The unprecedented inclusion of culture-bound syndromes in DSM-IV provides the opportunity for highlighting the need to study such syndromes and the occasion for developing a research agenda to study them. The growing ethnic and cultural diversity of the U.S. population presents a challenge to the mental health field to develop truly cross-cultural approaches to mental health research and services. In this article, the authors provide a critique of previous analyses of the relationship between culture-bound syndromes and psychiatric diagnoses. They highlight the problems in previous classificatory exercises, which tend to focus on subsuming the culture-bound syndromes into psychiatric categories and fail to fully investigate these syndromes on their own terms. A detailed research program based on four key questions is presented both to understand culture-bound syndromes within their cultural context and to analyze the relationship between these syndromes and psychiatric disorders. Results of over a decade of research on ataques de nervios, a Latino-Caribbean cultural syndrome, are used to illustrate this research program. The four questions focus on the nature of the phenomenon, the social-cultural location of sufferers, the relationship of culture-bound syndromes to psychiatric disorders, and the social and psychiatric history of the syndrome in the life course of the sufferer.
Seven members of a 15-man U.S. military team that had operated in rural Malaysia developed an acute illness consisting of fever, myalgias, bronchospasm, fleeting pruritic rashes, transient lymphadenopathy, and subcutaneous nodules associated with eosinophilia, elevated erythrocyte sedimentation rate, and elevated levels of muscle creatinine kinase. Sarcocysts of an unidentified Sarcocystis species were found in skeletal muscle biopsies of the index case. Albendazole ameliorated symptoms in the index case; however, his symptoms persisted for more than 5 years. Symptoms in 5 other men were mild to moderate and self-limited, and 1 team member with laboratory abnormalities was asymptomatic. Of 8 team members tested for antibody to Sarcocystis, 6 were positive; of 4 with the eosinophilic myositis syndrome who were tested, all were positive. We attribute this outbreak of eosinophilic myositis to accidental tissue parasitism by Sarcocystis.
Seroprevalence of HHV-8 has been studied in Malaysia, India, Sri Lanka, Thailand, Trinidad, Jamaica and the USA, in both healthy individuals and those infected with HIV. Seroprevalence was found to be low in these countries in both the healthy and the HIV-infected populations. This correlates with the fact that hardly any AIDS-related Kaposi's sarcoma has been reported in these countries. In contrast, the African countries of Ghana, Uganda and Zambia showed high seroprevalences in both healthy and HIV-infected populations. This suggests that human herpes virus-8 (HHV-8) may be either a recently introduced virus or one that has extremely low infectivity. Nasopharyngeal and oral carcinoma patients from Malaysia, Hong Kong and Sri Lanka who have very high EBV titres show that only 3/82 (3.7%) have antibody to HHV-8, demonstrating that there is little, if any, cross-reactivity between antibodies to these two gamma viruses.
Enterovirus 71 (EV71) (genus Enterovirus, family Picornaviridae), a common cause of hand, foot, and mouth disease (HFMD), may also cause severe neurological diseases, such as encephalitis and poliomyelitis-like paralysis. To examine the genetic diversity and rate of evolution of EV71, we have determined and analyzed complete VP1 sequences (891 nucleotides) for 113 EV71 strains isolated in the United States and five other countries from 1970 to 1998. Nucleotide sequence comparisons demonstrated three distinct EV71 genotypes, designated A, B, and C. The genetic variation within genotypes (12% or fewer nucleotide differences) was less than the variation between genotypes (16.5 to 19.7%). Strains of all three genotypes were at least 94% identical to one another in deduced amino acid sequence. The EV71 prototype strain, BrCr-CA-70, isolated in California in 1970, is the sole member of genotype A. Strains isolated in the United States and Australia during the period from 1972 to 1988, a 1994 Colombian isolate, and isolates from a large HFMD outbreak in Malaysia in 1997 are all members of genotype B. Although strains of genotype B continue to circulate in other parts of the world, none have been isolated in the United States since 1988. Genotype C contains strains isolated in 1985 or later in the United States, Canada, Australia, and the Republic of China. The annual rate of evolution within both the B and C genotypes was estimated to be approximately 1.35 x 10(-2) substitutions per nucleotide and is similar to the rate observed for poliovirus. The results indicate that EV71 is a genetically diverse, rapidly evolving virus. Its worldwide circulation and potential to cause severe disease underscore the need for additional surveillance and improved methods to identify EV71 in human disease.
The author investigated modes of self-expression as they reflect the quality of assertiveness among Japanese, Malaysian, Filipino, and U.S. white-collar workers. The author collected respondents' answers to a questionnaire consisting of 33 items involving assertiveness related to modes of expression typical of the Japanese people. Several modes of expression considered specific to the Japanese people--styles of group-oriented behavior, younger people's courtesy toward older people, and the deference of the individual to group consensus--were also found among the Malaysian and the Filipino respondents. These behaviors were in contrast to those observed among the U.S. respondents.
The First International Teleconference in Ophthalmology was held during March 1998 between five sites in the UK, USA, Greece and Malaysia. ISDN transmission at 128 kbit/s was used to reduce costs while maintaining the clarity of the presented material. Specialized lecture theatres were not available at all sites and conventional halls had to be adapted for videoconferencing. For this reason initial point-to-point testing was carried with Bristol to simplify problem solving. Thereafter, a multipoint bridge was used to connect all sites together. During the conference a number of individual presentations were given, all followed by extensive discussion periods. Special instructions were given beforehand on the production of slide material, with particular reference to font sizes and colour combinations. Full use was made of various presentation media, including slides, videos and live demonstrations. The conference was attended by over 500 delegates, all of whom were specialists in ophthalmology. The technology employed was ideal for teaching purposes. However, if used in a clinical field, it should be kept in mind that the choice of transmission rate makes certain features not easily apparent in images but they become clearer when pointed out by the presenter.
Diagnosis by histopathology remams as one of the most important investigative methods used to establish a definitive diagnosis of a lesion or disease state. The provision of oral tissue diagnostic services is therefore an essential function of an Oral Pathology unit. A review of the English language literature disclosed that much of the documented information on the patterns of oral diagnostic services were from the United States, Canada and the United Kingdom. This paper provides an overview of such surveys carried out in these countries.
In direct age-adjustment, a common age-structured population is used as standard. This population may actually exist (e.g., United States population, 1999) or may be fictitious (e.g., two populations may be combined to create a standard). In indirect age-adjustment, a common set of age-specific rates is applied to the populations whose rates are to be standardized. The simplest and most useful form of indirect adjustment is the standardized mortality ratio (SMR) (5).
Fusarium nygamai Burgess & Trimboli was first described in 1986 in Australia (1) and subsequently reported in Africa, China, Malaysia, Thailand, Puerto Rico, and the United States. F. nygamai has been reported on sorghum, millet, bean, cotton, and in soil where it exists as a colonizer of living plants or plant debris. F. nygamai was also reported as a pathogen of the witch-weed Striga hermonthica (Del.) Benth. To our knowledge, no reports are available on its pathogenicity on crops of economic importance. In a survey of species of Fusarium causing seedling blight and foot rot of rice (Oryza sativa L.) carried out in Sardinia (Oristano, S. Lucia), F. nygamai was isolated in association with other Fusarium species-F. moniliforme, F. proliferatum, F. oxysporum, F. solani, F. compactum, and F. equiseti. Infected seedlings exhibited a reddish brown cortical discoloration, which was more intense in older plants. The identification of F. nygamai was based on monoconidial cultures grown on carnation leaf-piece agar (CLA) (2). The shape of macroconidia, the formation of microconidia in short chains and false heads, and the presence of chlamydospores were used as the criteria for identification. Two pathogenicity tests comparing one isolate of F. nygamai with one isolate of F. moniliforme were conducted on rice cv. Arborio sown in artificially infested soil in a greenhouse at 22 to 25°C. The inoculum was prepared by growing both Fusarium species in cornmeal sand (1:30 wt/wt) at 25°C for 3 weeks. This inoculum was added to soil at 20 g per 500 ml of soil. Pre- and post-emergence damping-off was assessed. Both F. nygamai and F. moniliforme reduced the emergence of seedlings (33 to 59% and 25 to 50%, respectively, compared to uninoculated control). After 25 days, the seedlings in infested soil exhibited a browning of the basal leaf sheaths, which progressed to a leaf and stem necrosis. Foot rot symptoms caused by F. nygamai and F. moniliforme were similar, but seedlings infected by F. nygamai exhibited a more intense browning on the stem base and a significant reduction of plant height at the end of the experiment. Either F. nygamai or F. moniliforme were consistently isolated from symptomatic tissue from the respective treatments. References: (1) L. W. Burgess and D. Trimboli. Mycologia 78:223,1986. (2) N. L. Fisher et al. Phytopathology 72:151,1982.
OBJECTIVE:
To examine the extent to which clinicians from different cultures agree when rating the quality of a child's family environment and the effect of country, language, and training factors on these ratings.
METHOD:
Eighty-seven health professionals from Malaysia, Spain, Australia, Indonesia, the United States, Denmark, and Singapore rated 7 case vignettes using the Global Family Environment Scale. Half (54%) were psychiatrists. One quarter (26%) performed the ratings after attending a training session, the rest (n = 64, 74%) after reading a training manual.
RESULTS:
Overall, interrater agreement (intraclass r) was 0.84 (95% confidence interval: 0.68-0.96). There were no significant differences in agreement according to country, language, training, or professional group, although there were country differences in the ratings given to 2 vignettes. The majority of raters found the description of the anchor points (86%), training manual (95%), and case vignettes (97%) clear.
CONCLUSIONS:
Clinicians from different cultures seem to be able to make global ratings of the quality of the family environment that are reliable and consistent when using case vignettes. This can be achieved with little training. Global ratings of the quality of the family environment may be a useful tool in mental health research and clinical work.
A pig-borne virus causing viral encephalitis amongst human beings in Malaysia was detected in 1997 by the Ministry of Health. Initially, the disease was considered to be Japanese encephalitis. Subsequently, it was thought to be a Hendra-like viral encephalitis, but on 10th April, 1999 the Minister of Health announced this mysterious and deadly virus to be a new virus named Nipah virus. The virus was characterized at CDC, Atlanta, Georgia. The gene sequencing of the enveloped virus revealed that one of the genes had 21% difference in the nucleotide sequence with about 8% difference in the amino acid sequence from Hendra virus isolated from horses in Australia in 1994. The virus was named after the village Nipah. In all, the Ministry of Health declared 101 human casualties, and 900,000 pigs were culled by April, 1999. The worst affected area in Malaysia was Negri Sembilan. The symptoms, incubation period in human being and pigs, animal to human transmission, threat of disease to other livestock, and control program adopted in Malaysia is described.
A case of chronic fatigue syndrome (CFS) like illness was identified recently. Diagnosis CFS is commonly used in the western countries but not in Malaysia or other parts of Asia. It is probably because the diagnosis of neurasthenia has gradually disappeared especially in the United States and United Kingdom. Neurasthenia is dropped in the DSM-111 and DSM-1V but is still retained in the 10th International Classification of Disease. This paper is reporting the case and discussing the definition of chronic fatigue syndrome. (JUMMEC 2000; 2:103-104).
Stainless steel wrought wires used as clasp arms for removable partial dentures in Thailand were compared with those used in some other countries (in the as-received condition) in terms of flexibility, Vickers microhardness and composition. The results showed that there were significant differences (P< or =0.05) among the wires. A Japanese stainless steel wire (SK) was obviously different from the others. It had the lowest proportional limit and microhardness, but its flexibility was almost the same. The chemical composition of each wire was not greatly different. The wires were about 18-20 wt% chromium and 8-9 wt% nickel, except for the SK wire, which had about 12 wt% nickel.
The objective of the present study was to review published surveys on allelic frequencies S and Z in countries outside Europe to evaluate the validity of the reported data. Studies on the topic, published from 1965 to May 2001, were retrieved using MEDLINE and bibliographic reference consultations. The criteria for the selection of the studies were the following: 1) sample size >or=250 individuals; 2) alpha1-antitrypsin phenotype determination performed by means of crossed antigen-antibody, isoelectric focusing in polyacrylamide gels, or polymerase chain reaction (PCR); 3) PI type determination performed without any previous screening procedure; 4) S and Z 95% CI of the reported outcomes within the limits of a calculated coefficient of variation. Forty-three out of 85 studies comply with the established criteria for being analysed. Worldwide maps of geographical distributions of PI S and PI Z frequencies have been designed by the authors by adding the data provided by these 43 selected studies to the 70 reported in a recent European meta-analysis.
The Asian Osteoporosis Study (AOS) is the first multicenter study to document and compare the incidence of hip fracture in four Asian countries. Hosital discharge data for the year 1997 were obtained for the Hong Kong SAR, Singapore, Malaysia and Thailand (Chiang Mai). The number of patients who were 50 years of age and older and who were discharged with a diagnosis of hip fracture (ICD9 820) was enumerated. The age-specific incidence rates were deduced and were directly adjusted to the US white population in 1989. The age-adjusted rates for men and women (per 100,000) are as follows: Hong Kong, 180 and 459; Singapore, 164 and 442; Malaysia, 88 and 218; Thailand, 114 and 289; compared with US White rates of 187 in men and 535 in women, published in 1989. We conclude that there is moderate variation in the incidence of hip fracture among Asian countries. The rates were highest in urbanized countries. With rapid economic development in Asia, hip fracture will prove to be a major public health challenge.
Rambutan (Nephelium lappaceum L.) is a tropical fruit grown in Hawaii for the exotic fruit market. Fruit rot was observed periodically during 1998 and 1999 from two islands, Hawaii and Kauai, and severe fruit rot was observed during 2000 in orchards in Kurtistown and Papaikou on Hawaii. Symptoms were characterized by brown-to-black, water-soaked lesions on the fruit surface that progressed to blackening and drying of the pericarp, which often split and exposed the aril (flesh). In certain cultivars, immature, small green fruits were totally mummified. Rambutan trees with high incidence of fruit rot also showed symptoms of branch dieback and leaf spot. Lasmenia sp. Speg. sensu Sutton, identified by Centraalbureau voor Schimmelcultures (Baarn, the Netherlands), was isolated from infected fruit and necrotic leaves. Also associated with some of the fruit rot and dieback symptoms were Gliocephalotrichum simplex (J.A. Meyer) B. Wiley & E. Simmons, and G. bulbilium J.J. Ellis & Hesseltine. G. simplex was isolated from infected fruit, and G. bulbilium was isolated from discolored vascular tissues and infected fruit. Identification of species of Gliocephalotrichum was based on characteristics of conidiophores, sterile hairs, and chlamydospores (1,4). Culture characteristics were distinctive on potato dextrose agar (PDA), where the mycelium of G. bulbilium was light orange (peach) without reverse color, while G. simplex was golden-brown to grayish-yellow with dark brown reverse color. Both species produced a fruity odor after 6 days on PDA. In pathogenicity tests, healthy, washed rambutan fruits were wounded, inoculated with 30 μl of sterile distilled water (SDW) or a fungus spore suspension (105 to 106 spores per ml), and incubated in humidity chambers at room temperature (22°C) under continuous fluorescent light. Lasmenia sp. (strain KN-F99-1), G. simplex (strain KN-F2000-1), and G. bulbilium (strains KN-F2001-1 and KN-F2001-2) produced fruit rot symptoms on inoculated fruit and were reisolated from fruit with typical symptoms, fulfilling Koch's postulates. Controls (inoculated with SDW) had lower incidence or developed less severe symptoms than the fungus treatments. Inoculation tests were conducted at least twice. To our knowledge, this is the first report of Lasmenia sp. in Hawaii and the first report of the genus Gliocephalotrichum on rambutan in Hawaii. These pathogens are potentially economically important to rambutan in Hawaii. G. bulbilium has been reported previously on decaying wood of guava (Psidium guajava L.) in Hawaii (2), and the fungus causes field and postharvest rots of rambutan fruit in Thailand (3). References: (1) J. J. Ellis and C. W. Hesseltine. Bull. Torrey Bot. Club 89:21, 1962. (2) D. F. Farr et al. Fungi on Plants and Plant Products in the United States. The American Phytopathological Society, St. Paul, MN, 1989. (3) N. Visarathanonth and L. L. Ilag. Pages 51-57 in: Rambutan: Fruit Development, Postharvest Physiology and Marketing in ASEAN. ASEAN Food Handling Bureau, Kuala Lumpur, Malaysia, 1987. (4) B. J. Wiley and E. G. Simmons. Mycologia 63:575, 1971.
All obligate bacterial endosymbionts of free-living amoebae currently described are affiliated with the alpha-Proteobacteria, the Chlamydiales or the phylum Cytophaga-Flavobacterium-Bacteroides. Here, six rod-shaped gram-negative obligate bacterial endosymbionts of clinical and environmental isolates of Acanthamoeba spp. from the USA and Malaysia are reported. Comparative 16S rDNA sequence analysis demonstrated that these endosymbionts form a novel, monophyletic lineage within the beta-Proteobacteria, showing less than 90% sequence similarity to all other recognized members of this subclass. 23S rDNA sequence analysis of two symbionts confirmed this affiliation and revealed the presence of uncommon putative intervening sequences of 146 bp within helix-25 that shared no sequence homology to any other bacterial rDNA. In addition, the 23S rRNA of these endosymbionts displayed one polymorphism at the target site of oligonucleotide probe BET42a that is conserved in all other sequenced beta-Proteobacteria. Intra-cytoplasmatic localization of the endosymbionts within the amoebal host cells was confirmed by electron microscopy and fluorescence in situ hybridization with a specific 16S rRNA-targeted oligonucleotide probe. Based on these findings, the provisional name 'Candidatus Procabacter acanthamoebae' is proposed for classification of a representative of the six endosymbionts of Acanthamoeba spp. studied in this report. Comparative 18S rDNA sequence analysis of the Acanthamoeba host cells revealed their membership with either Acanthamoeba 18S rDNA sequence type T5 (Acanthamoeba lenticulata) or sequence type T4, which comprises the majority of all Acanthamoeba isolates.
Quality assurance of medical practice requires assessment of doctors' performance, whether informally via a system such as peer review or more formally via one such as credentialing. Current methods of assessment are, however, subjective or implicit. More objective methods of assessment based on statistical process control technique such as cumulative sum (CUSUM) procedure may be helpful.