The cooperation between professional societies contributes to the capacity building and system development for prevention and control of cancer in low- and middle-income countries: the practice of Cervical Cancer Prevention and Control Project in Cambodia.

Globally, an estimated 570,000 women are newly diagnosed with cervical cancer, and 311,000 women die every year, with approximately 90% of the cases occurring in low- and middle-income countries (LMICs). Cervical cancer is the most common cancer in women in Cambodia, with age-standard incidence rate of 13.5/100,000 and mortality rate of 10.1/100,000. This paper introduces the educational and managerial interventions of Cambodia Cervical Cancer Project 2015-2018 by two professional societies of Cambodia and Japan. It can be categorized into three phases: health education and screening; diagnosis and treatment of precancerous lesions; and pathology service. Human papillomavirus test-based cancer screening and treatment of precancerous lesions were successfully initiated. Key factors contributed to optimal outcomes are partnership between two professional societies with strong commitment, and a comprehensive and stepwise quality-focused approach. A complementary role and joint society initiatives is a novel approach and substantial in sustainability for developing a system of cervical cancer management. This effort might serve as a good example how professional societies can contribute to capacity building and system development for prevention and control of cancer in LMICs.

Development and evaluation of a cervical cancer screening system in Cambodia: A collaborative project of the Cambodian Society of Gynecology and Obstetrics and Japan Society of Obstetrics and Gynecology.

AIM: In Cambodia, the Japan Society of Obstetrics and Gynecology and the Cambodian Society of Gynecology and Obstetrics have an on-going project, started in 2015, for cervical cancer prevention and treatment. The project, currently aimed at factory workers, includes a women's health education program that leads into cervical cancer prevention by establishment of a system for early detection and treatment. It begins by health education, screening for human papillomavirus (HPV), followed by colposcopy and quicker treatment of earlier precursor lesions. METHODS: Rates for participant screening, HPV test positivity, cervical intraepithelial neoplasia (CIN) detection and distribution of HPV types were compared between two screening programs, factory-based and hospital-based. Some HPV test samples were divided into two, one of which was sent to Japan for a quality-control check of the Cambodian testing. RESULTS: The factory-based participant screening rate was 19% (128/681). HPV was detected more frequently in the factory-based program participants (12%) than in the hospital-based program participants (5%). Unfortunately, however, the rate of receiving proper secondary colposcopy screening among the HPV-positive females was significantly higher in the hospital-based program (94%) than the factory-based program (40%) (P < 0.001). The Cambodian laboratory HPV testing accuracy was 92.6%. HPV types demonstrated no significant difference between the two prevention programs. CONCLUSION: We could successfully introduce HPV-based screening, starting from health education. However, low rate of screening, especially secondary screening for HPV positive factory workers was identified. Also, HPV testing could be further improved for accuracy through close monitoring.

How can we strengthen pathology services in Cambodia?

Rapid economic growth and a changing disease burden have increased the demand for pathology services in Cambodia. This paper describes the status of pathological services and international support for pathology professionals in Cambodia, and discusses future needs for strengthening pathology services. In 2016, there were only four pathologists and 18 pathology technologists in Cambodia. A postgraduate course in pathology was created in 2015, and five residents became certified in 2018. Besides multinational support with lectures and practice for pathologists, the Japanese team provides on-the-job training for pathology technologists to improve slide preparation for diagnosis. A clinicopathological conference was introduced to strengthen the communication among pathologists, pathology technologists, and gynecologists. Although there is a long way to go to reach high quality pathological services, coordination among international partners needs to continue, as does the balance between human resource development for pathology professionals, to provide a higher level of care to local citizens.

Family size preference and factors affecting the fertility rate in Hyogo, Japan.

BACKGROUND: Japan has consistently shown a low fertility rate, which has been lower than the replacement level since 1974, and represents one of the least fertile countries in the world. This study was designed to determine the family size preference of and its effect on Japanese women. METHODS: We conducted a questionnaire survey among women who visited the obstetrics and gynecology department of 18 hospitals and clinics in the Hyogo Prefecture, Japan, between October 2011 and February 2012. All the women were categorized according to age group and area of residence, and the survey results were statistically analyzed using a t test. RESULTS: A total of 1616 women were included in this study. There was no significant difference between the mean desired and actual marital ages (26.70 and 26.67 years, respectively). The mean desired number of children was 2.55, which was significantly more than the mean actual number of children (1.77) in all generations. The mean desired and actual numbers of children were more in the rural areas (2.73 and 2.09, respectively) than in the urban (2.54 and 1.70, respectively) and semi-urban areas (2.49 and 1.60, respectively). The mean number of family members was significantly greater in the rural areas (3.84) than in the urban (3.25) and semi-urban areas (3.05).The most important concern among women who had never delivered a baby was childbearing itself, followed by the expenses related to pregnancy and childbearing. CONCLUSIONS: The family size preference of the women in our study was higher than the actual numbers of children. The fertility intentions were low among the younger women but high among those living in rural areas with larger families.

Humanised care and a change in practice in a hospital in Benin.

OBJECTIVE: to describe the process of introduction and implementation of humanised care (humanised childbirth); to determine how the practice of humanised care affects midwives, obstetricians, and other service providers in the hospital; and to determine the factors influencing the change in practice. DESIGN: a qualitative study with grounded theory approach. A semi-structured, in-depth individual interview was conducted for data collection with open coding and a constant comparative analysis until the saturation of concepts. SETTING: mothers' and children's hospital functioning as a top referral centre in Benin. PARTICIPANTS: 16 hospital staff, including 6 midwives. FINDINGS: humanised care was initiated by midwives with hesitation and difficulties. Midwives and obstetricians learned that a supportive environment for women could produce a positive birth outcome without medication. Communication between the midwives and women and their families improved with a higher level of appreciation of the care provided by the midwives among the women and their families. Humanised care appears to affect the professional value of midwives, their levels of job satisfaction, and their personal motivation for work towards improving their performance. A positive influence on obstetricians and other staff was observed. These individuals were inspired to make changes in hospital culture to improve care, to avoid unnecessary interventions, and to improve communication. Important factors in achieving favourable results were the leadership and commitment of the hospital management team and the recognition and support they extended towards the hospital staff, especially the midwives. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a system of humanised care that stresses improved communication between the women giving birth, their families, and care providers, based on respect for women's dignity and liberty, and avoidance of unnecessary intervention can be promoted with proper managerial support. This system can promote favourable changes in hospital practice, which are helpful in motivating midwives in resource-limited settings.

Efficacy of chloroquine plus primaquine treatment and pfcrt mutation in uncomplicated falciparum malaria patients in Rangamati, Bangladesh.

A combination of chloroquine (CQ) and primaquine (PQ) had been used as the first-line treatment of uncomplicated Plasmodium falciparum malaria in Rangamati, Bangladesh until the end of 2004. Doctors or medical staffs had felt that CQ plus PQ had become less effective against uncomplicated falciparum malaria patients, but that it was more effective against the minority-indigenous patients than the Bengali patients. The efficacy of CQ plus PQ and the mutation status of the CQ resistance transporter (pfcrt) gene of infecting P. falciparum were, thus, investigated for 45 uncomplicated falciparum malaria patients in Rangamati in 2004. The total failure rate was 57.8%. One or two pfcrt sequences (CIETH and SMNTH at positions 72, 74-76, and 97, mutation underlined) with K76T mutation known to be related to CQ-resistant phenotype were detected in 38 patients' blood samples. Of the 38 patients, in total 15 patients (14/25 minority-indigenous and 1/13 Bengali patients) resulted in adequate clinical and parasitological response (ACPR). There was a statistically significant difference in ACPR rate between the minority-indigenous patients and the Bengali patients. P. falciparum with mutant or resistant pfcrt (pfcrt-resistant) was detected by PCR in blood samples on day 28 for 10 ACPR minority-indigenous patients but not for the only one Bengali ACPR patient, who all were infected with pfcrt-resistant P. falciparum on day 0. The minority-indigenous patients, but not Bengalis, are suggested to be often cured by CQ plus PQ, leaving a very few parasites detectable only by PCR, even when they are infected with pfcrt-resistant P. falciparum.

Perception of oral contraceptives among women of reproductive age in Japan: a comparison with the USA and France.

AIM: In order to reveal the differences between oral contraceptives (OC) perceptions and actual needs, we performed a web-based study in the USA, France, and Japan. MATERIALS AND METHODS: The study was carried out using a web-based questionnaire in May 2009. Two hundred women each from the three countries who were in their 20s, 30s, or 40s were randomly selected and asked about contraception. RESULTS: The most frequently used contraceptive method was OC in the USA and France and condoms in Japan. The most commonly used OC information source was doctors in the USA and France, but the media in Japan. The main reason for taking OC was 'contraception' in the USA and France, but it was relief from menstruation-related problems in Japan. Partner agreement was highest in France, and partner disagreement was highest in the USA. The most common reason for discontinuing OC use was 'contraception became unnecessary' in all three countries. The second most common reason was 'troublesome to take everyday' in the USA and France but 'troublesome to get a doctor's prescription' in Japan. The most common reason for never taking OC was also 'troublesome to get a doctor's prescription' in Japan. As a non-contraceptive benefit, 'relief of dysmenorrhea' was well known in all three countries; however, other non-contraceptive benefits were little known among Japanese. CONCLUSIONS: There are several differences in the patterns of OC use in the three countries studied. Providers should know more about current OC usage patterns in order to improve the quality of care.

Postpartum subarachnoid hemorrhage due to Moyamoya disease associated with renal artery stenosis.

Moyamoya disease is a cerebrovascular stenotic or occlusive disease predominantly seen in Asian countries. Sometimes there are coexisting renal artery lesions in Moyamoya disease patients. A 32-year-old multipara had a cesarean section at 33 gestational weeks due to preeclampsia. One month later, she developed subarachnoid hemorrhage and angiography demonstrated Moyamoya vessels with renal artery stenosis. After conservative therapy, the patient was discharged without any deficits. Our conclusion is that patients with Moyamoya disease carry a risk of cerebrovascular accident during pregnancy and postpartum. In this case, we did not diagnose Moyamoya disease with renal artery stenosis until the patient developed subarachnoid hemorrhage. It is very important to make a careful differential diagnosis of hypertension during pregnancy and the postpartum period.

Impact of use of combined oral contraceptive pill on the quality of life of Japanese women.

AIM: To evaluate the impact of combined oral contraceptive pill (OC) use on quality of life (QOL) among Japanese women, we performed a prospective study using the Japanese version of the World Health Organization Quality of Life (WHOQOL) questionnaire. METHODS: Women who consulted Chayamachi Lady's Clinic to get a prescription for OC for the first time were recruited for our questionnaire study and asked to complete the WHOQOL questionnaire twice, before taking OC and more than 3 months after beginning OC use. Two hundred and seventeen women responded to our questionnaire before taking OC and 110 patients completed the questionnaire. The patients were divided into six groups based on the reason they wanted to take OC: contraception, relaxation of dysmenorrhea, regulation of menstrual cycles, improvement of acne, remission of menorrhagia, and improvement of premenstrual tension syndrome (PMS). RESULTS: WHOQOL scores showed significant improvement in all domains of the dysmenorrhea group, all domains but the social of over all participants, the social and overall domain of the irregular cycle group, physical, environmental, and overall domain of the acne group, and psychological and overall domain of the PMS group. The WHOQOL score worsened in the social domain of the contraception group; however, the score in the overall domain of that group improved. CONCLUSIONS: These results indicate that OC can provide higher QOL for women with problems involving menstrual pain and/or hormonal abnormalities. However, those using OC for contraception only were found to be unsatisfied with taking OC in a relationship with their partners.

Measles encephalitis in early pregnancy and after delivery.

We present two cases of measles encephalitis, one in early pregnancy and one after delivery. In case 1, the patient became unconscious 6 days after the appearance of a rash and was treated with glycerol and immunoglobulin. In case 2, the patient became unconscious 6 days after the appearance of a rash and was also treated with glycerol and immunoglobulin. Both of them recovered without any neurological sequelae. Pregnancy is a risk factor for severe measles complications, and vaccination should be promoted much more in countries with poor measles control, such as Japan.