Asia-Pacific Journal of Public Health

Published by SAGE Publications
Online ISSN: 1941-2479
Print ISSN: 1010-5395
We aimed to provide systemic, empirical evidence on the coverage expansion of primary health care (PHC) linking to good health in low- and middle-income countries. We conducted a pooled, cross-sectional analysis using the 2011 World Health Statistics for World Health Organization Member States at low- and middle-income levels (n = 102). With life expectancy, infant mortality, and under-5 mortality as health indicators, we examined the effect of service coverage rate using variables under 2 domains: health expenditure and PHC (public health provision, primary care access). Our results indicated that after controlling for gross national income per capita, higher total health expenditure as share of gross domestic product was associated with shorter life expectancy (β = -0.99; P = .014), higher infant mortality (β = 1.65; P = .155), and under-5 mortality (β = 4.82; P = .020). Multivariate analysis showed higher coverage of public health services was significantly associated with improved population health. Making public health and primary care services accessible and be used by everyone is the wise means toward improved health.
Studies on socioeconomic and epidemiological effects of hearing impairment in middle-income countries of Southeast Asia are still quite scarce. This study examines the association between hearing impairment and health outcomes in Thailand. Data derived from a cohort of 87 134 Open University adults aged 15 to 87 years residing throughout Thailand. Approximately 8.5% of cohort members reported trouble hearing and 0.13% reported being deaf. After adjusting for age and gender, poor self-assessed health was strongly associated with some trouble hearing (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 2.48-2.93) and deafness (OR = 3.08, 95% CI = 1.73-5.50). Population attributable fractions for hearing impairment were 12.9% for poor self-assessed health, 9.8% for poor psychological health, 3.3% for metabolic disorders, and 4.1% for cardiovascular conditions. More attention needs to be paid on hearing impairment with regular check-ups and early detections.
Population Attributable Fractions (PAF) by selected health outcomes 
To date, more than 300 million people worldwide live with low vision and blindness, imposing social and economic burdens on individuals and families. This study analyzes a cohort of 87134 Thai adults, reporting odds ratios (ORs) and calculating population attributable fractions (PAFs). PAF estimates the proportion of the disease or condition that would not occur if no one in the population had the risk factor. Approximately 28% and 8% reported having refractive errors and vision impairment not correctable by visual aids. Both types of vision impairment were positively associated with poor self-assessed health (adjusted ORs = 1.23 to 2.03) and poor psychological health (adjusted ORs = 1.13 to 1.63). PAFs show that refractive errors explain 6.1% of poor self-assessed health, 3.5% of poor psychological health, and 2.2% of falls in the last year. PAFs for vision impairment not correctable by visual aids explain 7.5%, 4.7%, and 3.1%, respectively. Incorporating early detection and prevention of vision impairment at the primary health care level will contribute to promoting the health of Thais.
BACKGROUND: The effect of individual educational attainment on health has been extensively documented in western countries, whereas empirical evidence of education spillover effects in marital dyads is scarce and inconsistent. METHODS: A total of 2764 individuals (or 1382 marital dyads) were surveyed in the Shanghai Healthy City Project 2008. Logistic regression models were used for analysis, and all analyses were stratified by gender. RESULTS: Significant protective associations were observed in univariate models linking general health status to the individual's own educational attainment and to their partner's educational level. After controlling for presence of chronic conditions, lifestyle factors, and social support, these associations were attenuated. CONCLUSIONS: The authors found a gender difference in the association of spouse's educational attainment with self-rated health. The influence of education on health may be partly mediated by lifestyle and other factors.
This study assessed the preparedness of school health personnel to develop and deliver HIV/AIDS prevention education programmes for young people in China. A survey of 653 personnel working in secondary schools in 14 cities was conducted. More than 90% had basic knowledge of ways in which HIV can be transmitted, but knowledge of ways in which the virus is not transmitted needs improvement. Substantial numbers of teachers were not sure whether there was an effective preventive vaccine (42%) or did not know whether AIDS was a curable illness or not (32%). The great majority approved of AIDS prevention programmes in universities (98%) and secondary schools (91%), although fewer (58%) agreed that the topic was appropriate for primary schools. Currently, most classroom activities focuses on teaching facts about HIV/AIDS transmission, while less than half are taught about HIV/AIDS related discrimination and life skills to reduce peer pressure. Personnel with some prior training on HIV/ AIDS education (53%) had better factual knowledge, more tolerant attitudes and more confidence in teaching about HIV/AIDS than those without training. The majority of teachers indicated a need for more resource books, audiovisual products, expert guidance, school principal support and dissemination of national AIDS prevention education guidelines to schools.
Measles immunisation of nine-month-old Thai children has been part of the national health programme since 1984. In this study we compared the seroconversion rate following measles immunisation in nine-month-old Thai children with the older age groups, i.e. 10 to 14 months of age, to see whether revaccination at over 12 months of age is necessary. In 223 children, 204 had no measles haemagglutination inhibition antibody before measles vaccination. The seroconversion rates in children aged nine to ten, 11 to 12, and 13 to 14 months were 96.1%, 94.5% and 100% respectively with no difference statistically.
The purpose of this cross-sectional study was to find out the prevalence of obesity and overweight among intermediate school adolescents aged 10 to 14 years. The study comprised a multistage stratified random sample that included 5402 children (2657 males and 2745 females). They represent 12.7% of the total number of children between 10 and 14 years during the educational year 2005-2006. The weights and heights of adolescents were measured, from which the body mass index (BMI) was calculated, which is the weight in kilograms divided by the height in meters squared (kg/m(2)). BMI values higher than 95 percentile were accepted as being obese and those in between 85 and 94 percentile were accepted as overweight. Dietary intake was assessed by the investigators using food exchange lists designed by American Diabetic Association and physical fitness was measured by modified Harvard step test. Data regarding monthly income of the chosen sample were collected from parents of those children. The overall prevalence of overweight and obesity in adolescent Kuwaiti children aged 10 to 14 years was 30.7% and 14.6%, respectively. The overall prevalence of overweight and obesity among males was 29.3% and 14.9%, respectively (P < .001) and the prevalence of overweight and obesity among females was 32.1% and 14.2%, respectively (P < .001). High daily caloric intake by the obese and overweight children and physical inactivity was reported among the majority of them. Health education programs should be conducted to control this syndrome in order to prevent future risk of obesity-related disease, and physical activity programs should be incorporated in the schools. Any management plan for overweight and obese children should include 3 major components: diets, exercise, and family-based behavior and they should not be placed on restrictive diets because adequate calories are needed for proper growth.
Age-Specific Death Rates (Per 100 000 Person Years) for Coronary Heart Disease and Stroke in the PROLIFE Population 
In India, Kerala has the best health indicators, having experienced dramatic shifts in mortality and fertility. However, the mortality pattern in Kerala has not been studied. In this article, the authors analyze and report the pattern of mortality in the PROLIFE cohort (n = 161,942). Data on death were collected through regular home visits using a pretested, structured questionnaire. The data were validated by a physician. The deaths were grouped under disease categories using ICD 10. Out of 4271 deaths recorded during 5 years, diseases of the circulatory system contributed 40%. Coronary heart disease was the leading cause of death in men (31.1%) and women (17.6%). Age-standardized cardiovascular disease (CVD) death rates were 490 for men and 231 for women per 100,000 person years. The burden of CVD deaths in this community now exceeds that of industrialized countries.
Descriptive Characteristics 
Bivariable Associations Between Covariates and Global and Age-Relative Poor Self-Rated Health as Numbers, Prevalence (%), and ORs With 95% CIs a
Multivariable Associations Between Sex and Age, and Global and Age-Relative Poor Self-rated Health (ORs With 95% CIs) a 
Background: This study examines inequalities in health in Laos. Because perception of health might affect ratings, we used both a global and a relative self-rated health (SRH) question. Methods: The study was based on the fourth Lao Expenditure and Consumption Survey, 2007-2008. The study population consisted of 24 162 individuals 20 years or older. Two single-question measures of SRH were used: a global with no reference point and a relative with age group reference. Results: Significant associations were found with age, sex, illiteracy, ethnicity, remote location, health measures, nutrition, and household poverty. Worse health was reported using SRH questions with reference points by the young rather than the old. Conclusion: In Laos, poor SRH is associated with illiteracy, inaccessibility, Mon-Khmer ethnicity, age, being a woman, and being poor. More factors were found to be associated with global rather than relative SRH.
OBJECTIVE: . To investigate the association between childhood obesity and neighborhood-level socioeconomic and environmental factors in Japan. METHODS: . The prevalence of childhood obesity in 2008 was obtained from annual reports of the School Health Survey. The following 12 factors were publicly available: income per person, ratio of people completing up to college or university education, population density, total length of roads per square kilometer, number relative to the population of food and drink stores, restaurants, large-scale retail stores, convenience stores, passenger cars, traffic accidents, criminal offenses, and death by accidents. RESULTS: . The ratio of people completing up to college or university education was inversely associated with obesity in boys and girls. No association was found between obesity and the other factors examined. CONCLUSION: . An inverse association was shown between educational level and childhood obesity in both boys and girls. Further studies integrating associations between childhood obesity and neighborhood-level factors are needed.
This study describes the development and reproducibility of a 128-item quantitative food frequency questionnaire (FFQ) to measure usual food consumption for women in southeast China. The FFQ was pre-tested using 51 Chinese women who recently migrated to Australia. Cronbach's alpha coefficient was 0.81 for internal consistency. The reliability of the FFQ was then assessed by another test-retest study. A sample of 41 women residing in southeast China was interviewed twice within 12 weeks. Intraclass correlation coefficients were moderate to high for mean food group consumption (0.43-0.96) and mean daily nutrient intakes (0.47-0.89). Kappa statistics for eating habits ranged from 0.27 to 0.89 in the test-retest. The mean ratio of energy intake to basal metabolic rate was 1.73 (S.D. 0.39) in both test and retest samples. The study confirmed that the FFQ method using standard containers is appropriate to assess dietary intake for women in southeast China.
Study Population and Deaths Reported From March 2009 to August 2010, in 25 Villages of Kampong Cham Province, Cambodia. 
Causes of death investigation, N = 280 deaths in 25 villages of Kampong Cham province, Cambodia, from March 2009 to August 2010. 
Causes of death by age group in 25 villages of Kampong Cham province, Cambodia, from March 2009 to August 2010. N = 272 cases with coded cause of death. 
Leading Causes of Death, by Age Group and Gender, Among 10 632 Children Younger Than 15 Years, in 25 Villages of Kampong Cham Province, Cambodia, From March 2009 to August 2010, N = 32 Death Cases. 
Univariate and Multivariate Analysis of Factors Associated With a Death at Home Versus a Death in at Hospital, in 25 Villages of Kampong Cham Province, Cambodia, From March 2009 to August 2010, N = 236 Verbal Autopsies. 
To estimate the 2009-2010 death rates, causes, and patterns of mortality in rural Cambodia, we conducted active, population-based death surveillance in 25 rural villages of Cambodia from March 2009 to August 2010. Among the population of 28 053 under surveillance, 280 deaths were reported and explored by physician-certified verbal autopsies, using the International Classification of Diseases 10, yielding an overall mortality rate (MR) of 6.7/1000 persons-year (95% CI 5.74-7.68). The MR was 39.1/1000 live births for those younger than 5 years old. Infants accounted for 5.4% of all deaths. In children younger than 5 years, infectious and parasitic diseases were the leading causes of death. In children 5 to 14 years, 3 out of 4 deaths were due to injuries. Adult deaths were mainly attributed to noncommunicable diseases (52%). We conclude that this rural population is facing a substantial burden of noncommunicable diseases while still struggling with infectious diseases, respiratory diseases in particular.
Season is one of the factors affecting blood pressure. The objectives of this study are to quantify the magnitude of seasonal changes in blood pressure among normotensive women aged 18 to 40 years and to find out the association of blood pressure variation between winter and summer with body mass index, temperature, humidity, day length, and salt intake. The study was carried out on 132 women, included 4 home visits during the seasons of spring, summer, autumn, and winter. Mean increase in systolic blood pressure (SBP)/diastolic blood pressure (DBP) in winter was 11.07/6.79 mm Hg during summer (P < .001). No significant relationship in blood pressure variation with change in environmental variables was observed. Mean increase in SBP/DBP in winter was more among underweight than individuals who were normal/overweight/obese (P < .05). There was significant increase in SBP/DBP during winter compared with summer. This seasonal factor should be considered while evaluating individual blood pressure and comparing community studies.
The purpose of our study was to survey the area of public health, written by the Thai Constitutional Law since 1932-2006 (B.E. 2475-2549) and to estimate the Thai Constitutional Laws. A review of all constitutional laws in Thailand enacted between 1932 and 2006. The most important responsibility of a government is its responsibility towards citizen's rights. Most Thai Constitutional Laws have prescribed the state's responsibility for providing public health for the Thai population and the majority of them included health promotion and the provision of health care free of charge. Some also stipulated that the medical services be of international standard. But there was no responsibility expected of the Thai citizen for their own health. Public health features prominently in the Thai constitution as a responsibility of the government. However there is no mention of the responsibilities of citizens to take some care with their own health.
The objective of this study was to conduct a systematic review of the literature on the prevalence of low back pain in Australian adults. All Australian low back pain prevalence studies published between 1966 and 1998 were identified. General and methodological criteria using current best practice were applied to each prevalence study. Five studies meeting the inclusion criteria were identified. Out of these, three met the minimum current criteria for methodologic acceptance. These studies were Australian Government Health studies conducted over the past 12 years. However, even these studies were flawed, and thus the true prevalence of low back pain in Australia remains uncertain. A methodologically sound study for Australia is recommended as are best practice guidelines for other studies.
Suicide statistics are generally recognised to be unreliable. This study of the reported rates of suicide in West Malaysia between 1966-1990 shows that the mean crude suicide rate between 1966-1974 was 6.1 per 100,000, but had dropped drastically between 1975-1990 to a mean of 1.6 per 100,000. Three lines of evidence are presented to show that this reduction in the suicide rate is due to a systematic misclassification of medically certified suicides as deaths due to undetermined violent deaths (which refers to violent deaths not known to be accidentally or deliberately inflicted). Firstly, the large drop in reported suicide rates corresponds closely to an increase in the rate of deaths due to undetermined violent deaths. There is a highly positive negative correlation between the two rates (coefficient of correlation, r = -0.9). Secondly, the misclassification appears to be mainly a problem with the medically certified deaths which follow the ICD classification. The mean ratio of uncertified to certified suicides before 1975 was 0.8, but from 1975 onwards the mean was 3.1. This is in contrast to the corresponding ratio for deaths due to all accidents which has remained fairly constant throughout these years. Thirdly, the race and sex differences for the rates of undetermined violent deaths are identical to those of suicide. Taking the misclassification into account the corrected suicide rate for West Malaysia is estimated to be between 8-13 per 100,000 since 1982.
The present study was conducted on changes in the coefficient variations of live birth weight and in the proportion of singleton live birth weight by gestational age using vital statistics compiled by the Japanese government from 1969 to 1985. The coefficient variations of live birth weight declined between 1969 and 1977-78 and then increased. The coefficient variations of live birth weight were affected by the percentage of low birth weight infants. The decline in the coefficient variations depends on the decrease of low birth weight infants, while the increase in the coefficient variations depends on the increase of low birth weight infants. Recently, the proportion of low birth weight infants has increased in Japan. Perinatal mortality rates, which indicate the level of maternal and child health, have decreased annually.
Using large-scale data from the national conventional statistics and nationally representative sample surveys, the current study aims to assess the level, mode, and determinants of modern contraceptive use from 1970 to 2004 among married couples aged 20 to 49 years in China. A relatively stable Chinese mode of contraception has been established and maintained since the 1980s, characterized by prominent, long-acting contraceptive use and the highest overall prevalence in the world during the past 3 decades. In recent years, the composition of contraceptive use has changed, characterized by the increasing use of the intrauterine device and short-acting methods and a drastic decrease in male and female sterilization. However, the dominance of the long-acting methods has not undergone substantial change. The results from a multinomial logit model employed in this study indicate that family planning policy and socioeconomic and demographic factors jointly influence contraceptive choice. In particular, contraceptive choice is closely associated with the strength of family planning policy in China.
The effect of changes in the age distribution of the Japanese population from 1970 to 1980 was investigated to determine whether they played a role in the halving of the road accident death rate in Japan during that decade. This was done by applying the 1980 age-specific death rates to a population having the 1970 age distribution in percentage terms. Substantial changes in the percentage of the population in specific age groups during the 1970s resulted in major, but opposing, changes in the overall road accident death rate. When combined with the effect of an increase in the percentage of the elderly in the population, the overall effect of changes in the population distribution on the road accident death rate was negligible. In the absence of other changes, the ageing of the Japanese population is likely to lead to an increase of about 10&percnt; in the overall road accident death rate by the year 2000.
Dengue fever (DF) has been endemic in Malaysia since 1902 and reached epidemic proportions in 1973. The incidence rate of the disease in 1973 was 5.4 cases per 100,000 and reached 10.4 cases per 100,000 in 1987. The Chinese are the main ethnic community affected showing an overall morbidity rate of 9.0 cases per 100,000 followed by Malays 2.9 cases per 100,000 and Indians 2.4 cases per 100,000. The ethnic race ratio between Chinese, Malays and Indians which was 3.7:1:1.3 in 1975 reached 3.7:1:0.9 in 1987. The attack rates were observed to be higher in the males. The mean male:female ratio among Chinese was 1.1:1, while for Malays and Indians it was 1.5:1. The age-specific morbidity rate was highest in the 10- to 19-year age group followed by the 20- to 29-year age group. Epidemics of dengue fever were found to occur seasonally with the appearance of two peaks, viz. one in June and the other in August. Dengue fever, a rural disease before, has established itself as an urban disease.
Dengue hemorrhagic fever (DHF), though endemic in the sixties, emerged as a major public health problem in Malaysia from 1973 onwards. The incidence rate of DHF which was 10.1 per 100,000 in 1973 has fallen down to 1.9 per 100,000 in 1987 with a mean case fatality rate of 6.4 per 100 persons. The Chinese appear to be more prone to DHF with the highest mean morbidity rate of 5.5 per 100,000 and case fatality rate of 6.1%. The incidence of DHF is higher in the males with a higher case fatality rate in females. Male Chinese appear to be mainly affected. The overall age-specific incidence rate is highest in two age groups, viz. 5-9 years and 10-19 years of age with a mean morbidity rate of 4.9 cases per 100,000. The mean age-specific case fatality rate was highest in the 0-4 years age group. Dengue hemorrhagic fever is predominantly an urban disease in Malaysia with a mean incidence rate of 5.3 cases per 100,000 as opposed to 1.2 cases per 100,000 being reported from rural areas. The mean overall incidence of deaths in the urban area is 0.5 compared to 0.1 per 100,000 for rural areas. There is a marked seasonal correlation between DHF cases and rainfall, with a peak in August. While all four serotypes of dengue viruses are found in Malaysia, Den 2 appears to be isolated with greater frequency during all the epidemics.
The mortality experience of Taiwan was examined for two time periods (1976 and 1983) to determine the magnitude and direction of change in age-adjusted mortality and to identify deviation from the expected progress by comparison with two industrialized nations, the USA and Japan. Between 1976 and 1983 the overall mortality showed an annual average of nearly 2% decrease, mostly contributed by the marked reduction in the number of young. Significant reductions were also observed for deaths from strokes, rheumatic heart disease, ill-defined conditions, cancer of the stomach, and infectious diseases such as tuberculosis. A disturbing increase in suicide as well as accidents primarily caused by motor vehicles was noted. In general, cancer increased, to an alarming degree for environmentally implicated cancers such as lung, pancreas, nasopharynx, brain and liver in men. When compared to that of the USA or Japan, the mortality experience of Taiwan showed the following increases: overall female mortality, accidental deaths, suicide among elderly women, deaths from strokes, ulcers, asthma, and liver, nasopharyngeal and cervical cancers. However, the overall cancer mortality rate was still much lower than that either in the USA or Japan. Despite marked reductions in infectious disease mortality, deaths from tuberculosis were nearly 40 times those of the USA. Although deaths from ill-defined conditions decreased by half during this study period, they were still high, particularly among elderly women (13% of all deaths and 22 times higher than the USA), which probably reflects inadequate medical services for women. The role of the Taiwanese government in the financing of health services was found to be far smaller than that of the USA or Japan. Expanding health care expenditure by the government is desirable if improvement in the maldistribution of medical services is to be achieved and the untoward health effects of rapid industrialization is to be reduced.
The authors attempted to confirm the reliability of the linear log-log model presented by Goldsmith and Hexter in 1967. The data used were from seven reports published since 1977, including that of the authors. The age of the subjects in these reports ranged from three to over 65 years. Various methods of air sampling and pre-treatment of collected particulate matter were employed. Lead was determined by atomic absorption spectrophotometry. The mean value of lead in the atmosphere ranged from 0.11 to 19 micrograms/m3. A regression line obtained from 13 pairs of averaged lead in the atmosphere and in blood was log(Pb-B) = 0.259 x log(Pb-A) + .243, and the Pearson's moment correlation coefficient between the logarithm of Pb-A and the logarithm of Pb-B was 0.839. These results were roughly the same as those of Goldsmith. This finding confirms the consistency of the association between Pb-A and Pb-B, which may be used to monitor atmospheric and blood lead quantitatively in those countries conducting a lead reduction program in gasoline.
A detailed analyses of gastric cancer incidence and mortality rates in Tasmania was done using fifteen years (1978-1992) of population based Tasmanian Cancer Registry data. The age standardised incidence rates for the period were 12.5 per 100,000 men (95% CI 11.4-13.6) and 5.2 per 100,000 women (95% CI 4.6-5.8). The age standardised mortality rates were 10.6 per 100,000 men (95% CI 9.6-11.6) and 4.1 per 100,000 women (95% CI 3.5-4.6). Male:Female ratio of mortality rates was 2.6. Gastric cancer mortality rates have now significantly declined among males (p = .03) and females (p = .02). No significant decline was observed for incidence rates among males (p = .1) and females (p = .3). For cases overall, there was a preponderance of intestinal type of gastric cancer (76.5%). No significant trend over time was observed in the mean rate of occurrence of intestinal or diffuse type of gastric cancer. The ratio of intestinal: diffuse was 6.5 for all ages. Among males, a significant (p = .03) upward trend in the incidence was observed for proximal tumours, while no such trend (p = .07) was observed among women. A significant decline in incidence of distal tumours was observed for males (p = .000) and females (p.007). Male:Female ratio for proximal tumour was 4.7:1. The results suggests that Tasmanians may have been a population at high risk of gastric cancer.
To examine the practicability and value of mapping cancers in Hong Kong, selected data from consecutive censuses were used to assess the demographic stability and sociocconomic characteristics of the 27 districts. Mortality data in two quinquennia (1979-1988) were used to calculate the districts' standardized mortality ratios (SMRs) for various cancers and their ranks were presented in maps. Correlations were calculated between the SMRs for the cancers, and between the SMRs and the sociocconomic characteristics. Population sizes and sociocconomic characteristics of the districts were fairly stable in most districts. The SMRs of many cancers differed widely between districts. Affluent districts tended to have high SMRs for colorectal and breast cancers, but low SMRs for nasopharyngeal cancer (NPC) as well as liver and lung cancers. The directions of the SMR ranking correlations between the two quinquennia were generally consistent. Statistically significant correlations between some cancers were replicated, particularly for males, and between some cancers and sociocconomic characteristics.
We examined the spatial patterns of mortality from various non-malignant diseases in Hong Kong during the two quinquennia, 1979-83 and 1984-88. Population data and parameters reflecting socioeconomic factors, including ethnic backgrounds, were selected from census data. Mortality data were obtained from death registration files. The standardized mortality ratios (SMRs) for major diseases were calculated for 27 census districts. The rankings of the districts' SMRs were shown in map form. Correlations were calculated between the districts' SMRs for the diseases, between them and the SMRs for cancers, and between them and socioeconomic and ethnic parameters. Many spatial patterns and correlations showed consistency and were biologically plausible. These results showed that mapping for a rapidly growing city such as Hong Kong could be a valuable exercise for detecting “at risk” populations where causal factors for non-malignant diseases can be investigated and identified for possible elimination.
A total of 269 pathologically confirmed carcinoma cases (118 male, 151 female) were recorded in the seven year period 1980 to 1986 in Vanuatu, an island nation within the Melanesia region in the South Pacific. Cervical cancer was numerically the most important malignancy in females (25% of all female cancers). In males, liver cancer was the most commonly observed (14.4% of all male cancers). Almost one-half (44.4%) of the available paraffin blocks from liver carcinoma cases (18 cases) demonstrated positivity of HBV antigens in liver tissue. The most interesting feature was the high proportion of thyroid cancers, especially in females. It represented 12.1 percent of all cancers in female and 5.2 percent in male Melanesians in Vanuatu. These percentages were found to be even higher than among Hawaiians for whom the highest incidence rates in the world have been recorded. Since our study was based solely on pathologically diagnosed cases, the findings should be regarded as minimum estimates.
Anti-smoking programs have been advocated by the government and other private organizations for decades in Taiwan, especially in the past ten years. We conducted an analysis to assess the effectiveness of anti-smoking programs by examining the changes in active smoking attributable mortality (ASAM) and active smoking attributable years of potential life lost (ASAYPLL) between 1980 and 1992. This analysis also evaluated the present health impact due to active smoking. Total estimated ASAM was 12,765 for 1980 and 14,764 for 1992, representing 34.9% and 31.8% of all deaths from smoking-related causes for each year, respectively. Our results suggested a progress of anti-smoking efforts contributed by tiie government and other private anti-snwktogoqjanizations. By comparing thefigures between 1980 and 1992, a reduction in aD dimensions has been observed. The overall smoking prevalence rate decreased from 31.7% to 29.5% and the ASAM rate declined from 121.8/10 ⁵ to 91.5/10 ⁵ . Additionally, the ASAYPLL rate declined from 513.4/10 ⁵ to 406.9/10 ⁵ . Furthermore, the ratio of ASAM from cardiovascular diseases (CVD) to all ASAM decreased from 56.3% in 1980 to 46.7% in 1992, white die ratio of ASAM from cancer to aD ASAM increased from 22.9% in 1980 to 34.9% in 1992. Our analysis also found that active smoking seemed to be a more important risk factor for smoking-related causes of death in people aged 41-65 than in people of other age group. Although the anti-smoking programs seemed effective over the past 13 years, active smoking stiD contributed to an estimated number of 14,764 deaths and 63,743 economicauy productive years lost in 1992. More efforts should be devoted to further reduce the high smoking prevalence in men and particularly to hamper the increasing smoking trend in adolescents and young women. This remains a challenge for tile government of Taiwan.
The objective of this study is to describe and analyze the incidence trend of colon cancer in Tianjin, China from 1981 to 2000. Tumour cases were coded by ICD-9 in this study. Incidence rates were calculated by five-year age-groups as well as sex and year of diagnosis. From 1981 to 2000, the total number of colon cancer cases ascertained in urban Tianjin was 4954, including 2547 males and 2407 females. 67.88% colon cancer cases occurred in the age group 55-79 and age specific incidence rate reached its peak in the age group 75-79. The mean incidence rate of colon cancer during the 20 years was 7.01/100000 and this rate had been increasing constantly from 1981 to 2000. The average age at diagnosis was 62.41 years. An ascending trend was observed in the mean age at diagnosis of colon cancer from 1981 through 2000. As for the sex ratio, there was no clear trend exhibited. The incidence trend of colon cancer during 1981 to 2000 in Tianjin warranted a further research on its risk factors and prevention warranted.
From January 1983 to December 1992 a total of 20,874 salmonella were serotyped in the Bacteriology Division IMR, which showed an increase of 100% compared to the previous ten-years. There were 97 serotypes which belonged to 22 Kauffmann-white groups. Twenty two serotypes hitherto were seen in this study period. S. typhi was the commonest serotype isolated. Overall there was a rise in the isolation of non-typboidal salmonella particularly S. enteritidis which increased by 760% and S. blockley which increased by 720%. However there is a drop in the isolation of S typhimurium by 223% and S. paratyphi B by 319%.
Growing concern about possible harmful visual display terminal (VDT) radiation emissions by East-West Center (EWC) staff members, particularly secretarial staff, resulted in the formation of a VDTs Health Effects Committee in August, 1982. The Committee recommended that all EWC VDTs currently in use be surveyed for X-ray and ultraviolet radiation emissions to determine if staff members were being exposed to potentially hazardous levels of radiation. The committee also recommended that all VDTs falling into one of the following categories be surveyed: those that were being used for the first time; those that had just been repaired or serviced; those that were five years old; or those that were being used after being in storage. In total, 186 VDTs were surveyed for X-ray and ultraviolet radiation emissions by the University of Hawaii radiation safety of ficer and the East-West Center health of ficer between April 1983 and June 1985. The surveys were done in two phases. In the first phase, 101 VDTs were surveyed during April and May, 1983. This constituted all the available terminals in use at that time. Over the next two years, 85 VDTs were surveyed when they experienced one of the four conditions mentioned above. The majority of VDTs surveyed (163 or 87.6% of the sample size) were from one manufacturer and the remaining 23 terminals (12.3% of the sample size) were from eight different manufacturers. All surveys were done during work hours and disruption of the employee's work routines was minimal. All terminals surveyed were being used by EWC employees. Two instruments were used to measure ultraviolet radiation in the range of 254 to 400 nanometers (nm). This is the known range of carcinogenic effects in humans. All the measurements with the instruments were taken on contact with the VDT screen. Two instruments that were capable of detecting low energy X-rays (the type potentially emitted by VDTs) were used to measure X-ray radiation. The radiation levels emitted by VDTs are very low compared to current occupational exposure standards. The results from the 186 VDTs surveyed at the EWC demonstrated that exposure to ultraviolet and X-ray radiation was below the detection capability of the survey Instruments and thus well below current occupational exposure standards. Based on this survey data, it appears that VDTs do not present a radiation hazard to the employee working on or near a terminal.
The Ministry of Health and Welfare forms the AIDS Surveillance Committee, which publishes HIV infection at two-month intervals. As at December 1993, the Ministry of Health and Welfare reported 267 AIDS cases and 1,143 HIV infection cases. Epidemiological data in Japan showed a rapid increase of cases of transmission through heterosexual contact since 1991, before which cases of transmission due to homosexual contact were relatively large in number according to reports. Sporadic cases of mother-to-child transmission and some cases due to injection of drug use were also reported. However, others/unknown cases were 449 (31.8%). Although the reported number of AIDS cases and HIV infection cases in Japan is still small, a rapidly increasing HIV epidemic is feared. It is predicted that the primary mode of transmission will be heterosexual contact and that another epidemiological characteristics will be diversified modes of transmission. Therefore, the present surveillance should continue and actively track the epidemic and provide useful information for planning prevention strategies in Japan.
Trends in the incidence of thyroid cancer and all other cancers in men and women: A. Number of patients with thyroid cancer, men and women. B. Proportion of thyroid cancer among all cancers. C. Age-standardized incidence of thyroid cancer per 100 000 in men and women. D. Joinpoint regression of incidence of thyroid cancer in men. E. Joinpoint regression of incidence of thyroid cancer in women. F. Age-standardized incidence of all the cancers per 100 000 in men and women. G. Joinpoint regression of incidence of all cancers in men. H. Joinpoint regression of incidence of all cancers in women  
Increasing incidence of thyroid cancer has been observed in some countries such as the United States, United Kingdom, France, and so on. Joinpoint regression was used to analyze the incidence of thyroid cancer in Shanghai, China, from 1983 to 2007. The results showed that there were 2 distinct slopes: in men, representing a significant annual percentage change (APC) of 2.6% from 1983 to 2000 (P < .001) followed by a sharp APC of 14.4% (P < .001), and in women, representing a significant APC of 4.9% from 1983 to 2003 (P < .001) followed by a sharp APC of 19.9% (P = .001). The sharp increase in thyroid cancer occurred 5 and 8 years after the iodine supplementation by salt, for men and women, respectively, suggesting that either the developed screening techniques or iodine supplementation might have contributed to the rapid increase in the incidence of thyroid cancer. The burden of thyroid cancer cases is expected to be substantial, based on predictions through 2020.
In January of 1984, five deans of schools of public health from Asia and the Pacific came together on the island of Kauai in Hawaii to formally establish the Consortium. The Consortium owes its cohesive strength through those first ten years of operation, to the dedicated faculty members in the fields of public health and community medicine whose overarching desire has been to seek representation of academic public health in the health decision making process affecting the positive promotion of health. By 1994 the Consortium found itself recognized on a world wide basis in the field of global health with what was described as having: "A great potential for extending the effectiveness of community and public health". "The author, a founding Dean feels that the Consortium's commitment is to shape rather than to await the future of health status improvement for the citizens of the Asia-Pacific region.
Despite the secular trend of decreasing prevalence of smoking and consumption of tobacco in most industrialized countries, the prevalence of smoking in Japan continues to be one of the highest. Based on the alternative measure of population attributable fractions, the present study gives an estimate of the number of deaths and the years of life lost (YLLs) attributable to tobacco in Japan for both 1985 and 1995. This study shows a considerable increase in mortality from tobacco-related diseases over the decade, in particular from lung cancer and chronic obstructive pulmonary disease, a consequence of the intensified exposure to tobacco in the early 1960s. Although the period of the highest exposure to tobacco was in the late 1970s, prevalence of smoking is still considerably high in Japan and the burden from tobacco will persist if proper anti-smoking measures are not implemented immediately.
Suicide mortality rates by period (1985-2006) and age (50-64) in Japan 
Estimates of the age, period, and cohort effects on suicide mortality during 1985 to 2006 in Japan. a a Solid line with black squares represents estimates of age, period, or cohort effects; broken line indicates upper or lower limits of 95% credible intervals. The numbers in the cohort charts correspond to the birth years listed in Table 1 
Because suicide is increasingly becoming a public health threat in Japan, it is necessary to identify high-risk groups to develop effective preventive measures. The suicide mortality trends from 1985 to 2006 for Japanese aged between 15 and 79 years were analyzed by a Bayesian age-period-cohort analysis to evaluate the independent effects of age, period, and birth cohort. Age-specific effect showed an overall increase with age in both genders, but a distinct increase was noted only among men aged between 50 and 64 years. The period effect exhibited a sudden rise in 1998; this effect was more apparent in men than in women. The cohort-specific effect increased in male birth cohorts born after 1926 and in female birth cohorts born after 1956. In conclusion, a gender difference was detected in the effects of age, period, and cohort on suicide risk among Japanese.
Health Benefits of Physical Activity Among Hong Kong Children and Adolescents. 
Flow diagram of literature search. 
Physical Activity Participation by Children and Adolescents in Hong Kong. 
Correlates of Physical Activity Examined in Hong Kong Compared With Previous Review. 
A comprehensive understanding of research on the physical activity (PA) of Hong Kong youth is necessary to develop specific and effective intervention strategies. This review summarizes existing evidence in studies on PA among the Hong Kong youth. An electronic literature search was conducted using MEDLINE, SPORTDiscus, ERIC, and HighWire database. Forty-five studies published from 1987 to 2012 were included in this review. The findings are presented in five categories, namely, health benefits of PA, participation in PA, assessment of PA, correlates of PA, and interventions to promote PA. The results indicate that PA among the youth in Hong Kong has attracted concern in the past decade. Specifically, extensive studies focused on the areas of health benefits of PA, participation in PA, and correlates of PA. Research into context-specific correlates of PA and tailored PA promotion programs for the Hong Kong youth is warranted in the future.
Temporal trends in age-standardized hospital admissions rates for sunburn injury, Western Australia, 1988 to 2008 
Age-specific sunburn hospitalization rate estimates for Western Australia, 1988 to 2008 
Incidence Rate Ratios of Hospital Admissions for Sunburn by Age Group, Western Australia, 1988 to 2008 
Unlabelled: The objective of this study was to assess the trends in hospitalization for sunburn in Western Australia from 1988 to 2008. De-identified linked hospital morbidity data for all index sunburn admissions in Western Australia for the period 1988 to 2008 were analyzed. Poisson regression analysis was used to estimate trends in hospital admissions. Hospitalizations increased from 1.6 (95% confidence interval [CI] = 1.0-2.2) per 100 000 person years in 1988 to 2.7 (95% CI = 1.9-3.4) per 100 000 person years in 1997, declining thereafter to 1.5 (95% CI = 1.0-2.0) per 100 000 person years in 2008. Increased hospitalizations rates were estimated for adults 25 to 44 years and 65 years or older, with a significant decline estimated for children younger than 5 years; rates remained stable for all other age groups. This study found no significant overall reduction in sunburn hospitalizations over the 20-year study period. Results: raise concerns about the sun-protective behaviors and skin cancer risk of the population in Western Australia.
Distribution of All PubMed Citations and MH Research Ratio in GCC Countries in the Past 20 Years 
This article aims to describe the characteristics of the United Arab Emirates (UAE) mental health research published from 1989 to 2008 in PubMed indexed journals to identify gaps and to suggest recommendations. Our sensitive PubMed search for general and mental health publications in Gulf Cooperation Council (GCC) countries and the UAE revealed a total of 192 mental health studies published in GCC countries over the past 20 years, which constituted less than 1% of the GCC total biomedical research. Most of the studies were from the UAE University and were either epidemiologic (48.98%) or psychometric (24.49%) with no studies addressing mental health systems research. Underrepresented were studies on health promotion and interdisciplinary, cross-cultural, ethnic, and gender research. There is a need for more international collaboration and for policies that link research conducted to services provided with longitudinal studies to test the long-term impact of early preventive interventions.
This study was based on a hepatitis B screening program conducted in one of the states in Malaysia in 1989. The majority (84.6%) of the 2986 health employees were screened. One quarter (25%) was found to have serological markers for the Hepatitis B Virus (HBV); 2.1% had Hepatitis B surface Antigen (HBsAg) and 22.8% had antibody to the Hepatitis B surface Antigen (anti-HBs). The occurrence of HBsAg was higher in ethnic Chinese (6.3%) compared to Malays (1.8%) and Indians (0.9%), even when analyzed by sex, but not with age, type of institution and geographical locality. The distribution of anti-HBs was higher with ethnic Chinese (41.6%), male sex (27.2%) and age. There was a wide variation of the prevalence of serological markers among occupations and increased relative risks of HBsAg were found among medical assistants (RR3.7; 95% CI 1.4-9.1) and laboratory staff (RR 3.2; 95% CI 1-8.8), and that of anti-HBs among medical assistants (RR 2.8; 95% CI 1.8-3.7). The variations of HBsAg among occupations by type of institutions was marginal while that of anti-HBs was higher among attendants and midwives in hospitals, medical assistants in health departments, and assistant nurses and dentists in dental centers. The patterns of distribution of serological markers of HBV among health staff reflect the situation in the community with high endemicity and resemble specific occupational factors noted in previous studies in the West.
In the 1990s, North Korea experienced one of the severest famines in modern history. Considering the level of food deprivation during famines in totalitarian states, substantial debate exists over how differently the crisis affected households and regions. Here, the authors investigate regional differences in socioeconomic living conditions by comparing height-for-age z scores (HAZs) of 9934 preschool children living in 11 administrative provinces. Data are based on 2 UN/DPRK anthropometric surveys performed in North Korea representing cohorts born from 1991 to 2002. Through regression of pooled HAZs on a set of province dummies, the authors find that children born in Pyongyang are more healthy, providing evidence that elites residing in the capital seemingly possess comparative advantages in food supply. When controlling for further variables, they find that boys and older children suffered more during the crisis, although cohorts born before the onset of the famine were significantly better-off.
Retinopathy of prematurity (ROP) is one of the most important causes of childhood blindness worldwide. The trend of ROP in Malaysia was unclear because there was no national registry before 2002. The purpose of this study is to analyze ROP students of different ages in the schools for the blind in Malaysia in order to evaluate the trend of ROP from 1992 to 2001. Data were obtained from a previous survey of 24 blind schools. It was found that 78 students or 17.4% were blind/severely visual impaired as a result of ROP. There was a significant surge in the number of ROP students who were born in 1994 when the use of synthetic surfactants was first introduced in Malaysia; otherwise there was no increasing trend in the number of students with ROP. However, the percentage of ROP in total was increasing, which indicates that ROP is becoming a more important cause of childhood blindness in this country.
Maternal mortality in Bangladesh was 320 per 100,000 live births between the years of 1998 and 2000. Utilization of maternal health services remains low in the low-resource countries like Bangladesh. This study attempts to evaluate the levels, patterns, and trends of utilization of antenatal care (ANC) services in Bangladesh. This is a descriptive study based on national surveys of Bangladesh Demographic and Health Survey (BDHS) 2007, 2004, 1999-2000, 1996-1997, and 1993-1994. Bangladeshi women reported low utilization of ANC. Approximately 52% of women received antenatal care from medically trained providers in 2007. The median number of ANC visits was 3.1 in 2007. About 63% of women were not informed about the signs of pregnancy complications. The proportion of women who received ANC services and information on the signs of pregnancy complications as well as the median number of ANC visits showed an increase in 2007 compared with 2004.
Introduction: . Many studies have demonstrated a strong relationship between alcohol availability and traffic crashes involving alcohol-impaired drivers. The present analysis focuses on the evaluation of the impact of alcohol availability on the Japanese population by comparing fatal and nonfatal motor vehicle crash rates before and after implementation of the alcohol deregulation policy in 1994. Participants and method. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRRs) in the population. To control for potential confounders, per capita alcohol consumption, unemployment rate, and vehicle miles travelled (VMT) were also added to the model. The exponents of the fitted coefficients are equivalent to the IRRs. Results: . Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities and other traffic crashes in Japan. In the overall study results, nighttime fatalities were reduced statistically significantly by 6% since the implementation of the alcohol deregulation policy in 1994. Discussion. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation. Further well-designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.
There is strong evidence of a positive secular trend in body mass index (BMI) and skinfold thickness (SFT) in most of the world over the past 10 years. However, no studies on this trend have been reported in Shandong Province, China. The present study assessed the decennial change in BMI and SFT in Shandong Province during the past 10 years and the prevalence of overweight and obesity among adolescents. The BMI and SFT of adolescents aged 7 to 18 years was calculated using data from 2 national surveys on students' constitution and health carried out by the government in 1995 and 2005 in Shandong Province, China. The distribution of BMI and SFT was reported, and the prevalence of overweight and obesity were obtained according to the screening criteria of overweight and obesity for Chinese students using BMI. In the past 10 years, the P(50) (50th percentile) of BMI and SFT increased rapidly. The average increments of BMI and SFT were 0.91 kg/m(2), 7.99 mm for boys and 0.55 kg/m(2), 7.13 mm for girls, respectively. The prevalence of overweight and obesity increased rapidly: for overweight from 7.53% (boys), 4.89% (girls) in 1995 to 14.28% (boys), 8.75% (girls) in 2005; and for obesity from 2.92% (boys), 1.72% (girls) in 1995 to 10.78% (boys), 5.76% (girls) in 2005. The average value of BMI and SFT has increased over time; overweight and obesity among adolescents has become a serious public health problem. Comprehensive evidence-based strategies of intervention should be introduced, including periodic monitoring.
This study examines variations in ante-natal care (ANC) and family planning in Krakor, Pursat, Cambodia between 1996 and 1998. Population-based survey interviews were conducted with a total of 291 women in 1996 and 211 women in 1998. An intervention strategy designed to enhance the skills and roles of Health Centre staff, Village Health Volunteers (VHVs) and Traditional Birth Attendants (TBAs) was conducted. Over this timeframe, reported ANC access increased from 37% to 47%. Most women delivered their last child at home, usually assisted by a TBA. Few women practiced family planning, despite the fact that most reported that they did not want any further children. A range of reasons for not practicing family planning were found to be highly significant, including the lack of available services (p<0.01). The fear of side-effects decreased significantly (p<0.01), with the community education provided by the VHVs and TBAs, potentially being one contributing factor. The results of this study suggest that continual support of VHVs and TBAs will further improve the health of women in Cambodia.
Top-cited authors
Peng Bi
  • University of Adelaide
S. M. Mostafa Kamal
  • Islamic University (Bangladesh)
Wah Yun Low
  • University of Malaya
Tord Kjellstrom
  • Health and Environment International Trust, New Zealand
Keith Dear
  • University of Adelaide