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    Comparative spatial dynamics of Japanese encephalitis and acute encephalitis syndrome in Nepal
    (PLOS, 2013-07) Robertson, Colin; Pant, Dhan Kumar; Joshi, Durga Datt; Sharma, Minu; Dahal, Meena; Stephen, Craig
    Geographical patterns can provide important clues about disease etiology. Infectious diseases, such as Japanese Encephalitis (JE), are driven by ecological and social processes which result in heterogeneous distribution of disease risk. Pattern indices describing the amount of irrigated land edge density and the degree of landscape mixing for irrigated areas were positively associated with (JE) and acute encephalitis syndrome (AES) risk, while fragmented forest measured by the number of forest patches were negatively associated with AES and JE. These landscape variables highlight the importance of integrating healthy land management policies and disease prevention strategies in both rural and urban-fringe developing areas.
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    Os desafios da geração do conhecimento em saúde ambiental : uma perspectiva ecossistêmica
    (Associação Brasileira de Saúde Coletiva (ABRASCO), 2013-05) Weihs, Marla; Mertens, Frédéric
    O artigo explora as oportunidades e as limitações da geração de conhecimento no campo da saúde ambiental. Argumenta que a compreensão da complexidade dos fatores que condicionam a saúde humana e dos ecossistemas demanda redefinições na tradicional distribuição de papéis e responsabilidades na pesquisa científica. Estas práticas de pesquisa encerram enfoques inter e transdisciplinares e a aplicação de uma abordagem ecossistêmica (ecosaúde). Desafios e oportunidades da aplicação da inter e transdisciplinaridade a problemáticas de saúde ambiental são discutidos e ilustrados por meio de dois estudos de caso que utilizam uma abordagem ecosaúde: uma experiência brasileira que trata da contaminação e exposição ao mercúrio na Amazônia, e outra nepalense, sobre a transmissão urbana de equinococose. Concluímos apresentando o potencial de uma abordagem ecosaúde na superação dos limites das práticas unidisciplinares e na valorização dos saberes e da participação local.
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    Global epidemiology of clonorchiasis and its relation with cholangiocarcinoma
    (BioMed Central, 2012-10) Men-Bao Qian; Ying-Dan Chen; Song Liang; Guo-Jing Yang; Xiao-Nong Zhou
    Human beings are infected through ingestion of raw or undercooked fish, which contains the metacercariae of liver flukes. This paper reviews the epidemiological status and characteristics of clonorchiasis at global level and the relationship between Clonorchis sinensis infection and cholangiocarcinoma (CCA). Liver flukes are a polyphyletic group of trematodes, including Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. Cholangiocarcinoma (CCA) is a cancer of the bile ducts. The epidemiology of clonorchiasis is characterized by a rising trend in prevalence, variability among sex and age, as well as endemicity in different regions. Accurate evaluation of prevalence is necessary to promote adoption of suitable interventions.
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    Knowledge and practices of pig farmers regarding Japanese encephalitis in Kathmandu, Nepal
    (Blackwell Verlag, 2012) Dhakal, S.; Stephen, C.; Ale, Anita; Joshi, D.D.
    Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population.
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    Sustaining a regional emerging infectious disease research network : a trust-based approach
    (2013-01) Silkavute, Pornpit; Dinh Xuan Tung; Jongudomsuk, Pongpisut
    The paper describes some history and achievements of the Asia Partnership on Emerging Infectious Diseases Research (APEIR) with a focus on the partnership's five major areas of emerging infectious disease research: wild migratory birds, backyard poultry systems, socio-economic impact, policy analysis, and control measures. Two case studies are highlighted, illustrating how the partnership's research results are being used to inform policy. Also highlighted are lessons learned after five years of building partnerships and the value-added by a multi-country, multi-sectoral, multi-disciplinary research partnership like APEIR.
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    Comparative characterization of MicroRNAs from the liver flukes Fasciola gigantica and F. hepatica
    (PLOS, 2012-12) Xu, Min-Jun; Ai, Lin; Fu, Jing-Hua; Nisbet, Alasdair J.; Liu, Qing-You; Chaturvedi, Sudha
    MicroRNAs (miRNAs) are key regulators of gene expression at the post-transcription level. The present study specifically explored and compared the miRNA expression profiles of F. gigantica and F. hepatica using an integrated sequencing and bioinformatics platform and quantitative real-time PCR. Nineteen and 16 miRNA candidates were identified from F. gigantica and F. hepatica, respectively. The two parasites shared 11 miRNAs, with 8 also showing similarity to miRNAs of Schistosoma japonicum. Another 8 miRNAs were identified as F. gigantica-specific and 5 as F. hepatica-specific, most of which were novel. Predicted target analysis with 11465 mRNA and EST sequences of F. hepatica and F. gigantica revealed that all of the miRNAs had more than one target, ranging from 2 to 398 with an average of 51 targets. Some functions of the predicted targets were only found in F. gigantica, such as ‘‘transcription regulator’’, while some others were only found in F. hepatica, such as ‘‘reproduction’’ and ‘‘response to stimulus’’, indicating the different metabolism and gene regulation patterns of the two parasites. The present study represents the first global comparative characterization of miRNA expression profiles of F. gigantica and F. hepatica, which has provided novel valuable resources for a better understanding of the two zoonotic trematodes.
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    Characterization of microRNAs in Taenia saginata of zoonotic significance by Solexa deep sequencing and bioinformatics analysis
    (Springer-Verlag, 2011-12) Ai, Lin; Xu, M.J.; Chen, M.X.; Zhang, Y.N.; Chen, S.H.
    The beef tapeworm Taenia saginata infects human beings with symptoms ranging from nausea, abdominal discomfort to digestive disturbances and intestinal blockage. In the present study, microRNA (miRNA) expressing profile in adult T. saginata was analyzed using Solexa deep sequencing and bioinformatics analysis. A total of 15.8 million reads was obtained by Solexa sequencing, and 13.3 million clean reads (1.73 million unique sequences) was obtained after removing reads smaller than 18 nt. Ten conserved miRNAs corresponding to 607,382 reads were found when matching the reads against known miRNAs of Schistosoma japonicum in miRBase database. The miR-71 had the most abundant expression in T. saginata, followed by miR-219-5p, but some other common miRNAs such as let-7, miR-40, and miR-103 were not identified in T. saginata. Nucleotide bias analysis found that the known miRNAs showed high bias and the uracil was the dominant nucleotide, particularly at the first and 11th positions which were almost at the beginning and middle of conserved miRNAs. One novel miRNA (Tsa-miR-001) corresponding to ten precursors was identified and confirmed by stem-loop RT-PCR. To our knowledge, this is the first report of miRNA profiles in T. saginata, which will contribute to better understanding of the complex biology of this zoonotic trematode. The reported data of T. saginata miRNAs should provide valuable references for miRNA studies of closed related zoonotic Taenia cestodes such as Taenia solium and Taenia asiatica.
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    Vietnam one health – ecohealth alliance newsletter, issue no. 1, January 2013
    (Center for Public Health and Ecosystem Research (CENPHER), Hanoi School of Public Health, Hanoi, VN, 2013-01) Hanoi School of Public Health. Center for Public Health and Ecosystem Research (CENPHER)
    The newsletter provides links to activities and events, conferences and collaborative partnerships, that work towards better research and understanding in zoonotic disease prevention. Ecosystem approaches to health, or Ecohealth, acknowledge the complex, systemic nature of public health and environmental issues and the inadequacy of conventional methodologies for dealing with them.
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    Vitamin A status of the minority ethnic group of Karen hill tribe children aged 1-6 years in Northern Thailand
    (2007) Tienboon, Prasong; Wangpakapattanawong, Prasit
    Vitamin A deficiency (VAD) is the most common cause of childhood blindness in the developing world. It is estimated that by giving adequate vitamin A, in vitamin A deficient populations, child mortality from measles can be reduced by 50%, and mortality from diarrheal disease by 40%. Overall mortality in children 6-59 months of age can be reduced by 23%. This paper reported results from a study of vitamin A status and malnutrition of the minority ethnic group of Karen hill tribe children aged 1-6 years in the north of Thailand. All children aged 1-6 years (N = 158; 83 boys, 75 girls) from the three Karen villages (Mae Hae Tai, Mae Yot, Mae Raek) of Mae Chaem district in the north of Thailand were studied. The Karen is the largest mountain ethnic minority (“hill tribe”) group in Thailand. All children were examined by a qualified medical doctor and were assessed for their vitamin A intakes using 24 hours dietary recall. Thai food composition table from Ministry of Health, Thailand were used as references. The results were compared with the Thai Recommended Dietary Allowances. Children aged 1-3 years and 4-6 years were separately analysed due to the differences in Thai Recommended Dietary Allowances between the two age groups. A whole blood of 300 μL was obtained by “fingerstick” for determination of serum vitamin A. Community or village’s vitamin A status was assessed by using Simplified Dietary Assessment (SDA) method and Helen Keller International (HKI) food frequency method. Descriptive statistics were used to analyse the data. All families of the study boys and girls had income lower than the Thailand poverty line (US $ 1,000/year). On average, 63% of children from Mae Hae Tai village, 1.5% of children from Mae Yot village and none of children from Mae Raek village had serum vitamin A <0.7 μmol/L which indicated VAD. All boys and only girls from Mae Raek village consumed vitamin A more than the Thai RDA but girls from Mae Hae Tai village and Mae Yot village consumed vitamin A less than the Thai RDA. Both boys and girls from Mae Raek village and also girls from Mae Yot village consumed vitamin A more than the Thai RDA. Using SDA and HKI methods to assess vitamin A status of the villages to see whether VAD is a village's nutritional problem, it was found that all children from the three villages were at risk of VAD. In order to improve vitamin A status of the Karen children in Mae Chaem district, recommendations were made as follow: (1) increased use of fat and oil, particularly in areas with high risk of VAD; (2) more general work with Karen communities on how children’s diets might be improved in a culturally acceptable manner, so as to bring vitamin A consumption closer to recommended allowance level.
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    Nutritional status, body composition and health conditions of the Karen hill tribe children aged 1-6 years in Northern Thailand
    (2007) Tienboon, Prasong; Wangpakapattanawong, Prasit
    Introduction: In Thailand, according to the national nutrition survey of the Thai population who live in the cities by the Ministry of Public Health, about 12% of preschool children aged 1-6 years were malnourished. The rate of malnutrition is much higher among mountain minority (‘hill tribe’) children than city children. This paper reports a study of malnutrition, body composition and health conditions of Karen hill tribe children aged 1-6 years in Thailand. Methods: All children aged 1-6 years (N = 158; 83 boys, 75 girls) from the three Karen villages (Mae Hae Tai, Mae Yot, Mae Raek) of Mae Chaem district in the north of Thailand were studied. Anthropometric measurements of all children were obtained and body composition data were derived. All children were examined by a qualified medical doctor. A stool sample and blood smear for malaria from all children were examined by a well qualified medical technologist. Results: All families of the study boys and girls had incomes lower than the Thailand poverty line (US $ 1,000/year). There were no significant differences in weight, height or body mass index of boys and girls from each of the three villages. Malnutrition in children were found 85.5% by using weight-for-age, 73% by heightfor- age (stunting) and 48.4% by weight-for-height (wasting). Boys had more total body fat mass than girls. However, all of them had low lean body mass and fat mass. Nearly all children (98%) suffered from either upper respiratory tract infection, skin infection, scabies and/or diarrhoea. Also, nearly all of them (97%) had scaly and dry skin over their chest walls and legs. About 10% of children had either angular stomatitis (5%) or bleeding per gums (3%) or bow legs (1%) or frontal bossing (1%) with their implications for micronutrient deficiency. None of the children from the three villages were infested with the malarial parasite. On average, 54% of children from Mae Hae Tai village and 85% of children from Mae Yot village but only 4% of the children from Mae Raek village were infested with parasites. Ascaris lumbricoides was the most common infestation in all children from three villages. Conclusion: The prevalence of malnutrition was high among the Karen hill tribe children aged 1-6 years, Thailand. Most of the children suffered from upper respiratory tract infection, skin infection, scabiasis and/or diarrhrea. Nearly all of them had scaly and dry skin over their chest walls and legs which indicated essential fatty acid deficiencies. However, only 10% of them had vitamin deficiencies such as B2, C, and D.
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    Return to Kathmandu - A Post Hoc Application of AMESH
    (2008) Neudoerffer, R Cynthia; Waltner-Toews, David; Kay, James J
    This chapter provides background to the development of the adaptive methodology for ecosystem sustainability and health (AMESH). AMESH approaches seemed to parallel ecological, economic, demographic, and social developments in Nepal. AMESH is characterized by: (1) Documenting the presenting situation; (2) Analysis of stakeholders, issues, policy, politics and governance; (3) People and their stories; (4) Systems descriptions and narratives; and (5) Collaborative learning and action. Descriptions include details of case studies derived from various stakeholder groups. Often community development work requires sanctioning by local leaders, who can act as entry points between researchers and the community.
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    Perspective changes everything: managing ecosystems from the inside out
    (2003) Waltner-Toews, David; Kay, James J; Neudoerffer, Cynthia; Gitau, Thomas
    In the past, environmental managers could behave as if they were managing a "natural" system to which they were external; criteria for successful management could be derived from historical data or from current pristine systems elsewhere in the world. With a few localized exceptions, this approach is no longer viable. Most of the ecosystems for which critical and urgent decisions need to be made are best seen as complex ecosocial systems, with people firmly embedded as an integral element. We can no longer manage ecosystems per se, but rather we must learn to manage our interactions within our ecological context. This view, which incorporates notions of multiple, interacting, nested hierarchies, feedback loops across space and time, and radical uncertainty with regard to prediction of system behavior, requires rethinking. How should we now think about science and science-based management? Post-normal science, complex systems theories, and the creation of collective narratives offer the best hope for making progress in this field. We use several ecosystem management and community health programs in Peru, Kenya, and Nepal to demonstrate the characteristics necessary for this kind of "inside-out" approach.
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    Asian Partnership on Emerging Infectious Disease Research (APEIR), Organizational Consolidation and Development (16 June – to 31 October 2011) : narrative report
    (APEIR Organizational Consolidation and Development, TH, 2011) APEIR Regional Coordinating Office
    APEIR aims to build and strengthen their partnership, to become recognized by peers, donors and research partners as a “market leader” on Emerging Infectious Diseases (EID) research, and to become self-reliant in resource mobilization. This report discusses activities carried out during the period of implementation that began in June 2010 and assesses how project objectives were achieved. Meetings, workshops and other activities are reported on.
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    Water management challenges in the context of agricultural intensification and endemic fluorosis : the case of Yuanmou county
    (Springer, 2012) Jing Fang; Xinan Wu; Jianchu Xu; Xuefei Yang; Xiaoxiao Song
    Fluoride in water is mostly of geological origin, often at the foot of high mountains. Fluorosis is caused by overexposure to fluoride with moderate amounts leading to dental effects, but long-term ingestion can lead to potentially painful and severe skeletal problems. In Yuanmou County in Yunnan Province, the combined effects of high evaporation caused by hot weather, largescale vegetable planting, and high fluoride concentrations reduce the amount of safe water available for local consumption, which affects people’s health. The paper describes water management challenges facing the county, analyzes remaining and emerging challenges, and suggests an ecohealth framework for better management.
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    Proceedings of the IDRC-organised panels at the 8th International Conference on Urban Health, ICUH 2009, Nairobi, Kenya, October 18 - 23, 2009
    (IDRC, 2010) IDRC
    Workshop papers focus on waste management in informal settlements and urban slum conditions. Neglect by local leaders/government is key to an ongoing poorly functioning system. Urban authorities continue to leave beneficiary communities as ‘passive’ service consumers. To improve the urban environment and health status of the urban poor, affected communities should be involved in problem identification and proposed solutions. Unsafe water, poor drainage and garbage disposal, inadequate latrines and air pollution are key urban environmental problems.
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    Kathmandu urban ecosystem health project a model approach
    (2009) Joshi, D.D.; Sharma, Minu
    International Development Research Centre (IDRC) supported research study on Echinococcosis/Hydatidosis which was carried out between 1992 and 2001 in Kathmandu Metropolitan City Nepal. The research work was carried out in two distinct project stages in wards 19 and 20 of KMC one from 1992-1996(applying a traditional epidemiology approach) and a second was Urban Ecosystem Health Project (UEHP) Approach from 1998-2006. Overall, there were three main step of activities in the development of the UEHP in Nepal: First is an exploratory/analytical systemic steps focusing on linkages between social, ecological, and health variables (1998-2001); The second a community action step employing a variety of systemic, narrative, and participatory-action research tools (2003-2006); and the third phase of urban ecosystem health project started from 2007 to 2009 which is now running. Community participation or participatory action research is a key element of ecosystem health programmes. Participatory Action Research approaches have three main goals. The first step is to describe what is there? What are the physical and socio-economic possibilities of this person or place? If we use the analogy of a person. The Second step, for ecosystems as for individuals, health is not just a physical state, but what we might call a spiritual state. It has been said that in any part of the world no solutions will be sustainable in the long run unless they are rooted in the communities where the problems occur, drawing on the people in these communities and their many skills, resources, and important knowledge, and those communities feel empowered and supported by higher levels of government. If such approaches can be worked out between local communities in Indian Subcontinent, non-government organizations, businesses, regional institutions of government and university, and with outside input only as necessary, then truly sustainable solutions will be found, and Kathmandu.
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    Current status of Opisthorchiasis and Clonorchiasis in the Mekong Basin
    (Elsevier, 2012) Sithithaworn, Paiboon; Andrews, Ross H.; Nguyen Van De; Wongsaroj, Thitima; Sinuon, Muth
    Despite decades long treatment and control programs, all countries of the Lower Mekong Basin are still highly endemic with liver flukes, O. viverrini and/or C. sinensis as well as alarmingly high levels of CCA (type 1 carcinogens) incidence. A common pattern is emerging in each country indicating a difference in transmission of O. viverrini between high prevalence in lowlands, versus highlands. This seems to be associated with wetlands, flooding patterns and human movement and settlement. The report highlights current status and control of liver fluke infections in the Mekong Basin, providing updates in research relevant to opisthorchiasis and clonorchiasis.
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    Diagrammatic approach to understanding complex eco-social interactions in Kathmandu, Nepal
    (Resilience Alliance, 2005) Neudoerffer, R. Cynthia; Waltner-Toews, David; Kay, James J.; Joshi, D. D.; Tamang, Mukta S.
    As part of developing an international network of community-based ecosystem approaches to health, a project was undertaken in a densely populated and socio-economically diverse area of Kathmandu, Nepal. Drawing on hundreds of pages of narrative reports based on surveys, interviews, secondary data, and focus groups by trained Nepalese facilitators, the authors created systemic depictions of relationships between multiple stakeholder groups, ecosystem health, and human health. These were then combined to examine interactions among stakeholders, activities, concerns, perceived needs, and resource states (ecosystem health indicators). These qualitative models have provided useful heuristics for both community members and research scholars to understand the eco-social systems in which they live; many of the strategies developed by the communities and researchers to improve health intuitively drew on this systemic understanding. The diagrams enabled researchers and community participants to explicitly examine relationships and conflicts related to health and environmental issues in their community.
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    Three years progress report on Urban Ecosystem Health Project phase - II, 14 October 2003 – 13 October 2006
    (National Zoonoses and Food Hygiene Research Centre (NZFHRC), Kathmandu, NP, 2006) Joshi, D.D.
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    Avian and pandemic human influenza policy in South-East Asia : the interface between economic and public health imperatives
    (Oxford University Press, 2011) Pongcharoensuk, Petcharat; Adisasmito, Wiku; Sat, Le Minh; Silkavute, Pornpit; Muchlisoh, Lilis; Cong Hoat, Pham; Coker, Richard
    Whereas countries have adopted similar strategic policies for antiviral stockpiling in relation to highly pathogenic avian influenza, their differing economic imperatives are of critical importance. While Thailand’s poultry industry is principally an export economy, Vietnam’s and Indonesia’s are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and have a major impact on its economy. Economic imperatives have been critically important in guiding policy formulation in the agriculture sector, however, questions arise regarding how to reconcile agricultural policy with public health policy across the region.