WORLD HEALTH ORGANIZATION REGIONAL OFFICE

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WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

SUMMARY OF 1995 ACTIVITIES OF THE

WORLD HEALTH ORGANIZATION COLLABORATING CENTRES IN THE WESTERN PACIFIC REGION

Manila. Philippines February 1998

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FOREWORD

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PROGRAMME AREAS:

1. Acute respiratory infections 1

2. Blindness and deafness ... 3

3. Cancer ... 11

4. Cardiovascular diseases ... 25

5. Clinical, laboratory and radiological technology for health systems based on primary health care ... 45

6. Community water supply and sanitation ... 89

7. Disease vector control... 91

8. Drug and vaccine quality, safety and efficacy... 101

9. Environmental health in rural and urban development and housing ... 107

10. Food safety ... 111

11. Health information support ... 119

12. Health of the elderly ... 123

13. Health situation and trend assessment ... 131

14. Health systems research and development ... 137

15. Human reproduction research ... 139

16. Leprosy 163 17. Malaria 165 18. Maternal and child health, including family planning ... 169

19. Oral health ... 175

20. Organization of health systems based on primary health care ... 179

21. Other communicable disease prevention and control activities ... 201

22. Other noncommunicable disease prevention and control activities ... 229

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Contents

23. Parasitic diseases ... 239

24. Prevention and control of alcohol and drug abuse ... 265

25. Prevention and treatment of mental and neurological disorders ... 269

26. Psychosocial and behavioural factors in the promotion of health and human development ... 283

27. Public information and education for health ... 285

28. Rehabilitation ... 295

29. Research and development in the field of vaccines 303 30. Research promotion and development including research on health-promoting behaviour ... 305

31. Sexually transmitted diseases 309 32. Tobacco or health ... 317

33. Traditional medicine ... 321

34. Tuberculosis ... 347

35. Workers' health ... 353

36. Zoonoses 371 ANNEXES: Annex 1 - List of Collaborating Centres in the Western Pacific Region 375 Annex 2 - Summary of Collaborating Centres in the Western Pacific Region - (By Programme and by Country) ... 395

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Foreword

FOREWORD

WHO collaborating centres are national institutions supporting WHO programmes at country, intercountry, regional and global levels. As national institutions, their principal role is to contribute, through research, training and services, to national health development.

However, as part of a collaborative network, they also make a considerable contribution to the development and implementation of globally conceived and directed WHO programme activities.

WHO collaborating centres are involved in activities based on individual plans of work agreed upon by the centres and supported by WHO at all levels. These plans must reflect WHO policies and priorities. In addition, the network of centres should pursue the major goal of technical cooperation between the Member States of the Organization. WHO collaborating centres should play a major role in facilitating exchange of information, experience and expertise. They should also stimulate the integration of various national actions towards self-reliance.

Each collaborating centre must submit an annual report immediately after the end of each year. The report reflects the progress made by the centre during the previous year and covers only the information concerning the activities of the institution as a WHO collaborating centre.

Many people are unfamiliar with the activities of these collaborating centres. In many cases, one centre may not be aware of another's work, even though they may be from the same country or involved in the same WHO programme. With this in mind, we have prepared this summary of the salient points from the 1995 annual reports submitted by the WHO collaborating centres in the Western Pacific Region in 1996. We hope that this publication will improve information exchange among all the relevant parties and bring about even more fruitful collaboration.

S.T. Han, MD, Ph.D.

Regional Director

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1995 REPORTS OF COLLABORATING CENTRES

BY PROGRAMME AREAS

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Acute respiratory infections

NAME OF CENTRE: WHO Collaborating Centre for Epidemiology and Control of Acute Respiratory Infections

ADDRESS: Capital Institute of Paediatrics No.2 Ya Bao Road

Beijing 100020, People's Republic of China

PHONE NUMBER: (8610) 65240934

FAX NUMBER: (8610) 65128367

E-MAIL ADDRESS: not available HEAD OF CENTRE: Dr Zhu Zonghan DATE OF DESIGNATION: 18 January 1988 TERMS OF REFERENCE:

(1) To develop, test, finalize and reproduce ARI training and health education materials, based on WHO materials and results from quantitative and qualitative studies at health facility and community level;

(2) To develop and test communication and education strategies and approaches to improve communication between health workers and mothers and to promote the recommended health-seeking behaviour;

(3) To develop and test rapid and practical qualitative monitoring tools to follow up on programme implementation and impact.

ACTIVITIES OF CENTRE IN RELATION TO TERMS OF REFERENCE

1. Research

1.1 Policy and strategies of implementing the National Programme of Action (in collaboration with the nongovernmental organization, Expert Committee of China National Committee on Care for Children, and supported by UNICEF)

The guidelines of ARI standard case management and training modules

recommended by WHO were being used to train health workers. The Centre was responsible for designing the proposal, training, data collection and analysis, and coordinating the

activities.

1.2 Preventive strategies of reducing the high risk factors related to pneumonia mortality in rural China (IORC project)

The first phase of the qualitative study using the modified focused ethnographic study (FES) was completed. The findings are being used in a case-control study.

1.3 Expansion of the communication plan on ARI (AusAIOIWHO project)

Training modules on communication for both facilitators and health workers have

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Acute respiratory infections

2. Training

2.1 The first national training course for trainers was conducted In Nanning, Guangxi Province, in December 1995. The nine participants were from the MCH institutes of Guangxi and Hubei Provinces and from the four counties in four Provinces participating in the AusAID project. This is a new approach in training trainers from different levels (national, provincial and county) in the same course.

3. Specific activities

3.1 The national ARI control programme was expanded to 53 counties in 26 provinces, covering about 25% of the total counties in the country. The Centre reproduced the following materials for training: technical documents recently developed by WHO; communication materials for training, including facilitator guide, participant manual and home care card; and pocket-size assessment and treatment chart, mostly based on WHO ARI management chart and revised to include guidelines for referred cases and for cases that cannot be admitted or referred.

3.2 Two volumes of ARJ news (Chinese version) were published by the Centre and 20000 copies were distributed throughout the country.

3.3 One paper was published during 1995.

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Blindness and deafness (1)

NAME OF CENTRE: WHO Collaborating Centre for the Prevention of Blindness ADDRESS: Department Of Ophthalmology

The University Of Melbourne The Royal Eye and Ear Hospital 32 Gisborne Street

East Melbourne, Victoria 3002, Australia PHONE NUMBER: (613) 96659564

FAX NUMBER: (613) 96623859 E-MAIL ADDRESS: not available

HEAD OF CENTRE: Professor Hugh R Taylor DATE OF DESIGNATION: 27 November 1992 TERMS OF REFERENCE:

(1) To participate actively in the development of activities for the prevention of blindness;

(2) To provide facilities for the training of personnel at different professional levels, especially from developing countries;

(3) To conduct applied field research on the epidemiology, management and operational aspects of avoidable blindness,

(4) To foster a multidisciplinary approach to the promotion of eye health and to the delivery of eye care, including rehabilitation, to all;

(5) To participate in the collection, elaboration and distribution of pertinent information.

ACTIVITIES OF CENTRE IN RELATION TO TERMS OF REFERENCE

1. Research

1.1 Effectiveness of vitamin E in preventing cataract and age-related macular degeneration

One thousand two hundred volunteers over the age of 55 were randomly assigned to receive vitamin E. Results will assist in the development of strategies for the prevention of these two eye diseases which are commonly associated with aging.

1.2 Prevalence and causes of eye disease in an Australian aboriginal community The study will concentrate on the early detection of diabetic eye disease, particularly diabetic retinopathy. The aboriginal health workers have started training in the use of the non- mydriatic fundus camera.

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1.3 Ocular trauma survey

Half of all reported eye Injuries occur at work. Children are four times more likely than adults to suffer serious eye injuries The wearing of proper eye protection could prevent the occurrence of nearly all work-related eye injuries. while the wearing of suitable eye protection at home could prevent another 14% of serious eye injuries

The identification of children as a high-risk target group led to the development of an interactive computer game to teach 8 to 14 year-olds about eye safety. It was hoped that the computer game would be introduced into the school syllabus.

1.4 Prevention and treatment of trachoma with azithromycin Early results from this new treatment have shown great promise 1 5 Melbourne Visual Impairment Project (VIP)

This project investigated the prevalence, causes and risk factors of eye disease and the utilization of eye health services in Australia. The key findings were the following the rate of visual impairment and blindness trebles with each decade after the age of 60: the rate of cataract doubles with each decade after 40; the rate of macular degeneration increases ten- fold as people age from their 70s to their 80s. almost every person with diabetes will develop diabetic eye disease after 20 years of diabetes, glaucoma is relatively rare before 50 but affects one person In 15 Over the age of 70; and the number of people with blindness or visual impairment will double within the next 20 years

Twelve percent of the people living In residential care (nursing homes) had significant eye disease This was 13 times higher than among people who lived In the general

community.

The methodology used In this project has been transferred and shared with the LV Prasad Eye Institute in Hyderabad, India. and the Chinese University of Hong Kong

The Melbourne VIP questionnaire includes questions on exposure to UV-B to

determine the role of exposure as a risk factor In eye disease. This has been provided to the WHO programme on prevention of blindness and deafness for use in future Intersun studies.

The Centre is also collaborating with the development of the new simplified cataract grading system.

The utilization of eye care and rehabilitation services for people with visual impairment was assessed. Initial findings Indicated that 37% of people who are visually Impaired have been referred to or have used rehabilitation services Results from a survey of

ophthalmologists conducted by the Low Vision Unit also indicated that few ophthalmologists refer their patients with low vision to rehabilitation services This was in contrast to the higher level of referral to low vIsion clinics

Results from this project showed that 60% of urban residents with diabetes had not visited an ophthalmologist in the prevIous two years and that 36% had not seen an

ophthalmologist or optometrist A survey of general practitioners revealed that 37% of them did not have the resources for a dilated fundus examination and that three-quarters were not entirely confident in performing this examination.

1.6 Corneal wound healing and corneal cancers

The work has concentrated and led to significant findings on the characteristics of limbal stem cells in order to gain an understanding of the regeneration of the corneal

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Blindness and deafness {11

epithelium. The studies have also been successful in identifying the origin of the most common type of ocular surface cancer.

1.7 Glaucoma Inheritance Study (GIST)

This is a population-based c)inical study aimed at determining the genes responsible for glaucoma. The GIST started in 1994 with the identification of a large number of families in which glaucoma runs as an hereditary disease. Glaucoma pedigrees were then constructed.

and families that demonstrated significant patterns of glaucoma inheritance were selected.

Eye examinations were conducted on over 1000 :nembers from these "glaucoma" families.

DNA from blood samples from these family members was being tested and analysed to identify and map the genes responsible for glaucoma.

1.8 Development and testing of new drugs for the treatment of glaucoma

Five drug trials were conducted during 1995. The Glaucoma unit of this Centre was selected as the only southern hemisphere site in a long-term prospective trial of ocular beta- blockers in glaucoma.

1.9 Epidemiological and surgical management of the primary and recurrent form of pterygium

This is a large prospective, randomized trial. Follow-up of patients with primary pterygium has begun.

2. Training

2.1 The Centre and the Royal VictOrian Eye and Ear Hospital have developed a clinical fellowship programme for sub-specialty training. In 1995, fellows came from China, India, Thailand, UK and USA as well as from Australia

2.2 Two honorary visiting scholars from Indonesia and Viet Nam were enrolled for training in the Centre.

2.3 Training for higher academic degrees (Doctor of Medicine, Doctor of Philosophy, Master of Medicine (Ophthalmology) and Master of Surgery) is available in an extensive variety of research topics.

2.4 Low vision courses were conducted in Ghana and Kenya. The courses train trainers to initiate low vision programmes in their countries in west and east Africa. The Low Vision Kit is used as the basic material for the trainers.

2.5 Low vision training initially conducted in the south of India in 1993-1994 was evaluated.

3. Specific activities

3.1 The Low Vision Kit developed in the Centre was published by the WHO programme on prevention of blindness and deafness. The kits will be distributed by the WHO Regional Offices and from this Centre.

3.2 An informal quarterly meeting of nongovernmental organizations interested in prevention of blindness, either nationally or internationally. was held at the Centre.

3.3 The fourth annual meeting between nongovernmental organizations and the

Vietnamese government was convened in collaboration with the Fred Hollows Foundation and

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Prevention of Blindness). The purpose of the meeting was to coordinate activities to best meet the needs of the people in Viet Nam.

3.4 An inexpensive and portable diathermy and cautery unit for use during cataract surgery in developing countries was developed during collaboration between the Centre and another University department The battery powered diathermy unit was field-tested in Nepal by members of the Fred Hollows Foundation.

3.5 Registrars from the Royal Victorian Eye and Ear Hospital travelled to remote areas of Nepal to assist in eye camps conducted under tr,e auspices of the Fred Hollows Foundation 3.6 The Centre continued to collaborate with the Beijing Institute of Ophthalmology, Beijing, China (WHO Collaborating Centre for the Prevention of Blindness); Juntendo University School of Medicine (WHO Collaborating Centre for the Prevention of Blindness);

and the Dana Centre for Preventive Ophthalmology, Johns Hopkins Hospital, Baltimore, Maryland, USA (WHO Collaborating Centre for the Prevention of Blindness, Xerophthalmia and Onchocerciasis).

3.7 Thirteen papers were published during this reporting period.

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Blindness and deafness (2)

NAME OF CENTRE: WHO Collaborating Centre for the Prevention of Blindness ADDRESS: Beijing Institute of Ophthalmology

17 Hou Gou Lane Chong Nei Street

Beijing 100735, People's Republic of China PHONE NUMBER: (8610) 65241024

FAX NUMBER: (8610) 65125617 E-MAIL ADDRESS: not available HEAD OF CENTRE: Dr Zhang Shiyuan DATE OF DESIGNATION: 16 February 1988 TERMS OF REFERENCE:

(1) To participate in the development of activities for the prevention of blindness with emphasis on the control of blindness due to cataract and corneal diseases, including trachoma;

(2) To provide facilities for the training of personnel at different professional levels;

(3) To conduct applied field research on the epidemiology, management and operational aspects of avoidable blindness;

(4) To promote the Wider application of the principles of eye health and the delivery of eye care to the public;

(5) To participate in the collection, elaboration and distribution of pertinent information;

(6) To provide, on request, advisory services and expertise which might be required.

1. Research

1.1 Study of xerophthalmia and keratomycosis

1.2 Biochemical study on the causes of the development of cataract 1.3 Screening of Chinese traditional drugs to control cataract 1.4 Study of immunological corneal diseases

1.5 Study of retinoblastoma 1.6 Early diagnosis of glaucoma 1.7 Study of functional vision

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1.8 Study of keratopathy

The report did not contain any results of the above studies.

2. Training

2.1 One postgraduate student completed a ttlree-year training programme. There are nine postgraduate students currently undergoing training at the Centre.

3.1 The Centre and the Beijing Tongren Hospital launched a series of activities entitled Eye Health Day in Beijing during which ophthalmic consultations and pamphlets on common blindness-inducing eye diseases were offered to the public.

3.2 The low vision clinic at the Centre supervised the low vision rehabilitation programmes in the 18 counties and districts of Beijing municipality It also treated 206 patients who were presented with low vision aids.

3.3 In collaboration with the Beijing Municipal Federation of Disabled, Education Bureau and the Golden Key Research Centre of Education for Visually Impaired, the Centre launched a pilot programme to enrol low vision children in regular schools. There are 100 such children presently studying In 20 elementary schools along with visually normal children, and their academic achievements ranked in the middle of their classes.

3.4 Three hundred corneal transplantations were performed in the Tongren Eye Bank of the Beijing Centre There were 2500 cataract operation and 2300 cases with IOLs in Tongren Hospital

3.5 Three ophthalmology journals are being edited and published by the Centre: Foreign Medicine - section on ophthalmology (six issues per year); Chinese Medicine - section on ophthalmology (four issues per year): and Ophthalmology in China (four issues per year).

3.6 There were 41 publications in 1995.

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Blindness and deafness 13)

NAME OF CENTRE: WHO Collaborating Centre for the Prevention of Blindness ADDRESS: Department of Ophthalmology

Juntendo University School of Medicine 3-1-3 Hongo, Bunkyo-ku

Tokyo 113, Japan PHONE NUMBER: (813) 38133111 FAX NUMBER: (813) 38170260 E-MAIL ADDRESS: not available

HEAD OF CENTRE: Professor Atsushi Kanai DATE OF DESIGNATION: 1 January 1980

TERMS OF REFERENCE:

(1) To participate actively In the development of activities for the prevention of blindness, with special emphasis on collection of data on prevalence and causes;

(2) To provide facilities for training at different professional levels, especially for personnel from developing countries;

(3) To conduct applied field research on the epidemiology, management and operational aspects of avoidable blindness;

(4) To foster multidisciplinary approach to the promotion of eye health and to the delivery of eye care to all;

(5) To participate in the collection, elaboration and distribution of pertinent Information;

(6) To provide, on request, the advisory services and expertise which might be requested;

(7) To make an inventory of past, and more particularly, ongoing prevention of blindness activities in as many countries/areas of the Western Pacific Region as possible, In this connection, to prepare a directory of persons and institutions involved in such prevention of blindness activities;

(8) To review any research proposals to WHO on the subject.

1. Research

1,1 Intractable ocular disorders

These are the major causes of blindness in Japan, The study concentrated on the genetic structure of retinitis pigmentosa, which is the most common blindness among the

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1.2 Corneal blindness study

The study covered the histopathological approach and therapeutic technology for different types of keratopathy including the conditions from prolonged exposure to the sun.

The Centre has an eye bank which supplied grafts for more than 200 cases of keratopathy each year.

1.3 National survey of blindness In Thailand

Field work and data collection were completed. Data is currently being analysed.

Preliminary findings have shown that the prevalence of blindness was reduced, less than 0.4%.

1.4 Development of cataract grading system

This was a simplified system to grade three different types of lens opacity. It was field-tested In China, but further trials were required. Specific details on the field test were not mentioned in the report.

2. Training

2.1 The Centre has made arrangements for a group of Chinese ophthalmologists to train in different institutions in Japan for a period of one year.

2.2 Two ophthalmologists (one each from China and Indonesia) are attached to the Centre as research fellows while undergOing training at the National Rehabilitation Centre for the Disabled in Tokyo.

2.3 A Centre staff member Joined the faculty of the Nakhon Ratchasima course on eye care for nurse praclitioners In Thailand This was a six-month course.

3 Specific activities

3.1 The Centre was involved in organizing the special session on prevention of blindness during the Annual Congress of Clinical Ophthalmology held in Utsunomiya city

3.2 A Centre staff member JOined the annual meeting of ophthalmologists in the Thailand Ministry to discuss the progress of blindness prevention programmes.

3.3 A staff member from the Centre organized a three-day course on eye care management at Nam Ha, Viet Nam, and also conducted a national workshop on blindness prevention in Cambodia in October 1995.

3.4 The WHO collaborating centres in Tokyo and Melbourne, Australia, supported the annual meeting of all nongovernmental organizations working in blindness prevention in Viet Nam. It was held in Ho Chi Minh City in March 1995.

3.5 An intercountry workshop on the management of national blindness prevention programmes was held in Vientiane, Lao PDR in October 1995. There were participants from Cambodia, Lao PDR, Thailand and Viet Nam.

3.6 The Centre participated in the third Sight First regional course on prevention of blindness and eye care management. It was held at the Institute of Public Health Ophthalmology in Nakhon Ratchasima, Thailand, in NovemberlDecember 1995.

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NAME OF CENTRE: WHO Collaborating Centre for Research on Cancer ADDRESS: Cancer Institute and Hospital

Chinese Academy of Medical Sciences Zuo An Men Wai, PanJiayuan

Chaoyang District

Beijing 100021, People's Republic of China PHONE NUMBER: (8610) 67740307

FAX NUMBER: (8610) 67713359 E-MAIL ADDRESS: caodx@sun.ihep.accn HEAD OF CENTRE: Dr Dong Zhiwei DATE OF DESIGNATION: 23 May 1980 TERMS OF REFERENCE:

(1) The development of a cancer information system covering the whole country;

Cancer (11

(2) The development of a comprehensive cancer control programme on cancer of the oesophagus, incluoing prevention, case-finding and treatment;

(3) The development of simple and effective control methods for cancer of the oesophagus.

(4) The development of a method of evaluation of the cancer control programme as a whole and of each control activity such as, in particular, case-finding methods, surgical

treatment, radiotherapy and preventive measures;

(5) The development of a training programme for health workers of various categories and at various levels in cancer control;

(6) Research into the effectiveness of Chinese traditional medicines for the treatment of cancer, based on the principles of modern medical science, and collection of such data;

(7) The strengthening of the existing cancer registration system.

1. Research

1.1 Etiology and carcinogenesis of oesophageal cancer (OEC)

The alteration and regulating mechanism of oncogenes and tumour suppressor genes In the various stages of oesophageal carcinogenesis induced by N-nitrosamine have been systematically studied using cellular and molecular biological techniques. The figure of the oncogenes in the

multistage process of oesophageal carcinogenesis has been detailed, especially the role of the tumour suppressor genes.

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Cancer (1)

1.2 Suspected etiological agents and factors in a high incidence area for OEC

A series of prophylactic measures were carried out in a high incidence area for OEC

Improving water quality preventing mould contamination; using molybdenum fertilizer; and eliminating undesirable eating habits. Preliminary comprehenSive preventive plans were put forward.

1.3 Precancerous lesions of OEC and their inhib,tion

Use of "zeng shan ben" (Chinese herb) or calcium plus riboflavin inhibited OEC lesions as confirmed dUring a follow-up after two and a half years. The incidence of EC decreased by about 50%.

1 A Mass screening method and monitoring technique for OEC

The occult blood test for the gastrointestinal tract (including oesophagus) was established.

Patients with a positive reaction then underwent an endoscopic examination. There were 680 cases of early OEC. Forty-eight of them were micro-OEC, their diameters being less than 05cm, hence early stages of OEC were detected

1.5 Chemoprevention of primary liver cancer (PLC)

People receiVing tdu:e salt with selenium (Se) showed PLC incidence reduced by 35.1 % as compared to no reduction for the controls. The HBsAg+ rate was 11.6% in those receiving the Se- supplemented table salt, while It was 21.6% in the controls.

1 6 Stereotactic localization technique on X-ray Image units

This technique provided a destructive dosage to lesions while sparing the surrounding normal tissues and organs With a very low dosage.

1 7 Disturbance of immune regulation dUring tumour growth

Immune suppression was due both to disturbance of the hosts immuno-regulatory mechanism and to tumour-derived immunosuppressive factors. Disturbance of Immune regulation was

characterized by a decreased production of cytokines (IL-2, IFN-,) With up-regulating actiVity and an increased production of cytokine (I L-1 0) with down-regulating activity Well-defined molecules with immunosuppressive activities from tumour cells, such as TGF-~ and p15E, shown at mRNA and protein levels would further aggravate immune suppression

1.8 Inhibitory effect of "zeng sheng ping" (ZSP) on cancer metastasIs

Metastatic rates in control mice were 100%. The inhibitory rates of ZSP on pneumonic metastasis were 50% and 32.6% in the two animal models, respectively.

2. Training

2.1 Training courses on the following subjects were organized by the Centre immunological tumour mark analYSIS; oesophageal speeCh (2), strategies and approaches of cancer registration and surveillance: and English.

2.2 Fourteen students were enrolled for the Masters degree course and 15 for the doctoral degree course.

2.3 The Centre trained 136 doctors from various parts of the country

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Cancer (1)

3.1 Seven lectures on cancer research were given at the Centre.

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Cancer (1)

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NAME OF CENTRE:

ADDRESS:

WHO Collaborating Centre for Research on Cancer Cancer Research Institute

Sun Vat-Sen University of Medical Sciences Dong Feng Road, East

Guangzhou 510060 People's Republic of China PHONE NUMBER: (8620) 87775466

FAX NUMBER: (8620) 87754506 E-MAIL ADDRESS: not available

HEAD OF CENTRE: Professor Wan Desen DATE OF DESIGNATION: 23 May 1980

Cancer (2)

(1) The development of simple, practical and effective case-finding methods for cancer of thE: nasopharynx;

(2) The development of the most effective method of treatment of cancer of the nasopharynx in relation to the stage of the disease;

(3) The development of a follow-up system to discover relapses at the earliest stage:

(4) Research on the effectiveness of Chinese traditional medicine for treatment of cancer based on the principles of modern medical science:

(5) The development of a training programme for health workers of various categories and at various levels In cancer control:

(6) The strengthening of the existing cancer registration system.

1. Research

1.1 Study of nasopharyngeal carcinoma (NPC)

It was found that sex and age had no significant influence on cancer progression.

while the presence of antibodies to Epstein-Barr virus did.

1.2 Methods for treating NPC in relation to the stages of the disease

External radiation (50-60 Gy) plus after-loading (20-30 Gy) could be used for patients in stage T,_₂N_{o_,} Combined therapy could be used for stage III or IV patients. External radiotherapy could be coordinated with another method such as induction chemotherapy, simultaneous radiotherapy, accelerated hypersection radiotherapy, radiochemistry, radiosensitizer, etc according to local conditions and patients.

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Cancer (2)

13 Effectiveness of traditional Chinese medicine for treatment of cancer

A study was conducted on Isatis root, Panax noto-ginseng and Iris pallasii chinensis seed. Chinese herbal plaster was also studied for pain relief. Combined therapy using Chinese herbs and radiotherapy was carried out to determine whether the survival rate of NPC was increased.

2 Training

2.1 The Centre trained 33 doctors from 12 cities and provinces for one year In tumour control. Another 36 doctors, three nurses and four technicians were trained for a shorter time.

2.2 The Guangdong provincial advanced study and training course in tumour control was conducted by the Centre. The 50 trainees came from 44 medical institutions located in 28 counties and cities in Guangdong Province.

3.1 The computer-based cancer registration system in Zhong shan City and Sihui County was further reinforced and expanded

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NAME OF CENTRE: WHO Collaborating Centre for Research on Cancer

ADDRESS: Shanghai Cancer Institute

2200/25 Xie Tu Road

Shanghai 200032, People's Republic of China

PHONE NUMBER: (8621) 64046550

FAX NUMBER: (8621) 64041428

E-MAIL ADDRESS:fanjin@fudan.ihep.ac.cn HEAD OF CENTRE: Professor Gao Yutang DATE OF DESIGNATION: 23 May 1980

TERMS OF REFERENCE:

Cancer (3)

(1) To develop a comprehensive control programme on common sites of cancer, with particular reference to liver, lung and cervical cancer, which would become a WHO demonstration project on cancer control in the Shanghai municipality;

(2) To carry out operational research to determine the most effective and efficient way of case-finding for common sites of cancer, including a cost and

effectiveness analysis;

(3) To carry out research on the effectiveness of Chinese traditional medicine for the treatment of cancer, based on the principles of modern medical science;

(4) To develop a training programme for health workers of various categories and at various levels in cancer control;

(5) To strengthen the existing cancer registration system as an essential component of the comprehensive approach to a cancer control programme;

(6) To carry out research on the indicators for monitoring and evaluation of the cancer control programme, in terms of impact and outcome measures,

1, Research

1,1 Relationship between cigarette smoking and cancers and respiratory diseases The study showed a close relationship between cigarette smoking and the mortality rates of cancers (lung, oesophageal, stomach, pancreatic, bladder), chronic bronchitis and pulmonary heart disease among urban, suburban and rural residents of age 20 and over in Shanghai. The population attributable risk of cancer and lung cancer death is 30,3% and 64,5%, respectively, in urban males,

1,2 Risk factors of lung cancer among female non-smokers

This was a multicentre study conducted in Shanghai, Tianjin, Shenyang and Harbin,

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Cancer (3)

pulmonary diseases (especially tuberculosis) and lung cancer history among relatives were risk factors. Higher consumption of fresh fruits and vegetables and drinking of green tea were protective factors.

2 Training

2.1 Cancer control activity training classes were organized for about 100 people from the newly established cancer control offices.

2.2 Training courses on standard guides on diagnosis and treatment of commonly seen cancers were organized for senior physicians.

3 Specific activities

3.1 The network of cancer control in urban areas was continuously consolidated in 1995.

It was also being expanded into suburban and rural areas of Shanghai. Presently the network covers 16 urban districts and counties of Shanghai Municipality.

3.2 Efforts were being made to decrease the rising incidence rates of cancers through health education and health promotion. A method for early diagnosis of colon cancer was being used. Self-examination of breasts was being advocated.

3.3 One week in Aprli 1 q95 saw efforts to educate the population on cancer prevention.

Five booklets (lifestyle and cancer; smoking and cancer; breast self-examination; liver cancer prevention; and early detection of colon cancer) were printed and distributed. More than half a million residents sought advice at nearly 500 stations set-up throughout the city. Over 2300 physicians participated.

3.4 A follow-up survey for all cancer patients registered from 1972 to 1991 was conducted

In 1995. Population-based cancer survival rates are now being analysed.

3.5 The International Classification of Diseases, 10th edition (ICD-10) was translated into Chinese by the Centre.

3.6 The Centre provided cancer data for urban areas of Shanghai to IARC for

incorporation into "Cancer incidence in five continents, Vol. VII" and "Incidence of childhood cancers, Vol. II".

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Cancer (4)

NAME OF CENTRE: WHO Collaborating Centre for Research on Thyroid Disease ADDRESS: First Department of Internal Medicine

Nagasaki University School of Medicine Nagasaki 852, Japan

PHONE NUMBER: (81958) 472111 (Ext 2800)

FAX NUMBER: (81958) 430255

E-MAIL ADDRESS:nagataki@net.nagasaki-u.ac.jp HEAD OF CENTRE: Dr Shigenobu Nagataki

DATE OF DESIGNATION: 18 May 1994 TERMS OF REFERENCE:

(1) To engage in collaborative research projects on radiation and in particular radiation due to nuclear or natural sources and medical radiation;

(2) To provide advice and training on iodine deficiency disorders (100) especially in the Western Pacific Region and in any other country outside the Region;

(3) To participate in the standardization of classification of autoimmune thyroid diseases including exophthalmos.

1. Research

1.1 HTLV-1 antibody among atomic bomb survivors 1.2 Relationship between goitrogenesis and iodine

No details of the above studies were presented in the annual report.

2. Training

2.1 Doctors and scientists were trained while visiting the five diagnostic centres around Chernobyl, Russia.

2.2 An education programme had been arranged for scientists and doctors from the Commonwealth of Independent States. Thirteen doctors and scientists were trained at the Centre for different periods of time.

3.1 Two papers were published during this reporting period.

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Cancer (5)

NAME OF CENTRE: WHO Collaborating Centre for Primary Prevention, Diagnosis and Treatment of Gastric Cancer

ADDRESS: National Cancer Centre Hospital 1-1 Tsukiji 5-chome, Chuo-ku Tokyo 104, Japan

PHONE NUMBER: (813) 35422511 FAX NUMBER: (813) 35423815

E-MAIL ADDRESS:msasako@gan2.ncc.go.jp HEAD OF CENTRE: Dr.Mitsuru Sasako DATE OF DESIGNATION: 1 January 1970 TERMS OF REFERENCE:

(1) To conduct and promote basic and clinical research in the prevention, diagnosis and treatment of gastric cancer;

(2) To transfer new knowledge and technologies in the prevention, diagnosis and treatment of gastric cancer to other countries and areas, especially to the developing countries of the Region;

(3) To coordinate with other WHO collaborating centres and technical institutions in different parts of the world which have joined the collaborative network of the Centre to promote technical collaboration in the area of gastric cancer;

(4) To advise the national cancer control programme of Member States on the development of strategies and approaches for the prevention, early detection and effective treatment of gastric cancer;

(5) To organize and support training activities and scientific meetings on the research, epidemiology, prevention, diagnosis and treatment of gastric cancer;

(6) To publish newsletters, the new primary tumour, regional nodes and metastasis (TNM) classification, the English edition of the Japanese manual of gastric carcinoma and the new international documentation system.

1. Research

1.1 Basic research included studies on molecular biology and oncogenes. Extended lymph node dissection, preservation of functions in surgical procedures and endoscopic mucosal resection were some of the developments in clinical research. No details of the studies were provided for any of the studies undertaken by the Centre.

2. Training

2.1 The Centre accepted many researchers, trainees and observers for training. No specific details were presented in the annual report.

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Cancer (6)

NAME OF CENTRE: WHO Collaborating Centre for Hospice and Palliative Care ADDRESS: Catholic Medical Centre

College of Nursing

Catholic University of Korea 505 Banpo-dong, Socho-ku Seoul 137-701, Republic of Korea PHONE NUMBER: (822) 5901295

FAX NUMBER: (822) 5901297

E-MAIL ADDRESS:cuncweb@cmc.cuk.ac.kr HEAD OF CENTRE: Dr Euy Soon Choi DATE OF DESIGNATION: 28 September 1995 TERMS OF REFERENCE:

(1) To collaborate with Member States on formulation and implementation of national policy and programmes in hospice and palliative care;

(2) To collaborate with Member States in improving home care and its coverage for terminally sick persons;

(3) To collaborate with WHO in developing curricula and teaching materials, to train health professionals and volunteers on hospice and palliative care, and to conduct relevant research;

(4) To raise general public awareness of the value of and need for hospice and palliative care;

(5) To facilitate the exchange of information on palliative care.

1. Training

1.1 Three one-day courses on hospice and palliative care were provided at the Centre for 78 nurses in September 1995.

1.2 Similar courses were also held at St Mary's Hospital, Seoul (four courses), Kangnam St Mary's Hospital, Seoul (one), St Mary's Hospital, Euijungbu (one) and St Paul's Hospital, Seoul (two). Participants ranged from 70 to 150 nurses or volunteers.

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Cancer (6)

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Cardiovascular diseases (1)

NAME OF CENTRE: WHO Collaborating Centre for the Epidemiology of Cardiovascular Diseases

ADDRESS: Centre for Clinical Epidemiology and Biostatistics Faculty of Medicine and Health Sciences

University of Newcastle

Newcastle, New South Wales 2308, Australia PHONE NUMBER: (6149) 236142

FAX NUMBER: (6149) 236148 E-MAIL ADDRESS:rfh@ibm.net

HEAD OF CENTRE: Professor Richard F. Heller/Professor Annette J. Dobson DATE OF DESIGNATION: 12 December 1983

(1) Research and training in the epidemiology of cardiovascular diseases;

(2) Collection of relevant data on trends in cardiovascular disease incidence in Australia and the preparation of reports on the epidemiological situation with regard to cardiovascular diseases in the Western Pacific Region;

(3) Evaluation of the effectiveness of interventions to prevent and treat cardiovascular diseases.

1. Research

1.1 WHO MONICA project

This large epidemiological project involves monitoring trends and determinants of coronary heart disease among all residents aged under 70 years in the lower Hunter region of New South Wales, Australia. So far it is apparent that both incidence and mortality rates of coronary disease are declining in this population. Use of effective medical treatment is increasing. Cigarette smoking, blood pressure levels and total cholesterol all declined but other risk factors such as overweight and obesity increased over the three surveys during the decade. A large part of the decline in mortality can be accounted for by changes in risk factors in the population.

1.2 Prevention of coronary disease

The extent of community adoption of the programme was demonstrated by a successful application for government salary support for a full-time project officer and the award of a community development prize. Rel\ults in terms of health outcomes in the community have been analysed, and do not appear to differ significantly from trends in the rest of the Hunter region. Major structural changes have taken place in primary school education as a result of this project.

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Cardiovascular diseases 11'

1.3 Secondary prevention and rehabilitation for coronary patients

Large reductions in mortality or reinfarction were not seen but there is some evidence of improvements in psychosocial well-being and quality of life.

2.1 A report was prepared Jointly with the Australian Institute of Health and Welfare on the patterns of fatal and non-fatal cardiovascular eve,lts in Australia using various methodological approaches. One of the main outcomes was an evaluation of alternative epidemiological and statistical approaches to obtain valid estimates.

2.2 The Centre provided statistical expertise for the WHO MONICA project.

2.3 A collaborative study was planned to look at the development of overweight and obesity in different parts of the world. Focus groups have been carried out in number of countries and among Australian immigrants. The results are being collated and should provide insights into underlying attitudes to food and exercise.

2.4 Details of clinical management of heart disease patients were recorded in a variety of settings in several developing countries and Australia. Pilot studies of stated and actual practice have been performed

2.5 Long-term effed::. of alternative treatments and of behavioural changes in coronary patients registered in the MONICA project have been examined. Patterns of survival, reinfarction and development of congestive heart failure following myocardial infarction have been explored.

2.6 A simplified monitoring system for coronary events needs to be developed. Several problems have been identified in obtaining adequate data if busy clinical staff are expected to complete the forms. A particular difficulty has been the identification of ECG patterns and diagnosis by non-medical staff.

2.7 Collaboration with other WHO collaborating centres has been predominantly among those centres involved in the MONICA project. Most of them are in Europe.

2.8 Five papers were published and four were in press during this period.

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NAME OF CENTRE:

ADDRESS

PHONE NUMBER:

FAX NUMBER:

E-MAIL ADDRESS:

HEAD OF CENTRE:

DATE OF DESIGNATION TERMS OF REFERENCE:

WHO Collaborating Centre for Population-Based Cardiovascular Disease Prevention Programme Menzies Centre for Population Health Research University of Tasmania

Menzies Building, 17 Liverpool Street Hobart, Tasmania 7000, Australia (613) 62267700

(613) 62267704

T. Dwyer@menzies.utas.edu.au Professor Terence Dwyer 1 June 1990

(1) To conduct research on the use of non-pharmacological measures in the prevention and management of cardiovascular disease;

(2) To collaborate in the development of databases in the Region concerning lifestyle and related cardiovascular disease risk factors;

(3) To train health workers from the Region in the implementation and evaluation of programmes to combat cardiovascular disease using lifestyle interventions.

1. Research

1.1 Multicentre study of coronary health diseases of oriental populations living in Asia When the proposal was first put forward, Singapore had just completed a survey where key measurement on· coronary heart disease (CHD) risk factors and on CHD incidence and mortality had been made on such a population sample. Beijing had comparable

measurements on both disease and most exposures through their MONICA project and will expand that data collection. Data collection in Hong Kong started in 1995 and measurements have already been conducted on subjects. This Centre in Hobart will serve as the data management and coordinating centre for the entire study.

1.2 Effect of physical activity on cardiovascular disease risk factors in children

The determinants of high density lipoprotein cholesterol (HDL-C) concentrations in children were examined. This involved an extensive review of the current literature concerning the relationship between HDL-C in children and physical fitness and activity, obesity and body composition, diet and Cigarette smoking.

The Centre has been interacting with colleagues in the USA and Japan to look at the lifestyle influences on lipoproteins in adolescents. Data supplied by the Tokyo Medical College (WHO Collaborating Centre for Health Promotion through Research and Training in

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Cardiovascular diseases (2)

Sports Medicine) showed that there is only a minimum fall in HDL cholesterol levels in boys aged 12-15 years compared to Australian and American males.

2. Training

2.1 A four-day teaching course on principles and methods of epidemiology was organized in September 1995. There were 86 participants, with two from Japan, eight from New Zealand and the rest from Australia.

3.1 The head of the Centre was invited to the Philippines to review the cardiovascular diseases (CVD) situation in the country and to assess the national programme on prevention and control of CVD.

3.2 In 1995, two papers were published and two were in press.

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NAME OF CENTRE: WHO Collaborating Centre for Research and Training in Cardiovascular Diseases

ADDRESS: Cardiovascular Institute and Fu Wai Heart Hospital

Chinese Academy of 'V1edical Sciences and Peking Union Medical College

Beijing 100037, People's Republic of China

PHONE NUMBER: (8610) 68316048

FAX NUMBER: (8610) 68313012

E-MAIL ADDRESS:tsq@public.eastcn.net HEAD OF CENTRE: Professor Tao Shouchi DATE OF DESIGNATION: 1 May 1980

TERMS OF REFERENCE:

(1) To collaborate with WHO in research and training in the field of cardiovascular diseases, with special reference to epidemiology, prevention and control relevant to the Chinese population;

(2) To collaborate with WHO in collecting information on research activities being carried out in the People's Republic of China, especially on epidemiology, prevention and control of cardiovascular diseases

1. Research

1.1 Prevention and control of cardiovascular diseases in Fangshan community

The second epidemiological survey was carried out with 3000 residents in the community.

The results indicated that the knowledge, attitude and behaviour of the intervention population were significantly improved compared with the controls. There was an increase in the treatment and control of the hypertensives and a decrease in morbidity and mortality among the intervention group.

1.2 Prevention of cardiovascular diseases in Beijing Capitol Iron and Steel Complex

The intervention including health education and control of hypertension was continued. The results showed that the workers in the intervention factory took in less salt daily. Non-drug therapy was used and was effective on mild hypertensives.

1.3 Multicentre epidemiological cardiovascular study

The results indicated that the mean intake of fish and fruits was significantly and inversely associated with the blood pressures of the population. The mean intake of animal fat, salt and salty food was significantly and directly associated with blood pressure. The clustering of risk factors was more marked in the northern population of China. The population with higher salt and fat intakes showed a greater clustering of multiple risk factors and had remarkably higher incidence and mortality rates of cardiovascular diseases.

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2 Training

2.1 A training workshop on cardiovascular epidemiology was held in Hangzhou, Zhejiang Province, in September 1995. Forty participants attended this workshop.

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NAME OF CENTRE: WHO Collaborating Centre for Research and Training in Cardiovascular Diseases

ADDRESS: Guangdong Provincial Cardiovascular Institute 96 Dongchuan Road

Guangzhou 510100. People's Republic of China

PHONE NUMBER: (8620) 83827812

FAX NUMBER: (8620) 83827712

E-MAIL ADDRESS:gzcdvl@public1.guangzhou.gd.cn HEAD OF CENTRE: Dr Lin Shuguang

DATE OF DESIGNATION: 1 May 1980 TERMS OF REFERENCE:

(1) To collaborate with WHO in research and training in the field of cardiovascular diseases, with special reference to epidemiology, prevention and control relevant to the Chinese population;

(2) To collaborate with WHO in collecting information on research activities being carried out in the People's Republic of China, especially in the fields of epidemiology, prevention and control of cardiovascular diseases;

(3) To collaborate with WHO in carrying out investigative surveys and other

research activities; in surveillance and follow-up; in preventive activities including training and education; and also to exchange information and disseminate and publish knowledge, particularly in the field of rheumatic fever and rheumatic heart disease.

1. Research

1.1 Rheumatic fever (RF)/rheumatic heart disease (RHO) investigation and primary prevention

The incidence of RF was 3.67-13.34 per 100000 (average 9.03). The prevalence of RHO was 0.03 - 0.42 per 1 000 (average 0.24).

1.2 WHO global programme for RF/RHD prevention in Guangdong In 1995, 77 522 school children aged 5-18 were surveyed.

1.3 Comparison study of cardio-cerebral diseases in high and low incidence areas in China

The data was being analysed.

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Cardiovascular diseases 141

1.4 Relationship between Chinese food and cardiovascular disease

One thousand people were given a physical examination and completed a questionnaire.

1.5 Cardiovascular disease and its risk factors in Zhu Hai No details were available in the report.

1.6 Surveillance programme on morbidity and mortality of cardiovascular disease in Guangzhou and Panyu City

A population of 192 637 people were involved in the study.

2. Training

2.1 Thirty-five physicians and paediatricians from different provinces attended the 15th national training course in advanced cardiology and paediatric cardiology in 1995.

2.2 Staff from the Department of Epidemiology of the Centre provided training on cardiovascular prevention in the field.

3.1 Consultations were provided for 3 700 outpatients in 1995.

3.2 The Centre continued to collaborate with the Cardiovascular Institute and Fuwai Hospital, Beijing (WHO Collaborating Centre for Research and Training in Cardiovascular Diseases).

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NAME OF CENTRE: WHO Collaborating Centre for Research and Training in Cardiovascular Diseases

ADDRESS: Shanghai Institute of Cardiovascular Diseases 180 Feng Ling Road

Shanghai 200032. People's Republic of China PHONE NUMBER: (8621) 64037186 or 64041990

FAX NUMBER: (8621) 64038472 E-MAIL ADDRESS:hzchen@shmu.edu.cn HEAD OF CENTRE: Professor Chen Haozhu DATE OF DESIGNATION: 1 May 1980

(1) To collaborate with WHO in research and training in the field of cardiovascular diseases, with special reference to epidemiology, prevention and control relevant to the Chinese population:

(2) To collaborate with WHO in collecting Information on research activities being carned out in the People's Republic of China, especially on epidemiology, prevention and control of cardiovascular diseases.

1. Research

1.1 Monitoring the incidence and mortality rate of coronary heart disease and stroke This 12-year study was still being carned out among the 200 000 inhabitants in the assigned urban and rural areas of Shanghai.

1.2 No specific details were available on the following studies which have been

undertaken by this Centre during this reporting period risk factors of coronary heart diseases and stroke; evaluation of the effect of angiotensin-converting enzyme inhibitor on mortality and complications in the acute phase of myocardial infarction; clinical trial on the long-term

therapeutic effect of angiotensin-converting enzyme inhibitor and diuretic in treating hypertensives; studies on pulsed-dye laser thrombolysis for treatment of acute myocardial infarction; protective effects of some traditional Chinese medicines and ions on myocardial cells with anoxia and reoxygenation injury; basic and clinical studies on viral heart diseases;

detection of specific enterovirus structural protein antibodies in blood and myocardium of patients with viral myocarditis and dilated cardiomyopathy; diagnosis, pathogenesis and treatment of viral heart diseases at the molecular level; treatment of viral myocarditis and dilated cardiomyopathy using integrated traditional and western medicine; enteroviral vaccines including gene engineering and DNA vaccines; immunological pathogenesis of viral heart diseases; application of intracoronary ultrasound imaging in interventional therapy for coronary arterial atherosclerosis; dynamic three-dimension reconstruction with multi plane

transoesophageal echocardiographic imaging; diagnosis and valvoplasty for mitral incompetence; development and clinical application of computer techniques in cardiology;

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chains; clinical application of annuloplasty and valvoplasty for mitral incompetence; study on heart transplantation.

2. Training

2.1 The 18th annual national advanced course in cardiology was attended by 60 physicians from different parts of China.

2.2 Training in the Centre was completed by 131 clinical fellows from throughout China (33 in cardiology; 2 in cardiac surgery; 79 in echocardiology; 14 in electrocardiography; 3 in viral heart diseases).

23 A total of 30 postgraduates were being trained at the Centre (10 for Masters degree;

19 for doctoral degree; one for postdoctoral training).

3 Specific activities

3.1 The Centre organized the national congress of viral myocarditis and dilated

cardiomyopathy in Wuhan, China, in October 1995. More than 150 researchers and doctors attended the meeting.

3.2 The Shanghai Centre of Pulsed-dye Laser Thrombolysis was established in the Centre in 1995.

3.3 The Centre was involved in the WHO MONICA project, monitoring the incidence and mortality rate of coronary heart disease and stroke.

3.4 One hundred and thirteen papers were published during this reporting period.

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Cardiovascular diseases (61

NAME OF CENTRE: WHO Collaborating Centre for Research and Training in Cardiovascular Diseases

ADDRESS: National Cardiovascular Centre 5-7-1 Fujishirodai, Suita Osaka 565, Japan PHONE NUMBER: (816) 8335012 FAX NUMBER: (816) 8339865

E-MAIL ADDRESS:who-cc@mgtncvc.go.jp HEAD OF CENTRE: Dr Haruhiko Kikuchi DATE OF DESIGNATION: 19 February 1986 TERMS OF REFERENCE:

(1) To carry out research and training in the field of cardiovascular diseases With special reference to the epidemiology, prevention and control of hypertension, cerebrovascular disease and coronary heart disease;

(2) To collect, evaluate and broadcast information on cardiovascular disease research and prevention;

(3) To help develop and transfer appropriate technology for prevention, diagnosis and treatment of cardiovascular diseases In the Western Pacific Region;

(4) To give advice to WHO on cardiovascular diseases when requested,

1, Research

1,1 Biocommunication system and regulation

12 Genetic and environmental factors of atherosclerOSiS, thrombosis and their related diseases 1,3 Pathophysiological studies on inter-relationship between hypertension and cardio- and

cerebrovascular diseases

1.4 Evaluation of diagnostic and therapeutic methodology of cardiovascular diseases

There were no specific details on the above studies (1,1-1.4) mentioned in the annual report, 1,5 Research and development for organ replacement

Various artificial organs have been developed, including a clinical ventricular assistance device; a totally implantable artificial heart; a centrifugal blood pump for chronic use; a respiratory support system; and artificial vascular grafts. Immunosuppression therapy and mechanism of immunological tolerance have also been studied,

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Cardiovascular diseases (61

2. Training

2.1 Many doctors, nurses and paramedical staff from both Japan and abroad have trained at the Centre.

3.1 The Centre published the annual archives of tne National Cardiovascular Centre which includes nearly 1000 articles.

3.2 The Centre supported the China-Japan Friendship Hospital Project under the sponsorship of the Japanese Government. Expert missions were sent to the China-Japan Friendship Hospital in Beijing.

3.3 The following international meetings were either organized or supported by the Centre: Asian symposium on microcirculatory approach to Asian traditional medicine (Beijing, August);

biocommunication system regulating cardiovascular function (Osaka, November); and Japan-Korean workshop for totally implantable artificial heart and its haemocompatibilities (Yong Pyung, Republic of Korea, December)

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Cardiovascular diseases 17}

NAME OF CENTRE: WHQ Collaborating Centre for Health Promotion through Research and Training in Sports Medicine

ADDRESS: Department of Preventive Medicine and Public Health Tokyo Medical College

1-1 Shinjuku, 6-chcme, Shinjuku-ku Tokyo 160, Japan

PHONE NUMBER: (813) 53794339 or 33516141 (Ext 295 or 237) FAX NUMBER: (813) 33530162 or 32265277

E-MAIL ADDRESS:whoccsm@tokyo-med.ac.jp HEAD OF CENTRE: Dr Toshihito Katsumura DATE OF DESIGNATION: 19 December 1991 TERMS OF REFERENCE:

(1) To provide technical collaboration in research aimed at:

(a) the role of physical activity in cardiovascular and other noncommunicable disease prevention;

(b) the role of physical activity in health promotion;

(2) To cooperate with WHO in standardization of exercise for different population groups and in standardizing methods for physical activity in primary and secondary prevention of diseases related to sedentary habits;

(3) To collaborate with WHO in developing a programme in sports and exercise medicine;

(4) To provide training in sports medicine research and application;

(5) To participate with WHO in its role of promoting the appropriate use of physical and sports activity to prevent cardiovascular diseases and noncommunicable diseases;

(6) To periodically review available methods and activities to measure the role of physical activity and sports in health;

(7) To develop information exchange on sports and exercise medicine.

1. Research

1.1 Relationship between oxidative stress caused by strenuous exercise and the production of lipid peroxidation in serum

Strenuous endurance exercise caused a decrease in serum lipid peroxidation as a

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1.2 Effects of a single bout of strenuous endurance exercise on reverse cholesterol transport through high density lipoprotein

A single bout of strenuous endurance exercise hindered the reverse cholesterol transport activity of high density lipoprotein through a reduction of serum cholesterol ester transfer protein activity.

1.3 Relation of exercise and oxidative stress

The change in the ratio of ubiquinol and ubiquinone demonstrated an increase in oxidative stress during endurance exercise (collaborative study with the Research Centre of Advanced Science and Technology, University of Tokyo).

1.4 Isolating and characterizing lipoproteins from sedentary and physically active subjects This is a collaborative study with the Department of Molecular and Nuclear Medicine, Lawrence Laboratory, University of California at Berkeley.

1.5 Relationship between oxygen consumption rate and muscle phosphate kinetics in muscle contraction

Oxygen was used for biochemical processes other than the aerobic phosphocreatine resynthesis in recovery. The combination of near-infrared spectroscopy (NIRS) and

phosphorous magnetic resonance spectroscopy (31P_MRS) provided a comprehensive means of evaluating muscle metabolism non-invasively.

1.6 Estimating the aerobic and anaerobic metabolism In human muscles during isometric exercise using NIRS and 31 p _MRS

The contribution of anaerobic metabolism to total energy consumption was enhanced with an increase in exercise intensity. 31 p _MRS and NIRS allowed a non-invasive

quantification of aerobic and anaerobic muscle metabolism during exercise under arrested circulation.

1.7 Evaluating the effects of endurance training on muscle energy metabolism in young women through the use of non-invasive 31 p _MRS

The endurance training of the forearm for six weeks improved the oxidative capacity in females by 33.3%. The increment performance correlated with muscle oxidative capacity 1.8 Measurement of muscle metabolism uSing both NMR and NIRS

This is a collaborative study with the Copenhagen Muscle Research Centre, University of Copenhagen, Denmark. The data was being analysed in this reporting period 1.9 Determining the cause of the reduction in left ventricular function after prolonged

endurance exercise

The reduction in left ventricular function may not result from myocardial injury but from certain impairments of myocardial contractility and relaxability, causing exercise-related sudden cardiac death in some cases.

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WORLD HEALTH ORGANIZATION REGIONAL OFFICE