The biodiversity of species and their rates of extinction, distribution, and protection.

Recent studies clarify where the most vulnerable species live, where and how humanity changes the planet, and how this drives extinctions. We assess key statistics about species, their distribution, and their status. Most are undescribed. Those we know best have large geographical ranges and are often common within them. Most known species have small ranges. The numbers of small-ranged species are increasing quickly, even in well-known taxa. They are geographically concentrated and are disproportionately likely to be threatened or already extinct. Current rates of extinction are about 1000 times the likely background rate of extinction. Future rates depend on many factors and are poised to increase. Although there has been rapid progress in developing protected areas, such efforts are not ecologically representative, nor do they optimally protect biodiversity.

Achieving the convention on biological diversity's goals for plant conservation.

Identifying which areas capture how many species is the first question in conservation planning. The Convention on Biological Diversity (CBD) aspires to formal protection of at least 17% of the terrestrial world and, through the Global Strategy for Plant Conservation, 60% of plant species. Are these targets of protecting area and species compatible? We show that 67% of plant species live entirely within regions that comprise 17% of the land surface. Moreover, these regions include most terrestrial vertebrates with small geographical ranges. However, the connections between the CBD targets of protecting area and species are complex. Achieving both targets will be difficult because regions with the most plant species have only slightly more land protected than do those with fewer.

A quartet of lateral sinus thrombosis, extradural abscess, subdural abscess and occipital abscess: complications of acute mastoiditis in a pre-adolescent child.

Neurological complications of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We present a unique case of acute otitis media progressing to occipital, extradural and subdural abscess formation and lateral sinus thrombosis in a child. The clinical course and management of a pre-adolescent male is presented and discussed. We review the incidence, presentation and treatment of occipital abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended cortical mastoidectomy, neck exploration and broad spectrum intravenous antibiotics, the patient made a full recovery. This is the first reported case of acute mastoiditis associated with occipital abscess in a child. Early, aggressive treatment is required for a successful outcome. The rarity of neurological complications, in addition to the insidious onset and subtle symptoms associated with antibiotic therapy, can make diagnosis extremely difficult. Patients with acute otitis media who fail to respond fully to treatment should be referred early for a specialist otology opinion.

What happens to the lateral sinus following thrombosis? A case of failed recanalization.

Recanalization of the lateral sinus thrombosis is an expected outcome in patients who respond to treatment. We report a case of persistent lateral sinus thrombosis many years after treatment for peri-sinus infection.

Liver carcinoma prevention among Asian Pacific Islanders. Getting hepatitis B shots into arms.

BACKGROUND: For the past 20 years, the hepatitis B virus (HBV) has infected at least 250,000 persons annually in the United States. Persons with chronic HBV infection are at increased risk for liver carcinoma. Among immigrants to the United States from countries with high HBV endemicity, high rates of chronic HBV infection account in large part for their high incidence rates of liver carcinoma. Among those who have not been infected, hepatitis B and hepatitis B-related liver carcinoma can be prevented through hepatitis B vaccine immunizations. In this article, the authors examine hepatitis B vaccine coverage rates from surveys of Asian and Pacific Islander children in Houston, Texas and Los Angeles County, California. METHODS: In Houston, the authors surveyed the parents of 300 students aged 10 to 18 years at a Vietnamese-language school. In Los Angeles County, they surveyed parents of 471 fourth grade students from 6 different Asian and Pacific Islander ethnic groups in 8 public elementary schools. RESULTS: In Houston, 55% of responding parents submitted immunization records indicating that their child had had 3 hepatitis B shots; 3% reported that their child had had no shots. In Los Angeles County, 37% (Filipino) to 67% (Japanese) had had 3 shots; proportions of children having had no shots ranged from 5% to 15%. CONCLUSIONS: Under current immunization practices, the authors estimate that nearly 13,000 Asian and Pacific Islander children living in the United States today will become infected with HBV in the future, resulting in more than 600 liver carcinoma deaths. It is essential that cancer control agencies in the United States take leadership in raising awareness about the role of HBV in the etiology of liver carcinoma and that of the hepatitis B vaccine in preventing it.

Promoting early detection of breast cancer among Vietnamese-American women. Results of a controlled trial.

BACKGROUND: Although breast cancer is the second most common cancer among Vietnamese-American women, previous research has shown that they are less likely to have ever had, and to be more often overdue for, clinical breast examinations (CBE) and mammograms than women in the general population. METHODS: Over a 2.5-year period, the following intervention activities were targeted at both Vietnamese women and physicians in Alameda County, California: neighborhood-based educational activities; dissemination of health education materials; a media campaign; and continuing medical education seminars for physicians. Women in Los Angeles and Orange Counties served as controls. Preintervention telephone interviews were conducted with 384 randomly selected Vietnamese women in the intervention community and 404 women in the control community in 1996, and post-test intervention interviews were conducted with 405 and 402 women, respectively, in 1998. RESULTS: Multiple logistic regression analyses of postintervention surveys showed the intervention community women at posttest were no more likely to recognize, receive, plan, or be up-to-date for CBE or mammograms than women in the control community. However, women who reported greater exposure to the various intervention elements were significantly more likely to have heard of, have had, and to plan CBE and mammograms than women with less exposure. CONCLUSIONS: Although the effect on the women in the intervention group was not significant, the intervention did have a modest positive impact on women who had more exposure to it.

Promoting cancer prevention activities among Vietnamese physicians in California.

BACKGROUND: To promote prevention and early detection of cancer, the authors conducted a three-year intervention targeting Vietnamese physicians in solo practice in California. METHODS: Twenty subjects who had received their medical training in Vietnam were recruited into a randomized controlled trial. The intervention included computerized or manual cancer screening reminders, continuing medical education seminars, Vietnamese-language health education materials, newsletters, and oncology data-query programs. Evaluation included chart audits for eight targeted activities pre- and post-intervention. RESULTS: Before the intervention, annual physician performance rates were low for all eight activities: routine checkups (65.6%), Pap testing (13.8%), pelvic examinations (19.8%), clinical breast examinations (13.3%), mammography (6.4%), hepatitis B serologies (21.9%), hepatitis B immunizations (12.8%), and smoking cessation counseling (1.6%). After the intervention, performance rates increased significantly for smoking cessation counseling (p = 0.02), Pap testing (p = 0.004), and pelvic examinations (p = 0.01). CONCLUSIONS: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities.

Applying the quit & win contest model in the Vietnamese community in Santa Clara county.

OBJECTIVE: To evaluate the effectiveness of modifying and applying a Quit & Win contest model to Vietnamese Americans. DESIGN: Uncontrolled trial, multicomponent program, including two Quit & Win incentive contests, smoking cessation classes, videotape broadcasts, and newspaper articles. SUBJECTS AND SETTING: Vietnamese smokers living in Santa Clara County, California. MAIN OUTCOME MEASURES: Contest participation rates and quit rates at six month follow up; saliva cotinine validation of quitting. RESULTS: There were 57 eligible contest entrants to the 1995 contest, approximately 0.9% of the potential pool of smokers, and 32 entrants to the 1996 contest, approximately 0.5% of the potential pool. Overall, 48 of 49 (98%) individuals who said that they had quit smoking had validation of that fact by saliva cotinine testing. At six months, telephone follow up of 76 individuals revealed a self reported continued abstinence rate of 84.2%. CONCLUSION: Modification and application of the Quit & Win contest model for Vietnamese resulted not only in reasonable participation by Vietnamese male smokers, but also good success in initial quitting and an unexpectedly high abstinence rate at six month follow up.

Hepatitis B immunization coverage among Vietnamese-American children 3 to 18 years old.

OBJECTIVE: Persons with chronic hepatitis B virus (HBV) infection are at increased risk of chronic hepatitis, cirrhosis, and liver cancer. Although HBV infection is relatively uncommon in the United States, the disease is endemic in persons born in Southeast Asia, including Vietnamese-Americans. Current US infant immunization recommendations and state-mandated school-entry programs have left many nontargeted age-cohorts unvaccinated and at risk of infection. To assess the need for catch-up hepatitis B immunizations, this study reports the hepatitis B immunization rates of Vietnamese-American children 3 to 18 years old living in the metropolitan areas of Houston and Dallas, Texas, and the Washington, DC, area. DESIGN: We conducted 1508 telephone interviews with random samples of Vietnamese households in each of the 3 study sites. We asked for hepatitis B immunization dates for a randomly selected child in each household. Attempts were made to verify immunization dates through direct contact with each child's providers. Low and high estimates of coverage were calculated using reports from providers when reached (n = 720) and for the entire sample (n = 1508). RESULTS: Rates of having 3 hepatitis B vaccinations ranged from 13.6% (entire sample) to 24.1% (provider reports, Dallas), 10. 3% to 26.4% (Houston), and 18.1% to 37.8% (Washington, DC). Children living in the Texas sites, older children, children whose families had lived in the United States for a longer time, and children whose provider was Vietnamese or who had an institutional provider were less likely to have been immunized. The odds of being immunized were greater, however, for children who had had at least 1 diphtheria, tetanus toxoid, and pertussis shot, and whose parents had heard about HBV infection, and were married. CONCLUSIONS: The low rates of hepatitis B vaccine coverage among children and adolescents portend a generation which, too old to benefit from infant programs and school entry laws, will grow into adulthood without the protection of immunization. Increased efforts are needed to design successful catch-up campaigns for this population.

Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women.

BACKGROUND: Previous research has shown that breast and cervical cancer screening rates are low among Vietnamese women. METHODS: Over a 24-month period, we implemented a media-led community education campaign to promote recognition, intention, receipt, and currency of routine checkups, clinical breast examinations, mammograms, and Pap tests among Vietnamese-American women in Alameda and Santa Clara Counties in northern California. Women in Los Angeles and Orange Counties in southern California served as controls. To evaluate its impact, pretest telephone interviews were conducted of 451 randomly selected women in the intervention area and 482 women in the control area and posttest interviews with 454 and 422 women, respectively. RESULTS: At posttest, after controlling for demographic differences in the surveyed populations, the odds ratios for the intervention effect were statistically significant for having heard of a general checkup, Paptest, and clinical breast examination (CBE); planning to have a checkup, Pap test, CBE, and mammogram; and having had a checkup and Pap test. The intervention had no effect on being up to date for any of the tests. CONCLUSIONS: A media-led education intervention succeeded in increasing recognition of and intention to undertake screening tests more than receipt of or currency with the tests.

A survey of depressive symptoms among Vietnamese-American men in three locales: prevalence and correlates.

Vietnamese are one of the fastest growing ethnic minority groups in the United States. The purpose of this study was to determine the prevalence and correlates of high depression scores among Vietnamese men in three locales. Computer assisted telephone interviews were conducted with adult Vietnamese men in San Francisco/Alameda Counties, Santa Clara County, and the city of Houston. Telephone numbers of households with Vietnamese surnames were chosen randomly from area telephone books. Depression was assessed using a previously validated Vietnamese language depression screening instrument with 86% sensitivity and 96% specificity for major depression. Between 8.2% and 9.8% of the men scored above the cut-off. Logistic regression analysis revealed that men who were the least proficient in English, poorer, unemployed or disabled, veterans, and those living in Houston were more likely to have a high depression score. Based on the characteristics of the screening instrument, rates of clinical depression among Vietnamese men may be modestly higher than rates for men in the general population. However, high-risk subgroups identified by our analyses may suffer from substantially higher rates of clinical depression. To our knowledge, ours is the first study to show that community context or locale is an independent predictor of high depressive symptoms in this population. These findings have important implications for prevention and intervention approaches to depression among Vietnamese men.

Characterization of primary intracranial lymphoma by computed tomography: an analysis of 36 cases and a review of the literature with particular reference to calcification haemorrhage and cyst formation.

Previous published series describing the appearances of primary central nervous system lymphoma (PCNSL) state that calcification, haemorrhage and cyst formation are rare, but generally fail to quantify or expand on this statement. We present the pre-treatment computed tomography (CT) findings of 36 patients with biopsy proven PCNSL. In this series, calcification was present in only one very atypical lesion and evidence of haemorrhage was not seen. Small intralesional cysts were present in four of the total of 50 lesions. PCNSL usually appeared as one or more well defined focal lesions, iso- or hyperdense to grey matter, with homogeneous enhancement following IV contrast injection. Less commonly the contrast enhancement was inhomogeneous, only one lesion failed to enhance. Disproportionately little oedema and mass effect compared with lesion size was noted on approximately half the CTs. Lesions usually touch either the ependymal lining of the ventricles or the leptomeningeal surface.

Accuracy of racial classification of Vietnamese patients in a population-based cancer registry.

Racial classification of Asian subgroups is increasingly important for health statistics, given the growing Asian-American populations. This study reports the reliability of racial classification of Vietnamese in population-based cancer registry data from northern California. From the Greater Bay Area Cancer Registry, we selected 2240 persons diagnosed with cancer in 1989-1992 and whom the registry considered Vietnamese by birthplace and/or registry race and/or surname, or who were Southeast Asian or Chinese by race. One thousand ninety persons (49%) were interviewed. Sensitivity and predictive value positive, and cancer incidence rates, were calculated using different combinations of the classification factors (birthplace, registry race, and name). By registry-reported race alone, 74% of those the registry classified as Vietnamese agreed with this classification on interview, while 90% of those identifying themselves as Vietnamese were so classified. With classification based on 2 of 3 factors, 78% of those classified as Vietnamese agreed, and 91% of self-reported Vietnamese were correctly classified. Misclassification was associated with age, sex, year of immigration, education, and language use. Registry-based annual age-adjusted all-site cancer incidence rates per 100,000 for Vietnamese were 287.7 for males and 221.3 for females. Rates adjusted for self-reported ethnicity were 242.8 (male) and 213.7 (female). Registry classification of Vietnamese is currently problematic. Approximately 20% of cancer cases classified as Vietnamese are probably not Vietnamese. The higher incidence rates for Vietnamese in the United States than in Vietnam partly may reflect such classification error.

Opening pathways to cancer screening for Vietnamese-American women: lay health workers hold a key.

PURPOSE: We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women. METHODS: Over a 3-year period, indigenous lay health workers conducted small-group sessions of Vietnamese women in a low-income district of San Francisco, California. Women in Sacramento, California, served as controls. Lay workers conducted 56 sessions on general prevention, 86 on cervical cancer, and 90 on breast cancer. Surveys of 306 to 373 women were conducted in the study communities in 1992 and 1996. RESULTS: In the intervention community, recognition of screening tests increased significantly between pre- and postintervention surveys: CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P = 0.001 for all). Receipt of screening tests also increased significantly: CBE, 44 to 70% (P = 0.001); mammography, 54 to 69% (P = 0.006); and Pap smear, 46 to 66% (P = 0.001). Best-fitting logistic regression models, adjusting for preintervention rates and significant covariates, also showed statistically significant odds ratios for the intervention effect (P < 0.0001). CONCLUSIONS: Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer screening tests.

Ultrasound imaging in assessment of fractures of the orbital floor.

Twenty patients who had sustained facial trauma with clinical evidence of an orbital floor fracture were examined by ultrasound in a blinded prospective study to assess the utility of ultrasound in the diagnosis of orbital floor fractures. Ultrasound detected the presence of an orbital floor fracture with an overall accuracy of 86% and a sensitivity of 85% compared with computed tomography (CT) or direct surgical exploration of the orbital floor. This is lower than that quoted in previous reports. Although less sensitive than CT in the detection of orbital floor fractures, the technique appears useful as an adjunct to physical examination in the assessment of patients with facial trauma where an orbital floor fracture is suspected. The technique may also be useful in cases of coexistent cervical spine trauma or in assessment of uncooperative patients where CT is impracticable.

The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men.

OBJECTIVES: This study evaluated an anti-tobacco campaign targeting Vietnamese men in San Francisco, Calif. METHODS: The intervention included Vietnamese-language media, health education materials, and activities targeting physicians, youth, and businesses. Evaluation involved pretest and posttest cross-sectional telephone surveys and multiple logistic regression analyses designed to identify variables associated with smoking and quitting. RESULTS: At posttest, the odds of being a smoker were significantly lower (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.68, 0.99), and the odds of being a quitter were significantly higher (OR = 1.65, 95% CI = 1.27, 2.15), in San Francisco than in a comparison community. CONCLUSIONS: Despite modest success, further efforts are needed to reduce smoking among Vietnamese-American men.

Tobacco use in Vietnam. Prevalence, predictors, and the role of the transnational tobacco corporations.

OBJECTIVE: To describe tobacco use in Vietnam and the impact of transnational tobacco corporations there. DESIGN: In cities, a multistage cluster design; in communes, a systematic sample design, using face-to-face interviews in all sites. SETTING: Hanoi, Ho Chi Minh City, and 2 rural communes in Vietnam. PARTICIPANTS: Random samples totaling 2004 men and women aged 18 years or older. MAIN OUTCOME MEASURES: Prevalence and correlates of tobacco smoking, amount and duration of smoking, age at initiation, quitting behavior, knowledge of health hazards of and attitudes toward smoking, and cigarette brand smoked, preferred, and recognized as most widely advertised. RESULTS: Smoking prevalence among men (n=970) was 72.8% and 4.3% among women (n=1031). Male smokers had smoked a mean of 15.5 years; the median age at initiation was 19.5 years. Among male smokers, 16% smoked non-Vietnamese cigarettes. More than twice as many (38%), however, said that they would prefer to smoke a non-Vietnamese brand if they could afford the cost. Among those who recalled any cigarette advertising (38%), 71% recalled a non-Vietnamese brand as the most commonly advertised. Male smokers who were significantly more likely to smoke non-Vietnamese brands lived in the south, were engaged in blue collar or business/service occupations, earned higher incomes, and lived in urban areas. CONCLUSIONS: Vietnam has the highest reported male smoking prevalence rate in the world. Unless forceful steps are taken to reduce smoking among men and prevent the uptake of smoking by youth and women, Vietnam will face a tremendous health and economic burden in the near future. Implementation of a comprehensive national tobacco control campaign together with international regulation will be the keys to the eradication of the tobacco epidemic in Vietnam and throughout the developing world.

Barriers to breast and cervical cancer screening among Vietnamese-American women.

INTRODUCTION: We investigated barriers to breast and cervical cancer screening among Vietnamese women in San Francisco and Sacramento, California. METHODS: Face-to-face interviews were conducted in 1992 of 306 Vietnamese women in San Francisco and of 339 women in Sacramento. RESULTS: In both communities, only about one half of Vietnamese women had ever had routine check-ups, clinical breast examinations, mammograms, and Pap smear tests, and only about one third were up-to-date for these screening examinations. Among women age 40 or older, 35% had never even contemplated having a mammogram. This study identified several significant barriers to recognition, receipt, and currency of screening tests. Negative predictors of test recognition included low level of education and not having a regular physician. Negative predictors of test receipt included low level of education, not having a regular physician, short duration of residence in the United States, and never having been married. A major negative predictor of test currency was low level of education. With a few exceptions, attitudes and beliefs generally were not important predictors. CONCLUSIONS: Health education and screening programs for early breast and cervical cancer detection among Vietnamese women must be culturally appropriate and conducted in the Vietnamese language. Special outreach efforts are needed to assist recent immigrants in obtaining recommended breast and cervical cancer screening examinations.

Factors associated with breast and cervical cancer screening practices among Vietnamese American women.

PURPOSE: To investigate predictors of breast and cervical cancer screening tests among Vietnamese women in California in preparation for developing and testing interventions to promote such screening. METHODS: Cross-sectional telephone survey of 933 randomly selected Vietnamese women in four California counties. RESULTS: Overall, 70% of the respondents had had at least one prior clinical breast examination, but only 30% had had a mammogram and 53% a Pap test. Among women who had been screened, more than two-thirds were up-to-date and among those who had not been screened, more than two-thirds were planning future tests. Factors positively associated with receipt of one or more of the tests included age (among women < 40 years old), number of years in the United States, having ever married, and having health insurance. Factors negatively associated with test receipt included having a Vietnamese doctor, being unemployed, and being of Chinese-Vietnamese background. CONCLUSION: The multiple factors associated with utilization suggest intervention targets for promoting breast and cervical screening among new immigrant women. Increasing screening test receipt to recommended levels will require a two-pronged approach directed at both Vietnamese consumers and Vietnamese physicians.