A focus group interview of university students7 health in Sri Lanka / 国際保健医療

<B>Objective</B><BR>Despite the steady high prevalence of infectious diseases, Sri Lanka has an increasing awareness of lifestyle-related health diseases. To lower their risks in the future, making better lifestyle choices and establishing patterns of healthy behavior during young adulthood are essential. The purpose of this qualitative study was to explore current issues of university students' health behaviors and their environments.<BR><B>Methods</B><BR>The study was conducted in a university of the Central Province, Sri Lanka. Four graduate students in the Faculty of Medicine and three senior students in the Faculty of the Arts were interviewed in a focus group. Interviews were tape-recorded, transcribed, and analyzed inductively.<BR><B>Results</B><BR>The results yielded three core categories: little interests in health, unhealthy lifestyles, and lower usage of the Student Health Center. In addition, three major health problems were observed among the participants: eating habits, substance use, and mental health. Students had little paid attention to their health. It also showed passive participation on a health check-up. Additionally students' hidden risky behaviors were observed: alcohol intake and smoking. Mental health problem is one of the great health concerns among the students. Although the School Health Center was available, the gaps between its provisions of services and students' needs are an important issue.<BR><B>Discussion and Conclusion</B><BR>Students need to pay more attention on their health conditions and the importance of preventive health. Furthermore, to improve the current university health services, accessibility, usability, and students' needs should be carefully reviewed in the context of advocacy of preventive health behaviors.

Depressive symptoms among international university students in northern Japan: Prevalence and associated factors / 国際保健医療

<B>Objective</B><BR>The purpose of this article is to investigate the extent of depressive symptoms among international students and the characteristics of those at risk.<BR><B>Methods</B><BR>Evidence is derived from self-administered questionnaire interviews of 480 international students enrolled in a university in northern Japan. Depressive symptoms are measured using the Center for Epidemiologic Studies Depression scale. The associations of socio-demographic characteristics with depressive symptoms are examined using multiple logistic regression analysis.<BR><B>Results</B><BR>Of the 480 respondents, 197 (41%) have depressive symptoms. The results indicate that gender, course category, and residential arrangement are significantly associated with the risk of having depressive symptoms.<BR><B>Discussion</B><BR>Depressive symptoms are relatively prevalent, but these are not a generalized condition since these tend to occur among specific sub-groups of international students. There is a need to further investigate the mental illness so that those with elevated risks are identified and given support.

A Review of UNGASS-Based Outcomes and Impact of HIV/AIDS Programs in Eight sub-Saharan Countries / 国際保健医療

<B>Introduction</B><br>Whereas the numbers of new HIV infections and deaths due to AIDS have been reduced or stabilized, they remain high in sub-Saharan Africa. To further control the generalized epidemics and their consequences, countries have continued strengthening their programs to prevent new infections and deaths: however, program outcomes and impact at the national level are not well understood. The purpose of the review was to describe the country-level outcomes and impact of HIV/AIDS programs in eight sub-Saharan African countries in order to highlight future action agenda to meet universal access and policies related to Millennium Development Goals (MDGs).<br><B>Methods</B><br>The review used 16 of the 25 program outcome and impact indicators prescribed by the United Nations General Assembly Special Session (UNGASS). The review reported on the percentages accomplished by each country in their programs, categorized these figures into high (80% and higher), moderate (50-79%) and low (below 50%), and highlighted the domains in which outcomes and impact were high.<br><B>Results</B><br>Across countries, with the exception of Tanzania, programs had achieved nearly universal or universal outcomes and impact, but their coverage was limited to 2-5 program domains. Moreover, in domains with multiple target groups, such as in the provision of antiretroviral therapy and in the promotion and distribution of condom use, the programs were unable to produce high-end results for the affected populations. To further reduce their infections and deaths and to advance towards universal access and MDGs, countries must make their program outcomes and impact comprehensive and equitable.<br><B>Conclusion</B><br>Almost all national programs have high level accomplishments, but they must broaden their domain and audience coverage to further control the generalized epidemics and deaths in the eight countries. National responses must collect and analyze all the UNGASS data systematically and regularly in order to determine current HIV/AIDS knowledge and behaviors, ascertain program effects, and inform future actions.

Current HIV/AIDS Knowledge, Perceptions and Practices among the General Population in Kandy, Sri Lanka: Program Implications / 国際保健医療

<b>Introduction</b><br> Recent strategic plans for HIV/AIDS control in Sri Lanka have stressed the need to focus prevention interventions on most-at-risk populations and similarly laid out the importance of improving HIV/AIDS awareness among the general population. Programmatic attention has to be strengthened to effectively change AIDS-related poor knowledge, low risk perceptions and risky sexual practices at the individual level, and avert an epidemic. While current data on at-risk populations are available to inform interventions, there is paucity of latest evidence for the general population programs.<br><b>Methods</b><br> In April-May 2009, a cross-sectional study involving 1,239 population-based and randomly selected respondents aged 15-49 was completed in Kandy, Sri Lanka (response rate=87.2%). The study collected data on HIV/AIDS knowledge, perceptions and sexual practices among the general population to supply current information for the intervention. Data were analyzed using univariate, bivariate and multivariate approaches. <br><b>Results</b><br> While almost all respondents were aware of HIV/AIDS, sizeable proportions (44.7-76.2%) knew little about the types of sexually transmitted infections, and about the transmission modes and prevention methods of HIV/AIDS. Although 80% of respondents had low risk perceptions and were mostly at low risk behaviorally, their knowledge of HIV/AIDS was inadequate. They assessed their risks and practiced unsafer sex without the benefit of having evidence-based knowledge. The knowledge, perceptions and practices were significantly associated with gender, marital status, education, religion, and/or residence.<br><b>Conclusions</b><br> The gaps in substantive knowledge on HIV/AIDS suggest that no effective information and other related types of support have been provided to the general population in Sri Lanka. In the context of the need to contribute to sustaining the low prevalence of HIV in the country, a base of scientific knowledge and wider advocacy programs should be developed.

Community-based Evaluation of Health-seeking Behavior of People with Animal Bite Injuries in a District of Sri Lanka / 国際保健医療

<b>Introduction</b><br> Of the 55,000 deaths per year due to rabies, 56% occur in Asia and 44% in Africa. Despite the existence of the national rabies control program in Sri Lanka, rabies is still prevalent, suggesting that animal bite victims may have failed to observe the proper first aid measures and seek immediate medical treatment. The purpose of this study is to describe the health-seeking behavior among animal bite victims of a selected population in Kandy District, Sri Lanka. The influences of subjects’ demographic characteristics to these behaviors were studied.<br><b>Methods</b><br> We conducted face-to-face interviews in May 2006 among households with family members having history of animal bite injuries. Data on health-seeking behaviors such as first aid measure application, immediate medical consultation, and completion of post-exposure prophylaxis (PEP) were obtained. The association between behaviors and demographic characteristics were evaluated using Chi-square test or the Fisher’s exact test.<br><b>Results</b><br> Of the 6968 sample population, 357 (5.1%) had history of animal bites one year prior to the survey. Most of the subjects performed first aid measures (n=297, 83.2%) and sought medical treatment (n=319, 89.4%) within 24 hours (n=295, 82.6%) of the injury. Only 9.8% (n=35) of the subjects completed the PEP. There was no association between health-seeking behavior and demographic characteristics. Two subjects died having symptoms that resembled rabies without completing the necessary PEP, and two animal specimens were sent for laboratory testing that confirmed one case of feline rabies one year prior to the study.<br><b>Conclusion</b><br> In general, the health-seeking behaviors of the subjects were not influenced by their demographic characteristics which may contribute to greater difficulties in controlling rabies. To strengthen the rabies control program, effective education of both the public and health sectors by thorough and adequate wound washing, and strict adherence with the recommended treatment schedule is of paramount importance.

Expanding Capacity and Accelerating AIDS Vaccine Development in Asia / 国際保健医療

 It has been estimated that by 2010, there might be more people living with HIV in Asia than in Africa. There is an urgent need for a safe, effective, accessible and affordable AIDS vaccine suitable for use in Asia. Factors that may hinder the development of AIDS vaccines in Asia include: 1) difficulty in recruiting adequate number of trial participants due to the low incidence of HIV infection in the general population and in defined population groups at high risk for HIV; 2) circulation of multiple HIV genetic subtypes and recombinant forms, and 3) unique geographical diversity of populations, cultures, social and political backgrounds. A proposed strategy to accelerate the development of an effective AIDS vaccine for Asia could be the constitution of a collaborative regional network in support of AIDS vaccine research and development. Collaborations would include 1) promoting the conduct of additional epidemiological studies and establishment of regional vaccine trial cohorts to reach adequate sample size for efficacy trials, 2) developinga regional platform for the conduct of clinical trials at multiple sites and harmonization of legal, regulatory and ethical frameworks to facilitate the review and approval processes, 3) strengthening the regional clinical research capacities and human resources for efficient development and testing of various vaccine candidates; and 4) promoting the development of regional capacities and infrastructures for vaccine production for the conduct of all phases of clinical trials, licensing and future public health use. A collaborative regional network in support of AIDS vaccine research and development will also require strong political commitment and leadership by all regional and international partners playing a significant role in the region.

Knowledge, attitudes, and practices survey of rabies in a community in Sri Lanka

<p><b>OBJECTIVES</b>The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners.</p><p><b>METHODS</b>This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Landa.</p><p><b>RESULTS</b>Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%).</p><p><b>CONCLUSIONS</b>The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.</p>

An Increase in Lifestyle-Related Diseases and Challenges of the Technical Support for Health Care Delivery in Sri Lanka / 国際保健医療

<b>Backgroud</b><br>Sri Lanka is a developing and multiracial country, located in the Indian ocean near the equator, with a population of approximately 20 million. It has a parliamentary democratic system of government and over 80% of hospitals belong to government and medical services are free of charge. Literacy rate of Sri Lanka is higher than the neighbouring countries of the region, and the government's health policies, based on the promotion of Maternal & Child and Geriatric health, are on the way to success. <br>According to the Health Master Plan (HMP) by the Ministry of Healthcare & Nutrition (MOH&N) ,the health problems in this country are classified into three categories based on epidemiological and medical economics:<br>i) Continuing Problems such as dengue fever, ii) Emerging Problems such as HIV/AIDS, and iii) Evolving Problems such as lifestyle-related diseases. <br>It is apprehensive thatthe health conditions and economics of individual Sri Lankan and Nation's economics will be compelled to face the multiple burdens in the near future.<br><b>JICA's Technical Support (JTS)</b><br>JTS on the first prevention against non-communicable diseases (NCDs) has been already startedby JICA after receiving the request by the government of Sri Lanka in order to avoid the catastrophic situations pointed out by HMP. Futhermore, the trend analyses on the data of inpatients suffered 59 types of communicable or NCDs from 1983 to 2003 were performedto propose the tagets and contents of the new JTS. As a result, ffifteen diseases were statistically significant, and nine out of the above15 cases were NCDs.<br>Because lifestyle-related diseases such as ischemic heart disease, cardiovascular diseases occupy four positions out of five leading causes of death in recent past of Sir Lanka, new model system which combines the first prevention and screening of high-risk persons and early treatment system was proposed to MOH&N.<br>The flow of the basic model projiect, composed of two screening steps to detect thespecific persons having high-risks such as obesity, hypertension, high cholesterol, etc., is classified into three groups to receive optimum healthcare sevices at the nearby hospitals.<br>Fortunately, MOH&N made a request for the new JTS based on this proposal to the government of Japan. Consequently, the budget of this project proposal was approved and is now under the practical arrangements by JICA.

Knowledge, Attitudes, and Practices Survey of Rabies in a Community in Sri Lanka

Objectives: The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners. Methods: This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Lanka. Results: Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%). Conclusions: The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.

Advocacy, promotion and e-learning: Supercourse for zoonosis

This paper discusses the history of emerging infectious diseases, risk communication and perception, and the Supercourse lectures as means to strengthen the concepts and definition of risk management and global governance of zoonosis. The paper begins by outlining some of the key themes and issues in infectious diseases, highlighting the way which historical analysis challenges ideas of the 'newness' of some of these developments. It then discusses the role of risk communication to public accountability. The bulk of the paper presents an overview of developments of the Internet-based learning system through the Supercourse lectures that may prove to be a strong arm for the promotion of the latest medical information particularly to developing countries.

Strategic approach to information security and assurance in health research

Information security and assurance are an increasingly critical issue in health research. Whether health research be in genetics, new drugs, disease outbreaks, biochemistry, or effects of radiation, it deals with information that is highly sensitive and which could be targeted by rogue individuals or groups, corporations, national intelligence agencies, or terrorists, looking for financial, social, or political gains. The advents of the Internet and advances in recent information technologies have also dramatically increased opportunities for attackers to exploit sensitive and valuable information.Government agencies have deployed legislative measures to protect the privacy of health information and developed information security guidelines for epidemiological studies. However, risks are grossly underestimated and little effort has been made to strategically and comprehensively protect health research information by institutions, governments and international communities.There is a need to enforce a set of proactive measures to protect health research information locally and globally. Such measures should be deployed at all levels but will be successful only if research communities collaborate actively, governments enforce appropriate legislative measures at national level, and the international community develops quality standards, concluding treaties if necessary, at the global level.Proactive measures for the best information security and assurance would be achieved through rigorous management process with a cycle of "plan, do, check, and act". Each health research entity, such as hospitals, universities, institutions, or laboratories, should implement this cycle and establish an authoritative security and assurance organization, program and plan coordinated by a designatedChief Security Officer who will ensure implementation of the above process, putting appropriate security controls in place, with key focus areas such aspolicies and best practices, enforcement and certification, risk assessment and audit, monitoring and incident response, awareness and training, and modern protection method and architecture. Governments should enforce a comprehensive scheme, and international health research communities should adopt standardized innovative methods and approaches.

BSE safety standards: An evaluation of public health policies of Japan, Europe, and USA

Since the advent of bovine spongiform encephalopathy (BSE) in the United Kingdom in 1986, new BSE cases have recently become rare. However, in Japan and the United States, positive cases have started to be seen recently. The rise in BSE cases paved the way for the human form of this disease, the variant Creutzfeldt-Jakob disease (vCJD). The observed trends in the UK may be attributed to effective implementation of public health policies coupled with increased vigilance through advancement in science and technology, or they may well be a reflection of the natural disease progression. We aim to discuss the BSE chronology of events, and compare examination methods, costs and cost-efficiency, management, and public policies of Japan, Europe, and the USA.

BSE Safety Standards: An Evaluation of Public Health Policies of Japan, Europe, and USA

Since the advent of bovine spongiform encephalopathy (BSE) in the United Kingdom in 1986, new BSE cases have recently become rare. However, in Japan and the United States, positive cases have started to be seen recently. The rise in BSE cases paved the way for the human form of this disease, the variant Creutzfeldt-Jakob disease (vCJD). The observed trends in the UK may be attributed to effective implementation of public health policies coupled with increased vigilance through advancement in science and technology, or they may well be a reflection of the natural disease progression. We aim to discuss the BSE chronology of events, and compare examination methods, costs and cost-efficiency, management, and public policies of Japan, Europe, and the USA.

Strategic Approach to Information Security and Assurance in Health Research

Information security and assurance are an increasingly critical issue in health research. Whether health research be in genetics, new drugs, disease outbreaks, biochemistry, or effects of radiation, it deals with information that is highly sensitive and which could be targeted by rogue individuals or groups, corporations, national intelligence agencies, or terrorists, looking for financial, social, or political gains. The advents of the Internet and advances in recent information technologies have also dramatically increased opportunities for attackers to exploit sensitive and valuable information. Government agencies have deployed legislative measures to protect the privacy of health information and developed information security guidelines for epidemiological studies. However, risks are grossly underestimated and little effort has been made to strategically and comprehensively protect health research information by institutions, governments and international communities. There is a need to enforce a set of proactive measures to protect health research information locally and globally. Such measures should be deployed at all levels but will be successful only if research communities collaborate actively, governments enforce appropriate legislative measures at national level, and the international community develops quality standards, concluding treaties if necessary, at the global level. Proactive measures for the best information security and assurance would be achieved through rigorous management process with a cycle of “plan, do, check, and act”. Each health research entity, such as hospitals, universities, institutions, or laboratories, should implement this cycle and establish an authoritative security and assurance organization, program and plan coordinated by a designated Chief Security Officer who will ensure implementation of the above process, putting appropriate security controls in place, with key focus areas such as policies and best practices, enforcement and certification, risk assessment and audit, monitoring and incident response, awareness and training, and modern protection method and architecture. Governments should enforce a comprehensive scheme, and international health research communities should adopt standardized innovative methods and approaches.

Advocacy, Promotion and e-Learning: Supercourse for Zoonosis

This paper discusses the history of emerging infectious diseases, risk communication and perception, and the Supercourse lectures as means to strengthen the concepts and definition of risk management and global governance of zoonosis. The paper begins by outlining some of the key themes and issues in infectious diseases, highlighting the way which historical analysis challenges ideas of the ‘newness’ of some of these developments. It then discusses the role of risk communication to public accountability. The bulk of the paper presents an overview of developments of the Internet-based learning system through the Supercourse lectures that may prove to be a strong arm for the promotion of the latest medical information particularly to developing countries.

Trends and current issues in adult fecal incontinence (FI): Towards enhancing the quality of life for FI patients

Our goals are to review the literature on the definition and epidemiology of fecal incontinence (FI), the risk factors involved, available treatment options, and measurement of the quality of life (QOL) of patients with this condition. Articles included for review were searched following the guidelines set by Cochrane Reviewers' Handbook. FI was defined variously depending upon the duration, type, and amount of leakage. About 17 published papers were reviewed on the prevalence of FI that ranged from 1.4% to 50%. Potential risk factors included perianal injury/surgery, and fair/poor general health. QOL assessment using various grading scales provided an objective method of evaluating patients before and after treatment. Management included medical, physiotherapy, and surgical options. Through the range of various references, a clear definition of FI should be specified, which reflects its epidemiology in the various studies. These differences in definition would significantly affect its prevalence. Many risk factors have been sited but further epidemiological studies are necessary to elucidate FI. Understanding the etiology of the disease is an important initial step to provide adequate treatment of FI. QOL assessment provides objective and subjective method in the analysis of effectiveness of therapy.