Noriaki Ikeda

Serum antioxidant micronutrients and the risk of oral leukoplakia among Japanese

A population-based case-control study was designed for the investigation of any association between serum micronutrient levels and oral leukoplakia. Out of a total of 9536 subjects over the age of 40 years who participated in the oral mucosal screening programme in Tokoname city, 48 cases detected with oral leukoplakia (38 male:10 female) were recruited. For each case, four controls matched by age and sex were selected from the same cohort. We examined the fasting serum levels of retinol, alpha-tocopherol, zeaxanthin and lutein, cryptoxanthin, lycopene and carotenoids (alpha-carotene and beta-carotene) by high-performance liquid chromatography. Among males with leukoplakia mean serum lycopene and beta-carotene levels (0.175+/-0.202, 0.357+/-0.295 micromol/l) were significantly lower than those of controls (0.257+/-0.252, 0.555+/-0.408 micromol/l) (P<0.05, P<0.005). Logistic regression analysis with leukoplakia as the dependent variable showed that high serum levels of beta-carotene were related to low risk of oral leukoplakia (odds ratio 0.160, 95% C.I.: 0.029-0.866, P<0.05). There were no significant differences in any of the serum nutrients estimated in female subjects. Our results suggest for the first time that high serum levels of beta-carotene may provide protection against oral precancer for the Japanese male.

Outcome following a population screening programme for oral cancer and precancer in Japan

The purpose of this study was to evaluate the validity and outcome of an oral mucosal screening programme conducted in Japan. All adults over the age of 40 years resident in Tokoname city were invited by letter to attend a free general health screen and oral examinations annually. Twenty- to 39-year-old females were also encouraged to participate. During the years 1996-98, a total of 19056 subjects (5885 male, 13171 female: mean age 60.7+/-11.3 years) were examined by three types of screeners: postgraduate dental residents (n=17), hospital dentists (n=5) and general dental practitioners (n=15). In the cohorts examined screening dentists recorded oral mucosal lesions in 783 (4.1%) subjects. Of those detected with mucosal lesions, 200 (25.5%) were referred and 137 (68. 5%) attended for follow up examination in hospital departments by specialists with full diagnostic back up facilities. Thirty-nine subjects were confirmed as having oral cancer or precancer (two squamous cell carcinomas, 37 leukoplakias) and 40 with lichen planus. Five false positives (3.6%) were found. Among the cases referred under other diagnostic labels no cancers were detected. Among those who attended for confirmation of oral cancer or precancer by a specialist, sensitivity, specificity and positive predictive value were 0.92, 0.64 and 0.78, respectively. In males with oral cancer/leukoplakia, the prevalence of smoking, drinking and combined habits was higher than those with lichen planus or among negative subjects. The sensitivity and specificity determined from this research suggests that the performance of the Japanese dentists employed in screening was satisfactory. An attendance of 68% for re-examination by specialists compares well with other reported studies measuring patient compliance.

Oral cancer screening as an integral part of general health screening in Tokoname City, Japan.

Objectives To measure the attendance and compliance rates in oral mucosal screening (OMS) offered as part of a general health screen (GHS) undertaken as an organised programme in Japan. Methods In 1996, all adults over the age of 40 years resident in Tokoname City were invited by letter to attend a free GHS annually, conducted by the municipal cooperation and the medical and dental societies of Tokoname City. In the later years only those who attended in 1996 were reinvited. Females aged less than 39 years were also allowed to attend if they wished to participate in the GHS. The GHS consisted of completion of a self administered questionnaire to identify past and current illnesses and any medications used by the screened population coupled with a routine physical check, chest x ray, ECG, and blood and urine examination. The GHS was programmed annually during the years 1996 to 1998. All those attending the GHS were invited to participate in an OMS conducted under the same roof by a visiting dentist (n=37). A referral pathway was established for screen positives requiring follow up. Results A total of 19 305 subjects (5955 males, 13 350 females; mean age 59.2 years; 7033 in 1996, 6289 in 1997, and 5983 in 1998) attended the GHS. Of those who attended the GHS, 19 056 (98.7%) attended the OMS (1.3% refused). This rate was fairly constant over the three years. Excluding repeat examinations, new cases recruited for OMS over the three years were 8723. Of those participating in OMS, 4269 (60.7%) attended all three years. In the cohorts examined, screening dentists recorded oral mucosal lesions in 5.4% in 1996, in 4.0% in 1997, and in 2.6% in 1998. Overall, this amounted to a positive detection rate of 4.1%, or 4.9% excluding repeat examinations. A higher prevalence of oral pre-cancer was recorded among male smokers. Conclusions The overall results suggest that although compliance with attending a free GHS was low (26.2%) among Japanese subjects over 40 years of age, of those who complied 74–76% reattended annually. Hence a satisfactory participation rate can be obtained in Japan for OMS when this is coupled to a GHS conducted at the same visit.

Factors Associated with Severe Periodontitis in Rural Cambodia

An analytical cross-sectional study was conducted with 812 subjects aged 35-74 years in Prek Russey commune, Cambodia to detect some factors associated with severe periodontitis. Four calibrated examiners employed Community Periodontal Index (CPI) to ascertain periodontal pocket depth (PD) and loss of epithelial attachment (LA). A questionnaire was used to obtain tobacco and alcohol consumption habits. One hundred (12.3%) subjects had one or more sextants with ≥ 4mm PD and ≥ 6mm LA (severe periodontitis). Smoking, tobacco chewing and age were significantly associated with severe periodontitis in bivariate analysis while only age and quantified smoking remained significant in a logistic regression analysis. The impact of quantified smoking on severe periodontitis was almost negligible [OR: 1.0006 (95% CI: 1.0001, 1.001)] compared to that of age [OR ranged from 8.3 at 45-54 years to 22 at 65-74 years (95% CI: 3.1, 62.3)]. Nevertheless, both age and quantified smoking can be considered as factors associated with severe periodontitis in rural Cambodians. Asia Pac J Public Health 2004; 16(1): 50-53.

PERIODONTAL STATUS OF RURAL INHABITANTS IN PREK RUSSEY, CAMBODIA

There is a paucity of information pertaining to oral disease patterns including periodontal disease in Cambodia, which is just emerging from a 20-year ruin. A house-to-house survey was conducted to assess the periodontal status of 1948 subjects aged 15-74 years in a rural commune in Cambodia using Community Periodontal Index (CPI) and measuring Attachment Loss (LA). The periodontal status of Cambodians increased with age as indicated by both CPI and LA. Calculus was the most common finding among Cambodians pointing to overall poor oral hygiene levels. Notwithstanding the poor oral hygiene, however, the severe periodontitis as denoted by ≥ 6mm periodontal pockets was rare even in the elderly while edentulousness was not frequently observed until 65 years. Preventive programmes targeting periodontal disease in Cambodia should focus on oral health education and simple oral hygiene instructions while the ubiquitous calculus could be dealt with oral prophylaxis. Asia Pac J Public Health 2002; 14(2): 105-109.

Technologies for global health

1738 www.thelancet.com Vol 380 November 17, 2012 both surgeons and patients, further careful audit is clearly required. We appreciate that this might be diffi cult to achieve in a rural African setting, but hope that we can continue to rely on the help of profi table commercial companies in high-income countries until local public health-care policies grasp the cost-eff ectiveness of this “fabulously clever, inexpensive and context-appropriate way of treating surgical disease”.

The assessment of status of tobacco smoking among urban primary schoolchildren in Madagascar

The prevalence of tobacco smoking among adolescents aged 13-15 years old in Madagascar was previously reported to be higher than the average in other African regions. A preventive approach is urgently needed to avoid the initiation of early tobacco smoking. Therefore, the aims of this study were to evaluate the status of tobacco smoking among primary schoolchildren in Madagascar and explore the factors associated with initiation of tobacco smoking in the young. This study was conducted in the Mahajanga region of Madagascar. Three primary schools in this region and children of both genders between the ages of nine to 12 years old were randomly selected and approached to participate in this study. A self-administered questionnaire modified from the Global Youth Tobacco Survey Core Questionnaire 2007 was used to assess the status of tobacco smoking among primary schoolchildren. A total of 150 schoolchildren (14.0%) declared that they had smoked tobacco, with 30% starting to smoke tobacco at the age of seven or younger. The prevalence of tobacco smoking was lower among schoolchildren with non-smoking parents (p < 0.001) or non-smoking close friends (p < 0.001). Furthermore, schoolchildrens antismoking intention (p < 0.001) and their knowledge about the harmfulness of tobacco (p = 0.009) had significant effects on the prevalence of tobacco smoking. The results of this study indicate that tobacco smoking among schoolchildren in Madagascar may be influenced by peers, or parents, as well as smoking intention and knowledge about the harmfulness of tobacco use.