Pseudocholinesterase-variants in Thailand and Japan

Amoung 723 sera from Thailand and 371 sera from Japan the frequency of atypical genes at the E ₁ locus of pseudocholinesterase is estimated and compared with the results from other populations.     

Doing Health Anthropology: Research Methods for Community Assessment and Change

Doing Health Anthropology: Research Methods for Community Assessment and Change . Christie W. Kiefer. New York: Springer, 2007, xvii. 281 pp.     

Tracking Host Sources of Cryptosporidium spp. in Raw Water for Improved Health Risk Assessment

Recent molecular evidence suggests that different species and/or genotypes of Cryptosporidium display strong host specificity, altering our perceptions regarding the zoonotic potential of this parasite. Molecular forensic profiling of the small-subunit rRNA gene from oocysts enumerated on microscope slides by U.S. Environmental Protection Agency method 1623 was used to identify the range and prevalence of Cryptosporidium species and genotypes in the South Nation watershed in Ontario, Canada. Fourteen sites within the watershed were monitored weekly for 10 weeks to assess the occurrence, molecular composition, and host sources of Cryptosporidium parasites impacting water within the region. Cryptosporidium andersoni, Cryptosporidium muskrat genotype II, Cryptosporidium cervine genotype, C. baileyi, C. parvum, Cryptosporidium muskrat genotype I, the Cryptosporidium fox genotype, genotype W1, and genotype W12 were detected in the watershed. The molecular composition of the Cryptosporidium parasites, supported by general land use analysis, indicated that mature cattle were likely the main source of contamination of the watershed. Deer, muskrats, voles, birds, and other wildlife species, in addition to sewage (human or agricultural) may also potentially impact water quality within the study area. Source water protection studies that use land use analysis with molecular genotyping of Cryptosporidium parasites may provide a more robust source-tracking tool to characterize fecal impacts in a watershed. Moreover, the information is vital for assessing environmental and human health risks posed by water contaminated with zoonotic and/or anthroponotic forms of Cryptosporidium.     

Assessment of Potential Human Health Risks from Arsenic in CCA-Treated Wood

Chromated copper arsenate (CCA) is a chemical preservative used to treat wood for a variety of outdoor uses, including decks, fencing, and play structures. This article describes a methodology to quantify exposures to arsenic from CCA-treated wood. Exposure was evaluated for ingestion and dermal contact with arsenic-containing residue on treated wood surfaces (dislodgeable arsenic), and ingestion, dermal contact, and inhalation of soil containing arsenic originating from treated wood structures. Standard approaches were used to quantify exposures to arsenic in soil. In the absence of standard approaches for exposures to dislodgeable residue, an empirical approach was developed, extrapolating from studies of soil loadings on hands and soil ingestion rates to estimate the amount of dislodgeable residue on hands that is subsequently ingested. Results from animal studies were used to develop relative bioavailability estimates for dislodgeable and soil arsenic. A focused sensitivity analysis demonstrated that the assumptions used regarding hand loading and subsequent incidental ingestion of dislodgeable arsenic had the most significant impact on the results. This assessment indicates low uptake of arsenic into the body, resulting in incremental lifetime cancer risks within USEPA's target risk levels. We compare this approach to other methodologies used to assess exposures to treated wood.     

Advanced Sanitation Planning Tool with Health Risk Assessment: Case Study of a Peri-Urban Community in Thailand

This article presents an application of Material Flow Analysis (MFA) and Quantitative Microbial Risk Assessment (QMRA) as means for advanced sanitation planning in order to quantify domestic waste flows and to estimate microbial infectious risks. The main domestic waste flows include sewerage, greywater from households, effluent of on-site sanitation systems, and illegal dumping of fecal sludge. These flows could cause the contamination of E. coli in canals at the concentration range of 9.0E+01 to 9.2E+04 MPN/100 ml. This study analyzed three scenarios of domestic waste managements: (1) household greywater treatment, (2) fecal sludge treatment, and (3) sewerage treatment, resulting in substantial reduction of E. coli concentrations in those treated effluents. Subsequently, QMRA results could confirm whether the yearly infectious risks due to the uses of treated effluents were lower than the acceptable risk of 1.0E-04 (USEPA 1994 USEPA (US Environmental Protection Agency). 1994. “National Primary Drinking Water Regulations: Enhanced Surface Water Treatment Requirements”. In Proposed rule Washington, DC, , USA [Google Scholar]). With the aforementioned conditions, this research could demonstrate the potential as an advanced sanitation planning tool by integrating MFA and QMRA methods.     

Metal Sources for Freshwater Invertebrates: Pertinence for Risk Assessment

Ecological risk assessments are likely to be more effective if they are built upon knowledge of from where and in what manner animals take up contaminants. We discuss the relative importance of various metal sources for aquatic invertebrates. First, we address the question do sediment-dwelling animals take up their metals from the overlying water compartment or the sediment compartment or both (both compartments include water and particles). We find that the overlying water column is more important as a metal source for insects, whereas the sediment compartment is more important for oligochaete worms. We explain this tendency by the behaviors of the animals involved. Second, we ask the question do animals take up their metals from food or water within a given compartment. Through case studies on three widespread freshwater invertebrates, we conclude that for some predatory insects food is their major source of several metals, whereas for the crustacean Hyalella both food and water appear to be important depending on the metal involved and the experimental protocol used to study the question. We conclude that ignoring food as a metal source could severely underestimate metal exposures for some animals. We suggest that integrating these complexities into laboratory tests and risk assessment protocols will improve their meaningfulness and thus their ability to protect aquatic ecosystems.     

我国公立医院医疗服务多维价值评估研究

以效用价值论为基础,从病人、医院、社会等多角度分析医疗服务的价值内涵,构建生命健康效益、经济效益、公益效应、资源消耗4个维度的指标体系,并建立多维价值评估模型进行定量分析,为卫生政策的制定提供方向指导和理论支持。     

Nocardia cyriacigeorgica is a significant pathogen responsible for nocardiosis in Japan and Thailand

Nocardia cyriacigeorgica is a recently described species. During routine diagnostic testing of 121 clinical isolates, we found that about one fourth of the strains from Japan (19 isolates) and Thailand (8 isolates), which were identified in our laboratories as N. asteroides, in fact belong to N. cyriacigeorgica. To our knowledge, this is the first report of infection due to N. cyriacigeorgica in Japan and Thailand, and the third report of infection anywhere in the world. Although N. cyriacigeorgica is usually differentiated from other Nocardia species by utilization of glucose and gluconate, we found that it can also be differentiated by a characteristic synergistic effect between imipenem (IPM) and tobramycin (TOB).     

卫生技术评估研究结果产出方式的偏好分析

目的 比较研究人员和决策人员对卫生技术评估研究结果产出方式的偏好程度的差异,为扩大卫生技术评估研究的决策使用提供依据。方法 采用问卷调查的方法,收集研究人员和决策人员对不同卫生技术评估研究结果产出方式的评价,运用统计描述的方法,对偏好差异进行描述分析。结果 研究人员和决策人员对卫生技术评估研究结果的产出方式偏好有所差异;在不同行政单位、不同行政级别以及不同教育程度的决策者之间,对产出方式的偏好也存在不同;而不同职称、不同教育程度的研究者,所偏好的成果产出方式则较为一致。结论 进一步强化研究方与决策方之间的沟通交流,根据不同决策人员的需求采取合适的产出方式,加强机构对卫生技术评估结果决策转化的支持,逐步完善激励机制,并强化卫生技术评估结果向广大社会公众的传播。     

卫生技术评估认知与需求现况调查

??????? 目的 了解浙江省卫生技术及管理人员对卫生技术评估（HTA）的认知和需求,为进一步开展HTA工作提供建议。方法 采用问卷调查与访谈相结合的方法对3家医院,1家公共卫生机构,8家卫生行政机构的102位运用HTA结果的潜在使用者和22位决策者进行了调查。结果 被调查者认为卫生技术相关政策法规在卫生技术信息来源最为重要,卫生技术临床疗效在用于决策的卫生技术相关信息中最为重要,相关研究质量太差是影响卫生技术评估的最大障碍。结论 浙江省卫生技术及管理人员对于HTA有一定的认知与需求,但关注度不够,针对遇到的障碍提出了HTA进一步发展的建议。     

Clinical Data Extraction During Public Health Emergencies: A Blockchain Technology Assessment

Objective:We sought to explore the technical and legal readiness of healthcare institutions for novel data-sharing methods that allow clinical information to be extracted from electronic health records (EHRs) and submitted securely to the Food and Drug Administration''s (FDA''s) blockchain through a secure data broker (SDB).Materials and Methods:This assessment was divided into four sections: an institutional EHR readiness assessment, legal consultation, institutional review board application submission, and a test of healthcare data transmission over a blockchain infrastructure.Results:All participating institutions reported the ability to electronically extract data from EHRs for research. Formal legal agreements were deemed unnecessary to the project but would be needed in future tests of real patient data exchange. Data transmission to the FDA blockchain met the success criteria of data connection from within the four institutions'' firewalls, externally to the FDA blockchain via a SDB.Discussion:The readiness survey indicated advanced analytic capability in hospital institutions and highlighted inconsistency in Fast Healthcare Interoperability Resources format utilitzation across institutions, despite requirements of the 21st Century Cures Act. Further testing across more institutions and annual exercises leveraging the application of data exchange over a blockchain infrastructure are recommended actions for determining the feasibility of this approach during a public health emergency and broaden the understanding of technical requirements for multisite data extraction.Conclusion:The FDA''s RAPID (Real-Time Application for Portable Interactive Devices) program, in collaboration with Discovery, the Critical Care Research Network''s PREP (Program for Resilience and Emergency Preparedness), identified the technical and legal challenges and requirements for rapid data exchange to a government entity using the FDA blockchain infrastructure.

In the previous few decades, the world has been challenged by a barrage of public health emergencies (PHEs), from natural disasters to the infectious disease threats of SARS (severe acute respiratory syndrome), H1N1, Zika, Ebola, and the COVID-19 pandemic. We have learned that PHEs are imminent and that the need for preparedness is paramount to our nation''s resiliency.1In the wake of COVID-19, widespread data collection to understand the virus''s impact and effectiveness of treatment plans are needed. However, the United States'' ability to rapidly collect multisite patient data to understand the impact of a disease and develop a unified and effective response remains a considerable vulnerability despite significant health system and federal investment in electronic health records (EHRs).2,3 The all-hazardscore data set, created in 2015 to characterize serious illness,injuries, and resource requirements to devise a robustresponse to PHEs, remains a challenge to collect giventechnological and regulatory limitations3 in regard to datasharing. This has been observed in the response to COVID-19, where the lack of data to create consensus on effective treatment protocols has been hindered.4–6Several barriers exist to data sharing in PHEs, including academic competition and inadequate human and technological resources during responses to emergency.7–10 Neither a standard approach to data sharing nor a method to negotiate and enforce the requisite data legal agreements exists.11,12 Moreover, effective methods for addressing deficiencies or advancing data sharing in response to PHEs are lacking.12–14 A clear need exists to explore novel methods to secure data collection to bridge the gap in knowledge sharing during PHEs.The complexity of data sharing from disparate sources is a problem experienced in other industries. The finance sector requires the highest level of security to manage financial transactions with speed and integrity. Blockchain technology emerged in the finance industry as a disruptive technology aimed at facilitating a decentralized, secure, and distributed ledger of transactions on a global scale.15,16 Blockchain technology works as blocks of information across a computer network; when chained together, these blocks create a single data asset.Blockchain has been suggested as an information infrastructure that can be used to advance knowledge sharing in the public sector.17 The decentralized nature of blockchain allows for interoperability,15 which is a key functionality needed to enable data sharing among hospital systems. The use of blockchain in medicine has the potential to revolutionize healthcare''s approach to data access, storage, and security17–19 by providing a method to share confidential patient information across many sites regardless of the local technical infrastructure. Large-scale data sharing would contribute to more robust medical research, advanced analytics (e.g., artificial intelligence), and the ability to benchmark the quality of care across institutions.The Food and Drug Administration (FDA) partnered with the Society of Critical Care Medicine''s Discovery, the Critical Care Research Network''s Program for Resilience and Emergency Preparedness (PREP; referred to as “Discovery PREP” hereafter) to explore the feasibility of using blockchain for multisite healthcare data collection in preparation for the required rapid data sharing during a PHE. Discovery PREP is one of many networks forming the Resilience Intelligence Network (RIN) with a combined focus on the nation''s resilience, preparedness, and response.2Discovery PREP and the FDA Real-Time Application for Portable Devices (RAPID) program20 collaborated to test the use of RAPID''s blockchain technology to determine the technical, legal, and resource challenges in the healthcare context. The RAPID program was designed to facilitate the automated extraction of key information from EHR systems needed to respond to adverse events without adding to the burden of data collection on healthcare practitioners.     

Organophosphate Pesticide Residues in Drinking Water from Artesian Wells and Health Risk Assessment of Agricultural Communities,Thailand

Organophosphate pesticide (OPPs) concentrations in artesian wells located in Thai agricultural and non-agricultural communities were studied during both wet and dry seasons. A total of 100 water samples were collected and subjects were asked to complete a survey. Gas chromatography flame photometric detector was used for OPP analysis. The average OPP concentration in the agricultural communities (0.085 and 0.418 μg/l in dry and wet season) was higher than in the non-agricultural communities (0.004 μg/l in both seasons). Ingestion of OPPs in contaminated water in the agricultural communities were estimated to be 0.187 and 0.919 μg/day during the dry and wet seasons, respectively, and 0.008 μg/day during both seasons in the non-agricultural communities. Agricultural communities were exposed to pesticide residues under the oral chronic reference dose. This study suggests that people in agricultural communities may be exposed to significantly greater levels of pesticides than non-agricultural populations during the dry and wet seasons (p < .001, .001).     

Portuguese Migrants in Switzerland: Healthcare and Health Status Compared to Portuguese Residents

Background

Most migrant studies have compared health characteristics between migrants and nationals of the host country. We aimed at comparing health characteristics of migrants with nationals from their home country.

Methods

Portuguese national health survey (2005-6; 30,173 participants aged 18-75 years) and four national health surveys conducted in Switzerland (2002, 2004, 2007 and 2011, totalling 1,170 Portuguese migrants of the same age range). Self-reported data on length of stay, cardiovascular risk factors, healthcare use and health status were collected.

Results

Resident Portuguese were significantly older and more educated than migrants. Resident Portuguese had a higher mean BMI and prevalence of obesity than migrants. Resident Portuguese also reported more frequently being hypertensive and having their blood pressure screened within the last year. On the contrary, migrant Portuguese were more frequently smokers, had a medical visit in the previous year more frequently and self-rated their health higher than resident Portuguese. After adjustment for age, gender, marital status and education, migrants had a higher likelihood of smoking, of having a medical visit the previous year, and of self-rating their current health as good or very good than resident Portuguese. Compared to Portuguese residents, cholesterol screening in the previous year was more common only among migrants living in Switzerland for more than 17 years.

Conclusion

Portuguese migrants in Switzerland do not differ substantially from resident Portuguese regarding most cardiovascular risk factors. Migrants consider themselves healthier than Portuguese residents and more often had a recent medical visit.     

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

Background

Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.

Purpose

To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed.

Methods

This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.

Results

Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities.

Conclusion

There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.     

Spatial Distribution,Potential Sources,and Risk Assessment of Trace Metals of Groundwater in the North China Plain

Diversion of water for irrigation from the Yellow River has impacted groundwater quality in the North China Plain (NCP). In this study, by using geochemical and isotope methods, groundwater origin, the spatial distribution of trace metals, pollution sources, and health risks were evaluated. Groundwater is recharged from surface water. The primary pollution components in surface water were B, Al, Se, Zn, Mn, and Ni—with concentrations exceeding standards by 100%, 84.4%, 64.4%, 31.1%, 20%, and 2.2%, respectively. In groundwater, exceeding standard rates for those elements were 100%, 100%, 61%, 25.7%, 39%, and 4.9%, respectively. The spatial distribution of polluted metals in surface water and groundwater was correlated, indicating an irrigation-influenced spatial distribution of trace metals in the groundwater. The trace metals were introduced via anthropogenic and geogenic activities. Zinc poses the most serious non-carcinogenic hazard for local residents. The ingestion pathway is much more likely to lead to zinc toxicity than the dermal absorption pathway. The carcinogenic Cd and Pb could result in an increased cancer risk for individuals exposed to the water. Non-carcinogenic hazard and carcinogenic risk attributable to groundwater is serious in the regions traversed by the rivers in the study area.     

泰国玉米生产和遗传改良研究

玉米是泰国一种重要的谷类作物。2000年种植面积估计为1.30百万公顷,籽粒产量约4.48百万吨。杂交种种植面积占到玉米总面积的85?08％,以单交种类型为主,占到杂交种各种类型的74％,其次为三交种。玉米生产主要限制因素为病害(高粱霜霉、南方锈、茎腐、大斑、小斑病)、虫害(亚洲玉米螟)和干旱胁迫。玉米种质发展和品种遗传改良开始于1950年,主要从事单位为农业部农业厅和大学部肯色萨大学。先后育成Suwan 1、Suwan 2、Suwan 3,Nakhon Sawan 1,Suwan 5等改良群体和Suwan Complex、KS 23 broadbase syn.。并从中提取出Ki21、45、Ni1等几十个优良系,组配出Suwan 2301、3851、Nakhon Sawan 72等十多个优良杂交种。分别应用10个群体双列杂交法、顶交法和优良适应品种与外引种质杂交法等,确定了如下几个杂种优势模式：(Suwan 1,Suwan 3)×(Caripeno DMR,KS6);(Suwan 1,Suwan 3,KS6选育系)×(Ki21,Mo17衍生系);[KS 23(S)C2,Suwan 5(S)C3]×[Suwan 1(S)C11]。 Abstract：Maize is one of major cereal crops in Thailand.In the year 2000,it was estimated that the planted area is of 1.30 million hectares and produces about 4.48 million tons.The amount of hybrid seed was 17.76 thousand tons with acquiring 85.08％ of total planted area.Production constraints main were biotic and abiotic factors,involving diseases of sorghum Downy Mildew,Southern rust,Southern corn leaf blight,Northern corn leaf blight and Charcoal stalk rot and inset of the Asian corn borer,and drought stress.The maize research for germplasm development and varietal genetic improvement in Thailand was initiated by the Department of Agriculture in 1950 and Kasetsart University in 1958.Several elite populations of Suwan 1,Suwan 2,Suwan 3, Suwan 5,KS6,KS23,and Suwan-Complex were developed.The superior lines of Ki21,Ki 45,Ni1 etc and elite hybrids of Suwan 2301,Suwan 3851,Nakhon Sawan72＃ etc. were bred.In order to search for heterotic partners,diallel crosses of elite populations with differing in genetic background were performed by the breeding program.The several heterotic partners were determined.i.e.(Suwan 1,Suwan3)×(Caripeno DMR,KS6);(Inbred lines from Suwan 1,Suwan 3,KS6)×(Ki21,a Mol7 derivative line) and [KS 23(S)C2,Suwan 5(S)C3]×[Suwan 1(S)C11].