, experience over the last decades proves the feasibility of helminth control, but also shows the need for long-term commitment and continuous support. (+info)
STD history, self treatment, and healthcare behaviours among fishermen in the Gulf of Thailand and the Andaman Sea.
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OBJECTIVE: Migrant populations are at higher risk for HIV infection. Access to health care and STD treatment is thought to lower this risk. This study aims to examine determinants of STD history and treatment and healthcare behaviours among fishermen in the Gulf of Thailand and the Andaman Sea. METHODS: A cross sectional survey of fishermen working on commercial fishing trawlers was conducted in four provinces in Thailand in early 1998. RESULTS: Of the 818 fishermen interviewed, 30% reported a history of STD, of which 31% reported self treatment of the last STD. 32% reported self care for general health while ashore. In multivariate analyses, a history of STD was significantly more often reported by older men compared with younger men, by owners and skippers compared with lower positions on the boat, and by men who have ever visited female sex workers. Self treatment of the last STD was related to being Burmese compared with being Thai, and to working as a steersman or ship hand compared with as a skipper. Self care for general health while ashore was significantly related to being Burmese or Khmer compared with being Thai, and to being unmarried compared with married. CONCLUSION: Burmese migrant fishermen and their needs should be targeted for culturally specific interventions to increase their understanding of STD treatment and improve their access to health care. (+info)