Country-wide Survey Research Articles

Assessing access to surgical care in Nepal via a cross-sectional, countrywide survey

Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool. Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ(2) test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy. Of respondents with a surgical condition (n=1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P<.001) and median transport costs to secondary and tertiary centers (P<.001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66-1.80, P<.01). Those without transport money were less likely to access care at any facility in all analyses (P<.01). The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration.

Spatial and temporal country-wide survey of temephos resistance in Brazilian populations of Aedes aegypti.

The organophosphate temephos has been the main insecticide used against larvae of the dengue and yellow fever mosquito (Aedes aegypti) in Brazil since the mid-1980s. Reports of resistance date back to 1995; however, no systematic reports of widespread temephos resistance have occurred to date. As resistance investigation is paramount for strategic decision-making by health officials, our objective here was to investigate the spatial and temporal spread of temephos resistance in Ae. aegypti in Brazil for the last 12 years using discriminating temephos concentrations and the bioassay protocols of the World Health Organization. The mortality results obtained were subjected to spatial analysis for distance interpolation using semi-variance models to generate maps that depict the spread of temephos resistance in Brazil since 1999. The problem has been expanding. Since 2002-2003, approximately half the country has exhibited mosquito populations resistant to temephos. The frequency of temephos resistance and, likely, control failures, which start when the insecticide mortality level drops below 80%, has increased even further since 2004. Few parts of Brazil are able to achieve the target 80% efficacy threshold by 2010/2011, resulting in a significant risk of control failure by temephos in most of the country. The widespread resistance to temephos in Brazilian Ae. aegypti populations greatly compromise effective mosquito control efforts using this insecticide and indicates the urgent need to identify alternative insecticides aided by the preventive elimination of potential mosquito breeding sites.

Culture, health, gender and coffee drinking: a Costa Rican perspective

Purpose – The purpose of this paper is to identify the effect of culture, gender and perceived health benefits on coffee drinking in Costa Rica. Design/methodology/approach – A telephone survey (n=1,328) was conducted in the province of San Jose, where the capital city is located. This location has a population of 845,000, with a 99 per cent, confidence, 1 per cent error and 50 per cent response distribution, the total usable surveys were 1,199. The analytical procedure, consisted of three steps; instrument validation, consumer profile development and developing ordinal logistic modelling. Findings – The total α was estimated at 0.71. The coffee consumer profile is described but consisted of 52 per cent female and 48 per cent male with 77 per cent receiving a secondary education. The factors influencing coffee drinking by Costa Ricans, are in order of importance: first gender followed by family as a source of information, health, amount spent, aroma, anti-migraine effect, family tradition, flavour and energizing effect. H1 – health, culture and gender influence the frequency of coffee consumption in Costa Rica is accepted; H2 – the importance of the health factor varies with gender is accepted and H3 – culture is an important factor in determining coffee consumption is also accepted. Research limitations/implications – The study was only conducted in the province of San Jose. This is considered the urban heart of the country urban but its finding should not be extrapolated to the entire country. A rural/urban comparison may be needed. Practical implications – The results suggest that a country wide survey may be useful in providing information for differential coffee marketing strategies. Originality/value – The material is the first of its kind in the Central American region and may help orient other countries of the area.

Antibiotic Prescription Knowledge of Dentists in Kingdom of Saudi Arabia: An Online, Country-wide Survey.

Dentists are probably contributing to the development of bacterial resistance to certain antibiotics. Campaigns to promote prudent use of antibiotics in dentistry are, thus, needed but require proper identification of dentists' knowledge gaps. The objective here was to comprehensively evaluate antibiotic prescription knowledge of dentists in Saudi Arabia. A link to an online, previously validated questionnaire was emailed to 5199 dentists registered with the Saudi Dental Society. The questionnaire comprised 42 scorable items measuring antibiotics prescription knowledge in five different domains in addition to nonscorable questions regarding first-choice antibiotics and previous attendance of a course/workshop about antibiotic prescription. Each correct answer was given one mark. Mean scores were calculated as percentages and categorized as good (> 80%), intermediate (60-80%), or poor (< 60%). The response rate was 9.4%; however, only 373 (7.2%) fully completed the questionnaire. Around half of the participants (52%) reported prescribing amoxicillin/clavulanate as the first-choice antibiotic; 62% reported attending a course/workshop in the last 5 years. The average knowledge score was 69%, being highest for nonclinical indications (79%) and lowest for prophylactic use (56%). The worst per-item scores were noted for rheumatic heart disease (19%), trismus (28%), surgical extraction (30%), apicectomy (31%), and periodontal abscess (33%). Female dentists, dentists in governmental sector, and those with higher qualifications had significantly better knowledge. The level of knowledge was hardly intermediate and several deficits were identified, indicating an urgent need for educational campaigns and provision of guidelines promoting rational use of antibiotics by dentists. Irrational use of antibiotics by dentists can contribute to the problem of antibacterial resistance.

Investigating the Demand of Small Hotel and Restaurant Businesses for Bank Financing: The Case of Turkey

The literature argues that small businesses are highly dependent on bank financing due to their inability to access the capital markets. We paint a different picture in this paper that analyzes the demand of small hotel and restaurant businesses for bank financing in Turkey. The results of a countrywide survey done with the owners/managers of the businesses that were responsible for the financial affairs are used for the analysis. We find that the majority of the businesses in the sample did not make a loan application in the last three years. Moreover, the tendency of firms to apply for bank financing did not change with age. When asked whether their firm were in a position not to apply for a bank loan in the last three years even if they needed bank financing with the idea that the application would be rejected, nearly all the participants responded negatively. The majority of the owners/managers of the firms declared that their firm’s demand for bank loans would increase with lower interest rates and lower collateral requirements. On the other hand, firms that would have a higher demand for bank loans if there were a reduction in interest rates and collateral requirements were younger firms.

P-131: Arterial hypertension and its risk-factors in women population

Objectifs Arterial hypertension (AH) – - a major risk factor for the cardiovascular diseases, and this is a priority for the population of Georgia, which is among the top five countries with the highest rates of high blood pressure., according WHO in the 2002, According to a recent countrywide survey (STEPs-2010) the prevalence of AH is 33.4 % in 18-64 years old population The goal of survey – AH and its risk factors in the spread of the latest figures reveal the women’s population. Methodes The target population – university teachers. Sample size – 300; Sample frame – Women population in the Tbilisi State University. Survey tools – structured quantitative questionnaire, KAB qualitative research elements (knowledge, attitude, behavior), blood pressure measurement, antro-pometry, 12 lead ECG Survey results with the Minnesota Codes, HADS – Anxiety and Depression Hospital Scale. Resultats • Response rate −48,9%; • The average age −51, 2%; • Prevalence of AH −58.9%; • Overweight −33.6%; • Obesity −29.2%; • Excessive salt intake −28.9%; • Tobacco use −23.0%; • Hypodinamy −40.3%; • Complicated obstetric history −43.7%; • Symptoms of anxiety and depression −65.5%; • Defects in management of AH (wrong attitude to the problem, lack of knowledge of normal blood pressure values, lack of information about benefits of long-term treatment, etc.) −94,8%. Conclusion To improve the AH control, in the first place provides a full understanding their clinical condition for individuals with the hypertension or its risks – for successful management indicators. Last improves incentives for participation in such screening surveys, especially asymptomatic individuals

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey.

To determine the unmet anaesthesia need in a low resource region. Surgery and anæsthesia services in low- and middle-income countries (LMICs) are under-equipped, under-staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of unmet need. Without such an understanding it is impossible to formulate solutions. Therefore, we re-examined Surgeons OverSeas (SOSAS) unmet surgical need data to extrapolate unmet anaesthesia need. For the untreated surgical conditions identified by SOSAS, we assigned anaesthetic technique required to carry out the procedure. The chosen anaesthetic was based on common practice in the region. Procedures were categorized into minimal anaesthesia, spinal anæsthesia, regional anaesthesia, ketamine/monitored anaesthesia care (MAC), and general endotracheal anæsthesia (GETA). Ninety-two per cent (687 of 745) of untreated surgical conditions in Sierra Leone would require some form of anaesthesia. Seventeen per cent (125 of 745) would require MAC, 22% (167 of 745) would require spinal anaesthesia, and 53% (395 of 745) would require GETA. Analyses such as this can provide guidance as to the rational and efficient production and distribution of personnel, drugs and equipment.

Ampelographic and genetic characterization of an initial Israeli grapevine germplasm collection

The Holy Land has a long history of winemaking, widely mentioned in ancient scripts. The Muslim occupation of this region, starting in the 7th century initiated a wine consumption prohibition, resulting in the abandonment of most wine varieties. The renewing of Israeli wine industry in the 19th century was based on international cultivars. Between the years 2011-2014 we conducted a country-wide survey towards the collection and assessment of an Israeli grapevine germplasm collection, including for the first time Vitis vinifera L. subsp. sylvestris (Gmelin) Hegi accessions. The collected population consists of 148 accessions which revealed 61 different genetic profiles when analysed at 9 SSR loci. Ten genotypes consistently matched the profiles of some Israeli and Palestinian accessions reported in previous studies. The phylogenetic analysis showed how the V. vinifera subsp. sylvestris accessions, all collected in the north of Israel around water sources, are well distinguished from the V. vinifera subsp. sativa group. Based on ampelographic evaluation we concluded that most V. vinifera L. subsp. sativa accessions have characteristics of the proles Orientalis. We believe that by our efforts of collecting and assessing these populations, an array of new-old grapevine varieties suited for quality wine production would be offered, reconnecting the Israeli wine industry to its historical origins.

Online Political Participation: A Study of Youth Usage of New Media

The Internet is considered a huge development in human civilization. It is literally considered as a practical key or essential to human development and social advancement causing massive innovation in the world. Over the years, the advent of new media has permeated most aspects of our lives, especially that of the young generation. It is against this background that this paper aims to analyse the present use of the new media by youth to gauge their usage in relation to political participation. This study is a country wide survey covering Peninsula and East Malaysia. For sampling purposes the country is divided into six zones. A survey research using questionnaire as instrument was used to obtain data. Prior to the actual survey, a pilot study was first conducted. Some 1182 respondents age between 18 and 25 were randomly sampled from the six zones and selection of samples was based on ethnic ratio. The data was analysed descriptively and inferentially using SPSS 20.0 From the results, majority of the respondents, 89% are social media users having a social media account. A discouraging trend with regard to participation is the very low level of giving comments on general societal issues ranging from social issues, the environment to politics. The youth are more inclined to using the new media for entertainment and social networking. It is time to use the new media to engage with community leaders and politicians and comment on issues related to political issues. DOI: 10.5901/mjss.2015.v6n4s3p88

Assessing the extent and the environmental drivers of Eucalyptus globulus wildling establishment in Portugal: results from a countrywide survey

Tasmanian blue gum (Eucalyptus globulus) has been increasingly used in forestry outside its native range, and is nowadays one of the most important pulpwood species in the world. E. globulus has great economic importance in many countries, and in Portugal it has recently become the most widespread tree species. However, there is also an increasing concern about the potential ability of eucalypts to naturally establish from seed (wildling establishment), because of negative ecological and economic impacts this could cause. The natural establishment of this fast-growing exotic species may have undesirable consequences, but little is known about its distribution, or which are the factors influencing its occurrence. In order to investigate these issues, we characterized wildling occurrence and abundance along 3111 roadside transects adjacent to eucalypt plantations distributed throughout continental Portugal. Eucalypt wildlings were found in 60 % of the sampled transects and across all natural regions, with densities ranging from 0 to 10,000 plants ha−1 (mean = 277 plants ha−1). The potential influence of environmental variables on wildling establishment from plantations was assessed using boosted regression trees. The abundance of wildlings was found to be primarily affected by precipitation and distance from the sea (used as a surrogate of thermal amplitude), although topography, frost occurrence and soil type also played a significant role. Plant density peaked at around 1500 mm of annual precipitation and it decreased with both decreasing and increasing precipitation, reaching the lowest values below 800 mm and above 2400 mm. Eucalypt wildlings were also more abundant in areas with milder temperatures, namely closer to the sea (with lower thermal amplitude) and with lower number of frost days. Finally, plant density also seemed to be favoured in areas with intermediate elevation, higher slope and with certain soil types (namely Cambisols and Podzols). Knowing the regions with higher wildling density and understanding the factors influencing plant establishment may help managers to establish and prioritize eventual control plans in regions with higher probability of recruitment.

South African consumers’ selection criteria for ornamental plants: a market perspective

The considerations of South African consumers in the ornamental plant sector can be interpreted as selection criteria and be used as a marketing tool to increase the use of indigenous plants for ornamental purposes locally. A countrywide survey was undertaken by sending questionnaires to role players in the formal ornamental plant industry. The data generated was statistically analysed to indicate market trends. The findings showed that modern-day consumers’ usually expect the new plant acquisitions to offer rapid results after planting, require low maintenance and complement their lifestyles. Consumers are often in search of new plant varieties and require more detailed information about the purchased plants. Further key plant attributes include attractive appearance, plant shape and size suitable to the intended surroundings, decent leafing and attractive flowering properties, and plants that attract wildlife. Consumers also value plants’ performance attributes such as longevity, a visual statement of good quality, good garden performance, and robust resistance to pests and diseases.

Community pharmacists' attitudes toward the quality and price of locally manufactured generic medicines in Kabul, Afghanistan.

ObjectiveTo report the attitudes of community pharmacists in Kabul, Afghanistan, concerning the quality and price of locally manufactured medicines.MethodsA cross-sectional descriptive study, involving a sample of 198 community pharmacists was conducted in Kabul city.ResultsWith a response rate of 100%, most of the respondents 70.7% had 11–20 years experience working as a pharmacist. About 84.3% of the pharmacists dispensed imported generic medicines from Pakistan, Iran, India, and the UAE. Only 15.7% of pharmacists were dispensing locally produced generics from Ariana (i.e. a local pharmaceutical manufacturer). Exactly half of the pharmacists 50.0% reported that locally produced generics were equally safe and efficacious as the imported generics, while 70.7% of the respondents believed that the local manufacturers of generic products had reliable logistics and supply systems. However, 80.8% of respondents expressed concerns regarding their own credibility when stocking the medicines. Consequently, 80.3% of the sample only stocked well-advertised domestic generics, which were likely to be seen by consumers as more credible alternatives. Most of the respondents 82.8% were confident that the locally manufactured generics were cheaper than imported generics. Interestingly, 80.8% of the respondents favoured the establishment of a national brand substitution policy. Furthermore, 90.4% of the respondents believed that it was the responsibility of the Afghan regulatory authorities to educate pharmacists on the quality of domestic generics.ConclusionAlthough community pharmacists had a positive attitude towards the quality and affordability of locally manufactured medicines, due to lack of resources most of their medicines are imported. Despite their positivity towards the quality and price of generics, the community pharmacists only dispense them to a minimal degree, because of low local production levels among other reasons. The findings call for improvements in the local pharmaceutical industry in order to substitute imported medicines with local generics. The government must take firm steps to formulate and reinforce pharmaceutical pricing and brand substitution policies to help in controlling healthcare costs. Further research, especially a countrywide survey, is required.

Perceptions of priority issues in the conservation of biodiversity and ecosystems in India

We report on the results of a country-wide survey of people’s perceptions of issues relating to the conservation of biodiversity and ecosystems in India. Our survey, mainly conducted online, yielded 572 respondents, mostly among educated, urban and sub-urban citizens interested in ecological and environmental issues. 3160 “raw” questions generated by the survey were iteratively processed by a group of ecologists, environmental and conservation scientists to produce the primary result of this study: a summarized list of 152 priority questions for the conservation of India’s biodiversity and ecosystems, which range across 17 broad thematic classes. Of these, three thematic classes—“Policy and Governance”, “Biodiversity and Endangered Species” and “Protection and Conservation”—accounted for the largest number of questions. A comparative analysis of the results of this study with those from similar studies in other regions brought out interesting regional differences in the thematic classes of questions that were emphasized and suggest that local context plays a large role in determining emergent themes. We believe that the ready list of priority issues generated by this study can be a useful guiding framework for conservation practitioners, researchers, citizens, policy makers and funders to focus their resources and efforts in India’s conservation research, action and funding landscape.

Uterine Prolapse in Nepal

BACKGROUND: Uterine prolapse is a significant public health problem in Nepal. The United Nations Population Fund reported a global prevalence between 2% to 20% in 2006 and approximately 10% for Nepali women. The aim of this study is to explore the prevalence of self-reported uterine prolapse in Nepal currently and determine the unmet surgical need. METHODS: A countrywide survey was done in Nepal using the Surgeons OverSeas Assessment of Surgical Need in May to June 2014. The two-stage cluster sampling was done randomly and population-weighted. χ2 tests and logistic regression assessed the associations. RESULTS: A total of 2,695 individuals (1,259 female) were surveyed, with a response rate of 97%; 957 (76%) women older than 18 years of age were used for this analysis. Fifty women stated they had experienced “something coming out of their vagina” (5.2%, 95% confidence interval [CI] 3.9–6.8%). The average parity and average age of first childbirth were 3.18 years (standard deviation [SD] 1.49) and 20.2 (SD 4.13) years, respectively. Of the 50 respondents, 20 (40%) reported urinary incontinence and 14 (28%) reported a chronic cough. Medical consultation occurred for 21 (42%) women with a prolapse, and two of those underwent major surgery, whereas 29 (58%) sought no health care at all. In adjusted regression analysis, the odds of prolapse in women with incontinence was 10.88 (P<.001, CI 5.10–23.23) and 3.52 in women with a history of chronic cough (P=.017, CI 1.24–9.93). CONCLUSION: Our estimation of uterine prolapse is 5.2%; these patients have high unmet need for evaluation and possible surgery.

Met and unmet needs for surgery in Sierra Leone: A comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012

Understanding a country's baseline operative actors and capacity is critical to improving the quality of services and outcomes. The aim of this study was to describe all operative providers and national operative production, to evaluate district and nationwide population rates for operations, and to estimate unmet operative need in Sierra Leone. A nationwide, exhaustive, retrospective, facility-based study of operative actors and surgical procedures was performed in Sierra Leone. Between January and May 2013, 4 teams of 12 medical students collected data on the characteristics of the institutions and of the operations performed in 2012. Data were retrieved from the log books of operations, anesthesia, and delivery. A total of 24,152 operative procedures were identified, equal to a national rate of 400 operative procedures per 100,000 inhabitants (district range 32-909/100,000, interquartile range 95-502/100,000). Hernia repair was the most common operative procedure at 86.1 per 100,000 inhabitants (22.4% of the total national volume) followed by cesarean delivery at 80.6 per 100,000 (21.0% of the total). Private, nonprofit facilities performed 54.0% of the operations, compared with 39.6% by governmental and 6.4% by private for-profit facilities. More than 90% of the estimated operative need in Sierra Leone was unmet in 2012. The unmet operative need in Sierra Leone is very high. The 30-fold difference in operative output between districts also is very high. As the main training institution, operative services within the governmental sector need to be strengthened. An understanding of the existing operative platform is a good start for expanding operative services.

How poverty restricts elderly Germans’ everyday travel

Many elderly people are affected by poverty. Furthermore, old-age poverty is likely to increase in the future. However, the everyday travel behaviour of disadvantaged elderly people is not a focus of German transport research. Against this background, the aim of this paper is to examine the everyday travel of older people (65+) at risk of poverty using the example of Germany. The empirical analysis is based on the country-wide survey “Mobility in Germany 2008”. A logistic regression has been undertaken alongside descriptive statistical analyses. The analysis shows that elderly people at risk of poverty are less mobile, are restricted in their access to transport, make significantly fewer trips and cover less distance daily than the group with above-average income. Furthermore, the trips of disadvantaged older women in low-status residential areas are rather concentrated on the local residential environment. The travel behaviour of elderly people is different depending on their income and gender. Disadvantaged older women in particular are characterised by limited mobility options and restricted everyday travel, which is concentrated to the local area even in deprived neighbourhoods. Further research has to examine if these restrictions lead to unsatisfied daily needs and could threaten the social participation of this growing group.

Identification of virulent entomopathogenic nematode isolates from a countrywide survey in India

Entomopathogenic nematodes (EPNs) have been successfully used in the USA and Europe for the biological management of insect pests, for example, invasive mole crickets, white grubs and other scarab larvae in lawns and turf, fungus gnats in mushroom, black vine weevil and Diaprepes root weevil in nursery plants and citrus, respectively. The use of EPNs in India is still in the preliminary stages. To find the best EPN isolates for use in local insect pest management programs, we previously collected 35 strains of EPNs from different parts of India, and screened them for insect infectivity at broad temperature range. Here we quantitated the virulence of seven EPN strains showing infectivity at broad temperature range against Galleria mellonella and Spodoptera litura. Three isolates of Steinernema and four isolates of Heterorhabditis were tested. The Heterorhabditis sp. Hmg3 was the most virulent EPN isolate among all the tested nematodes (LC50 = 16.1 infective juveniles (IJs)/insect larvae at 24 h), whereas the isolate Steinernema thermophilum Kr was the most virulent steinernematid (LC50 = 11.8 IJ/insect larvae at 36 h). These strains would be taken up for mass multiplication to facilitate their actual use in insect pest management programs at farmer's fields. Our results suggest that G. mellonella could be used as a primary model for assessing and predicting the virulence of EPN isolates on other insects such as S. litura.

Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal.

To determine a true denominator of worldwide surgical need, it is imperative to include estimations at a population-based level, to capture those individuals unable to access surgical care. This study was designed to validate the Surgeons OverSeas Assessment of Surgical need (SOSAS) tool with the addition of a visual physical examination, and describe the prevalence of surgical conditions, deaths possibly averted with access to surgical care, and the number of surgical procedures performed annually, in Nepal. The SOSAS tool, developed to measure the prevalence of surgical conditions at a population level and used in two African countries, was employed. Fifteen of the 75 districts of Nepal were chosen proportional to population. Responses were recorded for the head of the household for demographic information and recalled deaths, and two randomly selected household members underwent a verbal head-to-toe interview for surgical conditions and a visual physical examination by a trained physician. A total of 1350 households were surveyed (2695 respondents). Observed agreement between the verbal response and physical examination findings was 94·6 per cent. Some 10·0 (95 per cent c.i. 8·9 to 11·2) per cent of respondents had a current condition requiring surgical care and 23 per cent of deaths may have been averted with proper access to surgical care. An estimated 291·8 major operations per 100 000 population are performed annually in Nepal. The visual physical examination component validated the SOSAS tool, and justified the estimates of previous studies in Sierra Leone and Rwanda. These data provide insights into the health needs of Nepal and provide evidence to develop surgical programmes, assist with monitoring and evaluation, and help with advocacy for increased resources in Nepal.

Occurrence and ITS diversity of wood‐associatedBursaphelenchusnematodes in Scots pine forests in Switzerland

The quarantine pathogenBursaphelenchus xylophilus(pine wood nematode,PWN) represents a serious threat forPinusspecies in Europe. To exclude its presence in Switzerland, in 2010 and 2011 a countrywide survey was conducted in 102Pinus sylvestrisstands, chosen according to whether they contained dying or dead trees or were located in areas at risk ofPWNintroduction. In total, 285 trees (1–5 per site) were sampled. Nematodes were extracted from wood chips using a standard procedure, and identified to species by internal transcribed spacer (ITS) sequencing.Bursaphelenchusspecies were present in 34% of the trees, but noB. xylophiluswas identified, i.e.PWNis still not present in Switzerland. The nematodes found belonged to seven different species, withB. vallesianusthe most frequent species, followed byB. sexdentati,B. mucronatus kolymensisandB. eggersi. Three other species (B. borealis,B. pinophilus,B. poligraphi) were each only present in one or two trees. Three groups of sequences could not be assigned to a species because of the lack of matching reference sequences. The species composition found in Switzerland suggests co‐existence of southern and central EuropeanBursaphelenchusspecies. Intraspecific ITS variability differed considerably among the four most common species.Bursaphelenchus eggersi,B. mucronatus kolymensisandB. sexdentatihad several variable sites in the ITS region, resulting in multiple ITS genotypes in each species. In contrast, all 99B. vallesianusisolates had an identical ITS region. This could indicate a founder effect, and possibly thatB. vallesianusis not native to the Alpine region.

Rectal bleeding and implications for surgical care in Nepal

BackgroundBecause rectal bleeding is a cardinal symptom of many colorectal diseases including colorectal cancers, its presence alone could give insight into the prevalence of these conditions where direct population screening is lacking. In South Asia, which is home to over one fifth of the world's population, there is paucity of epidemiologic data on colorectal diseases, particularly in the lower-income countries such as Nepal. The aim of this study was to enumerate the prevalence of rectal bleeding in Nepal and increase understanding of colorectal diseases as a health problem in the South Asian region. MethodsA countrywide survey using the Surgeons OverSeas Assessment of Surgical Need tool was administered from May 25–June 12, 2014 in 15 of the 75 districts of Nepal, randomly selected proportional to population. In each district, three Village Development Committees were selected randomly, two rural and one urban based on the Demographic Health Survey methodology. Individuals were interviewed to determine the period and point prevalence of rectal bleeding and patterns of health-seeking behavior related to surgical care for this problem. Individuals aged >18 y were included in this analysis. ResultsA total of 1350 households and 2695 individuals were surveyed with a 97% response rate. Thirty-eight individuals (55% male) of the 1941 individuals ≥18 y stated they had experienced rectal bleeding (2.0%, 95% confidence interval 1.4%–2.7%), with a mean age of 45.5 (standard deviation 2.2). Of these 38 individuals, 30 stated they currently experience rectal bleeding. Health Care was sought in 18 participants with current rectal bleeding, with two major procedures performed, one an operation for an anal fistula. For those who sought health care but did not receive surgical care, reasons included no need (4), not available (6), fear and/or no trust (5), and no money for health care (1). For those with current rectal bleeding who did not seek health care, reasons included no need (1), not available (2), fear and/or no trust (6), and no money for health care (3). Twenty-three individuals had an unmet surgical need secondary to rectal bleeding (1.2%, 95% confidence interval 0.8%–1.8%). ConclusionsThe Nepal health care system at present does not emphasize the importance of surveillance colonoscopies or initial diagnostics by a primary care physician for rectal bleeding. Our data demonstrate limited access for patients to undergo evaluation of rectal bleeding by a health care professional and that potentially there are people in Nepal with rectal bleeding that may have undiagnosed colorectal cancer. Further advocacy for preventative medicine and easier access to surgical care in lower-income countries is crucial to avoid emergency surgeries, advanced stage malignancies, or fatalities from treatable conditions.