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Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare indolent stromal neoplasm of unclear histogenesis with a distinct histopathological entity. Immunophenotypes of sex cord positivity are the most significant information to confirm the diagnosis. We present the case of a 61-year-old female with a polypoid mass in the uterus which was successfully removed by surgical resection as hysterectomy. The pathological diagnosis was UTROSCT, which was characterized microscopically by sex cord images and immunohistochemical features of calretinin, CD99, and WT1 positivity.

We are living in the trend of the Internet of Things (IoT), electronic devices that are capable of connecting and exchanging information with each other via the Internet. For automation, monitoring and control systems, there is a need to upgrade existing systems so that users can remotely monitor via the Internet. The solution is to integrate the Gateway device to transmit and receive data. However, in the Internet environment, the issue of information security and safety always needs attention because of the risk of network attacks and data theft. In this paper, the authors present data security solutions for Gateway IoT devices to ensure information security against eavesdropping or sniffers. The device has been integrated into a landslide monitoring system, which has proven to work, increasing the reliability of the system.

Background: More than half of the people with dementia live in lower-middle income countries (LMIC), yet we lack research and evidence-based knowledge to guide health promotion and prevention strategies for cognitive decline. In the Philippines, the prevalence of mild cognitive impairment (MCI) and cardiovascular risk factors among older persons are high, making this population at high risk for developing dementia. This protocol describes a cluster randomized controlled trial that aims to investigate the efficacy of a multicomponent intervention to maintain cognitive performance among high-risk population. Methods: This is a cluster-randomized, two-arm, single-blind trial of a multicomponent intervention that combines dance called INDAK (Improving Neurocognition through Dance and Kinesthetics), nutrition counseling, and vascular risk management. The intervention arm will receive 12 months (1-h, twice per week) of INDAK and every 3 months of nutrition counseling and intensive vascular risk management and monitoring. The control group will receive the usual vascular care advice and referral. A total of 605 (20-25 clusters per arm) community-dwelling Filipino older adults aged ≥ 60 years old with MCI will participate in the study and will be assessed at baseline, 6th- and 12th-month follow-up. The primary outcome is cognitive performance assessed by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog), Mnemonic Similarity Tasks (MST), and executive function composite (EFC). Secondary outcomes are functional connectivity assessed through brain imaging, and measures of behavioral, functional level, and quality of life. Discussion: The study aims to provide scientific evidence on a public health intervention that is contextualized in a community setting to reduce dementia risk among older adults with MCI. This model can be an ecological, low-cost, and effective program, thereby conducive to widespread implementation in the Philippines as well as in other low-resource settings with similar public health challenges. The pilot phase was underway with eight villages (clusters), but temporarily interrupted by the pandemic. The full study is anticipated to start after community restrictions are eased. Ministry of Education (MOE) Published version This study was supported by grants from the Philippine Institute for Traditional and Alternative Health Care (PITHAC) of the Department of Health. The contributions of SC are partly supported by the Ministry of Education, Singapore, Academic Research Fund (MOE2019-T2-1-019).

Highlights • Lactating adenoma is a benign “tumor of pregnancy” which typically occur in the third trimester or lactation period. • In some cases, the clinical presentation of lactating adenoma might mimic breast cancer. • Surgery to remove the tumor for careful pathological assessment might be required to confirm the diagnosis., Introduction Lactating adenoma is a rare breast tumor which is commonly found in late pregnancy or lactation period. Despite its benign nature, lactating adenoma might develop aggressively and can be misdiagnosed as breast cancer. Case presentation We report a case of a 25-year-old female presenting with two large, ulcerative and bleeding breast masses. An open biopsy demonstrating lactating adenoma was considered discordant and surgery was performed to confirm the diagnosis. Conclusion Careful clinical and histological evaluations are necessary to diagnose and manage lactating adenoma.

Purpose: Mekong Delta's shrimp farming contributes to socio-economic development but tends to reduce the mangrove area. On the one hand, NGOs advocate balancing ecology and economy, while on the other hand, the Vietnamese government supports intensifying shrimp production. The latter strategy increases shrimp diseases and marginalises smallholders. To influence the opinions, knowledge and behaviour of shrimp farmers, we developed and tested a serious board game. Approach: Through several iterations, we designed a realistic board game mimicking local shrimp farming. Then, after conducting three sessions of gameplay with farmers in three sites, we assessed how this gameplay influenced players. We used a semi-experimental set-up by collecting data on the day of the gameplay, and on two further time-points. Findings: After the gameplays, farmers reported to have learned about the risks of monoculture-intensive-shrimp system and the advantages of hybrid systems. Likert ratings showed that players adopted innovations faster and, in case of shrimp diseases, consulted commercial service-providers less, but with other farmers more. They confirmed to have learned that the best strategy for them would be to adopt hybrid systems, i.e. intensify part of the area of mixed-mangrove or improved-extensive shrimp farms. Theoretical implications: Realistic board games can create opportunities for social learning and training of groups which are not always easy to reach. Practical implications: Board games can support transfer of knowledge and skills to farmers, and can develop their critical thinking. Creation: The findings that board games are effective in the context of a top-down extension systems offer value opportunities.

Background: In the midst of competing priorities and limited resources in low-middle-income countries (LMIC), convincing epidemiological evidence is critical for urging governments to develop national dementia plans. The majority of primary epidemiological studies on dementia are from high income countries (HIC). Implications for developing countries are typically extrapolated from these outcomes through modeling, meta-analyses, and systematic reviews. In this study, we directly assessed the incidence of dementia, disability adjusted life years (DALYs), and cost of care among community-dwelling Filipino elderly.Methods: This was a follow-up study of the prospective cohort Marikina Memory Ageing Project (MMAP). Baseline assessment was performed in 2011–2012, and follow-up was done in 2015–2016 (N = 748 at follow-up). Incident dementia was determined. Disease burden was computed using the incidence rates and DALYs. Both indirect and direct (medical and non-medical) costs of dementia care were computed.Results: The crude incidence rate was 16 (CI: 13–20) cases per 1,000 person-years (pyr) with 17 (CI: 12–21) per 1,000 pyr for females and 14 (CI: 9–21) per 1,000 pyr for males. Based on this incidence, we project an estimation of 220,632 new cases in 2030, 295,066 in 2040, and 378,461 in 2050. Disease burden was at 2,876 DALYsper 100,000 persons. The economic burden per patient was around Php 196,000 annually (i.e., ~4,070 USD, or 36.7% of average family annual income in the Philippines). The majority (86.29%) of this care expense was indirect cost attributed to estimated lost potential earning of unpaid family caregivers whereas direct medical cost accounted for only 13.48%.Conclusions: We provide the first Filipino community-based data on the incidence of dementia, DALYs, and cost of care to reflect the epidemiologic and economic impact of disease. The findings of this study serve to guide the development of a national dementia plan.

Background:Aberrant of p53 and Bcl2 genes cause changes in the quantity and quality of their proteins and contribute to the pathogenesis of some cancer types including breast cancer. Expression of p53 and Bcl2 were associated to adverse clinical outcomes in breast cancer.Purpose:To predict the survival outcomes of invasive breast cancer in Vietnam, using immunohistochemical expression of p53, Bcl2 proteins.Methods:The current study was conducted on 526 breast cancer patients who had surgical operations, but had not received neo-adjuvant chemotherapy, from 2011 to 2014. The clinicopathological characteristics were recorded. Immunohistochemical staining was performed on p53, Bcl2 markers. Expression of p53 and Bcl2 were paired into different immunophenotypes for analysis with clinicopathological characteristics and survival. All breast cancer patients’ survival were analyzed by using Kaplan-Meier and Log-Rank models.Results:The presence of p53 protein was detected in 44.1%. Positive p53, and p53+Bcl2- immunophenotype were significantly associated with poorer prognostic features. In contrast, the positive Bcl2 protein accounted on 57.6%, and combination of p53-Bcl2+ were strong correlated with better clinicopathological parameters. Bcl2 positivity was observed in higher than the negative Bcl2 in the five-year OS (Overall survival) proportion (91.2 vs 79.4%, respectively) (p < 0.05). Multivariate analysis revealed that the expression of p53, Bcl2 or combinations of these 2 proteins was no longer remained as an independent prognostic variable.Conclusion:The Bcl2 positivity had a distinct OS and DFS (Disease free survival). The expression of p53 and Bcl2 are inversely correlated to clinical outcomes in breast cancer.

In Vietnam, little is elucidated in scientific literatures about the mental health of caregivers of people with cancer. We conducted a cross-sectional study to report the situation and correlates of self-reported psychological distress among caregivers of cancer patients in Vietnam in 2019. Multiple logistic and linear regression analyses were performed. A total of 16.5% of the study participants had psychological distress. Respondent’s mean score of negative emotion was 7.6 ± 2. Educational level and type of support were significantly associated with having psychological distress among caregivers. Gender, occupation, financial difficulty, treatment belief and social support significantly correlated to psychological distress level of caregivers.

Objective This study aimed to analyze the treatment outcome and toxicities, along with prognosis factors of patients with FIGO 2018 stage III cervical cancer treated with definitive concurrent chemoradiation. Methods A total of 83 stage III cervical cancer patients with good performance status (ECOG PS 0, 1) were treated with three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy (weekly cisplatin), followed by high-dose-rate (HDR) brachytherapy between January 2017 and March 2019 at Vietnam National Cancer hospital. Treatment outcomes and prognosis factors were assessed along with acute and late toxicities. Results The 3-year DFS was 67.8% and 3-year OS was 80.3%. On multivariate analyses, short axis of pelvic lymph node diameter of ≥ 15mm, invasion of the lower third of vagina and para-aortic lymph node metastasis were identified as adverse prognostic factors for DFS. The cumulative incidence rate of gastrointestinal and genitourinary toxicity (≥ grade 2) at the 3-year follow-up were 29.6% and 11.6%, respectively. Conclusions 3D CRT and HDR brachytherapy with concurrent chemotherapy is an effective treatment, with acceptable toxicity for FIGO 2018 stage III cervical cancer in Vietnam. .

Background: Tumor budding (Bd) has been demonstrated to be a promising prognostic factor in many carcinomas and in gastric cancer. It may represent an optimal additional parameter that is helpful for risk stratification in gastric adenocarcinoma. Hence, the present research was designed to predict the survival outcomes of gastric cancer in Vietnam, applying the tumor budding criteria of the International Tumor Budding Consensus Conference (ITBCC) 2016. Methods: The present study was conducted on 109 gastric cancer patients who underwent surgery but did not receive neo-adjuvant chemotherapy from 2012 to 2015. The patients’ clinicopathological features were recorded. Bd was evaluated according to the 2016 ITBCC criteria and classified as Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (≥10 buds) grades, in addition to being categorized into 2 main Bd groups: low (Results: Of all the patients, 22.9% were classified as Bd1, 31.2% as Bd2, and 45.9% as Bd3 grades. Furthermore, 54.1% patients were categorized into the low and 45.9% into the high Bd groups. Patients with Bd1 and Bd2 grades (the low Bd group) exhibited the best prognosis, with 5-year overall survival (OS) rates of 85.7%, 90.8%, and90.3%, respectively. Patients with Bd3 grade (the high Bd group exhibited the worst prognosis, and none of them lived for 5 years (p < 0.001). Similar to OS rates, disease-free survival (DFS) rates markedly reduced from the Bd1 to Bd3 grade: Bd1, 95.0%; Bd2, 84.7%; and Bd3, 0% (p < 0.001). Conclusion: Patients with different gastric cancer Bd grades exhibited significantly different OS and DFS rates. The present study findings suggest that the ITBCC criteria can be used to stratify Bd for the treatment and prognosis of gastric cancer patients in Vietnam.

Background: Despite the current evidence of a high prevalence of forgetfulness in middle-aged individuals, and the evidence of a link between midlife memory complaints and biological changes in the brain, no previous study has yet investigated midlife forgetfulness in relation to risk of dementia in old age. Aims: We investigated whether midlife forgetfulness was an indicator of an increased risk of dementia in old age. Methods: We used data from 3,136 employed men and women who participated in the Danish Work Environment Cohort Study in 1990. These data were linked to Danish national registers. Participants were asked whether their closest relative had ever told them that they were forgetful. Incidence rate ratios (IRR) were estimated using Poisson regression analysis. Results: At baseline, 749 (24%) study participants were categorized as forgetful, and 86 (2.7%) participants were diagnosed with dementia during a total of 31,724 person-years at risk. After adjusting for sociodemographic factors, comorbidities, and work-related factors, midlife forgetfulness was associated with a higher risk of dementia (IRR = 1.82; 95% CI: 1.12–2.97). Conclusions: This study is the first to investigate midlife forgetfulness and dementia, and the results suggest that midlife forgetfulness is an early indicator of an increased risk of dementia in old age.

PURPOSE: Only a few studies have investigated the impact of negative aspects of social relations on cognitive function, and they have shown mixed results. Conflicts at work are part of the negative aspects of social relations, but the impact of experiencing conflicts at work has not yet been investigated as a risk factor for dementia. Therefore, we investigated whether experiencing prolonged or serious conflicts with a supervisor or colleagues at work was associated with incident dementia in old age.METHODS: We analyzed data of 6,436 men and women from the third survey of the Copenhagen City Heart Study. At baseline in 1991-1994, the participants reported whether they had ever had a prolonged or serious conflict at work. The participants were followed until 2014. We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI).RESULTS: After adjusting for potential confounders, the IRR for dementia was 1.53 (95% CI 0.77-3.03) among participants who had reported having prolonged or serious conflicts both with a supervisor and colleagues compared with participants who had never had such conflicts. In separate analyses stratified by sex, the IRRs were 2.14 (95% Cl 0.97-4.71) for men and 0.98 (95% Cl 0.29-3.32) for women.CONCLUSIONS: Our findings did not support an overall association between experiencing prolonged or serious conflicts at work and incident dementia. However, because of the large differences in the point estimates for men and women, future research could aim at investigating potential sex differences regarding the association between conflicts at work and dementia.

Background The Philippines is experiencing rapid demographic aging and with it, the dementia epidemic. Prevalence of dementia and associated risk factors have not been studied in the Philippines. Objectives The study aimed to provide a reliable estimate of dementia prevalence and identify associated risk factors in the Filipino population. Methods 1460 participants 60 years and older were randomly selected from the Marikina City's senior registry. A multidisciplinary team (nurse, psychologist, and neurologist) administered a comprehensive assessment to the study population: health history, neurological examination, Geriatric Depression Scale, Neuropsychiatric Inventory, Disability Assessment for Dementia, Alzheimer's Disease 8, and Clinical Dementia Rating Scale. The neurologist analyzed all clinical data to diagnose dementia based on the DSM-IV criteria, Alzheimer's Disease (AD) on the NINCDS-ADRDA criteria, vascular dementia (VaD) on the Hachinski Ischemic Scale, cognitive impairment no dementia (CIND) on a CDR score of 0.5 and not fulfilling DSM-IV criteria for dementia. Risk factors were correlated with dementia prevalence using multivariate binary logistic regression. Results 1460 persons were randomly selected. 1367 agreed to participate and underwent all assessments. The response rate was 93.6%. Dementia prevalence was found to be 10.6% (95% CI 9.0 to 12.4) with the breakdown 85.5% AD, 11.7% VaD, and 2.7% other dementias. In this population, 82.0% of men and 70.4% of women had at least one cardiovascular risk factor (hypertension, diabetes, dyslipidemia, smoking), which was associated with VaD prevalence but not AD. Conclusion The prevalence of dementia, CIND, and cardiovascular risk factors are high in the Philippines.

Objectives: We investigated if perceived stress in midlife increased the risk of dementia. Furthermore, we explored differences between subgroups related to sex, age and employment status when repo...

Mesectodermal leiomyoma of the ciliary body is exceptionally a rare intraocular tumor and apparently benign tumor is considered embryologically originating from the neural crest (ectoderm). Clinically, it is challenging identifying the mesectodermal leiomyoma and the most important differential diagnosis is uveal melanoma. We reported two females who presented the enlarged mesectodermal leiomyomas of the ciliary body of the right eye. The first patient was made newly diagnosed and the remaining one was locally recurred after 10-year the first surgeon. Histopathological and immunohistochemical findings demonstrated the mesectodermal leiomyoma. Early diagnosis and timely radical surgery is necessary to avoid ocular complications and local recurrence.

ObjectiveShift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia.DesignA longitudinal study.SettingDenmark.Participants3435 occupationally active men and women from the general working population.MethodsWork schedule covered day work (reference) and shift schedules without/with night work. Working hours covered ResultsWe identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38–44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working ConclusionWe did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard.

Opisthorchiasis is a serious public health problem in East Asia and Europe. The pathology involves hepatobiliary abnormalities such as cholangitis, choledocholithiasis and tissue fibrosis that can develop into cholangiocarcinoma. Prevention of infection is difficult as multiple social and behavioral factors are involved, thus, progress on a prophylactic vaccine against opisthorchiasis is urgently needed. Opisthorchis viverrini tetraspanin-2 (Ov-TSP-2) was previously described as a potential vaccine candidate conferring partial protection against O. viverrini infections in hamsters. In this study, we generated a recombinant chimeric form of the large extracellular loop of Ov-TSP-2 and O. viverrini leucine aminopeptidase, designated rOv-TSP-2-LAP. Hamsters were vaccinated with 100 and 200 µg of rOv-TSP-2-LAP formulated with alum-CpG adjuvant via intraperitoneal injection and evaluated the level of protection against O. viverrini infection. Our results demonstrated that the number of worms recovered from hamsters vaccinated with either 100 or 200 µg of rOv-TSP-2-LAP were significantly reduced by 27% compared to the adjuvant control group. Furthermore, the average length of worms recovered from animals vaccinated with 200 μg of rOv-TSP-2-LAP was significantly shorter than those from the control adjuvant group. Immunized hamsters showed significantly increased serum levels of anti-rOv-TSP-2 IgG and IgG1 compared to adjuvant control group, suggesting that rOv-TSP-2-LAP vaccination induces a mixed Th1/Th2 immune response in hamsters. Therefore, the development of a suitable vaccine against opisthorchiasis requires further work involving new vaccine technologies to improve immunogenicity and protective efficacy. This research was supported by Faculty of Medicine, Khon Kaen University, a project grant from the National Health and Medical Research Council of Australia (NHMRC), grant identification number APP1085309, and the National Cancer Institute, National Institute of Health, grant number 2R01CA164719-06A1. Sí

Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance.A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs.At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis.The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.

Background Influenza constitutes a leading cause of morbidity and mortality worldwide. There is limited information about the aetiology of infection presenting clinically as influenza in hospitalised adults and children in South-East Asia. Such data are important for future management of respiratory infections. Objectives To describe the aetiology of infection presenting clinically as influenza in those hospitalised in South-East Asia. Methods Respiratory specimens archived from July 2008 to June 2009 from patients hospitalised with suspected influenza from Indonesia, Thailand and Vietnam were tested for respiratory viruses and atypical bacteria by polymerase chain reaction. Results A total of 1222 patients’ samples were tested. Of 1222, 776 patients (63·5%) were under the age of 5. Viruses detected included rhinoviruses in 229 of 1222 patients (18·7%), bocaviruses in 200 (16·4%), respiratory syncytial viruses in 144 (11·8%), parainfluenza viruses in 140 (11·5%; PIV1: 32; PIV2: 12; PIV3: 71; PIV4: 25), adenovirus in 102 (8·4%), influenza viruses in 93 (7·6%; influenza A: 77; influenza B: 16) and coronaviruses in 23 (1·8%; OC43: 14; E229: 9). Bacterial pathogens were Mycoplasma pneumoniae (n = 33, 2·7%), Chlamydophila psittaci (n = 2), C. pneumoniae (n = 1), Bordetella pertussis (n = 1) and Legionella pneumophila (n = 2). Overall, in-hospital case fatality rate was 29 of 1222 (2·4%). Conclusion Respiratory viruses were the most commonly detected pathogens in patients hospitalised with a clinical suspicion of influenza. Rhinovirus was the most frequently detected virus, and M. pneumoniae, the most common atypical bacterium. The low number of detected influenza viruses demonstrates a low benefit for empirical oseltamivir therapy, unless during an influenza outbreak.

OBJECTIVE: Self-assessment of health is a strong and independent predictor of mortality for cognitively intact people. Because the ability of patients with dementia to rate their own health is questionable, caregiver-rated health for patients may serve as a proxy. The authors aimed to validate and compare self- and caregiver-rated health for patients with dementia as independent predictors of patient mortality.METHODS: This was a post-hoc analysis of data from The Danish Alzheimer's Disease Intervention Study, a randomized controlled trial of psychosocial intervention for 330 patients with mild dementia and their caregivers with a 36-month follow-up. Patients and caregivers rated patients' health on the Euro Quality of Life Visual Analog Scale (EQ-VAS) from 0 (worst) to 100 (best). The ability of self- and caregiver-rated health for the patient to predict patient mortality was analyzed as hazard ratios (HRs) from Cox proportional hazard regression models, controlling for age, depression, comorbidities, functional level, quality of life, and randomization group.RESULTS: Compared with the highest scores of 80-100, caregiver-rated EQ-VAS scores CONCLUSION: Caregiver-rated health for patients with mild dementia using the EQ-VAS was shown to be an independent predictor of patient mortality with a dose-response pattern but patient-rated EQ-VAS was not.

This paper documents how the implementation of forest tenure policy affects the decision-making of farmers in mangrove-shrimp farming systems with regard to their access to and management of mangrove forest in Ca Mau, Mekong Delta, which is the largest remaining mangrove forest in Vietnam. Policies on land allocation, land tenure and use-rights are important since they potentially promote sustainable mangrove-shrimp management. Forest management policy in Vietnam has been changed to promote equality of benefit sharing among stakeholders and devolved State forest management to the household level. However, to what extent its implementation can stimulate both mangrove conservation and livelihood improvement is still being debated. We use access and its social mechanisms to investigate how State Forest Companies (FC) and farmers can benefit from mangrove exploitation. The study was conducted from September 2008 to August 2010 using both qualitative and quantitative methods and using a participatory approach. After group discussions and in-depth interviews with a wide range of stakeholders, we interviewed 86 households in four communities using structured questionnaires. Results show the imbalance in access to finance, markets, and differences in authority between the two actors, farmers and FC. The discussion focuses on the possibilities of “win–win” outcomes, i.e. land tenure regimes promoting the devolution of sustainable forest management to farm households to balance benefits of both mangrove conservation and livelihood improvement.

Depression and dementia are commonly concurrent and are both associated with increased mortality among older people. However, little is known about whether home-dwelling patients newly diagnosed with mild dementia coexisting with depressive symptoms have excess mortality. We conducted a post hoc analysis based on data from the Danish Alzheimer’s Intervention Study of 330 individuals who were diagnosed with mild dementia within the past 12 months. Thirty-four patients were identified with major depressive symptoms (MD-S) at baseline. During the 3-year follow-up period, 56 patients died, and, among them, 12 were with MD-S at baseline. Multivariable analysis adjusting for the potential confounders (age, sex, smoking status, alcohol consumption, education, BMI, household status, MMSE, CCI, QoL-AD, NPIQ, ADSC-ADL, medication, and RCT allocation) showed that patients with MD-S had a 2.5-fold higher mortality as compared to the patients without or with only few depressive symptoms. Our result revealed that depression is possibly associated with increased mortality in patients with mild dementia. Given that depression is treatable, screening for depression and treatment of depression can be important already in the earliest stage of dementia to reduce mortality.

OBJECTIVES: The aim of this study was to investigate the effect of shift work and long working hours in midlife on the risk of dementia in old age. METHODS: The present study comprised 4766 participants from the Copenhagen Male Study. We used information on shift work (collected in 1970–1971 and 1985–1986), long working hours defined as >45 hours per week (collected in 1970–1971), socioeconomic status, sleep, stress, and cardiovascular risk factors. Information about dementia diagnoses was obtained from registers. Participants were followed until 2014 (mean length of follow-up was 17.8 years). We employed Poisson regression for the survival analyses and estimated incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS: We found no statistically significant association between shift work (IRR 0.86, 95% CI 0.70–1.05) or long working hours (IRR 0.97, 95% CI 0.79–1.19) and dementia. Adjustment for potential confounders and mediators did not change the estimates. Working shifts at both time points of exposure assessment was not associated with a higher incidence of dementia compared with non-shift workers at both time points (IRR 0.99, 95% CI 0.69–1.42). The lowest incidence of dementia was observed among participants who reported shift work at one time point (only in 1985–1986: IRR 0.44, 95% CI 0.16–1.23 and only in 1970–1971: IRR 0.58, 95% CI 0.31–1.11). CONCLUSION: We did not find positive evidence of an association between shift work or long working hours and the incidence of dementia, but the negative findings may reflect the crude assessment of shift work and long working hours, which is a major limitation of the present study.

Shrimp farming is a major livelihood activity in the Mekong Delta in the southernmost part of Vietnam. The Vietnamese government has promoted shrimp farming as a way to reduce poverty, provide employment opportunities and increase exports to support economic development. The shrimp farming system, however, is economically and ecologically risky and may negatively influence the environment and the sustainability of local people's livelihoods. Because very little is known about the diversity of strategies people employ to deal with these risks, a study was performed in the Mekong Delta across four shrimp farming systems: (1) improved extensive non-forest, (2) mixed mangrove-shrimp, (3) intensive and (4) clustered intensive. The risks and livelihood strategies that were encountered differed systematically across the four farming systems. It was found that the uncertainties that the shrimp farmers faced include limited access rights to the mangrove forest, crop failure due to regular occurrence of shrimp disease, high investment costs and volatile markets for shrimp. Shrimp farmers have created several strategies for coping with these uncertainties, including redesigning farms, producing salt, changing the species farmed from Penaeus monodon to Penaeus vannamei, becoming involved in a cooperative cluster, integrating aquaculture and agriculture, and farming shrimp by organic standards.

Fishery in Ca Mau, Viet Nam’s most southern province in the Mekong Delta, plays locally an important role for human nutrition and has great potentials for export earnings. The overexploitation of inshore fishing resources is a major problem in Viet Nam’s coastal areas along the Mekong Delta. As a result, the Catch per Unit of Effort of small-scale fishing enterprises has decreased, undermining the sustainability of livelihoods of fishing families. The paper focuses on livelihoods’ strategies and diversification in the context of overexploitation and exhaustion of near-shore resources in relation to fishery policies. The results show that overexploitation is unavoidable in near-shore waters because of the lack of enforcement of fishery regulations for offshore vessels and the limitation of alternative sources of income and opportunities for livelihood diversification for small-scale fishers. The present policies to prevent overexploitation need to be reconciled with livelihood sustainability and fishery management, resource conservation and socio-economic goals

Background/Aims: Diagnostic evaluation of dementia for ethnic minority patients may be challenging. This study aimed to evaluate the quality of diagnostic evaluation of dementia for patients from ethnic minorities in Denmark. Methods: The Danish national hospital registers were used to identify patients from the main ethnic minority groups in Denmark, who were diagnosed with dementia in the period 2005–2007. Three raters independently reviewed the patients’ medical records. Data were compared to data from a previous similar study in the general Danish population. Results: Fifty-seven medical records were reviewed. An acceptable diagnostic workup was documented in only 23% of the patients. Dementia diagnosis was confirmed in 35%. Significant differences in the quality of the diagnostic evaluation were found between patients from ethnic minorities and the general population. Conclusion: There are significant ethnic disparities in the quality of diagnostic evaluations and outcome of dementia in the secondary healthcare sector.

Background: To study the trend of diagnosing dementia in the secondary health care sector over time, we conducted a nationwide longitudinal study of the incidence and prevalence of registered dementia diagnoses in the Danish national hospital registers. Methods: All Danish residents born before 1964 and alive at their 40th birthday were followed from their 40th birthday or January 1, 1970, whichever came later, to the date of the first dementia diagnosis recorded in the hospital registers, the date of emigration, date of death, or December 31, 2004, whichever came first. The age- and period-specific incidence and prevalence of dementia were calculated and compared to estimates from large community-based cohort studies in Europe. Results: The study population consisted of 4,723,838 persons with 81,090,583 person-years of follow-up. 154,152 dementia cases were registered from 1970 to 2004. The incidence and prevalence of registered dementia diagnoses showed an increasing trend over time. In 2003, the age-standardized incidence rate ratio was 0.66 when compared to estimates from large European community-based cohort studies. Conclusions: The study shows a marked improvement in the diagnostic rate of dementia in secondary care over time and indicates that this sector can be an important point of entry for patients with dementia.

In the Mekong Delta coastal zone, decision makers must weigh trade-offs between sustaining the shrimp sector and thus ensuring economic development, while also promoting sustainable, environmentally friendly practices and planning for climate change adaptation. This study investigates future scenarios for development of shrimp aquaculture using a spatially explicit, agent-based model (ABM) simulating farmers' production system choices. A role playing game (RPG) with farmers was used to calibrate and validate the model. Four scenarios, representing different visions of aquaculture in the next 15 years, were elaborated with decision makers before discussing the different outputs of the model. Iterative consultation with farmers helped to fine-tune the model and identify key parameters and drivers in farmers' decision-making. The recursive process allowed us to construct a model that validly represents reality. Participants stated that use of the RPG improved their insight for planning. Results of the scenarios indicate that (i) intensification of production is unsustainable, (ii) market-based incentives are too limited to stimulate development of an integrated mangrove–shrimp production system and (iii) climate change will cause rapid decline of production in the absence of adaptation measures. RPG appeared to be a valuable method for formalizing local farmers' knowledge and integrating it into the planning approaches used by decision makers. The ABM, thus, can also be considered a medium or communication tool facilitating knowledge-sharing between farmers and decision makers.

Objective Among dementia professionals in several European countries, it is believed that dementia is under-diagnosed and under-treated to a greater extent among ethnic minorities than in the native population. It is unknown whether this belief holds true. The objective of this study was to compare the prevalence of register-based dementia diagnoses in the largest ethnic minority groups in Denmark with the prevalence of register-based dementia diagnoses in the general Danish population. Methods By linking the Danish hospital registers with the Danish Civil Registration System, nationwide dementia cases for three main ethnic minorities were identified. Age- and gender-specific prevalence rates for dementia were calculated and compared to previously published data for the general population. Results The study population consisted of 68 219 persons aged 20 and older. A total of 174 dementia cases were identified. The mean age at diagnosis was 57.7 years (SD = 16.2). Compared to the general population, there was a higher prevalence of dementia among those younger than 60 years, and a markedly lower prevalence of dementia among those 60 years and older. Conclusions Dementia is under-diagnosed to a greater extent among ethnic minorities in the age group 60 years and older but is over-diagnosed in the age group younger than 60 years. Several factors may contribute to this pattern, including cultural differences in help-seeking behaviour, and problems in navigating the health-care system. Furthermore, cross-cultural assessment of dementia can be difficult because of language barriers and cultural differences. Copyright © 2010 John Wiley & Sons, Ltd.

Background: This study aimed to determine whether there is an association between hysterectomy and dementia. Methods: All female Danish residents born before 1966, alive on their 40th birthday and without a dementia diagnosis prior to 1977 (n = 2,313,388) were followed from January 1, 1977, or the age of 40, whichever came later, until dementia diagnosis, death, emigration or December 31, 2006, whichever came first. The relative risks (RR) for developing dementia in women with hysterectomy/oophorectomy compared to referent women were calculated. Results: Overall, hysterectomy did not increase the risk of dementia. When stratified by age at dementia diagnosis, hysterectomy was associated with an increased risk for early-onset dementia before the age of 50: hysterectomy alone (RR = 1.38, 95% confidence interval (CI) = 1.07–1.78), with unilateral oophorectomy (RR = 2.10, 95% CI = 1.28–3.45), with bilateral oophorectomy (RR = 2.33, 95% CI = 1.44–3.77). The younger the age at hysterectomy/oophorectomy, the greater was the risk. Conclusions: Although statistically significant, the association between premenopausal hysterectomy and early-onset dementia is uncertain due to study limitations. Premenopausal bilateral oophorectomy is associated with a higher risk, suggesting a dose effect of premature estrogen deficiency on dementia. The age-dependent effect suggests that the younger brain is probably more vulnerable to estrogen deficiency.

Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time with a dementia diagnosis in the last 6 months of 2003. The patients’ medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety-seven journals were available for review and 51 patients were interviewed. A registered diagnosis of dementia was found to be correct in 169 (85.8%) cases. Regarding dementia subtypes, the degree of agreement between the registers and the results of the validating process was low with a kappa of 0.36 (95% CI 0.24–0.48). Conclusion: The validity of dementia syndrome in the Danish hospital registers was high and allows for epidemiological studies about dementia. Alzheimer’s disease, although underregistered, also had a good validity once the diagnosis was registered. In general, other ICD-10 dementia subtypes in the registers had a low validity and are less suitable for epidemiological research.

Background Although, medicinal plants have been important for women’s health historically, the knowledge about such use during pregnancy in developing countries is limited. This is the first quantitative, ethnobotanical study on Malian women’s use of and attitudes towards the use of medicinal plants during pregnancy. The aim of the study was to describe Malian women’s use of medicinal plants during pregnancy according to indications and to evaluate the potentially safety of such use. The overall aim was to preserve valuable information about medicinal plants for women’s reproductive health for the future. Methods Data was collected through structured interviews of 209 pregnant women or mothers in three health care centers in Mali. The women were interviewed about their uses of medicinal plants during pregnancy and their attitudes to such use. Nine specific medicinal plants commonly used in Mali and treatment of eleven common ailments in pregnancy were specifically queried about. Results In total, 79.9 % had used medicinal plants during pregnancy. Only 17 women (8.5 %) had received a recommendation from a traditional practitioner (TP). The most commonly used medicinal plants were Lippia chevalieri (55.5 %), Combretum micranthum (39.7 %), Parkia biglobosa (12.0 %) and Vepris heterophylla (8.1 %). The most common reasons for use were for well-being (37.7 %), symptoms of malaria (37.1 %) and ”increased salt-elimination” (to reduce edema) (19.2 %). For treatment of symptoms of malaria and urinary tract infections during pregnancy, the women’s choices of medicinal plants agreed with those previously reported from interviews with TPs. Almost 30 % believed that medicinal plants had no adverse effects for the mother. Conclusion This study showed an extensive use and knowledge of medicinal plants during pregnancy in three regions in Mali. However, exclusive use of medicinal plants as treatment of malaria and urinary tract infections during pregnancy may pose a health risk for the mother and her unborn child. A wider collaboration with TPs, with local communities and conventional health workers of the health care centers, on the safe use of medicinal plants, is important to promote safer pregnancies and better health care for pregnant women and their unborn infants in Mali.