1.Survey on the Awareness of Children's Illness by Their Mothers of Minorities Living in Northern Hilly Area, Lao P. D. R.
Tsutomu KOBAYASHI ; Hideki YAMAMOTO
Journal of International Health 2008;23(3):181-190
Objectives
Many ethnic groups live in northern hilly area in Lao people’s Democratic Republic. We can find some delays of development by the geographical and cultural reasons. This research clarified what kind of awareness about children’s health among the minority people living with their specificlifestyles and circumstances.
Methods
The participatory research for health problems was conducted to Khamu people at C-village in northern Laos. Data were analyzed qualitatively. Mothers who have children aged less than 10 years, were interviewed about illness of children and its treatment. The author interviewed about health problems with some key persons who were important position in the village.
Results
At C-village, they produced sticky rice which was their staple food. They depended on other food from forests. Mothers are aware that their children were always healthy when children were vigorous. Mothers brought their children to the hospital in spite of its long way when children got illness. Children had some experiences of malaria, diarrhea and other illnesses. Villagers stored up the knowledge of illness by themselves with their experience that children getting serious by specific illness. The key persons were also aware of health problems, for example malaria or parasite diseases.
Conclusion
At C-village, in recent years they didn’t suffer serious starving. Houses were comfortable because of its well-ventilated against hotness but structure of their houses can’t prevent children’s health by the aggression of mosquito, and smoke from kitchen. Their lives were exposed to some harmful influence; by malaria and pastured animals. About children’s health, mothers were aware of some specific illness and brought children to hospital. Mothers thought that their children had not any problems of health when they were vigorous and active. Many children had suffered some illness and villagers stored up the knowledge of illness by themselves with their experience that children got serious situation by specific illness.
The key-persons and villagers expected infrastructural developments such as the high-way which was under construction at that time.
2.Health Problems Due to Agricultural Decline in Cambodia- The Effects by the Superfluous Shift to a Cash Crop -
Tsutomu KOBAYASHI ; Hideki YAMAMOTO
Journal of International Health 2009;24(2):107-113
Introduction
Currently Cambodia depends on imported foods from Viet Nam and Thailand. To address this situation, the Asian Sustainable Village Network OKAYAMA that the author belongs to, has been cooperating with Cambodian Federal Farmers Organization, a local NGO to undertake a farming project. The importance of agricultural promotion mainly in vegetable farming sector was examined and it is hoped that this project will reduce malnutrition in Cambodia, particularly among the rural poor who suffer with malnutrition, disease and disorder related conditions and will make Cambodia a sustainable society.
Method
In order to determine agricultural conditions, we investigated market places in Phnom Penh and examined utilizing farmland in Kampong Cham. In addition, we visited market places in rural districts and farmers' homes to gain more information about eating habits of the population. To find out farming production we referred to statistical data from Cambodian Ministry of Agriculture. A PubMed review was undertaken to determine aspects of malnutrition.
Results
Phnom Penh is a very busy place for the daily sale of perishable vegetables which are predominantly transported from Viet Nam. Cambodia, despite of its little irrigation system, and another technical problems is sufficient in its production due to its large farming area. Recently, cassava cultivation has increased in Cambodia in order to meet increasing demands in bio-fuel. We came to know that Cambodians do not have a favorable opinion about vegetables imported from Viet Nam. One of the dissatisfaction voted by the people in Cambodia is that the vegetables from Viet Nam have excessive chemical contamination and they lack in freshness. Restaurants and supermarkets in Phnom Penh preferred local products if they were available. In farming areas the production and consumption of vegetables are limited. For many, vegetables are a luxury. Meals predominantly consist of rice, small dried salted fish and some herbs. This situation is considered a leading factor of malnutrition.
Conclusion
As a result of the limited production and supply of vegetables in Cambodia, vegetable consumption is limited and viewed as a luxury. This situation has led to a mal-balanced diet and requires considerable effort to uplift vegetable production in Cambodia to reverse the imbalance of nutritional intake. Thus it can be very well said that agricultural promotion in Cambodia, particularly in vegetable sector is deemed extremely important for the future development of Cambodia.
4.The Survival of Vibrio cholerae in the Natural Environment of Zambia : Fish, the suspicious Gateway of Cholera Outbreak?
Tsutomu KOBAYASHI ; Hang'ombe B.MUDENDA ; Hideki YAMAMOTO
Journal of International Health 2010;25(1):33-39
Preface and Objectives
Cholera has recently become more serious in African countries. In southern Africa, a serious cholera outbreak was reported in 2008. Here we investigate Vibrio cholerae in aquatic environments, rivers, tube well waters, fish tissues, and aquatic plants in Zambia.
Methods
The sampling was conducted on Kafue and Zambezi rivers as well as at public wells. The samples included river water, mud, fish, floating grass, and well water. All samples were enriched in alkaline peptone water (APW) and streaked on thiosulfate citrate bilesalts saccharos (TCBS) Vibrio agar. Some types of colonies were isolated using polymyxin mannose tellurite (PMT) agar. All water samples were analyzed for enterobacteria as well as vibrio contamination. River and shallow tube well water samples were analyzed for E. coli.
Results
Samples, including fish tissues, river, and tube well waters, except for the fish intestines, were found to be contaminated with vibrios when cultured on TCBS Vibrio agar.
Deep tube well water was not contaminated with vibrios or E. coli. V. cholerae El Tor was not detected through sampling and culturing on PMT agar. E. coli was detected in river and shallow tube well water samples.
Discussion
Vibrios were detected in Zambia’s aquatic environments. Cholera outbreak may occur. Vibrio contaminations in fish have been reported from Bangladesh, Laos, Kenya, and India. Fish is a good source of protein to improve person’s nutritional status. However, it must be treated properly so that any contamination of residential areas is avoided. Therefore, people must pay attention to fish.
Conclusion
Here several types of V. cholerae were isolated from different aquatic environments. Fish is a nutritious diet, but contaminated Vibrios fish must be treated so that it will not contaminate residential areas. We must investigate the gateway of cholera outbreaks in Zambia.
5.Questionnaire Surveys for Evalution of Quality of Life and Problems in Patients with Orthotopic Neobladder after Cystectomy.
Sachiko TOYAMA ; Tsutomu NISHIYAMA ; Mineko KOSAKAI ; Masahiro TERUNUMA ; Kazuko KOBAYASHI
Journal of the Japanese Association of Rural Medicine 2001;50(1):40-44
Questionnaire survey were conducted three times to evalute the social life and functional problems in patients with orthotopic neobladder after cystectomy. A total of 34 responses were collected froml9 patients with a mean age of 66 years at diagnosis. The patients with orthotopic neobladder were found to be troubled with prolonged urinary incontinence such as nocturnal enuresis and stress incontinence. The problems was deteriorating the quality of life of the patients.
6.Effects of different ventilation modes on efficacy of exogenous pulmonary surfactant for treatment of rats with ventilator-induced lung injury
Hailing WU ; Yulong BO ; Xiaoguang CUI ; Tsutomu KOBAYASHI ; Wenzhi LI
Chinese Journal of Anesthesiology 2010;30(4):444-447
Objectlve To investigate the effects of different ventilation modes on the efficacy of exogenous pulmonary surfactant(PS)for the treatment of rats with ventilator-induced lung injury(VILI).Methods Forty-two male Wistar rats weighing 310-356 g were randomly divided into 6 groups(n=7 each):group CVT6,group SVT6,group CVT10,group SVT10,group CVT14 and group SVT14.The tidal volume(VT)was set at 6,10 and 14 ml/kg respectively and the respiratory rate(RR) was 75,45 and 32 bpm respectively.The animals were anesthetized with intraperitoneal 3% Pentobarbital 50 mg/kg,then tracheostomized and intubated.VILI model was induced by high-pressure ventilation (HPV) with peak inspimtory pressure (PIP) 40 cm H2O and without positive end-expiratory pressure (PEEP).The air was injected into the trachea via the airway at the end ofexpiration before HPV (T0,baseline value) and 15-25 min of HPV,the airway pressure monitored and the lung compliance(C) calculated.When C was decreased to half of the baseline value,PEEP was increased to 7.5 cm H20.After the tracheal edema fluid was removed,the PS 100 mg/kg was immediately injected into the trachea in group SVT6,SVT10 and SVT14.The equal volume of air was injected into the trachea in group CVT6,CVT10 and CVr14 instead of PS.Then the rats in different groups were ventilated with the corresponding ventilation modes.MAP was monitored and blood samples were token from femoral artery for blood gas analysis at T0, 5 min after HPV (T1 ), and 15, 30, 60, 90, 120 min (T2-6) after administration of PS. The tracheal edema fluid was collected at T1 and T6.The rats were killed at T6 and the lung tissues taken for microscopic examination. Results With the same ventilation mode, the VILI was significantly alleviated after administration of PS. With different ventilation modes,the lung injury was significantly reduced in group SVT 10 compared with the other groups. Conclusion The efficacy of PS for the treatment of rats with VILI is good using the ventilation strategy with VT of 10 ml/kg and RR of 45 bpm.
7.Health Insurance Status and Access to Antiretroviral Treatment Among HIV/AIDS Patients in Northeast Thailand: a Patient-based Analysis
Satoshi TOYOKAWA ; Tsutomu KITAJIMA ; Yasuki KOBAYASHI ; Hajime SATO ; Weerasak CHAIPAH ; Ruengsin THUENNADEE
Journal of International Health 2006;21(2):129-135
The objective of this study is to assess the differences in access to antiretroviral treatment among health insurance recipients, using a patient-based analysis.
METHODS: The subjects were 324 outpatients with the human immunodeficiency virus who were treated at a regional hospital for infectious diseases in Khon Kaen Province. We collected data every visit of the patients during the study period between April1 and September 30 in 2002. We defined access to antiretroviral treatment as having a prescription for antiretroviral drugs on at least one visit during the study period. We examined the relationship between access to antiretroviral treatment and age, sex, stage of acquired immune deficiency syndrome (AIDS), and health insurance. We also compared the results of the patient-based analysis and the record-based analysis that was used in our previous study.
RESULTS: Multiple logistic regression analysis shows that patients insured by the Civil Servant Medical Benefit Scheme have better access to antiretroviral treatment than the others (vs. Universal Coverage; odds ratio=11.38, 95% confidence interval=4.09, 31.65). We have also shown that patients with AIDS-related complex have better access to antiretroviral treatment compared to asymptomatic AIDS patients (odds ratio=3.38, 95% confidence interval=1.31-8.76). Values of these odds ratios were lower in the record-based analysis than in the patient-based analysis.
CONCLUSIONS: Patients insured by the Civil Servant Medical Benefit Scheme had better access to antiretroviral drugs. We reconfirm the differences in access to antiretroviral treatment among health insurance recipients, using the patient-based analysis.
8.Use of HAART and safer sexual behavior among people living with HIV in northeast Thailand
Tsutomu KITAJIMA ; Yasuki KOBAYASHI ; Nonglak PAGAIYA ; Kittisuk NASUGCHON ; Hajime SATO ; Satoshi TOYOKAWA
Journal of International Health 2009;24(4):275-280
Objective
To investigate the relationship between uses of highly active antiretroviral therapy (HAART) and sexual behavior among people living with HIV (PLHIV) in northeast Thailand.
Methods
Data were collected both by interviews using a structured questionnaire and by a self-administered questionnairewith HIV positive patients who made an outpatient visit to a public hospital in northeast Thailand between March2004 and January 2005. Fisher's exact test and multiple logistic regression analysis were conducted to identify thefactors associated with regular condom use when these patients had sex with their spouse/partner.
Results
Among 289 patients (146 with HAART and 143 without HAART) who participated in the study, 122 had sex with their spouse/partner in the three months before the survey. Among them, 70 used a condom every time, 17 used a condom sometimes, 32 never, and 3 unknown. Excluding the 6 patients who did not answer all of the questions, 116 patients remained in the analysis. In the multiple logistic regression analysis, sex, education, employment, years since HIV infection, illness episode in the past one month, and use of HAART were entered as the explanatory factors. Use of HAART (odds ratio=9.8, 95% CI: 2.9 - 32.9) and current employment (odds ratio= 5.2, 95%CI: 1.3 - 20.9) were significantly associated with regular condom use.
Conclusion
Use of HAART was positively associated with use of condoms when PLHIV had sex with their spouse or partner.
9.Consultations by Nutrition Support Team (NST)
Naoko KURAMASU ; Junko YAMAMOTO ; Utako FUKUHARA ; Yumiko YOKOI ; Kimie KOBAYASHI ; Yumiko SHIOKAWA ; Shoichi ISAKA ; Tsutomu TOMINAGA
Journal of the Japanese Association of Rural Medicine 2004;53(5):805-810
Our hospital has a nutrition support team (NST) serving inpatients of all department. Two years ago, the team started activities with the motto “Apt nutritional management for inpatients”. It is an interdepartmental unit consisting of physicians, nurses, dietitians, pharmacists and speech therapists. Initially we found it difficult to make time to join forces, but now it has become possible to screen patients for undernourishment on a weekly basis while making nutritional assessment and planning, and holding consultations. The main purpose of the consultations is to improve the nutritional status of patients according to plans formulated after nutritional assessment made at the request of physicians and nurses in charge of the patients. To achieve the objective, we are expected to concentrate all our efforts and brains. This paper presents some consultation cases we have handled. In addition, the nutritional assessment and nutritional intervention activities of our hospital are described.
Nutrition Assessment
;
Nutritional status
;
Nutritional Support
;
Hospitals
;
Consultation