His 3

401: Soc Sci Med. 2007 Apr;64(7):1536-47. Epub 2007 Jan 17. Related Articles, Links

Intimate partner violence among Afghan women living in refugee camps in Pakistan. Hyder AA, Noor Z, Tsui E. Johns Hopkins Bloomberg School of Public Health, and Center for Injury Research & Policy, USA. [email protected] The purpose of this paper is to explore events and factors that lead to conflict in the home in the Afghan refugee setting, and the current status of the health sector's ability to respond to evidence of conflict. Qualitative interviews were conducted with 20 women of reproductive age and 20 health workers serving these women in an Afghan refugee camp near Peshawar, Pakistan, during the summer of 2004. In particular, this paper analyses women's explanations of how various marriage traditions may be linked to conflict in the home and how the interactions of different family members may be related to conflict. The relationships of women with their parents-in-law and husbands are highlighted in particular, and a model developed to explore the choreography of their relationships and the ways in which these dynamics may encourage or inhibit violence. The perspectives of health workers on the ways in which the health system responds to family conflict and violence are also presented. Finally, this paper provides information that helps to frame the issues of family violence and conflict in long-term refugee populations for intervention designers and those who are working to craft a health sector response to this problem. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17234316 [PubMed - indexed for MEDLINE] 402: Environ Res. 2007 Mar;103(3):424-31. Epub 2007 Jan 17. Related Articles, Links

Diurnal temperature range and daily mortality in Shanghai, China. Kan H, London SJ, Chen H, Song G, Chen G, Jiang L, Zhao N, Zhang Y, Chen B.

Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China. [email protected] Although the relationship between temperature level and mortality outcomes has been well established, it is still unknown whether within-day variation in temperature, e.g. diurnal temperature range (DTR), is a risk factor for death independent of the corresponding temperature. Moreover, DTR is a meteorological indicator associated with global climate change which may be related to a variety of health outcomes. We hypothesized that large diurnal temperature change might be a source of additional environmental stress and therefore a risk factor for death. We used daily weather and mortality data from Shanghai, China to test this hypothesis. We conducted a time-series study to examine the association between DTR and mortality outcomes from 2001 to 2004. A semi-parametric generalized additive model (GAM) was used to assess the acute effect of DTR on mortality after controlling for covariates including time trend, day of the week (DOW), temperature, humidity, and outdoor air pollution. We found a strong association between DTR and daily mortality after adjustment for those potential confounders. A 1 degrees C increment of the 3-day moving average of DTR corresponded to a 1.37% (95% CI 1.08-1.65%) increase in total non-accidental mortality, a 1.86% (95% CI 1.40-2.32%) increase in cardiovascular mortality, and a 1.29% (95% CI 0.49-2.09%) increase in respiratory mortality. The effects of DTR on total non-accidental and cardiovascular mortality were significant on both "cold" (below 23 degrees C) and "warm" (at least 23 degrees C) days, although respiratory mortality was only significantly associated with DTR on "cold" days. This study suggests within-day variation in temperature may be a novel risk factor for death. Publication Types: • • • • •

Comparative Study Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17234178 [PubMed - indexed for MEDLINE] 403: Int J Technol Assess Health Care. 2007 Winter;23(1):138-45. Related Articles, Links

Cost-effectiveness analysis of prenatal diagnosis intervention for Down's syndrome in China. Chen Y, Qian X, Li J, Zhang J, Chu A, Schweitzer SO.

National Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, P.R. China. [email protected] OBJECTIVES: The cost-effectiveness of prenatal diagnosis intervention for Down's syndrome (DS) in China was assessed and evidence-based information for policy makers and providers is presented. METHODS: Based on field surveys in four selected cities in China and a literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by costeffectiveness analysis. RESULTS: In current clinical practice, for a cohort of 10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of age and older (maternal age screening strategy) can detect .67 DS births. The strategy that offers the diagnostic test after maternal serum screening with alphafetoprotein and human chorionic gonadotrophin (maternal serum screening strategy) can detect 1.41 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is US$ 13,091 and US$ 56,048, respectively. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases. CONCLUSIONS: Although, in general, serum screening has been found to be more cost-effective than maternal age screening, this appears not to be the case in China. The reasons appear to be low uptake rate of the maternal serum strategy, low uptake rate of CVS or AC, and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17234028 [PubMed - indexed for MEDLINE] 404: Shokuhin Eiseigaku Zasshi. 2006 Dec;47(6):268-76. Related Articles, Links

[Identification of fungi using DNA sequences: an approach to identify Fusarium species isolated from domestic unpolished rice] [Article in Japanese] Sakai A, Ozeki Y, Sasaki Y, Suzuki C, Masui Y, Aihara M, Kikuchi Y, Takatori K.

National Institute of Health Sciences, 1-18-1, Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan. Molecular approaches are being developed to provide for the rapid and objective identification of fungi. We attempted the identification of Fusarium species by a genetic analysis to validate practically the utility of a molecular approach for fungal identification and to reveal its limitations, and sequenced three regions, the 5' end of the 28S rRNA gene (D2 region) and the internal transcribed spacer 1 and 2 (ITS1 and ITS2) regions, in the rRNA genes. The DNA sequences of 38 Fusarium strains isolated from domestic unpolished rice were compared for similarity with entries in the GenBank. Based on this comparison, it was estimated that all these three regions, as a minimum, must be compared with the database to identify Fusaria at the species level. According to the combinations of sequences in the three regions, the 38 isolates were classified into 13 groups. Out of the 13 groups, 6 groups (20 isolates in total) could be identified as definite species based only on the sequence data. For the other 6 groups (17 isolates in total), candidate species were limited on the basis of the sequence similarity, and then the isolates were identified at the species level with the aid of morphology. Only one isolate could not be identified. These results verified that DNA sequence comparison with the GenBank database is useful for the identification of Fusarium species. Publication Types: •

English Abstract

PMID: 17228792 [PubMed - indexed for MEDLINE] 405: J Public Health (Oxf). 2007 Mar;29(1):62-9. Epub 2007 Jan 16. Related Articles, Links

Analysis of news of the Japanese asbestos panic: a supposedly resolved issue that turned out to be a time bomb. Takahashi Y, Miyaki K, Nakayama T. Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe, Sakyo, Kyoto, Japan 606-8501. BACKGROUND: Asbestos-linked public health problems were widely reported in Japan, in 2005. The objective is to apply text mining with network analysis to characterize these problems. METHODS: Text mining with network analysis of newspaper headlines including the word 'asbestos' published in 1987 and 2005 was conducted. Outcome measures are occurrence of the words and simultaneous

occurrence of two words in the newspaper headlines. RESULTS: In 36 headlines, which contained the word 'asbestos' in 1987, the word 'pollution' (40%) appeared most frequently, followed by 'removal' (31%) and 'campaign' (29%). For combinations of words, the following occurred most frequently: 'campaign and expulsion' (26%) followed by 'removal and campaign' (14%). Of 293 headlines in 2005, the following words appeared: 'hazard' (31%), 'person' (16%) and 'death' (13%). For combinations, the following appeared: 'person and death' (9%). Asbestos pollution and removal campaigns were reported in 1987, but the death of citizens was reported in 2005. CONCLUSIONS: Text mining with network analysis, which presents one of the methods for visualization of text data, suggests the following insight. Insufficient steps against asbestos had been taken for 20 years, which is compatible with the latency period. It has resulted in widespread exposure to asbestos and more severe asbestos-related public health problems among citizens. This methodology suggests that analyzing text data by this method can serve future surveillance and efficient use of epidemiological knowledge. PMID: 17227791 [PubMed - indexed for MEDLINE] 406: J Public Health Dent. 2006 Fall;66(4):285-7. Related Articles, Links

Specific caries index: A new system for describing untreated dental caries experience in developing countries. Acharya S. Bhagyashree, Kunjibettu, UDUPI - 576102, Karnataka State, India. [email protected] OBJECTIVES: To develop a reproducible surface-specific caries index that provided qualitative and quantitative information about untreated dental caries, that could be used in conjunction with the DMFS index and would provide information on not only the caries prevalence but also the location and type of caries lesion in an individual based on clinical examination. METHODS: Untreated carious lesions were divided into six types based on the location of the lesions. 339 rural school children in the age group of 12-15 years were examined for dental caries using both the DMFS index and the Specific Caries Index. RESULTS: Type 1 and 2 were found to be the most common type of caries lesions. The reproducibility of the Specific Caries Index was also found to be good. CONCLUSIONS: Encouraging indications about the validity and reproducibility of this new caries index was found, suggesting the need for further studies to test its applicability in larger and different populations. PMID: 17225827 [PubMed - indexed for MEDLINE]

407: Osteoporos Int. 2007 Jul;18(7):923-9. Epub 2007 Jan 16. Related Articles, Links

Hormonal profiles and biochemical indices of bone turnover in Indian women. Desai Meena P, Khatkhatay MI, Bhanu Prakash KV, Savardekar LS, Shah RS, Ansari Z. Department of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health, Parel, Mumbai, India. [email protected] SUMMARY: The study establishes Indian referent database for bone turnover markers. The levels of markers decreased across the four quartiles of BMD showing a negative correlation with BMD. The study depicts that levels of hormones and bone turnover makers can aid in identifying women at risk for osteoporosis. INTRODUCTION: Biochemical markers of bone turnover reflect changes in bone metabolism earlier and aid in the management of osteoporosis. Since a referent database for Indian women is lacking, the study was initiated to establish the same and suggest that hormonal profiles and markers of bone turnover can aid in identifying women at risk for osteoporosis. METHODS: Osteocalcin (OC), bone specific alkaline phosphatase ((BSAP), C-terminal crosslinking telopeptide of type-I collagen (CTX-I), deoxypyridinoline (DPD), follicle-stimulating hormone (FSH) and estrone glucuronide (E(1)G) were measured in 365 Indian women (20-70 years) and correlated with BMD measurements by dual energy absorptiometry (DXA) using one way analysis of variance (ANOVA). RESULTS: The mean levels of bone resorption markers; CTX-I and DPD increased significantly across the age showing a negative correlation with BMD. The increase in levels of CTX-I and DPD was significantly higher (p < 0.0001) as compared to the femoral and spinal BMD, which dropped only 30-36%. The levels of bone turnover markers and FSH decreased across the four quartiles of spinal and femoral BMD showing a negative correlation whereas E(1)G levels increased across the four quartiles. CONCLUSION: The bone turnover markers were comparatively low in cohort of Indian women studied. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17225188 [PubMed - indexed for MEDLINE] 408: Indian J Med Ethics. 2006 Jul-Sep;3(3):93-4.

Related Articles,

Links

The cloning controversy. Nandakumar S. Suryodaya Centre for Health Information Pvt Ltd., Prashanthi, 11 Sivaganga Road, Nungambakkam, Chennai 600 034, India. [email protected] Stem cell research has captured the imagination of many, including the scientific and medical community. But the medical community received a wake-up call early this year when a well-known researcher publicly confessed to deception. While the core question relates to honesty and integrity, it is equally necessary to examine the system that made such deception possible. PMID: 17223682 [PubMed - indexed for MEDLINE] 409: J Egypt Public Health Assoc. 2002;77(1-2):143-58. Related Articles, Links

Mortality stastistics as indicators of quality of hospital care. Gabal MS, Salem KA. Dept. of Comm., Environ. and Occup. Medicine, Ain Shams University. Death rates have always been important information for hospitals to provide a solid base for the evaluation of the quality of their medical care. This study was carried out to find out the gross death rate (GDR) as well as net death rate (NDR) in King Fahad hospital, Jeddah, Kingdom of Saudi Arabia (KSA) in the period from 1994-2000 and also to find out demographic characteristics of deaths in the year 2000 according to ICD-10 as indicators of quality of hospital care. Medical records of discharged patients including deaths during the year 2000 were reviewed (13386). Complete data about deaths were obtained. Results of the studied hospital showed gradual decrease in GDR from 5.8% to 4.5% (19941998) then slight increase from 4.9% to 5.0% (1999-2000) but still below the year 1994 (5.8%) and also there is gradual decrease in NDR from 4.6% to 3.6% in the studied period. GDR in different departments of the hospital during the year 2000 showed that Medical ICU was the highest (24.5%) followed by Surgical ICU (17.9%) followed by Cardiac ICU (14.3%) while GDR in the Medical department was found to be (12.9 %) of the discharged subjects. According to nationality; proportional mortality rate (PMR) of Saudis represented 62% of total deaths followed by Yemenis (8.2%) meanwhile Egyptians represented 3.7% of total deaths in the studied year. As concerned to age groups; the highest PMR was found among those aged 65-74 years (21.9%) while the lowest PMR was found

among those aged 13-24 years (4.2%). The highest PMR of deaths during the studied year was reported in March (10.4%) followed by April (9.7%) then February (9.4%) which are the months of pilgrimage season while the lowest frequency was found in December (6.9%). Also PMR was found to be higher among females (57%) compared to males (43%). According to International Classification of Diseases (ICD-10); diseases of the circulatory system were found to be the commonest underlying cause of death in the studied year. It represented 35.5% of all deaths followed by neoplasms (11.2%) while the lowest cause reported was mental and behavioral disorders (0.1%). In conclusion, combination of the previous indicators and comparing the results with other hospitals in different countries indicates good quality of medical care in the studied hospital. PMID: 17219895 [PubMed - indexed for MEDLINE] 410: Isr Med Assoc J. 2006 Dec;8(12):865-9. Related Articles, Links

The use of medical informatics as a management tool for community health services during the 2006 Israel-Lebanon War. Kokia ES, Marom R, Shalev V, Jan Y, Shemer J. Maccabi Healthcare Services, Tel Aviv, Israel. [email protected] BACKGROUND: During war the health management organizations have tremendous difficulty monitoring members' needs according to geographic spread. OBJECTIVES: To describe how an HMO used its health information technology in a way that enables its management to receive updated online information on the needs of the insured, according to their distribution throughout the country during the time of the war in Lebanon in July-August 2006. METHODS: Data were derived from the computerized medical records of Maccabi Healthcare Services-the second largest HMO in Israel, providing care to more than 1.7 million members nationwide. Data on healthcare utilization by northern members were compared to the geographic distribution of clinics. RESULTS: The war was characterized by the massive evacuation of citizens southwards. During this period there was an abrupt decline in the utilization of medical services by northern members in the northern region. This decline returned to normal 10 days after the ceasefire. A reciprocal increase was noted in the use of health services by citizens from the north in other regions. This increase returned to normal after the war. No such pattern was noticed during the same period in 2005. CONCLUSIONS: Real-time surveillance of trends in consumption of health services by citizens in times of regular daily living as well as during emergencies and wars is a vital management tool for medical directors responsible for providing health services.

PMID: 17214108 [PubMed - indexed for MEDLINE] 411: J UOEH. 2006 Dec 1;28(4):431-8. Related Articles, Links

[The preparatory education of electronic patient record for nursing students before practical nursing training] [Article in Japanese] Nagamatsu Y, Kanayama M, Yoshioka M, Anan A, Takeyama Y, Kubo Y, Shibata H, Kawamoto R. Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Yahatanisi-ku, Kitakyusyu 807-8555, Japan. Preparatory education has been provided for both nursing students and teachers to understand the electronic patient record (EPR) since 2004 when EPR was introduced to the hospitals where students are allocated to undertake their work experience. First, the training and management board contacted our medical information department for an appointment and sent us a working group. They taught the nursing training staff how to use EPR and how to assign students to the proper patient record in the EPR system. Second, as preparatory education for the students, they explained the procedure for the use of EPR and the protection of personal information. Students practiced with training in the EPR system, focusing on the functions which are used frequently in practical tasks. As a result of this preparatory education, students understood the protection of personal information very well, although their understanding of the operation and management of the equipment was relatively poor and adversely affected their practice. We need to review our education contents more often. We also need to examine the present state of understanding of EPR and the problems of teaching in practical nursing training. Publication Types: •

English Abstract

PMID: 17209519 [PubMed - indexed for MEDLINE] 412: Ying Yong Sheng Tai Xue Bao. 2006 Oct;17(10):1918-22. Related Articles, Links

[Urban greenbelt eco-service value of Hangzhou City under effects of land use change: an evaluation with CITYgreen model] [Article in Chinese] Zhang K, Zhang J, Chen Y, Zhu Y. College of Environment and Resource Sciences, Zhejiang University, Hangzhou, China. [email protected] Based on the Landset TM information of land use/cover change and greenbelt distribution in Hangzhou city in 1994 and 2004, and by using CITYgreen model, this paper estimated the eco-service value of urban greenbelt in the city under the effects of land use change and economic development. The results showed that in the 10 years from 1994 to 2004, the greenbelt area in the city decreased by 20. 4% , while its eco-service value increased by 168 million yuan. The annual increment of greenbelt eco-service value and GDP was 111.92% and 5. 32% , respectively. Suitable adjustment of land use pattern in the city harmonized the relationships between urban economic development and urban eco-function, and achieved higher eco-service efficiency of land utilization. Publication Types: • •

English Abstract Research Support, Non-U.S. Gov't

PMID: 17209393 [PubMed - indexed for MEDLINE] 413: Trop Med Int Health. 2007 Jan;12(1):25-36. Related Articles, Links

Trial participation and vaccine desirability for Vi polysaccharide typhoid fever vaccine in Hue City, Viet Nam. Kaljee LM, Pham V, Son ND, Hoa NT, Thiem VD, Canh do G, Thoa le TK, Ali M, Ochiai RL, Danovaro-Holliday MC, Acosta CJ, Stanton B, Clemens J. Department of Pediatrics, School of Medicine, University of Maryland, Baltimore MD, USA. [email protected] OBJECTIVES: To identify demand for Vi typhoid fever vaccine for school-age children; obstacles and enabling factors for vaccine delivery; and sociobehavioural factors associated with trial participation and possible predictors of

future vaccine acceptance, in Hue City, Viet Nam. METHODS: Pre- and post-trial surveys of randomly selected households with children aged 6-17 years. Simple multinomial logistic analyses for ratios of relative risks (RRR) and significance on trial participation by demographics and variables related to typhoid fever, vaccination, and pre-trial experiences with information and consents. Multiple logistic regressions to assess differences in participation based on child's characteristics. RESULTS: As many as 62.6% of households let all school age children participate, 10.2% let some participate, and 26.8% let none of their children participate in the trial. Factors associated with all children participating included past use of healthcare facilities (RRR, 0.45; 95% CI, 0.24-0.83), knowledge of vaccines (RRR, 0.17; 95% CI, 0.03-0.86), and perceived causes of typhoid fever (RRR, 0.90; 95% CI, 0.81-0.99). Factors associated with some children participating included utilization of healthcare facilities (RRR, 0.08; 95% CI, 0.01-0.66) and perceived severity of typhoid fever (RRR, 0.64; 95% CI 0.460.88). Participation was associated with satisfaction regarding pre-vaccination information and consent procedures. Children and adolescents were active decision-makers. Only 14 of 461 (2.2%) respondents would not use the Vi vaccine in the future for their child(ren). CONCLUSIONS: Inter-related factors contribute to participation in a clinical vaccine trial, which may differ from desire to participate in a public health campaign. Educational campaigns need to be targeted to children and adolescents, and consideration for assent procedures for minors. Obtaining informed consent may affect trial participation within a social and political system unaccustomed to these procedures. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17207145 [PubMed - indexed for MEDLINE] 414: Health Policy. 2007 Sep;83(1):73-83. Epub 2007 Jan 3. Related Articles, Links

Reorienting Health Ministry roles in transition settings: capacity and strategy gaps. Fritzen SA. LKY School of Public Policy, National University of Singapore, Singapore. [email protected] Health authorities in developing countries must often cope with rapid changes in the administrative, policy and socioeconomic contexts in which they work. Changes in this external environment have important implications for the roles

that health planners can effectively play and the leverage they exercise throughout the system. This paper examines the challenges associated with reorienting ministry roles from administrative fiat to overall orchestration and strategic steering, using health workforce management in transitional Vietnam as a backdrop. Decentralization, commercialization of services and rising inequalities have reduced the efficacy of the administrative controls and standardized strategy on which Vietnam's Ministry of Health has traditionally relied. Reorientation, in Vietnam and elsewhere, depends on bridging significant capacity and strategy gaps, notably in the strengthening of information, planning and accountability systems that respect both the limitations of central control and the diversity of local conditions. PMID: 17204348 [PubMed - indexed for MEDLINE] 415: Indian J Public Health. 2006 Jan-Mar;50(1):24-7. Related Articles, Links

Geomatics and public health. Jaishankar R, Jhonson CP. Indian Institute of Information Technology and Management, Kerala, Thiruvananthapuram. [email protected] Geomatics technology has tremendous potential to address public health issues particularly under the present circumstances of global climate change and climate or technology induced human migration, which result in an increase in the geographical extent and re-emergence of vector-borne diseases. The authors present an overview of the science of geomatics, describe the potential impacts of climate change on vector-borne diseases and review the applications of remote sensing for disease vector surveillance. Publication Types: •

Review

PMID: 17193755 [PubMed - indexed for MEDLINE] 416: Diabetes Care. 2007 Jan;30(1):120-7. Related Articles, Links Comment in:

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Diabetes Care. 2007 May;30(5):e40; author reply e41.

Minimum waist and visceral fat values for identifying Japanese Americans at risk for the metabolic syndrome. Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY. Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. OBJECTIVE: Japanese American is an ethnic group with a high risk for type 2 diabetes, which is linked to the metabolic syndrome. Central adiposity is considered to play a key role in the metabolic syndrome. Not known are the optimal cut point values for central and visceral adiposity to identify Japanese Americans at risk for the metabolic syndrome. RESEARCH DESIGN AND METHODS: Study subjects included 639 Japanese Americans. The nonadipose variables of the metabolic syndrome were defined using modified International Diabetes Federation criteria, and the accuracy of identifying at least two of these by intra-abdominal fat area (IAFA) as measured by computed tomography and waist circumference was cross-sectionally assessed using area under receiver operating characteristic (ROC) curves. The values for IAFA and waist circumference that resulted in maximizing the Youden index were defined as "optimal." RESULTS: The area under the ROC curve for IAFA exceeded that for waist circumference (men 0.787 vs. 0.686; women 0.792 vs. 0.721). For women, the optimal cut points for IAFA and waist circumference were 51.5 cm(2) and 80.8 cm (age < or = 56 years) and 86.3 cm(2) and 89.0 cm (age > 56 years). For men, the optimal cut points for IAFA and waist circumference were 88.6 cm(2) and 90.0 cm (age < or = 57 years) and 96.1 cm(2) and 87.1 cm (age > 57 years). CONCLUSIONS: These results argue that current Japanese waist circumference cut points for the metabolic syndrome need to be revised. Moreover, the waist circumference and IAFA cut points should be age specific, especially in women. Appropriate waist circumference cut points are from 80 to 90 cm in women and from 87 to 90 cm in men. Publication Types: • • •

Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17192344 [PubMed - indexed for MEDLINE] 417: Int J Gynaecol Obstet. 2007 Jan;96(1):57-61. Epub 2006 Dec 21. Related Articles, Links

Cesarean births in Taiwan. Hsu CY, Lo JC, Chang JH, Chen CP, Yu S, Huang FY. Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan. [email protected] OBJECTIVE: To evaluate the use of cesarean delivery in Taiwan by comparing local clinical indications with those in international cohorts. METHODS: Inpatient claims from the National Health Insurance (NHI) in Taiwan were analyzed. Indications for cesarean delivery were evaluated with primary diagnosis codes and procedure codes from the NHI dataset. To produce a stable numerator for cesarean section, 3 years (1998-2000) of claims for cesarean delivery were abstracted and annualized. RESULTS: Rates ranged between 27.3% and 28.7% for primary cesarean delivery and were below 5% for vaginal birth after a cesarean section (VBAC). Compared with rates in other countries, rates for overall and primary cesarean section as well as for VBAC were significantly higher in medical centers in Taiwan (P<0.001). However, the clinics contributed the most to the difference in both overall and primary cesarean rates. The most common indication for cesarean section was prior cesarean section (43.3%45.5%), followed by malpresentation (19.6%-23.4%). The proportion of fetuses with malpresentation delivered by cesarean section in Taiwan was 7.9%, almost twice the upper limit expected for all pregnancies as indicated in international studies. CONCLUSION: It is important to use appropriately documented data and to compare them with international data when monitoring local obstetric practices. The disproportionately high cesarean delivery rates in Taiwan may hold major lessons for the many countries contemplating or having universal health insurance coverage with a similar mix of providers. PMID: 17187798 [PubMed - indexed for MEDLINE] 418: Environ Health Perspect. 2006 Dec;114(12):1847-52. Related Articles, Links

Arsenic exposure and age and sex-specific risk for skin lesions: a population-based case-referent study in Bangladesh. Rahman M, Vahter M, Sohel N, Yunus M, Wahed MA, Streatfield PK, Ekström EC, Persson LA. ICDDR, B: Centre for Health and Population Research, Mohakha, Dhaka, Bangladesh. [email protected]

BACKGROUND: The objective of this population-based case-referent study in Matlab, Bangladesh, was to assess the susceptibility to arsenic-induced skin lesions by age and sex, in a population drinking water from As-contaminated tube wells. METHODS: Identification of As-related skin lesions was carried out in three steps: a) screening of the entire population > 4 years of age (n = 166,934) by trained field teams; b) diagnosis of suspected As-related cases by physicians; and c) confirmation by experts based on physicians' records and photographs. A total of 504 cases with skin lesions were confirmed. We randomly selected 2,201 referents from the Matlab health and demographic surveillance system; 1,955 were eligible, and 1,830 (94%) were available for participation in the study. Individual history of As exposure was based on information obtained during interviews and included all drinking-water sources used since 1970 and concentrations of As (assessed by atomic absorption spectrophotometry) in all the tube wells used. RESULTS: Cases had been exposed to As more than referents (average exposure since 1970: male cases, 200 microg/L; female cases, 211 microg/L; male referents, 143 microg/L; female referents, 155 microg/L). We found a dose-response relationship for both sexes (p < 0.001) and increased risk with increasing socioeconomic status. Males had a higher risk of obtaining skin lesions than females (odds ratio 10.9 vs. 5.78) in the highest average exposure quintile (p = 0.005). Start of As exposure (cumulative exposure) before 1 year of age was not associated with higher risk of obtaining skin lesions compared to start of As exposure later in life. CONCLUSIONS: The results demonstrate that males are more susceptible than females to develop skin lesions when exposed to As in water from tube wells. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17185274 [PubMed - indexed for MEDLINE] PMCID: PMC1764143

419: J Nurs Scholarsh. 2006;38(4):352-7. Related Articles, Links

A cross-cultural analysis of dignified dying. Doorenbos AZ, Wilson SA, Coenen A. School of Nursing, University of Washington, Seattle, WA, USA. [email protected]

PURPOSE: To describe the characteristics of dignified dying and other terminology nurses used to describe this phenomenon in Ethiopia, India, Kenya, and the United States (US). DESIGN: A cross-sectional descriptive survey with a convenience sample of nurses who cared for dying patients in Ethiopia (n=14), India (n=229), Kenya (n=36), and the US (n=281). Data were collected between 2002 and 2004. METHODS: Nurses were recruited to complete the ICNP Dignified Dying survey, which consists of demographic information, 2 openended questions, and 14 questions about characteristics of dignified dying. FINDINGS: The 14 characteristics on the dignified dying scale reliably measured dignified dying, with a Cronbach's alpha coefficient of .91. All characteristics were rated as representative of dignified dying, with content validity scores ranging from .62 to .77. Factor analysis yielded a two-factor solution, which accounted for 53% of the variance. CONCLUSIONS: Findings of this study contribute to the ongoing development of the International Classification of Nursing Practice (ICNP) regarding the nursing phenomenon of dignified dying. The ICNP a unified nursing language system, is used to promote and facilitate scholarly exchange among nurses across countries. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 17181083 [PubMed - indexed for MEDLINE] 420: Health Policy Plan. 2007 Jan;22(1):49-59. Epub 2006 Dec 19. Related Articles, Links

The distribution of net benefits under the National Health Insurance programme in Taiwan. Huang N, Yip W, Chou YJ, Wang PJ. Institute of Public Health, National Yang Ming University, Taipei, Taiwan. [email protected] The redistributive effects of a social insurance programme are determined by how the programme is paid for-who pays and how much do they pay?-and how the benefits are distributed. As a result, the redistributive effects of a social health insurance programme should be evaluated on the basis of its net benefit-the difference between benefits and payment. Among the rich body of empirical analysis on equity in health care financing, however, most studies have relied on partial analysis, assessing equity by source of financing while ignoring the benefit

side, or looking at equity in benefits but ignoring the funding side. Either approach risks misleading findings. In this study, therefore, the primary objective was to assess the distribution of net benefits across income groups under Taiwan's National Health Insurance (NHI) programme. This study observed a nationally representative sample of 74 012 NHI enrolees from 1996 to 2000. The unique NHI databases in Taiwan provide comprehensive enrolment and utilization information, and allowed linkage to each enrolee's income tax files. In addition to crude estimates, two-part models and ordinary least-square models were used to adjust inpatient and outpatient benefits for health care needs (age, sex, major disease status and physical disability). After adjusting for health care needs, the distribution of net benefits showed an apparent pro-poor pattern, with the lowest income group receiving the highest net benefits (NT$3353) and the top income group receiving the lowest net benefits (-NT$3072) in 1996. Although a clear propoor pattern was observed among those enrolees who paid wage-based premiums, this vertically equitable pattern was less evident among the enrolees who paid fixed premiums. Overall, a trend of increasing net benefits was observed in all income groups between 1996 and 2000, and all the NHI enrolees can be considered better off over time. In addition to contributing to the limited literature on equity in net benefits, the study provides an important policy reference to developing countries with large underground economies and relatively small populations of regular wage-earners as it indicates that using fixed premiums as a major financing scheme may pose a serious equity concern and policy challenge. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17179170 [PubMed - indexed for MEDLINE] 421: Am J Prev Med. 2006 Dec;31(6 Suppl 2):S240-2. Related Articles, Links

International experience in stroke registry: Japanese Stroke Databank. Kobayashi S; Japan Stroke Scale Registry Study Group. Shimane University, School of Medicine, Shimane, Japan. [email protected] PMID: 17178311 [PubMed - indexed for MEDLINE] 422: J Water Health. 2006 Dec;4(4):463-77. Related Articles, Links

Rural communities' preferences for arsenic mitigation options in Bangladesh. Ahmad J, Goldar B, Misra S. The World Bank, 1818 H. St. NW, Washington DC, 20433, USA. In the context of arsenic contamination of groundwater in Bangladesh, this paper analyses rural people's preferences for arsenic-free drinking water options. A particular focus is on rural households' willingness to pay for piped water supply which can provide a sustainable solution to the arsenic problem, and how the preference for piped water supply compares with that for various other household/community-based arsenic mitigation technologies. The analysis is based on data collected in a survey of over 2700 households in rural Bangladesh. Six arsenic mitigation technologies were selected for the study: three-kolshi (pitcher) method, activated alumina method (household-based and communitybased), dugwell, pond sand filter and deep tubewell (handpump). The survey results indicate that, after taking into consideration the initial and recurring costs, convenience, associated risks and the advantages and disadvantages of each selected technology, the preference of the rural people is overwhelmingly in favor of deep tubewells, followed by the three-kolshi method. The analysis reveals a strong demand for piped water in both arsenic-affected and arsenic-free rural areas, and scope of adequate cost recovery. Between piped water and other arsenic mitigation technologies, the preference of the rural people is found to be predominantly in favor of the former. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17176817 [PubMed - indexed for MEDLINE] 423: Am J Trop Med Hyg. 2006 Dec;75(6):1223-31. Related Articles, Links

Urban farming and malaria risk factors in a medium-sized town in Cote d'Ivoire. Matthys B, Vounatsou P, Raso G, Tschannen AB, Becket EG, Gosoniu L, Cissé G, Tanner M, N'goran EK, Utzinger J. Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel,

Switzerland. Urbanization occurs at a rapid pace across Africa and Asia and affects people's health and well-being. A typical feature in urban settings of Africa is the maintenance of traditional livelihoods, including agriculture. The purpose of this study was to investigate malaria risk factors in urban farming communities in a medium-sized town in Côte d'Ivoire. Two cross-sectional surveys were carried out among 112 households from six agricultural zones. First, the heads of households were interviewed on agricultural land use, farming practices, water storage, sanitation facilities, and socioeconomic status. Second, a finger prick blood sample was taken from all household members and examined for the occurrence and density of Plasmodia. Geographic coordinates of houses, farming plots, and potential mosquito breeding sites were recorded and integrated into a geographic information system. Predictors of Plasmodium falciparum parasitemia were assessed using non-random and random effects Bayesian regression models. The overall prevalence of P. falciparum was 32.1%. In children < 15 years of age, risk factors for a P. falciparum infection included living in a specific agricultural zone, close proximity to permanent ponds and fish ponds, periodic stays overnight in temporary farm huts, and low socioeconomic status. Our findings indicate that specific crop systems and specific agricultural practices may increase the risk of malaria in urban settings of tropical Africa. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17172397 [PubMed - indexed for MEDLINE] 424: Lepr Rev. 2006 Sep;77(3):210-8. Related Articles, Links

Leprosy control activities in India: integration into general health system. Pandey A, Patel R, Uddin MJ. Regional Leprosy Training and Research Institute, Lalpur, Raipur, Chhattisgarh, India. [email protected] Integration of leprosy control into the general health system is an essential element of a leprosy elimination strategy. In India, the process has been undertaken with the assistance of World Bank in a phased manner. In the first phase (2001-2002), 24 low/moderately endemic provinces for leprosy were targeted. Operational research was undertaken in these low/moderate endemic provinces to assess the progress of integration of leprosy control in general health

system using defined categories, viz. structural integration, training status, availability of MDT and recording/reporting of cases. Selection of nine provinces, 18 districts, 86 health facilities and 108 sub-centres was performed using multistage stratified random sampling technique. Data were collected by interviewing GHS/vertical staff, scrutiny of records and spot checking of MDT stock by Health officers of three leprosy institutions of the Government of India. The result showed that district leprosy nuclei had formed in 16 of 18 districts. In 56% of health facilities vertical staff were redeployed for delivering general health care. Forty-five percent of medical officers, 71% of health supervisors and 75% of multipurpose workers were trained in leprosy. MDT treatment was available in >80% of health facilities. In only 2% of health facilities 3 months MDT stock of all types was present. Forty-four percent of sub-centres were delivering subsequent doses (second dose onward) of MDT. Reporting through a simplified information system was universal. This study emphasizes the need for reorientation training of Medical Officers, better MDT stock management and decentralized management of cases up to sub-centre level. Publication Types: •

Multicenter Study

PMID: 17172001 [PubMed - indexed for MEDLINE] 425: Environ Monit Assess. 2007 Aug;131(1-3):163-76. Epub 2006 Dec 14. Related Articles, Links

The valuation of health effects caused by stationary sources-related SO2 emissions: the adaptation of impact pathway approach in Taiwan. Lin SL, Lin KH. Department of Environmental Engineering and Management, Chaoyang University of Technology, 168 Gifeng E. Rd., Taichung County, Taiwan, Taiwan, 413, Republic of China. [email protected] This paper presents the externalities of sulfur dioxide (SO(2)) in the Taichung metropolitan, Taiwan. The human effects of SO(2) from stationary sources are a key element for local air quality management. A methodology to evaluate those effects in monetary term had been adapted and applied. This method was modified from the EU-based impact pathway approach link to the skill of geographic information systems. The studied area was divided into 66 districts and the quantity of SO(2) was allocated to each district. Then, the ambient concentration of SO(2) was estimated by using the ordinary kriging method. A

risk analysis was employed to characterize the health impacts caused by SO(2). Finally, a monetary transfer approach based on the European data was conducted to estimate local damage costs per ton of SO(2). Health impacts, especially acute mortality, dominate in term of costs. The calculation showed that damage costs ranged from 0.56 to 7.38 USD/kg SO(2) based on the 2002 emission data. The results could be used in the internalization of SO(2) externalities and management of the stationary sources in the studied area. This paper also concludes that the externalities caused by stationary-related SO(2) emissions are some 28.5 million US dollars in Taichung metropolitan (Taiwan) in 2002. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17171275 [PubMed - indexed for MEDLINE] 426: J Prev Med Pub Health. 2006 Nov;39(6):499-504. Related Articles, Links

[The socioeconomic cost of diseases in Korea] [Article in Korean] Jung YH, Ko S. Korea Institute for Health and Social Affairs. [email protected] OBJECTIVES: The aim of the study was to estimate the annual socioeconomic cost of diseases in Korea. METHODS: We estimate both the direct and indirect costs of diseases in Korea during 2003 using a prevalence-based approach. The direct cost estimates included medical expenditures, traffic costs and caregiver's cost, and the indirect costs, representing the loss of production, included lost workdays due to illness and lost earnings due to premature death, which were estimated based on the human capital theory. The cost estimates were reported at three different discount rates (0, 3 and 5%). RESULTS: The cost of diseases in Korea during 2003 was 38.4 trillion won based on 0% discount rate. This estimate represents approximately 5.3% of GDP. The direct and indirect costs were estimated to be 22.5 trillion (58.5% of total cost) and 15.9 trillion won (41.5%), respectively. It was also found that the cost for those aged 40-49 accounted for the largest proportion (21.7%) in relation to age groups. The cost of diseases for males was 23.5% higher than that for females. For major diseases, the total socioeconomic costs were 16.0, 13.4, 11.3 and 11.19% for neoplasms, and diseases of the digestive, respiratory and circulatory systems, respectively. CONCLUSIONS: This study can be expected to provide valuable information for

determining intervention and funding priorities, and for planning health policies. Publication Types: •

English Abstract

PMID: 17168203 [PubMed - indexed for MEDLINE] 427: Hu Li Za Zhi. 2006 Dec;53(6):5-13. Related Articles, Links

[The strategy and prospects of suicide prevention in Taiwan] [Article in Chinese] Lee MB, Tai CW, Liao SC, Chiang HC. Natonal Taiwan Suicide Prevention Center, Taiwan, ROC. [email protected] Suicide mortality rates have been steadily rising in Taiwan, and suicide has been among the top ten causes of death for the last consecutive eight years. In response to this situation, the Taiwan Department of Health assigned the Taiwan Association Against Depression the task of setting up the Taiwan Suicide Prevention Center. The mission of the Center, suicide prevention, is advanced by its establishment of efficient networks nationwide capable of delivering related care services. Suicide prevention strategies can be categorized, based on coverage, as universal, selective or indicated interventions. The Center also plans to standardize the national suicide report format and care delivery system, improve mental health service quality, and organize community support networks. It pursues an encompassing health care mechanism model, where clients are considered the first priority, the family a fundamental supporting unit, and the community a solid foundation. The Center will offer a helping hand for individuals who have attempted suicide by maintaining a spirit of positive values and achieving mutual benefits. Publication Types: •

English Abstract

PMID: 17160864 [PubMed - indexed for MEDLINE] 428: Nippon Rinsho. 2006 Dec;64(12):2194-200. Related Articles, Links

[Epidemiology of Basedow disease and other thyroid diseases] [Article in Japanese] Ashizawa K. Department of Clinical Studies, Radiation Effects Research Foundation. Basedow disease is one of several representative thyroid diseases. According to information from Japan's Ministry of Health, Labour and Welfare, it is estimated that there were a total of about 130,000 patients (32,000 male 98,000 female, sex ratio of 1 : 3) of thyrotoxicosis in Japan during 2002. This number accounts for about 0.1% of the entire population of Japan. Several reports based on data from medical examinations provide higher prevalence rates. A survey of subclinical thyroid diseases is now in progress. There are reports of cases of progression from subclinical status to overt status, which suggests that the number of affected individuals becomes higher. Epidemiological data are still insufficient. Disease registry systems and medical examination data should be further improved. Publication Types: • •

English Abstract Review

PMID: 17154078 [PubMed - indexed for MEDLINE] 429: Kekkaku. 2006 Nov;81(11):693-707. Related Articles, Links

[New era in molecular epidemiology of tuberculosis in Japan] [Article in Japanese] Takashima T, Iwamoto T. Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases. Molecular epidemiology of tuberculosis (TB) is a science to study TB transmission dynamics and to enhance our understanding of the epidemiology of TB by utilizing molecular typing methods as an adjunct to classical epidemiological approach. Before the era of molecular epidemiology, it was quite difficult to ascertain the source of the infections since M. tuberculosis is spread by

air-borne droplets of respiratory secretions expelled by an infectious person to a susceptible host and it can remain latent as an asymptomatic infection for years. Now a day, our understanding of TB transmission dynamics has been refined by genotyping of M. tuberculosis strains. The methods of molecular epidemiology, especially IS6110 RFLP of M. tuberculosis, were first introduced to outbreak investigations and then gradually been expanded its application to populationbased study in Japan. IS6110 RFLP is obviously a powerful tool for strain differentiation of M. tuberculosis but its labor-intensiveness limits the achievable throughput and makes it less useful for long-term prospective studies. Recently, apart from IS6110 RFLP, DNA amplification-based method, i.e., variable number of tandem repeats (VNTR) has appeared as a substitute for or adjunct to the IS6110 RFLP. In this symposium, we have invited four opinion leaders in molecular epidemiology of TB from different fields: Mycobacterium reference center, basic science, clinical practice, and public health practice. We, as the chairpersons of this symposium, hope that this symposium would trigger the development of molecular epidemiological network of TB in Japan. 1. Achievement and problem of molecular epidemiologic study with IS6110-RFLP analyses of tuberculosis in Okinawa: Shinji MAEDA (Mycobacterium Reference Center, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association) The long-term RFLP analyses of tuberculosis in Okinawa showed that endemic M. tuberculosis might be present. This is one of the achievements of our project study. On the other hand, for more effective examination of contact persons, information of molecular epidemiology should be used actively. Therefore because the analysis report needs to be sent back quickly, the PCRbased VNTR method should substitute for the RFLP analysis. 2. Basic knowledge and application of Variable Numbers of Tandem Repeats: Kei NISHIMORI (Department of epidemiology, National Institute of Animal Health) Genomic loci of Variable Numbers of Tandem Repeats (VNTR loci) in Mycobacterium tuberculosis complex and Mycobacterium avium, the history of analysis of VNTR loci, the hypothetical mechanisms of increase or decrease of number of repeats, the structures of the loci, and the necessity of standardizing the VNTR typing were introduced. 3. Clinical application of VNTR: Tomoshige MATSUMOTO, and Hiromi ANO (Department of Clinical Research and Development, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases) Tuberculosis genotyping was first introduced to outbreak investigations and population-based studies. The advent of Variable Numbers of Tandem Repeats (VNTR) can be applied to clinical fields of not only Mycobacterium tuberculosis but also of Mycobacterium avium. In Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, clinical application of VNTR was first introduced in Japan to determine whether Mycobacterium tuberculosis or avium disease was caused by reactivation or reinfection when relapsed. We showed some examples about usefulness of the clinical application of VNTR. 4. Molecular epidemiology of tuberculosis to improve TB prevention and control activities: Tomotada IWAMOTO (Department of microbiology, Kobe Institute of Health), Riyo FUJIYAMA, Noriko TANAKA, Yasuto KAWAKAMI (Kobe City Public Health Center),

Chika SHIRAI (Hyogo-ku Health and Welfare Department, Kobe) M. tuberculosis isolates in Kobe have been characterized as: a) Beijing family strains are highly prevalent (77%), b) two major MIRU profiles in Beijing family were found, one is globally pandemic genotype and the other is locally prevalent strains, c) six strains belonged to T3-Osaka family, and d) Manila family strains made cluster consisting of 3 strains. Kobe VNTR Database which consists of 12loci MIRU and 9 additional VNTR loci has been developed. The basis for the selection of these supplemental 9 VNTR loci and the application of VNTR database in TB control program were introduced. Publication Types: • •

English Abstract Review

PMID: 17154049 [PubMed - indexed for MEDLINE] 430: Ann Saudi Med. 2006 Nov-Dec;26(6):429-32. Related Articles, Links Erratum in: •

Ann Saudi Med. 2007 Jan-Feb;27(1):54.

Towards evidence-based medical education in Saudi medical schools. AlFaris E, Abdulgader A, Alkhenizan A. Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. [email protected] (EBME) [corrected] is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the 'science' of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students (the consumers), but also has a wider

impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal (secondary publication) that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use. PMID: 17143017 [PubMed - indexed for MEDLINE] 431: Chronic Illn. 2005 Jun;1(2):165-77. Related Articles, Links

Evidence of cultural hybridity in responses to epilepsy among Pakistani muslims living in the UK. Small N, Ismail H, Rhodes P, Wright J. School of Health Studies, University of Bradford, 25 Trinity Road, Bradford BD5 0BB, UK. [email protected] OBJECTIVES: To examine how people from Bradford's Pakistani Muslim community experience living with epilepsy. Specifically, the paper addresses social interactions and negotiations with care providers and considers how different understandings of epilepsy are integrated. METHODS: Interviews were conducted with a sample of Bradford's Pakistani Muslim community (n = 20). Interviews were analysed to identify themes and significant areas of shared concern. RESULTS: This paper identifies popular, professional and folk sectors contributing to an individual's 'health system'. Where sectors overlap, zones of hybridity are created: that is, a person might simultaneously seek help from a doctor and from a religious healer, or might offer explanations for seizures that include neurological and spiritual components. DISCUSSION: While there are many similarities between the experiences of these minority ethnic community members and published work on the lived experience of epilepsy in other communities, there are also important differences that service providers need to recognize and respond to. Differences include forms of cultural expression and specific language needs. Improving communication between professionals and persons with epilepsy needs to be prioritized. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17136922 [PubMed - indexed for MEDLINE] 432: Ann N Y Acad Sci. 2006 Oct;1081:17-29. Related Articles, Links

Perspectives on applied spatial analysis to animal health: a case of rodents in Thailand. Herbreteau V, Demoraes F, Hugot JP, Kittayapong P, Salem G, Souris M, Gonzalez JP. Center for Vectors and Vector-borne Diseases, Faculty of Sciences, Mahidol University, Thanon Rama VI, Phyathai, Bangkok 10400, Thailand. [email protected] Geographic information systems (GIS) and remote sensing have been increasingly used in ecology and epidemiology, providing a spatial approach for animal health issues. Recent development of earth environmental satellites--i.e., their growing number, improving sensor resolutions and capabilities--has offered new opportunities to delineate possible habitats and understand animals and associated parasites in their environment, by identifying the nature and structure of land use, hydrological network, soil hydromorphy, and human settlements. Integrated into GIS, remotely sensed and other geo-referenced data allow both spatial and temporal analyses of animal ecology and health. However, a review of their applications has showed the poor quality of data sources and processing used, revealing limitations between theory and practical implementations. As an example, the assessment of the expected distribution of Bandicoot rats, main agricultural pest and vector of zoonoses in Phrae province (North Thailand), illustrates a rational use of spatial analysis, with the choice of relevant data, scales, and processing. Vegetation indices are computed on a TERRA ASTER image and further classified using elevation data. The biotopes of Bandicota indica and Bandicota savilei are delimited, providing a major source of knowledge for rodent and human health analyses. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17135491 [PubMed - indexed for MEDLINE] 433: Chudoku Kenkyu. 2006 Oct;19(4):423-8. Related Articles, Links

[Health hazard cases caused by powder fire extinguishers reported to Japan Poison Information Center] [Article in Japanese] Yayoi H. Publication Types: •

News

PMID: 17133986 [PubMed - indexed for MEDLINE] 434: Drug Alcohol Rev. 2006 Nov;25(6):625-32. Related Articles, Links

Civil society-a leader in HIV prevention and tobacco control. Malinowska-Sempruch K, Bonnell R, Hoover J. International Harm Reduction Development Program (IHRD), Open Society Institute, New York 10019, USA. [email protected] Many civil society organisations (CSOs) have been at the forefront of identifying new ideas and implementing innovative models regarding health and health systems around the world. Their activities become highly charged, however, when they engage in advocacy efforts designed to influence change in policies and systems linked with more controversial or complicated public health issues. Policies, laws and regulations regarding illicit drugs and tobacco fall directly into that category. There is no doubt that the use of both kinds of substances can have the same health consequences-including ill health and death-yet they are approached in widely different ways. Smoking is legal to some extent in every country in the world, and is generally considered a matter of personal choice. Many people believe that efforts to limit tobacco use are coercive and impede on individual rights. Those who use illicit drugs such as heroin, meanwhile, are with few exceptions considered social deviants, misfits and lawbreakers. Many CSOs support comprehensive, government-funded prevention strategies coupled with non-punitive, non-judgmental programmes designed to help users change behaviour. Such strategies are designed to reflect and respond to the medically addictive nature of both tobacco and many illegal drugs. Proponents argue that not only are the public health benefits of expansive, well-conceived interventions potentially vast, but so too are the social and economic benefits accruing from lower rates of debilitating disease and premature death. To that end, many

international, national and local CSOs are identifying the direct and indirect health consequences of tobacco and illegal drug use; proposing and advocating for strategies to limit their impact; and sharing information and resources with like-minded organisations elsewhere. This leadership role has helped influence and shape policy, especially in recent years. This paper examines civil society's involvement in efforts to change drug and tobacco policy in selected countries in Central and Eastern Europe and the former Soviet Union (CEE/FSU). It concludes that in Poland and Kazakhstan, in terms of tobacco control, and increasingly in Ukraine and parts of Central Asia in terms of harm reduction, multi-sectoral approaches are the most effective way to engage citizens and to implement comprehensive strategies to change behaviour by supportive measures, not punitive ones. Publication Types: •

Review

PMID: 17132578 [PubMed - indexed for MEDLINE] 435: Br J Gen Pract. 2006 Nov;56(532):869-75. Related Articles, Links

Communication between South Asian patients and GPs: comparative study using the Roter Interactional Analysis System. Neal RD, Ali N, Atkin K, Allgar VL, Ali S, Coleman T. Department of General Practice, Cardiff University. [email protected] BACKGROUND: The UK South Asian population has poorer health outcomes. Little is known about their process of care in general practice, or in particular the process of communication with GPs. AIM: To compare the ways in which white and South Asian patients communicate with white GPs. DESIGN OF STUDY: Observational study of video-recorded consultations using the Roter Interactional Analysis System (RIAS). SETTING: West Yorkshire, UK. METHOD: One hundred and eighty-three consultations with 11 GPs in West Yorkshire, UK were video-recorded and analysed. RESULTS: Main outcome measures were consultation length, verbal domination, 16 individual abridged RIAS categories, and three composite RIAS categories; with comparisons between white patients, South Asian patients fluent in English and South Asian patients nonfluent in English. South Asians fluent in English had the shortest consultations and South Asians non-fluent in English the longest consultations (one-way ANOVA F = 7.173, P = 0.001). There were no significant differences in verbal domination scores between the three groups. White patients had more affective (emotional)

consultations than South Asian patients, and played a more active role in their consultations, as did their GPs. GPs spent less time giving information to South Asian patients who were not fluent in English and more time asking questions. GPs spent less time giving information to South Asian patients fluent in English compared with white patients. CONCLUSIONS: These findings were expected between patients fluent and non-fluent in English but do demonstrate their nature. The differences between white patients and South Asian patients fluent in English warrant further explanation. How much of this was due to systematic differences in behaviour by the GPs, or was in response to patients' differing needs and expectations is unknown. These differences may contribute to differences in health outcomes. Publication Types: • • •

Comparative Study Multicenter Study Research Support, Non-U.S. Gov't

PMID: 17132355 [PubMed - indexed for MEDLINE] PMCID: PMC1927096

436: Int J Tuberc Lung Dis. 2006 Nov;10(11):1241-7. Related Articles, Links

An Internet-based surveillance system for tuberculosis in Korea. Lew WJ, Lee EG, Bai JY, Kim HJ, Bai GH, Ahn DI, Lee JK, Kim SJ. Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Seoul, Korea. [email protected] SETTING: The Korea Tuberculosis Surveillance (KTBS) network includes 248 health centres throughout the country, as well as other public and private health institutions. OBJECTIVE: To develop a web-based surveillance system for tuberculosis (TB) and to monitor implementation of the National TB Control Programme (NTP) on an ongoing basis. DESIGN: A TB notification form was developed with new case definitions, and standardised to obtain uniform essential information of the cases with ease and speed. Data collection, compilation, analysis and feedback were made available at every level of the health authority via the Internet without restrictions of time and space. RESULTS: The Internetbased surveillance system was successfully implemented across the country, providing real-time national figures of TB using different variables-patient, time,

area, site and type of disease--and facilitating on-line evaluation of NTP implementation. CONCLUSION: The web-based surveillance system has been well established within the existing health infrastructure, providing real-time figures on the TB burden. However, it requires continued improvement of the quality of information and of case reporting activities. Publication Types: •

Multicenter Study

PMID: 17131783 [PubMed - indexed for MEDLINE] 437: Psychol Health Med. 2006 Aug;11(3):367-73. Related Articles, Links

Interventions to address the stigma associated with leprosy: a perspective on the issues. Cross H. ALM Prevention of Disability Consultant, Ayala Center, Cebu City, Philippines. [email protected] This paper presents a perspective on stigma as an effect of leprosy. It identifies some of the strengths and weaknesses of current approaches to stigma reduction in leprosy and presents a rationale for considering alternative strategies. It is suggested that models used to explain health behavior in developed societies are inappropriate for explaining leprosy stigma or for developing strategies to address it. The author recommends due consideration of the alternative logic that characterizes cultural belief systems in countries where leprosy is a challenge. Criticism of the common practice of information dissemination as a strategy to address leprosy stigma is defended and the merits and limitations of an integrated health service in India is discussed. The author defends the suggestion that the principal objective of stigma interventions should be "normalization". An example of a Nepalese project based on empowerment theory is given to demonstrate how the transformation of identity from outcast to positive change agent, can effect "normalization". PMID: 17130073 [PubMed - indexed for MEDLINE] 438: Acta Paediatr. 2006 Dec;95(12):1561-6. Related Articles, Links

Comparative analysis of neonatal morbidity for vaginal and caesarean section deliveries using hospital charge. Chang JH, Hsu CY, Lo JC, Chen CP, Huang FY, Yu S. Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan. AIM: To assess the neonatal morbidity of alternative modes of delivery using economic data. METHODS: Two groups of neonatal morbidity data were extracted according to mode of delivery from inpatient claims on National Health Insurance in Taiwan: uncomplicated vaginal and caesarean section deliveries. Outcome variables included number of infants treated as inpatients, duration of hospital stay, and hospital charge during both the first month and the first year of age. RESULTS: Uncomplicated caesarean section delivery of term infants carried a significant increase either in the first month of life or during the first year after birth in both duration of hospital stay and hospital discharge when compared with uncomplicated vaginal delivery. Neonatal jaundice accounted for the greatest morbidity among term newborns, irrespective of delivery mode, followed by infectious, gastrointestinal and respiratory morbidity. Logistic regression analysis demonstrated that uncomplicated vaginal delivery was associated with skin diseases. Uncomplicated caesarean section delivery was associated with infectious disease and disease of the respiratory, digestive and circulatory systems. CONCLUSION: The findings of this study may provide further information for clinicians and would be an important consideration when advising pregnant women on the preferred route of delivery. Publication Types: •

Comparative Study

PMID: 17129962 [PubMed - indexed for MEDLINE] 439: Int J Qual Health Care. 2007 Feb;19(1):21-8. Epub 2006 Nov 23. Related Articles, Links

Development and implementation of a nationwide health care quality indicator system in Taiwan. Chiu WT, Yang CM, Lin HW, Chu TB. Taipei Medical University School of Healthcare Administration, No. 250, WuHsing Street, Taipei 110, Taiwan.

QUALITY ISSUES: Quality is an increasingly important issue to the health care sector. The Taiwanese government also recognizes the need to implement a nationwide health care quality indicator system to strengthen quality surveillance. CHOICE OF SOLUTION: In 1999, the Department of Health funded a 2-year project led by the Taiwan Healthcare Executive College to develop a comprehensive performance assessment system, subsequently named as Taiwan Healthcare Indicator Series (THIS). The series includes four categories of indicators, namely outpatient, in-patient, emergency care, and intensive care, and has 139 items in total. IMPLEMENTATION: The system was officially launched in 2001. Participation is voluntary. The Taiwan Healthcare Executive College processes the data and provides feedback to the participating hospitals. The information is for the participating hospitals' own use and is not released to the public. EVALUATION: Participating hospitals have increased from 45 in 2001 to 227 in 2006 and now constitute approximately 50% of the total hospital population in Taiwan. The reporting rate averaged 77.7% in 2004. The first five most reported indicators are the percentage of first-visit outpatients to outpatient clinics, the average length of in-patient stay, the nosocomial infection rate, the occupancy rate, and the crude mortality rate. LESSONS LEARNED: How the data are interpreted and how data interpretation can lead to quality improvement are the principal concerns of participating hospitals. In light of the success of the indicator series, the Bureau of National Health Insurance (BNHI) of Taiwan has proposed participation in the series as being one of the criteria to be reimbursed for quality. PMID: 17124255 [PubMed - indexed for MEDLINE] 440: Ann Surg. 2006 Dec;244(6):1018-23. Related Articles, Links

Suicide bombers form a new injury profile. Aharonson-Daniel L, Klein Y, Peleg K; ITG. Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel. [email protected] BACKGROUND: Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect. METHODS: Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed. RESULTS: A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe

injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. CONCLUSIONS: Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity. PMID: 17122628 [PubMed - indexed for MEDLINE] PMCID: PMC1856624

441: Can J Public Health. 2006 Sep-Oct;97(5):398-401. Related Articles, Links

The three networks framework to deal with public health emergencies in Guangxi, China. Wen-kui G, Jia-tong Z, De-cheng L, Yan-xia H, Lin H, Hui W, Xiao-lan T. Public Health College, Guangxi Medical University, Guangxi Zhuang Autonomous Region, China. OBJECTIVE: To improve the detection and control of infectious diseases in Guangxi, China. SETTING/PARTICIPANTS: Guangxi province in southwest China has almost 50 million people, of whom approximately 30% reside in urban and 70% in rural areas. There are 12 minority nationality groups living in the region. INTERVENTION: A village doctor reports any infectious disease outbreak to the Reporting Network, which notifies the Service Network to organize the clinical response. This is supported by the Government Network that coordinates the response among the multiple layers of local governments. OUTCOMES: Since 2002 when the Three Networks system was first started, the time from incidence to report has been shortened on average from 30.6 to 7.6 days and the number of cases has increased from slightly less than 5000 cases/year

(4965) to almost 10,000 cases/year (9873). Average mortality has decreased from 3.23% to 0.74%. The Three Networks system has been successful in controlling measles outbreaks; and during SARS, when 11 cases came to Guangxi from the neighbouring Guangdong province, there were only 11 additional new cases with no community spread and no spread to medical staff. CONCLUSION: The Three Networks system has played an important role in infectious disease prevention and control in Guangxi province, and may be applicable to other areas with a similar situation. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17120880 [PubMed - indexed for MEDLINE] 442: Indian J Lepr. 2006 Jul-Sep;78(3):245-59. Related Articles, Links

Inter-state variations in integration of leprosy services into general health system in low/ moderately endemic states of India. Pandey A, Patel R, Rathod H. Regional Leprosy Training and Research Institute, Lalpur, Raipur, Chhattisgarh. [email protected] The objective of the study was to analyse inter-state variations in integration of leprosy services into the general health system, covering broad categories of structure integration, training of health functionaries, availability of MDT services and record maintenance, in 24 low/moderately endemic states. Multi-stage random sampling technique was used to select 9 states, 86 health facilities (including district hospitals, community health centres, primary health centres) and 108 sub-centres. Information from each level was collected on a pre-tested form by officers of three leprosy institutions of the Government of India. The results showed wide inter-state variations on each aspect. Redeployment of vertical staff was complete (100%) in Tamil Nadu and Tripura. Assam reported a higher level of training (97%) of medical officers in leprosy. Training of health supervisors and multipurpose workers was better than that of medical officers in most of the states. Tripura reported negligible training of all the health functionaries because of specific local problems. In Assam, Maharashtra and Sikkim, all the urban and rural health facilities were providing MDT. Three months' stock of all types of MDT blister packs was available only in one health facility in Andhra Pradesh and in Goa. Assam and Haryana had lower availability of MDT stocks. In Assam and Maharashtra, medical officers in all health facilities were diagnosing and treating leprosy cases, as compared with Himachal Pradesh

where the value was 30%. Involvement of sub-centres in MDT delivery was more at 92% and 100% in Tamil Nadu and Maharashtra respectively in comparison to none in Himachal Pradesh and Tripura. Use of the Simplified Information System (SIS) 2002 guidelines and formats was universal. However, lower involvement of GHS staff in recording and reporting was noted in Assam (0%), Andhra Pradesh (10% and 30%). The study emphasized the need for further tailor-made follow-up studies to suit local problems. PMID: 17120508 [PubMed - indexed for MEDLINE] 443: J Neurotrauma. 2006 Nov;23(11):1621-31. Related Articles, Links

Fighting for each segment: estimating the clinical value of cervical and thoracic segments in SCI. van Hedel HJ, Curt A. Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. [email protected] Patients suffering from complete spinal cord injury (SCI) are the most likely candidates for the application of new interventions for neural repair and regeneration. It is assumed that some of these treatments will have their strongest impact at the segmental level. Therefore, it is important to evaluate the clinical relevance of potential changes at the segmental levels concerning both improvement and deterioration. Data of 98 motor complete SCI patients were derived from the European Multicenter Study of Human Spinal Cord Injury database. Six months after injury, the ASIA motor score and Spinal Cord Independence Measure (SCIM) were assessed as dependent variables (linear regression analysis) to disclose the difference between each segment. Separate analyses using linear regression for tetraplegic patients (n = 39) and paraplegic patients with thoracic lesions (n = 54) were performed to calculate the difference between each spinal segment. In tetraplegic patients, both the ASIA motor score and the SCIM revealed relevant differences per spinal segment (9 and 4 points, respectively) while in paraplegic patients there was no difference for the SCIM and the ASIA motor score between T2 and T8. We suggest that in complete tetraplegic patients, changes of even one spinal segment will either improve or degrade both motor function and independence. Segmental changes at the thoracic level are not assessable by the ASIA motor score and SCIM tests. Therefore, the assessment of efficacy and safety in thoracic patients by these two tests has limited value when applied to cervical SCI. These findings may be considered in clinical trials for the evaluation of beneficial effects and risk management when treating patients with spinal cord injury.

Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 17115909 [PubMed - indexed for MEDLINE] 444: Comput Inform Nurs. 2006 Nov-Dec;24(6):346-52. Related Articles, Links

Mapping of nursing records into the NIC and the ICNP in a Korean oriental-medicine hospital. Lee E, Lee M, Jung OB. College of Nursing, Kyungpook National University, South Korea (Dr Lee, Ms Jung); and the College of Nursing, The University of Iowa, Iowa City, IA 52242, USA. [email protected] This study uses mapping methodology to examine the applicability of the Nursing Interventions Classification and the International Classification of Nursing Practice to nursing practice in a Korean Oriental-medicine hospital. Data were collected from the nursing records of 56 stroke patients in one unit, and intervention statements were mapped into NIC and ICNP. Of 147 unique nursing intervention statements extracted, 136 (92.52%) could be mapped into NIC and 99 (67.35%) statements could be completely mapped into ICNP. Using mapping methodology, this study validates that both NIC and ICNP would be useful for documenting nursing care in a Korean hospital, but it also identifies additional concepts that need to be represented in both of these standardized nursing languages. It is recommended that nurses be more careful in documenting their interventions and also that SNLs be developed further to more completely represent nursing practice. Publication Types: • •

Research Support, Non-U.S. Gov't Validation Studies

PMID: 17108754 [PubMed - indexed for MEDLINE] 445: Gan To Kagaku Ryoho. 2006 Nov;33(11):1563-7.

Related Articles,

Links

[Team approach for treatment of patients with cancer, how to cooperate with staffs of other medical institutions--a recent trend in Japan] [Article in Japanese] Tanimizu M, Kikuuchi Y, Funada C, Kameshima K, Kurita A, Takashima S. National Hospital Organization, Shikoku Cancer Center. For the team approach to patients with cancer both of consistency of medical services and patient's satisfaction are important. Japanese health care reform planning prescribes an establishment of a section which accepts patient's consultation and provides proper advice or information. Technology of the internet is also promising for team approaches with staffs of other medical institutions as well as the patient support section in the cancer centers. Publication Types: •

English Abstract

PMID: 17108718 [PubMed - indexed for MEDLINE] 446: Stud Health Technol Inform. 2006;124:699-704. Related Articles, Links

Agent based simulations in healthcare. Bilge U, Saka O. Akdeniz University Faculty of Medicine, Antalya, Turkey. [email protected] Agent Based Simulations (ABS) is a relatively recent computer paradigm. As opposed to "top down" conventional computer simulations, the ABS approach is a "bottom-up" modelling technique where a medium to high number of independent agents is modelled. These agents' interactions sometimes cause unexpected "emergent" system behaviour. ABS is particularly suitable in the social context such as healthcare where a large number of human agents interact and co-operate for common goals. Today ABS in the social context is often used together with the recently introduced network analysis techniques and network visualization tools for modelling and simulating social agents within organisations. At Akdeniz

University we are starting a number of projects for applying ABS technology in healthcare. In this paper we present two of the ongoing projects in this field. Firstly we have developed a prototype simulator for the long term monitoring of Chronic Obstructive Pulmonary Disease (COPD) as a major public health problem. We present the COPD simulator, its agents, parameters and working principles. Secondly we want to apply ABS and the network analysis techniques to visualise and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organisation in terms of its ability to innovate and share knowledge. In our applications, we primarily aim to use ABS in a web-based platform to create a virtual environment for discussion, visualising and running what-if scenarios to test out various options for managing healthcare, as well as sharing information and creating a virtual community. PMID: 17108597 [PubMed - indexed for MEDLINE] 447: Int J Cardiol. 2007 Sep 14;121(1):127-9. Epub 2006 Nov 14. Related Articles, Links

Impact of hospital and physician characteristics on medical expenditures for acute myocardial infarction hospitalization. Chen CS, Liu TC, Chiu WT, Lin HC. This study aims to examine the impact of length of stay, hospital characteristics, physician characteristics and other factors on the expenditures of hospitalization for acute myocardial infarction (AMI) under Taiwan's National Health Insurance program. This study uses data collected from the Taiwan's National Health Research Institute's 2001-2003 National Health Insurance Research Database. We estimated contributors to increased expenditures of hospitalization using threestage least square regression model. The hospital expenditures for the treatment of AMI averaged NT$126,366 (US$3829, US$1=NT$33) per discharge, with the largest proportion (27%) spent on room expenditures. They were strongly impacted by length of stay, increasing around 4.8% per day. We conclude that hospital expenditures for the treatment of AMI patients may vary widely depending on the characteristics of the hospital and physicians that provide them care. Publication Types: • •

Letter Research Support, Non-U.S. Gov't

PMID: 17107726 [PubMed - indexed for MEDLINE]

448: Stud Health Technol Inform. 2006;122:991. Related Articles, Links

Nursing data set development in Thailand. Phuphaibul R. Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. [email protected] The survey on nursing minimum data set was performed. Questionnaires were sent to 500 randomly selected hospitals, 378 returned questionnaires were analyzed. The top 10 minimum nursing data set were identified. They were patient's hospital number, name, personal ID number, medical diagnosis, referral, admission date, patient/family history, address and phone, gender, birth, religion, education, laboratory tests, discharge/expiration date, condition before discharge, nursing outcome, nursing problem, nursing intervention, admission number, health insurance, discharge plan and home visit. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102504 [PubMed - indexed for MEDLINE] 449: Stud Health Technol Inform. 2006;122:963-4. Related Articles, Links

Development of a web-based health information service system for maternal health care. Bae J, Heitkemper M. Department of Nursing, Inje University, Busan, Korea. [email protected] Information technology skills are essential for effective and efficient practice in maternal and child health. The purpose of this study was to develop a web-based multimedia health information system for maternal health care using principals of user centered design. Research process includes needs assessment, needs analysis, design, development/testing, and application release. This system will be a new way of nursing intervention and contribute to the maternal health promotion.

Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102488 [PubMed - indexed for MEDLINE] 450: Stud Health Technol Inform. 2006;122:941-2. Related Articles, Links

To realize easy-to-understand description of nursing practice terminology for consumer. Uchino S, Inoue M, Tsuru S, Nakanishi M, Dannoue H. Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan. [email protected] In Japan it is an important issue to introduce Electronic Health Records (EHR) in over 60% of hospitals with more than 400 beds. Introducing E.H.R is supposed to help provide a safe medical environment as well as practice medicine by description in plain terms among professionals and among patients and medical professions. We've developed Nursing Pr Terminology understandable to consumers visualization of nursing action, and arranged them by level and category. However, it is still difficult to express the appropriate contents because they consist of expert decisions and processes. Hereafter, it is a very important challenge of ours to develop an easy-to-understand description of the Nursing Practice Terminology to supply safe and patient-centered medicine to consumers. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102480 [PubMed - indexed for MEDLINE] 451: Stud Health Technol Inform. 2006;122:903. Related Articles, Links

Data mining approach to model the diagnostic service management. Lee SM, Lee AK, Park IS.

The Catholic University of Korea, Seoul, Korea. Korea has National Health Insurance Program operated by the government-owned National Health Insurance Corporation, and diagnostic services are provided every two year for the insured and their family members. Developing a customer relationship management (CRM) system using data mining technology would be useful to improve the performance of diagnostic service programs. Under these circumstances, this study developed a model for diagnostic service management taking into account the characteristics of subjects using a data mining approach. This study could be further used to develop an automated CRM system contributing to the increase in the rate of receiving diagnostic services. PMID: 17102454 [PubMed - indexed for MEDLINE] 452: Stud Health Technol Inform. 2006;122:889-90. Related Articles, Links

An XML-based framework for personalized health management. Lee HJ, Park SH, Jeong BS. Department of Medical Information System, Yongin Songdam College, Yongin, Gyeonggi, Korea. This paper proposes a framework for personalized health management. In this framework, XML technology is used for representing and managing the health information and knowledge. Major components of the framework are Health Management Prescription (HMP) Expert System and Health Information Repository. The HMP Expert System generates a HMP efficiently by using XMLbased templates. Health Information Repository provides integrated health information and knowledge for personalized health management by using XML and relational database together. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102446 [PubMed - indexed for MEDLINE] 453: Stud Health Technol Inform. 2006;122:886. Related Articles, Links

The evaluation criteria of internet health information.

Kang NM, Kim S, Hong S, Ryu S, Chang HJ, Kim J. College of Nursing, Konkuk University, Seoul, Korea. The Internet has great powerful forces for health information and education. This describes the development of a web-based evaluation criteria for internet health information. The purpose of this study was to explore the evaluation criteria (tool) of internet health information for Korean. This utilized a cross-sectional design with four sections: (1) CAHPS (Consumer assessment of health plans studies); (2) Health consumer terminology and understanding review; (3) web based interactive tool construction; (4) semantic web technology application. The findings showed follows; (1) literature review related quality evaluation tool for internet health information; (2) case study; (3) development of evaluation prototype; (4) validity assessment of tool; (5) Evaluation system information strategic planning. PMID: 17102445 [PubMed - indexed for MEDLINE] 454: Stud Health Technol Inform. 2006;122:868-9. Related Articles, Links

The development of NRMIS (Nursing Resources Management Information System)--Focused on patient classification. Moon WH. Department of Health & Medical Informatics, Daejeon Health Sciences College, Korea. [email protected] Information system can be useful to effective and flexible decision making of nursing resource administration. A Nurse Resources Management Information Model and a Nurse Resources Management Information System (NRMIS) were developed in this study. The NRMIS consisted of a nursing staff scheduling system (NRS), a patient classification system (PCS), and an optimal nursing manpower estimating system (ONMES). The patient classification system was developed according to nursing intensity. The system was evaluated through user interface satisfaction and usefulness in the clinical settings. The main challenge is how we realize this information model to support evidence-based nursing resource administration. PMID: 17102433 [PubMed - indexed for MEDLINE] 455: Stud Health Technol Inform. 2006;122:846. Related Articles, Links

Difference of needs on functionality of electronic health record systems. Hwang JI, Yoon SY, Chin HJ, Seo JW. Nursing Administration, Kyung Hee University, Korea. The study was conducted to assess needs on the functionalities of an electronic health record (EHR) system and to determine the difference of needs among MR administrators' groups and expert groups in Korea. PMID: 17102418 [PubMed - indexed for MEDLINE] 456: Stud Health Technol Inform. 2006;122:715-7. Related Articles, Links

Analysis of Nursing Interventions Classification (NIC) performed in the medical-surgical unit. Lee E. College of Nursing, Kyungpook National University, Daegu, Korea. To identify the interventions used in a medical-surgical unit, data were collected from 167 nurses working in 8 hospitals in Korea and analyzed by descriptive statistics. Two hundred and two interventions were selected by Korean nurses and 9 interventions used more than 50% of nurses surveyed. The nursing interventions of Korean nurses were heavily focused on the physiological domain. The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and developing educational curriculars for nursing students. PMID: 17102356 [PubMed - indexed for MEDLINE] 457: Stud Health Technol Inform. 2006;122:664-8. Related Articles, Links

Intelligent mobile voice information centre system: Taking the emergency triage support system as an example. Hsiao FY, Chang P. Institution of Health Informatics and Decision Making, National Yang-Ming

University, Taipei, Taiwan ROC. According to research by the International Telecommunications Union (ITU), Taiwan has the highest percentage of people holding mobile (cell) phones, and every one has one or two cell phones. We usually use mobile phones to make contact with hospitals or dial 119 in an emergency. We have developed a new call flow style and combine traditional passive call flow. The system is designed with a voice menu and users can command services actively. The telephone connects to a computer server to enter the call flow module with ASR and TTS. The recognition term comes from a voice term database. The voice management center is an ER triage decision system. We have tested three scenarios which are DOA, a large number of patients and critical trauma. We measured the completion time and recognition rate for all the scenarios. The recognition rate in all three cases was above 90%. The average completion time for DOA is 38.6 seconds, for the large number of patients is 20 seconds and for the critical trauma case, the average is 252.7 seconds. It is too slow to input one patient's data but the communication transfer of the message is fast and convenient; the DOA notice only takes 38 seconds to inform medical staff, which is very efficient and medical staff believe that this can help their communication. We will continue to extend our system and further apply it to other domains. Future studies may combine the Internet platform with the WiFi phone and soft phone (Skype) and broaden the scope of the application in Taiwan. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102346 [PubMed - indexed for MEDLINE] 458: Stud Health Technol Inform. 2006;122:654-6. Related Articles, Links

Experience sharing on the implementation of telehealth system in Hong Kong. Wong TK, Chung JW, Fan KL, Chow MW, Lau YK, Cheung CC, Au AY, Ma PM. Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China. With the growth of the ageing population in Hong Kong, healthcare professionals believe that there will be a great demand of healthcare service at the community level. In 2000, the first prototype of telehealth system was developed, tested and

validated by the School of Nursing, The Hong Kong Polytechnic University. With the advancement of information technology and inexpensive video- conference facility, an inter-clinic patient-centered healthcare information system has been evolved and used by a number of satellite clinics since 2003. In order to foster the importance of personal healthcare education at the community level, different versions of the telehealth system were designed and developed for school children and teenagers. Now the research team is focusing on the development of the pocket PC's version. Experience on the deployment of such technology-intensive system in healthcare was discussed in this paper. PMID: 17102343 [PubMed - indexed for MEDLINE] 459: Stud Health Technol Inform. 2006;122:565-9. Related Articles, Links

Attitudes of nurses towards End-user Development. Liu SC, Chang P, Huang F, Hou IC. Institute of Healthy Informatics and Decision Making, National Yang-Ming University, Taiwan ROC. The purpose of this study is to explore nurses' attitudes toward developing selfmade information tools. In order to understand nurses' attitudes, we studied the factors that affect nurses' attitudes toward End-user Development (EUD). The investigation of nurses in Taiwan hospitals showed that nurses had positive attitudes toward EUD. A framework of nurses' attitudes toward EUD is presented. A gap was found between the functions provided by the nursing information system and self-assessment required by the job. The nurses were inclined to be dissatisfied with support provided by the information centers. Nursing managers were advised to enhance on-the-job training for computer applications, and to include computer competencies in the nursing ladders program. The results indicated that nurses were willing to develop their own tools. We believe that nurses with computer application skills who are provided with appropriate tools can become nursing application developers. The results encourage nurses to develop software by themselves. Further research and development is required to enhance the impact of EUD and establish a sharing environment for EUD applications. PMID: 17102323 [PubMed - indexed for MEDLINE] 460: Stud Health Technol Inform. 2006;122:304-8. Related Articles, Links

Evaluation of electronic health records from viewpoint of patients.

Koide D, Asonuma M, Naito K, Igawa S, Shimizu S. Clinical Bioinformatics Research Unit, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan. [email protected] OBJECTIVE: To clarify the impacts of electronic health records (EHRs) on patients, especially patient's satisfaction by using questionnaire. DESIGN: Surveys were conducted at three hospitals. One of them was surveyed three times; three-months before (pre-EHR) and three-months after (post-3mo EHR) and ninemonths after implementation of EHR (post-9mo EHR). The other two hospitals (metropolitan-stable EHR and suburban-stable EHR) spent more than three years after implementation. Thus there were five stages of EHR. MEASUREMENTS: Comparisons were made among these five stages. RESULTS: The longer EHR has been operating, the more patients answered waiting time shortened. The patients in pre-EHR (73%) expected the benefit of cooperation between hospitals and clinics using EHR more. The longer experience of EHR a hospital had, the more patients were explained by watching the screen. Although overall satisfaction was high, there was no difference among the stages except metropolitan-stable EHR. CONCLUSION: Main benefits of EHR are reducing patient's waiting time, and enhancing explanation to patients. However it does not have significant effects to improve patient's satisfaction. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102269 [PubMed - indexed for MEDLINE] 461: Stud Health Technol Inform. 2006;122:112-6. Related Articles, Links

Early detection of pulmonary hypertension with heart sounds analysis pilot study. Chen J, Chung J, Wong T, Fan KL, Pun CO. School of Nursing, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hong Kong. There are strong evidences to support that the modification of the characteristics of the second heart sound has a high correlation with the pulmonary arterial pressure (PAP). It is hence postulated that a specific heart sound spectrum for this disease group could be generated as a decision support system to help healthcare

workers for the early detection of pulmonary hypertension. This paper described the design of a case-control study on identifying the heart sound pattern of people with pulmonary hypertension. In the proposed study, the heart sound of patients having pulmonary hypertension will be captured by an electronic stethoscope and processed into digital sound spectra which will be analysed to identify a specific heart sound pattern. In the future, an intelligent device will be developed based on the identified pattern to identify and diagnose early stage of pulmonary hypertension. PMID: 17102229 [PubMed - indexed for MEDLINE] 462: Stud Health Technol Inform. 2006;122:9-17. Related Articles, Links

Feeling the digital pulse: Consumer-centered approach to individual health profiling. Wong TK. Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong. New technologies from the new digital era are overcoming temporal, spatial and physical hurdles in the development and realization of individual health profiling and consumer health monitoring devices. Mature wireless and networking technologies promise more accessibility and portability of health data and records, and health monitoring. The increase in convenience and efficiency underlie the technological foundation for development of telehealth systems, which make personal health care available anytime, anywhere. On the one hand, advances in information technology are aiding in the creation of lifelong health records and hence in the tracking and understanding of the health history of individuals, which in turn will help shift the public health care delivery model toward more primary and secondary care and prevention from the current emphasis on curing. On the other, health monitoring devices are also benefiting from technological progress, and are increasingly moving toward more self-assistive, compact and appealing to consumers. However, although most of the necessary hardware and technologies are already mature and widely available, they have yet to be fully exploited for personal health care, and the general public also need to be educated and encouraged to adopt the concepts of individual health profiling and regular health monitoring into their lives. In this regard, the School of Nursing at The Hong Kong Polytechnic University has been working proactively on two fronts. First, a telehealth system has been installed in community-based venues such as clinics, hospitals and, most important, schools and youth centers in order to promote lifelong health profiling for all individuals. Second, the School of Nursing is committed to utilizing advanced technologies for developing more compact and

user-friendly consumer health monitoring devices such as non-invasive meters. This is with a view to encourage individuals to take more responsibility for their own health and behavior, which fits in with the Hong Kong government's aim of shifting the burden of public health care provision away from hospitals to community-based primary and secondary care. The ultimate goal of the School of Nursing's efforts in telehealth and consumer health monitoring devices is the wide adoption of home-based telehealth systems that will subsequently spur individual health profiling, which will in turn encourage personal responsibility for improving one's health. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17102209 [PubMed - indexed for MEDLINE] 463: Environ Sci. 2006;13(4):201-5. Related Articles

Current situation of web-based chemical registration system in the University of Tokyo. Tomita K, Tonokura K, Yamamoto K, Nakanishi T. Division for Environment, Health and Safety, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan. [email protected] The web-based University of Tokyo Chemical Registration Information System with computational support has been introduced in all areas using chemicals owing to the unified management of the university and the management of chemicals in conformity with legal controls. This system enables chemical users to manage chemicals easily and reduces the burden inflicted by such management. In this report, we introduce the style of chemical management in the University of Tokyo, the functions of the web-based chemical registration system, the current situation of the system and future plans. PMID: 17095992 [PubMed - indexed for MEDLINE] 464: Stud Health Technol Inform. 2006;121:15-21. Related Articles, Links

Empowering the impaired through the appropriate use of Information Technology and Internet.

Sanyal I. Turning Point, Rehabilitation Center, India. [email protected] Developments in the fields of science and technology have revolutionized Human Life at material level. But in actuality, this progress is only superficial: underneath modern men and women are living in conditions of great mental and emotional stress, even in developed and affluent countries. People from all over the world irrespective of culture and economic background suffer from mental illness and though a number of researches are carried out worldwide but till date it has not been possible to resolve the problem.In today's world stress is increasing everyday. The individualistic approach towards life; the neonatal family system has increased the burden even further. Without adequate support system of friends and relatives--people are falling prey to mental illness. The insecurities, the inferiority feelings of these persons lead to disruption of communication between the sufferer and the family members and friends. The sufferers prefer to confine themselves within the four walls of their home and remain withdrawn from the whole world. They prefer to stay in touch with their world of fantasy--far away from the world of reality. Disability caused by some of the mental illnesses often remains invisible to the society leading to lack of support system and facilities for them. These unfortunate disabled persons not only need medication and counseling but a thorough rehabilitation programme to bring them back to the main stream of life. The task being not an easy one. According to the research works these persons need some work and income to improve their quality of life.In this scenario where society is adverse towards them, where stigma towards mental illness prevails; where help from friends and community is not availabletraining them in computer and forming groups through computer was thought to be an ideal option for the solution- a solution to the problems of modern life through modern technology. * It was seen that this insecure disabled persons feel free to experiment with machine more easily than with society and people. * Computer provides them the needed education and information needed for their further developments. * Computers provide them facilities to interact with others and form self-help groups. * Computers also enabled them to earn their livelihood. Thus this modern gadget, which is sometimes believed to make a man loner, has been actually acting as the bridge between the persons suffering from mental illness to the society in general. The disabled person also gains confidence and courage as they gain control over the machine. Gaining control over the machine helps them to gain control over their life. The product of Science and technology has been seen to revolutionized Human Life not only in material level but also on personal level- helping the disabled to gain control over their lives. Publication Types: •

Comparative Study

PMID: 17095799 [PubMed - indexed for MEDLINE] 465: Kekkaku. 2006 Oct;81(10):591-602. Related Articles, Links

[Evaluation of effect of community DOTS on treatment outcomes by TB surveillance data] [Article in Japanese] Hoshino H, Kobayashi N. Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan. [email protected] OBJECTIVE: The purpose of this study is to evaluate effects of community DOTS on treatment outcome by cohort data derived from TB surveillance system and to find further problems. SUBJECTS: New sputum smear positive pulmonary TB patients registered in 2003 and 1998 under standard course regimens. METHODS: In Japan, DOTS as a method of directly observed treatment by Short Course Chemotherapy is divided into hospital DOTS and community DOTS. Hospital DOTS is to observe hospitalized patients' drug taking directly by hospital staff such as nurses, pharmacists or other hospital staff. Community DOTS is to observe or confirm discharged patients' drug taking by several methods such as direct observation at facility or patient's home, confirmation through checking treatment notes and examining empty blister packages and so on. TB patients were categorized to following 3 groups by available methods of community DOTS. Treatment outcome of patients registered in 2003 was compared with outcome of patients registered in 1998 as the control group before the introduction of community DOTS. Group 1: TB patients under PHC where at least daily observation DOTS (daily observation of drug taking at clinic or PHC to TB patients with risk factors of defaulting such as homeless, alcohol abuse, past history of default and so on) is available. Group 2: TB patients under PHC where home-visit DOTS (home-visit for observation of drug taking to the elderly TB patients who have risk to forget to take TB medicines regularly) only is available or, PHC where home-visit DOTS and confirmation DOTS (periodical confirmation of drug taking to TB patients without risk of defaulting) is available. Group 3: TB patients under PHC where only confirmation DOTS is available. Group 4: TB patients under PHC where community DOTS is not available. In addition, high death rate of patients under public assistance is analyzed. RESULTS: In group 1 with daily observation DOTS, TB patients under social or national health insurance showed higher treatment success rate and lower defaulter rate. TB patients with insurance for aged showed lower defaulter rate but high death rate due to old age did not improve. Patients under public assistance showed relatively lower defaulter rate. In group 2 with home-visit

DOTS, TB patients with national health insurance and insurance for aged showed rather lower defaulter rate. Cohort evaluation of TB patients under group 3 with confirmation DOTS and group 4 without community DOTS is difficult as high rate of unknown treatment result. TB patients receiving public assistance showed lower death rate than patients requiring but not receiving public assistance. Patients detected at clinic and hospitals showed higher death rate than other patients detected by screening for high risk groups and so on. CONCLUSION: Daily observation DOTS and home-visit DOTS were effective to improve success rate and defaulter rate but effect of confirmation DOTS was not proved due to lack of information. High death rate of patients with insurance for aged in all groups and lack of treatment results in group 3 and 4 were problems to be solved in the future. In order to avoid TB death among TB patients under public assistance, screening for homeless people as high risk groups, earlier detection and referral system of TB symptomatics and improvement of coverage in public assistance might be effective and be tried. Publication Types: •

English Abstract

PMID: 17094581 [PubMed - indexed for MEDLINE] 466: J Wildl Dis. 2006 Jul;42(3):561-9. Related Articles, Links

First report of Streptococcus agalactiae and Lactococcus garvieae from a wild bottlenose dolphin (Tursiops truncatus). Evans JJ, Pasnik DJ, Klesius PH, Al-Ablani S. Aquatic Animal Health Research Laboratory, United States Department of Agriculture, Agricultural Research Service, Chestertown, Maryland 21620, USA. The isolation and characterization of two bacterial species, Streptococcus agalactiae and Lactococcus garvieae, previously unreported in wild marine mammals are described from a freshly dead bottlenose dolphin, Tursiops truncatus, from Kuwait Bay, Kuwait, in September 2001. Conventional and rapid identification systems were used to determine that isolates from muscle and kidney were S. agalactiae and L. garvieae, respectively. The isolates were grampositive, catalase-negative, oxidase-negative, nonhemolytic cocci. The S. agalactiae was serotyped to group antigen B, whereas the L. garvieae could not be assigned to any serogroup. These Kuwait isolates displayed considerable homogeneity with corresponding American Type Culture Collection (ATCC) type isolates. Although the dolphin S. agalactiae isolate was nonhemolytic, it was

biochemically similar to S. agalactiae isolated from mullet sampled in the concurrent Kuwait Bay fish kill. Some biochemical heterogeneity was observed between the dolphin isolates and corresponding mammalian ATCC type isolates, especially with Voges Proskauer, alanine-phenylanaline-proline arylamidase, and alpha-galactosidase tests. Nile tilapia, Oreochromis niloticus, experimentally infected with the dolphin S. agalactiae and L. garvieae isolates experienced 90% and 0% mortalities, respectively. This is the first isolation of S. agalactiae and L. garvieae from a wild marine mammal, and the microbial characteristics established here provide pertinent information for the future isolation of these bacteria. PMID: 17092887 [PubMed - indexed for MEDLINE] 467: Gig Sanit. 2006 Sep-Oct;(5):4-10. Related Articles, Links

[Sanitary and epidemiological well-being: topical problems] [Article in Russian] Onishchenko GG. The interaction of the interested services and authorities in implementing a package of goal-oriented organizational, comprehensive preventive and antiepidemic measures has given stability of the sanitary-and-epidemiological situation in the Russian Federation in some recent years. To accomplish the tasks, particularly those in developing a package of measures to reduce the prevalence of infectious diseases, the "Health" national program has been drawn up for 20062007 this year. One of the priorities of the program is to enhance the prophylactic orientation of the public health care system. Within the framework of this direction, it is planned to provide a further steady decline in the incidence of infections controlled by specific preventive means, primarily, in that of hepatitis B and rubella, to eliminate the congenital rubella syndrome, and to maintain the status of the Russian Federation as a poliomyelitis-free area. The subjects of the Russian Federation should redistribute allocations, by taking into account the funds envisaged in the Health program for purchase of vaccines, and direct them for implementation of other measures, such as personnel training, refrigerating equipment purchase, information-propagandistic work among the population, etc. In 2005, the poor situation established in the world due to the spread of avian influenza and there was a possible threat of influenza pandemic. Investigations ascertained the identity of influenza A virus (H5N1) isolated in the Russian Federation with the South-Eastern Asia-isolated viruses that caused mass epizooties of birds and severe diseases in persons contacting infected birds. It was assumed that 2006 spring migration might lead to the spread of pathogenic influenza H5N1 viruses throughout European Russia. This was due to the fact that the birds migrating to European Russia and a portion of birds migrating from

Siberia have common winter nesting areas. To prevent mass influenza virusinfected birds' death and human infection in the epizootic localities, the federal surveillance service for protection of users' rights and human well-being jointly with the federal veterinary and phytosanitary surveillance service, and public health care administrative bodies has organized and implemented a package of measures: active headquarters have been set up in the epizooty-afflicted subjects to coordinate activities in localizing the spread of epizooty of birds; emergency commissions and antiepizootic commissions have been held; regulatory documents on the Russian Federation's subjects have been published; daily collection, analysis, systematization, and exchange of information between interested services, et. are under way. Publication Types: • •

English Abstract Review

PMID: 17087198 [PubMed - indexed for MEDLINE] 468: J Med Liban. 2006 Apr-Jun;54(2):61-4. Related Articles, Links

Epidemiology of HIV infection in Lebanon. Data from 1985-2005. Traboulsi R, Kanafani ZA, Nakib M, Kanj SS. Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Hamra, Lebanon. Lebanon is considered among the countries where the HIV epidemic is still in its early phase of spread. Little information is available on the magnitude of the problem due to the lack of an efficient surveillance system. In this review, we report on the epidemiology of HIV infection in Lebanon, based on limited data generated by the Lebanese National AIDS Control Program (NAP). By May 2005, a cumulative number of 813 cases had been diagnosed. The most prevalent mode of HIV transmission in Lebanon is heterosexual exposure accounting for around 50% of the cases. Two hundred ninety-six patients (36.4%) fulfilled the AIDS case definition. Despite the availability of highly active antiretroviral therapy (HAART) provided by the Ministry of Health, the disease burden of HIV infection remains unknown in this country. PMID: 17086995 [PubMed - indexed for MEDLINE] 469: Burns. 2007 Feb;33(1):46-51. Epub 2006 Nov 2.

Related Articles,

Links

Burns in Turkish children and adolescents: nine years of experience. Sakallioğlu AE, Başaran O, Tarim A, Türk E, Kut A, Haberal M. Başkent University, Burn and Fire Disaster Institute, Turkey. AIM: The aim of this study was to describe information about burns that occur in children and adolescents in Turkey. PATIENTS AND METHODS: The subjects were 362 patients whom were younger than 18 years who were treated at 3 burn centers in 2 different regions of Turkey between 1997 and 2005. The data collected for each case were age, gender, place of residence, cause and extent of burn, body sites affected, environment in which the injury occurred, interval from injury to arrival at a burn center, hospitalization status (inpatient versus outpatient), surgical treatment, and mortality. RESULTS: The 362 patients comprised 35.5% of all 1021 burn victims admitted during the study period. There were 183 boys and 179 girls (ratio 1:0.98) and the mean total body surface area burned was 17.7+/-16.5%. The highest proportion of patients were in the 1-6 years age group. Non-bath (not immersed) hot water scalding (216 cases, 59.7%) was the leading burn cause. The most common environment in which burn injury occurred was the home. The trunk was the body site most frequently affected (62.7%). 241 (66.6%) subjects lived in urban environments and 121 (33.4%) lived in rural areas. 171 patients (47.2%) were taken directly to the burn units, whereas the others (52.8%) were referred from other medical centers. 124 (34.3%) subjects were treated as outpatients and 238 (65.7%) were hospitalized. The overall mortality rate was 8.6% (31 deaths). Of the 238 inpatients, 92 (38.7%) were treated with daily dressings only, 128 (53.8%) required debridement, and 75 (31.5%) needed both debridement and grafting. CONCLUSION: Every country needs a nationwide public education system that is aimed at preventing burns and ensuring that burn victims receive proper first aid and age-appropriate, specialized burn care. Publication Types: •

Multicenter Study

PMID: 17084031 [PubMed - indexed for MEDLINE] 470: Comput Biol Med. 2007 Jun;37(6):879-89. Epub 2006 Nov 1. Related Articles, Links

Creating a GIS application for health services at Jeddah city.

Murad AA. Department of Urban and Regional Planning, Faculty of Environmental Design, King Abdulaziz University, PO Box 80210, Jeddah 21589, Saudi Arabia. [email protected] This paper explores the possibilities of using GIS for private hospitals at Jeddah city, Saudi Arabia. A GIS application is created to cover three main health planning issues which are distribution of health demand, classification of hospital patients and the definition of hospital service area. Each one of these issues is covered using several GIS functions including network analysis and overlay analysis. The former is used to produce drive-time hospital service area and the latter is applied at the selected hospital to calculate the size of its served demand. GIS has several useful functions and tools that can be used in health planning field. This paper uses some of these functions for one private hospital. These functions are used to help health planners on evaluating the spatial distribution of hospital demand and for defining hospital service area. All the produced models can be applied on any private or public hospital in Jeddah city. They can be used to build a spatial decision support system for hospitals in Jeddah city. PMID: 17081511 [PubMed - indexed for MEDLINE] 471: Health Care Manage Rev. 2006 Oct-Dec;31(4):280-8. Related Articles, Links

Using path analysis to examine causal relationships among balanced scorecard performance indicators for general hospitals: the case of a public hospital system in Taiwan. Yang MC, Tung YC. Institute of Health Care Organization Administration, National Taiwan University, Taipei. [email protected] Examining whether the causal relationships among the performance indicators of the balanced scorecard (BSC) framework exist in hospitals is the aim of this article. Data were collected from all twenty-one general hospitals in a public hospital system and their supervising agency for the 3-year period, 2000-2002. The results of the path analyses identified significant causal relationships among four perspectives in the BSC model. We also verified the relationships among indicators within each perspective, some of which varied as time changed. We conclude that hospital administrators can use path analysis to help them identify and manage leading indicators when adopting the BSC model. However, they should also validate causal relationships between leading and lagging indicators periodically because the management environment changes constantly.

PMID: 17077702 [PubMed - indexed for MEDLINE] 472: J Prev Med Pub Health. 2006 Sep;39(5):433-7. Related Articles, Links

[Estimation of a nationwide statistics of hernia operation applying data mining technique to the National Health Insurance Database] [Article in Korean] Kang S, Seon SK, Yang YJ, Lee A, Bae JM. School of Health Administration, Inje University. OBJECTIVES: The aim of this study is to develop a methodology for estimating a nationwide statistic for hernia operations with using the claim database of the Korea Health Insurance Cooperation (KHIC). METHODS: According to the insurance claim procedures, the claim database was divided into the electronic data interchange database (EDI_DB) and the sheet database (Paper_DB). Although the EDI_DB has operation and management codes showing the facts and kinds of operations, the Paper_DB doesn't. Using the hernia matched management code in the EDI_DB, the cases of hernia surgery were extracted. For drawing the potential cases from the Paper_DB, which doesn't have the code, the predictive model was developed using the data mining technique called SEMMA. The claim sheets of the cases that showed a predictive probability of an operation over the threshold, as was decided by the ROC curve, were identified in order to get the positive predictive value as an index of usefulness for the predictive model. RESULTS: Of the claim databases in 2004, 14,386 cases had hernia related management codes with using the EDI system. For fitting the models with applying the data mining technique, logistic regression was chosen rather than the neural network method or the decision tree method. From the Paper_DB, 1,019 cases were extracted as potential cases. Direct review of the sheets of the extracted cases showed that the positive predictive value was 95.3%. CONCLUSIONS: The results suggested that applying the data mining technique to the claim database in the KHIC for estimating the nationwide surgical statistics would be useful from the aspect of execution and cost-effectiveness. Publication Types: •

English Abstract

PMID: 17076185 [PubMed - indexed for MEDLINE]

473: J Prev Med Pub Health. 2006 Sep;39(5):397-403. Related Articles, Links

[Cost-of-illness study of asthma in Korea: estimated from the Korea National Health insurance claims database] [Article in Korean] Park CS, Kang HY, Kwon I, Kang DR, Jung HY. Health Insurance Review Agency, Graduate School of Public Health, Yonsei University. OBJECTIVES: We estimated the asthma-related health care utilization and costs in Korea from the insurer' s and societal perspective. METHODS: We extracted the insurance claims records from the Korea National Health Insurance claims database for determining the health care services provided to patients with asthma in 2003. Patients were defined as having asthma if they had > or =2 medical claims with diagnosis of asthma and they had been prescribed anti-asthma medicines. Annual claims records were aggeregated for each patient to produce patient-specific information on the total utilization and costs. The total asthmarelated cost was the sum of the direct healthcare costs, the transportation costs for visits to healthcare providers and the patient's or caregivers' costs for the time spent on hospital or outpatient visits. RESULTS: A total of 699,603 people were identified as asthma patients, yielding an asthma prevalence of 1.47%. Each asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per year to treat asthma.The per-capita insurance-covered costs increased with age, from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged 75 or older. The total cost in the nation varied from 121,865 million to 174,949 million Won depending on the perspectives. From a societal perspective, direct healthcare costs accounted for 84.9%, transportation costs for 15.1% and time costs for 9.2% of the total costs. CONCLUSIONS: Hospitalizations and ED visits represented only a small portion of the asthma-related costs. Most of the societal burden was attributed to direct medical expenditures, with outpatient visits and medications emerging as the single largest cost components. Publication Types: •

English Abstract

PMID: 17076180 [PubMed - indexed for MEDLINE] 474: Environ Int. 2007 Feb;33(2):206-18. Epub 2006 Oct 30. Related Articles, Links

A systemic health risk assessment for the chromium cycle in Taiwan. Ma HW, Hung ML, Chen PC. Graduate Institute of Environmental Engineering, National Taiwan University, 71 Chou-Shan Rd., Taipei 106, Taiwan. [email protected] Health risk assessment (HRA) has been recognized as a useful tool for identifying health risks of human activities. In particular, this method has been well applied to spatially defined units, such as a production plant, a treatment facility, and a contaminated site. However, the management strategies based on the risk information will be more efficient if the comprehensive picture of total risks from all kinds of sources is depicted. In principle, the total risks can be obtained when all risk sources are assessed individually. Apparently, this approach demands huge amount of efforts. This study develops a methodology that combines substance flow and risk estimation to facilitate examination of risk in a systemic way and provide comprehensive understanding of risk generation and distribution corresponding to flows of substances in the anthroposphere and the environment. Substance flow analysis (SFA) and HRA method is integrated to produce a systemic risk assessment method, from which substance management schemes can be derived. In this study, the chromium cycle in Taiwan is used as an example to demonstrate the method, by which the associated substance flow in the economy and the risk caused by the substance in the environmental system is determined. The concentrations of pollutants in the environmental media, the resultant risks and hazard quotients are calculated with the widely-used CalTOX multimedia model. PMID: 17074391 [PubMed - indexed for MEDLINE] 475: Fertil Steril. 2006 Dec;86(6):1716-22. Epub 2006 Oct 30. Related Articles, Links

Methylenetetrahydrofolate reductase C677T polymorphism and the risk of unexplained recurrent pregnancy loss: a meta-analysis. Ren A, Wang J. Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing, China. [email protected] OBJECTIVE: To investigate the association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and the risk of unexplained recurrent pregnancy loss (URPL). DESIGN: Meta-analysis of published case-control studies of the MTHFR C677T variant and URPL risk. SETTING: A research

institution in China. PATIENT(S): Women with URPL. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Odds ratios (ORs) and 95% confidence intervals (CIs) for TT versus CC genotype, CT versus CC genotype, TT versus CT and CC genotype combined, and for T versus C allele. RESULT(S): Twentysix studies with 2120 URPL cases and 2949 controls were included. Overall random-effects ORs of 1.49 (95% CI, 1.12-2.00) for TT versus CC genotype, 1.40 (95% CI, 1.11-1.77) for TT versus CT and CC genotype combined, and 1.21 (95%CI, 1.04-1.40) for T versus C allele were found. Stratified analysis showed that significant strong associations between MTHFR C677T polymorphism and URPL were present only in the five Chinese studies (OR = 2.96 for TT versus CC genotype; OR = 2.30 for TT versus CT+CC genotype; OR = 1.73 for T versus C allele), but not in any other studies, including the studies conducted in the European countries. CONCLUSION(S): The MTHFR C677T mutation is not a genetic risk factor for URPL except in a Chinese population. Publication Types: •

Meta-Analysis

PMID: 17074326 [PubMed - indexed for MEDLINE] 476: J Cross Cult Gerontol. 2005 Dec;20(4):269-84. Related Articles, Links

Aging in Southeast and East Asia: issues and policy directions. Chan A. Department of Sociology, National University of Singapore, 11 Arts Link, Singapore 117570, Singapore. [email protected] Population aging is unique in Asia given the speed at which it is occurring and the immense social and economic changes that the region is experiencing at the same time. Compared to their Western counterparts, Asian governments have much less time to prepare for population aging. Asian countries that have traditionally relied on family-based support for older family members are worried that increased numbers of older adults may stress these family systems. At the same time, information concerning the effectiveness of formal programs for older adults is scarce. This paper reviews current research on informal support versus formal support of older adults in Southeast and East Asia, with a larger aim of assessing the current well-being of older Asians and suggesting areas of policy concern. Current research reveals that formal programs in the majority of Southeast and East Asian countries have very low coverage of today's older adults, and the figures for future generations are not that much higher. However, family support

of older persons may not be deteriorating as predicted by modernization theory. Asian families continue to play a major role in supporting older members, thus policies should focus on enabling Asian families to provide this support. Publication Types: •

Review

PMID: 17072767 [PubMed - indexed for MEDLINE] 477: Int Dent J. 2006 Oct;56(5):277-82. Related Articles, Links

A reassessment of recall frequency intervals for screening in low caries incidence populations. Tan EH, Batchelor P, Sheiham A. Eastman Dental Institute, London, UK. OBJECTIVES: To reassess the recall frequency interval for dental examinations for children, based on annual caries increments. METHODS: Cross sectional data collected on school children in eight rural and urban schools through the national Incremental Dental Care Programme (IDCP) for one district in Malaysia were analysed to assess their annual caries increment and trend lines. The Restorative Index was calculated to assess the success of the IDCP in rendering children dentally fit. RESULTS: The annual caries increments were low; the current caries levels were between 0.65 and 1.50 for 12 year-old children in Kota Tinggi District. Most of the caries experience was on pits and fissures. From 7 to 12 years old, the overall annual caries increment for the total study population was 0.19. The mean annual caries increment increased slightly between the ages of 12 to 14 years and 14 to 16 years and was 0.24 and 0.25 respectively. Two distinct caries incremental trend lines were observed for children aged 7 to 16 years. One group reached a mean DMFT of about 0.75 while the other group a mean DMFT of about 1.4 at 12 years. The trend lines continued over the next 4 years until the children were 16 years old. The Restorative Index was higher in urban schools that also had low DMFT levels. CONCLUSIONS: Based on the low annual caries increments of between 0.65 and 1.50, yearly dental examination intervals can safely be extended to 2-yearly intervals or even longer. Such a change of screening recall intervals would help improve resource allocation. Resources saved by extending recall intervals can be redirected to the small proportion of children with higher disease levels. This will help render more school children dentally fit and reduce inequalities in oral health. PMID: 17069070 [PubMed - indexed for MEDLINE]

478: Int Dent J. 2006 Oct;56(5):272-6. Related Articles, Links

Education of dentists in China. Komabayashi T, Zhu Q, Jiang J, Hu DY, Kim KJ, Toda S, Tanne Y, Tanimoto K, Kirkland MD, Bird WF. Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington 06030-1715, USA. [email protected] China is geographically located in the east of Asia and its population exceeds 1.3 billion. An understanding of dental education in China is thus of interest. However, as there is little published information on this topic, this paper provides information about China regarding its dental history, dental school system including curriculum and dental licensure. High school graduates take a nationwide entrance examination to apply for dental school, of which there are more than 50 in China. A five year dental education leads to the BDS degree. Dental school graduates must then pass the nationwide licensure examination to practise dentistry. Currently, there are not adequate numbers of dentists to provide the necessary oral health care for people living outside metropolitan areas. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17069069 [PubMed - indexed for MEDLINE] 479: Beijing Da Xue Xue Bao. 2006 Oct 18;38(5):525-8. Related Articles, Links

[The community health diagnosis of life-way disease in Peking University Health Science Center] [Article in Chinese] Han FQ, Ma YH, Ding SQ, Guo Q, Li HF. Hospital of Peking University Health Science Center, Beijing 100083, China. [email protected] OBJECTIVE: To study the basic information of life way disease and the corresponding risk factors of behavior in the community of Peking University

Health Science Center, understand the background issue and social support system, and analyze the requirement for community health service so that the critical issue for health can be dealt with and the comprehensive program of prevention and treatment of the disease can be accordingly supplied. METHODS: The random face to face questionnaire about life way disease and risk factors in 1051 residents over 6 years of age in the community of Peking University Health Science Center was conducted according to the typical sampling principle in 1 primary school, 1 middle school, 1 university and its community, and the investigations of health data from the hospital and the police office in the community were also conducted through discussing about life ways risk factors. Accordingly , the data obtained by way of EXCEL were analyzed and processed using SPSS 11.5. RESULTS: Diagnostic data of demography, epidemiology, behavior environment, education and organization were obtained concerning the public health of the Peking University Health Science Center community. CONCLUSION: The key health issue in the Peking University Health Science Center community is significantly influenced by the bad way of life. And some behavior risk factors, such as fatness, lack of outdoor exercise in the community members. Thus, the major necessary health service of Peking University Health Science Center residents is to carry out a comprehensive management program of life way disease for the whole people. Publication Types: •

English Abstract

PMID: 17068629 [PubMed - indexed for MEDLINE] 480: J Microbiol Immunol Infect. 2006 Oct;39(5):402-7. Related Articles, Links

Complications of varicella infection in children in southern Taiwan. Chi CY, Wang SM, Lin HC, Liu CC. Division of Clinical Research, National Health Research Institutes, Zhunan, Taiwan. BACKGROUND AND PURPOSE: This study was designed to compare the change in complications of varicella infection in children requiring hospitalization before and after varicella vaccine introduction at a tertiary care hospital in southern Taiwan. METHODS: Based on the results of a retrospective study conducted in the pre-vaccine era (1988-1998), a second study was carried out from 1998-2004 (post-vaccine era). In children admitted for varicella-related complications, demographic data, clinical features, microbiological findings, and

outcomes were recorded and compared between the two eras. RESULTS: A decreased annual rate of hospitalization was observed between the two eras. Agespecific hospitalization rates significantly declined in the age group of 1-10 years after vaccine introduction. Secondary skin or soft tissue infections were the most common complications in both periods (pre-vaccine era, 44.1%; post-vaccine introduced era, 56.6%). In the post-vaccine era, 23 (52%) patients had positive bacterial isolates, including 19 Staphylococcus aureus (12 oxacillin-sensitive, 7 oxacillin-resistant) and 4 coagulase-negative staphylococci; a higher rate of pneumonitis and lower rate of central nervous system involvement were also observed. No differences were observed in other complications between the two eras. In the post-vaccine era, hematological diseases were the most common underlying conditions (17/18, 94%). The case-fatality rate in the post-vaccine era (1.3%) was similar to that in the pre-vaccine era (2.2%). CONCLUSIONS: A universal childhood varicella vaccination program would ultimately prevent the spread and potential complications of varicella. The result of this study may serve as baseline information as the national vaccination program begins. Publication Types: •

Comparative Study

PMID: 17066203 [PubMed - indexed for MEDLINE] 481: Eur J Public Health. 2007 Jun;17(3):306-13. Epub 2006 Oct 25. Related Articles, Links

'We will speak as the smoker': the tobacco industry's smokers' rights groups. Smith EA, Malone RE. Department of Social and Behavioral Sciences, University of California San Francisco Box 0612 San Francisco, CA 94143, USA. [email protected] Introduction: The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts. METHODS: Searches of the Legacy Tobacco Documents Library, the British American Tobacco documents database, and Tobacco Documents Online. RESULTS: 1100 documents pertaining to SRGs were found, including groups from across Europe and in Australia, New Zealand, and Hong Kong. From the late 1970s through the late 1990s they were active in numerous policy arenas, particularly the defeat of smoke-free laws. Their

strategies included asserting their right to smoke and positioning themselves as courteous victims of tobacco control advocates. However, most SRGs were shortlived and apparently failed to inspire smokers to join in any significant numbers. CONCLUSION: SRGs conflated the legality of smoking with a right to smoke. SRGs succeeded by focusing debates about smoke-free policies on smokers rather than on smoke. However, SRGs' inability to attract members highlights the conflict between the image of the smoker in cigarette ads and that of the smokers' rights advocate. The changing social climate for smoking both compelled the industry's creation of SRGs, and created the contradictions that led to their failure. As tobacco control becomes stronger, the industry may revive this strategy in other countries. Advocates should be prepared to counter SRGs by exposing their origins and exploiting these contradictions. Publication Types: • • •

Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Review

PMID: 17065174 [PubMed - indexed for MEDLINE] 482: Sangyo Eiseigaku Zasshi. 2006 Sep;48(5):169-75. Related Articles, Links

[Occupational health of endoscope sterilization workers in medical institutions in Osaka Prefecture] [Article in Japanese] Miyajima K, Tabuchi T, Kumagai S. Osaka Prefectural Institute of Public Health, Osaka, Japan. [email protected] To clarify the actual condition of endoscope sterilization work and the adverse health effects of disinfectants on personnel, a questionnaire was sent to 173 medical institutions in Osaka Prefecture. Glutaraldehyde (GA), orthophtalaldehyde (OPA), and hyperacetic acid were used as disinfectants of endoscopes by 55.5%, 32.4%, and 8.7% of the medical institutions respectively. The kind of disinfectant used had been changed in 57.8% of these institutions during the past five years, and it was confirmed that the use of substitutes for GA, such as OPA and hyperacetic acid, has increased. Personnel in 35.8% of the institutions complained about symptoms during sterilization work. The kind of disinfectant being used when they complained was GA in many cases and OPA in

others. A general ventilation system has now been installed in 72.3% of the institutions; local exhaust systems have been installed in fewer, only 23.4%. Protective gloves were used at about half of the institutions, but protective masks and glasses were seldom used. This study shows that the occupational health problems of endoscope sterilization work have not been resolved. Consequently, it is necessary to promote the installation of ventilation systems and the use of protective devices in all institutions. Health education in regard to the handling of disinfectants is also necessary. Because little information is available about the toxic effects of OPA and hyperacetic acid, epidemiological studies must be conducted to clarify the human health effect of these disinfectants. Publication Types: •

English Abstract

PMID: 17062996 [PubMed - indexed for MEDLINE] 483: J Nurs Educ. 2006 Oct;45(10):391-5. Related Articles, Links

The history of nursing services and education in Sri Lanka and the effects on developing professionalism. Jayasekara RS, McCutcheon H. The University of Adelaide, Eleanor Harrold Building, Level 3, Royal Adelaide Hospital, Adelaide, South Australia 5005. [email protected] Understanding the evolution of nursing in a country provides perspective on the origins of current successes and dilemmas and enables the development of strategies and plans for future trends in the profession. This article explores the evolution of nursing services and education in Sri Lanka and the effects on developing professionalism in nursing. Internet database searches, personal communication, and published and unpublished literature and reports were reviewed to obtain historical information on nursing services and education in Sri Lanka. The Sri Lankan health system is reviewed, and the establishment of Western medicine in Sri Lanka and its effects on developing institutionalized nursing education is presented, with a focus on the evolution of nursing education. Major challenges for the nursing profession in Sri Lanka are discussed, and some recommendations are shared. Publication Types: •

Historical Article

PMID: 17058693 [PubMed - indexed for MEDLINE] 484: Environ Monit Assess. 2007 Apr;127(1-3):363-81. Epub 2006 Oct 21. Related Articles, Links

Characteristics and driving factors of marsh changes in Zhalong wetland of China. Han M, Sun Y, Xu S. School of Electronic and Information Engineering, Dalian University of Technology, Dalian, 116023, China. [email protected] Zhalong National Nature Reserve in the northeast of China is a large wetland and a habitat of hundreds species of fauna and flora. The rare red-crowned crane is one kind of endangered birds in it. Recently, Zhalong wetland is shrinking and it encounters many problems including occasional fires, bad water quality, human activities, etc. In order to find out a proper way to protect and restore the wetland, this study, using a geographic information system, the global positioning system and remote sensing techniques, analyses the spatial characteristics of the changes in marsh landscape pattern and examines the driving factors for these changes. Data sources include 8 Landsat Thematic Mapper satellite images of Zhalong area in the period of 1986-2002 and the investigation information on site. Based on the analysis of changes of marsh area and annual precipitation during the 16 years, it is found that there is a close correlation between annual precipitation and marsh area. It means that climate is one of driving factors of marsh pattern changes. To understand influences of other kinds of land uses on marsh spatial distribution in Zhalong wetland, this paper analyses the relationship between marsh and different kinds of land uses, such as water surface, residential area, farm land, salina land and grass land, respectively. According to the patch analysis theory, a fragmental index and a fractal dimension of the marsh are calculated with perimeter-area method. The results indicate that the marsh pattern is affected by human activities significantly. In addition, the location alteration of marsh centroid point over the 16 years is studied. The movement trace of marsh centroid point is concerned with different hydrological situation in different areas of the wetland. In summary the characteristics of the marsh landscape pattern evolution during the 16 years are affected by multiple driving factors. The main driving factors are climate, human activities, distribution of other kinds of land uses and hydrological situation in different areas. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17058002 [PubMed - indexed for MEDLINE] 485: J Adolesc Health. 2006 Nov;39(5):720-8. Epub 2006 Jul 10. Related Articles, Links

Can the Internet be used effectively to provide sex education to young people in China? Lou CH, Zhao Q, Gao ES, Shah IH. Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, Shanghai, China. [email protected] PURPOSE: To assess the feasibility and effectiveness of sex education conducted through the Internet. METHODS: Two high schools and four colleges of a university in Shanghai were selected as the research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductive health knowledge, service information, counseling and discussion to all grade one students in the intervention group. The intervention phase lasted for 10 months and was implemented through a special website, with web pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from the intervention, and 713 from the control schools and colleges participated in the baseline survey, and about 97% of them were followed up in postintervention survey to assess changes that can be attributed to the sex education interventions provided through the Internet. RESULTS: The median scores of the overall knowledge and of each specific aspect of reproductive health such as reproduction, contraception, condom, sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) were significantly higher in the intervention group as compared with those in the control group at postintervention (p < .0001), although no significant differences were found between these two groups in the baseline survey (p > .05). Group by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p < .0001) and in attitude of high school students toward sex-related issues (p < .05), suggesting that interventions increased subjects' knowledge significantly and changed high school students' attitudes to being less liberal toward sex. The intervention also had positive influence on students' attitudes toward providing contraceptive service for unmarried people. CONCLUSIONS: Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people.

The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17046509 [PubMed - indexed for MEDLINE] 486: Vet Parasitol. 2007 Feb 28;143(3-4):364-7. Epub 2006 Oct 10. Related Articles, Links

Validation of a geographic information system model for mapping the risk of fasciolosis in cattle and buffaloes in Cambodia. Tum S, Puotinen ML, Skerratt LF, Chan B, Sothoeun S. Department of Animal Production and Health, 74 Monivong Boulivard, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia. Maps showing gradations of risk of fasciolosis due to Fasciola gigantica in Cambodia were produced using geographic information systems (GIS) technology in conjunction with determinants of fasciolosis. A comparison between levels of risk predicted by the maps and field measurements of prevalence in 11 provinces (n=1406) showed general agreement, which suggested the epidemiological determinants and weightings used to produce the maps were appropriate. However, due to logistical constraints, prevalence was measured at the provincial level and animals were not randomly sampled (and thus were unlikely to be representative of variability within provinces). To address this, additional field work was carried out to measure prevalence in more detail--faecal samples were collected from a randomly selected set of animals in four districts across a representative province for areas predicted to be at high risk (n=311), moderate risk (n=268) and no risk (n=262). As with the original field survey, the results show general agreement between prevalence and risk predicted by the maps, with the best fit found for areas predicted to be at high risk. Publication Types: • •

Research Support, Non-U.S. Gov't Validation Studies

PMID: 17045401 [PubMed - indexed for MEDLINE]

487: Int J Health Plann Manage. 2006 Jul-Sep;21(3):229-38. Related Articles, Links

The cost of treatment for child pneumonias and meningitis in the Northern Areas of Pakistan. Hussain H, Waters H, Omer SB, Khan A, Baig IY, Mistry R, Halsey N. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Rm. W5504 Baltimore, MD 21205, USA. [email protected] Pneumonia, meningitis, and sepsis place a significant economic burden on health care systems, particularly in developing countries. This study estimates treatment costs for these diseases in health facilities in the Northern Areas of Pakistan. Health facility resources are organized by categories--including salaries, capital costs, utilities, overhead, maintenance and supplies--and quantified using activitybased costing (ABC) techniques. The average cost of treatment for an outpatient case of child pneumonia is dollar 13.44. For hospitalized care, the health system spent an average of dollar 71 per episode for pneumonia, dollar 235 for severe pneumonia, and dollar 2,043 for meningitis. These costs provide important background information for the potential introduction of the conjugate Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in Pakistan. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17044548 [PubMed - indexed for MEDLINE] 488: J Adv Nurs. 2006 Nov;56(3):314-24. Related Articles, Links Comment in: •

J Adv Nurs. 2007 Dec;60(5):570-1; author reply 572-3.

A revision of a job evaluation system. Kahya E.

Department of Industrial Engineering, Eskisehir Osmangazi University, Bademlik Campus, TR26030 Eskisehir, Turkey. [email protected] AIMS: This paper reports a revision of the United Kingdom's National Health Service Job Evaluation System and tests the revised system in eight clinical nursing management jobs in four Turkish hospitals. BACKGROUND: A job evaluation system was developed in the United Kingdom in 2003-2004. Most studies have focused on how the whole system will be implemented in a health organization. No study investigating proficiency of the system in terms of factors and their level definitions was found. METHODS: The factors Knowledge, Training and experience and Working conditions were divided into five factors: Knowledge, Experience, Education, Environmental conditions and Hazards. To test the revised system, all the nursing management jobs in four hospitals were evaluated using a factor-based questionnaire including nurses' demographic information and 19 variables. The questionnaire was distributed to 57 supervisor nurses in 31 clinics at four hospitals in one Turkish city in 2005. All the questionnaires were analysed to evaluate the jobs. RESULTS: The job scores change depending on clinical conditions. Although the score range in the National Health Service Job Evaluation system has been determined as 405-465 points (band VI) for Nurse team leader and 469-536 points (band VII) for Nurse team manager jobs, the job scores in the present study were 363 (band V) - 557 points (band VIIIa) and 379 (band V) - 586 points (band VIIIa) respectively. CONCLUSION: Although this exploratory study was limited to four hospitals in one city in Turkey, the results indicated that two new jobs would be identified in the National Health Service system to match the jobs in the intensive care and emergency units. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 17042810 [PubMed - indexed for MEDLINE] 489: Int J Biometeorol. 2007 Jan;51(3):193-200. Epub 2006 Oct 13. Related Articles, Links

Heat wave impacts on mortality in Shanghai, 1998 and 2003. Tan J, Zheng Y, Song G, Kalkstein LS, Kalkstein AJ, Tang X. Jiangsu Key Laboratory of Meteorological Disaster, Nanjing University of Information Science & Technology, Nanjing, 210044, People's Republic of China. [email protected]

A variety of research has linked extreme heat to heightened levels of daily mortality and, not surprisingly, heat waves both in 1998 and in 2003 all led to elevated mortality in Shanghai, China. While the heat waves in the two years were similar in meteorological character, elevated mortality was much more pronounced during the 1998 event, but it remains unclear why the human response was so varied. In order to explain the differences in human mortality between the two years' heat waves, and to better understand how heat impacts human health, we examine a wide range of meteorological, pollution, and social variables in Shanghai during the summers (15 June to 15 September) of 1998 and 2003. Thus, the goal of this study is to determine what was responsible for the varying human health response during the two heat events. A multivariate analysis is used to investigate the relationships between mortality and heat wave intensity, duration, and timing within the summer season, along with levels of air pollution. It was found that for heat waves in both summers, mortality was strongly associated with the duration of the heat wave. In addition, while slightly higher than average, the air pollution levels for the two heat waves were similar and cannot fully explain the observed differences in human mortality. Finally, since the meteorological conditions and pollution levels for the two heat waves were alike, we conclude that improvements in living conditions in Shanghai, such as increased use of air conditioning, larger living areas, and increased urban green space, along with higher levels of heat awareness and the implementation of a heat warning system, were responsible for the lower levels of human mortality in 2003 compared to 1998. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17039379 [PubMed - indexed for MEDLINE] 490: Int J Health Geogr. 2006 Oct 13;5:45. Related Articles, Links

Application of Poisson kriging to the mapping of cholera and dysentery incidence in an endemic area of Bangladesh. Ali M, Goovaerts P, Nazia N, Haq MZ, Yunus M, Emch M. International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7 dong, Kwanak-gu, Seoul, Korea. [email protected] BACKGROUND: Disease maps can serve to display incidence rates geographically, to inform on public health provision about the success or failure

of interventions, and to make hypothesis or to provide evidences concerning disease etiology. Poisson kriging was recently introduced to filter the noise attached to rates recorded over sparsely populated administrative units. Its benefit over simple population-weighted averages and empirical Bayesian smoothers was demonstrated by simulation studies using county-level cancer mortality rates. This paper presents the first application of Poisson kriging to the spatial interpolation of local disease rates, resulting in continuous maps of disease rate estimates and the associated prediction variance. The methodology is illustrated using cholera and dysentery data collected in a cholera endemic area (Matlab) of Bangladesh. RESULTS: The spatial analysis was confined to patrilineally-related clusters of households, known as baris, located within 9 kilometers from the Matlab hospital to avoid underestimating the risk of disease incidence, since patients far away from the medical facilities are less likely to travel. Semivariogram models reveal a range of autocorrelation of 1.1 km for dysentery and 0.37 km for cholera. This result translates into a cholera risk map that is patchier than the dysentery map that shows a large zone of high incidence in the south-central part of the study area, which is quasi-urban. On both maps, lower risk values are found in the Northern part of the study area, which is also the most distant from the Matlab hospital. The weaker spatial continuity of cholera versus dysentery incidence rates resulted in larger kriging variance across the study area. CONCLUSION: The approach presented in this paper enables researchers to incorporate the pattern of spatial dependence of incidence rates into the mapping of risk values and the quantification of the associated uncertainty. Differences in spatial patterns, in particular the range of spatial autocorrelation, reflect differences in the mode of transmission of cholera and dysentery. Our risk maps for cholera and dysentery incidences should help identifying putative factors of increased disease incidence, leading to more effective prevention and remedial actions in endemic areas. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17038192 [PubMed - indexed for MEDLINE] PMCID: PMC1617092

491: Diabetes Technol Ther. 2006 Oct;8(5):587-97. Related Articles, Links

Diabetes information systems: a rapidly emerging support for diabetes surveillance and care. Joshy G, Simmons D.

Waikato Clinical School, University of Auckland, Hamilton, New Zealand. [email protected] BACKGROUND: With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. OBJECTIVE: The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. LITERATURE REVIEW: A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. RESULTS: National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. CONCLUSIONS: With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines. Publication Types: •

Review

PMID: 17037973 [PubMed - indexed for MEDLINE] 492: J Expo Sci Environ Epidemiol. 2007 Jan;17(1):106-21. Epub 2006 Oct 11. Related Articles, Links

On ecological fallacy, assessment errors stemming from misguided variable selection, and the effect of aggregation on the outcome of

epidemiological study. Portnov BA, Dubnov J, Barchana M. Department of Natural Resources & Environmental Management, University of Haifa, Haifa, Israel. [email protected] In social and environmental sciences, ecological fallacy is an incorrect assumption about an individual based on aggregate data for a group. In the present study, the validity of this assumption was tested using both individual estimates of exposure to air pollution and aggregate data for 1,492 schoolchildren living in the in vicinity of a major coal-fired power station in the Hadera region of Israel. In 1996 and 1999, the children underwent subsequent pulmonary function tests (PFT), and their parents completed a detailed questionnaire on their health status and housing conditions. The association between children's PFT results and their exposure to air pollution was investigated in two phases. During the first phase, PFT averages were compared with average levels of air pollution detected in townships, and small census areas in which the children reside. During the second phase, individual pollution estimates were compared with individual PFT results, and pattern detection techniques (Getis-Ord statistic) were used to investigate the spatial data structure. While different levels of areal data aggregation changed the results only marginally, the choice of indices measuring the children's PFT performance had a significant influence on the outcome of the analysis. As argued, differences between individual-level and group-level effects of exposure (i.e., ecological or cross-level bias) are not necessary outcomes of data aggregation, and that seemingly unexpected results may often stem from a misguided selection of variables chosen to measure health effects. The implications of the results of the analysis for epidemiological studies are discussed, and recommendations for public health policy are formulated. PMID: 17033679 [PubMed - indexed for MEDLINE] 493: Med Lav. 2006 Mar-Apr;97(2):369-75. Related Articles, Links

Lessons from SARS in an age of emerging infections. Ooi PL, Lim S, Tham KW. Ministry of Health, Singapore. [email protected] SARS, the first pandemic of this century, commanded the world's attention and required public health actions at the national and international levels. In an age of emerging infections, the lessons learnt from combating SARS can be used to improve our preparedness capabilities in three key areas to effectively tackle a public health emergency of international concern. The first area is in outbreak

alert, which encompasses use of surveillance to detect, assess, notify and report events involving death or disease, and share information widely to enable proper risk assessment. The system must able to build up a comprehensive picture with appropriate warning for zoonotic diseases, environmental health and food safety. The second area is in public health response. In the event of an outbreak alert, the authorities must be able to quickly investigate cases/deaths and institute comprehensive control measures to break the chain of transmission. Protection of healthcare workers and reducing the opportunities for spread of infection through contact tracing and quarantine are important. The third area is in international health. This comprises health requirements for inbound and outbound travellers at the border checkpoints and global information exchange to mitigate the risks of travel abroad. Extrapolating these lessons to a wider public health context, our rapidly changing global infectious diseases situation mandates that we evaluate all available public health tools and build institutional capacity to effectively manage emerging infections. PMID: 17017373 [PubMed - indexed for MEDLINE] 494: Yakugaku Zasshi. 2006 Oct;126(10):1003-10. Related Articles, Links

Introduction and evaluation of a newly established holiday work system in the pharmacy ward at Municipal Ikeda Hospital. Myotoku M, Iwamoto C, Tomida Y, Murayama Y, Irishio K, Nakanishi A, Shimomura K, Ihara Y, Shioishi T, Inui T, Yohiro C, Miyamoto E, Suemura N, Kawaguchi S. Department of Pharmacy, Municipal Ikeda Hospital, Ikeda City, Japan. [email protected] At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one ward pharmacy dispense drugs to be administered by injection and injectable preparations delivered to patients' bedsides was introduced in April 2000. This system was aimed at minimizing risks related to injections. Initially, however, on holidays, nurses played the roles of pharmacists in terms of the injections, and there were concerns over a possible rise in the incidence of errors (adverse events/near-misses) related to injections on these days compared with weekdays. Later, when planning to introduce a new holiday work system in the ward pharmacy, we took into account such factors as the number of pharmacists needed on holidays, their duties on holidays and the influence on weekday pharmacy activity of compensatory days-off taken by such pharmacists. In May 2004, the new holiday work system was introduced in the ward pharmacy. Under the new system, 5 pharmacists work at the ward pharmacy on holidays. After this system was put into operation, the number of injections dispensed at the ward pharmacy

averaged 230 per day, and 177 per holiday. To evaluate the validity of this system, we recently conducted a questionnaire survey of nurses at our hospital. The survey involved 139 nurses. Of these nurses, 69.1% responded that the number of incidents (adverse events/near-misses) related to dispensing injections on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease in incidents related to the delivery and administration of injectable preparations. More than half of the nurses answered that the new system had made it easier for them to collect information on medicines and helped them provide better nursing services. When the nurses were asked to make a general assessment of the new system, 90% rated the system as "good." The results of this survey indicate that keeping the ward pharmacy open on holidays contributes to the promotion of the proper use of medicines, reduction of risks related to injections and improvement in the quality of medical care. PMID: 17016030 [PubMed - indexed for MEDLINE] 495: Public Health. 2006 Nov;120(11):1055-63. Epub 2006 Oct 2. Related Articles, Links

Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan. Huang N, Yip W, Chang HJ, Chou YJ. Institute of Public Health, National Yang Ming University, 155 Ni-Long Street, Taipei 112, Taiwan, ROC. OBJECTIVES: Rural-urban disparities in health remain a major focus of concern. This population-based study examined the performance of Taiwan's universal healthcare system in reducing rural-urban disparities in health, through better accessibility. Changes in the rates of ruptured appendicitis were compared between residents of remote and non-remote areas in Taiwan, under the National Health Insurance (NHI) programme. METHODS: We identified all 128,930 patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI inpatient files, enrolment files, major disease files, hospital registry and the household registry were linked to provide comprehensive individual and hospital information. Probit regression analyses were used to obtain adjusted estimates. RESULTS: During the first 3 years, although the differences between the remote and non-remote areas were apparent, they were seen to be narrowing. This downward trend continued, and, since 1999, few discernible differences have been observed. After adjusting for individual and hospital characteristics, over time, the ruptured appendix rate among remote area residents was seen to be decreasing significantly faster (1.1%) than among non-remote area residents. More specifically, the children showed a substantially steeper narrowing trend

(3.3%) in rural-urban disparities, than did adults. CONCLUSIONS: Our findings have shown a significant narrowing of health disparities between remote and nonremote populations, resulting from free access to care and more healthcare provision in remote areas under the NHI programme; particular success has been observed in rural children. Although certain disparities still exist, Taiwan's universal healthcare system has effectively reduced rural-urban disparities in access to care and in ultimate health outcomes. Publication Types: • • •

Comparative Study Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 17011602 [PubMed - indexed for MEDLINE] 496: Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):86-95. Related Articles, Links

Usage of the claim database of national health insurance programme for analysis of cisapride-erythromycin co-medication in Taiwan. Gau CS, Chang IS, Lin Wu FL, Yu HT, Huang YW, Chi CL, Chien SY, Lin KM, Liu MY, Wang HP. School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. PURPOSE: This study aimed to use the National Health Insurance Research Database, Taiwan for risk analysis of concomitant use of cisapride and erythromycin. METHODS: The sample consisted of subjects identified in the Outpatient Sampling Database (OSD) and Longitudinal Health Insurance Database 2000 (LHID 2000), derived from the original claim data of the National Health Insurance Research Database, Taiwan. RESULTS: According to the LHID 2000, a total of 464 individuals experienced 685 episodes of cisaprideerythromycin co-medication prescribed by 295 physicians, revealing a prevalence of 4.5% concomitant use, with higher prevalence in clinics (9.2%) than in other medical institutes (3.7-5.4%). Among the co-medication episodes, 81.9% and 61.2% were prescribed from the same health institutes and by the same physicians, respectively. No medical record of cardiac arrhythmias was found among these patients in 2001 and 2002, probably due to the fact that 78.9% of the 464 individuals were under age 16, 84.0% had short exposure duration (1-4 days) and 98.0% of the episodes were prescribed with a cisapride dose of less than 0.8 mg/kg/day. CONCLUSIONS: Findings from this study suggest that there exists

an urgent need for accreditation in terms of pharmacovigilance of clinical sites and their practicing physicians for the prevention of irrational concomitant prescription in Taiwan. Our findings also indicate that it is necessary to investigate other possible conditions of potentially dangerous co-medication in Taiwan and other developing countries. Copyright (c) 2006 John Wiley & Sons, Ltd. PMID: 17006967 [PubMed - indexed for MEDLINE] 497: J Air Waste Manag Assoc. 2006 Sep;56(9):1342-8. Related Articles, Links

Determination and impact of volatile organics emitted during rush hours in the ambient air around gasoline stations. Wu BZ, Hsieh LL, Sree U, Chiu KH, Lo JG. Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan, Republic of China. This study analyzes the volatile organic compounds (VOCs) in the ambient air around gasoline stations during rush hours and assesses their impact on human health. Results from this study clearly indicate that methyl tertiary butyl ether (MTBE), toluene, and isobutane are the major VOCs emitted from gasoline stations. Moreover, the concentrations of MTBE and toluene in the ambient air near gasoline stations are remarkably higher than those sampled on surrounding roads, revealing that these compounds are mainly released from gasoline stations. The concentration of VOCs near the gasoline stations without vapor recovery systems are approximately 7.3 times higher than those around the gasoline stations having the recovery systems. An impact on individual health and air quality because of gasoline station emissions was done using Integrated Risk Information System and Industrial Source Complex Short Term model. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 17004688 [PubMed - indexed for MEDLINE] 498: Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2006 May-Jun;(3):32-6. Related Articles, Links

[Problems of registration of morbidity and ways of its improvement]

[Article in Russian] Asadov DA, Ismailov SI, Durmanov BD. New system of registration of primary morbidity was developed for the purpose of elimination of systemic error factors and decrease of human element input. The following principles are included: simplification of registration rules; more exact registration of acute conditions; unified rules of registration for out-patient and inpatient medical institutions; unified form of information fields in medical documentation for morbidity registration in out-patient and in-patient medical institutions; succession in basic parameters, indicators and terms of medical statistics in currently in force and modernized systems. New system includes following information fields: "stage of diagnostics", "urgency of condition"; "ICD-10 code", "diagnosis", "life identification", "calendar year identification". All fields, except field "diagnosis", are formalized and for them (except field "ICD-10 code") corresponding codings are developed. Rules for filling information fields, algorithms of validity control of primary information and receiving such indicators as first time identified morbidity", "chronic morbidity", "emergency (acute) morbidity", "chronic sickliness/morbidity identified for the first time in previous years", "chronic sickliness" are developed. This system is implemented experimentally in medical institutions of primary and secondary levels of health care system in Yakka-Saraysk district of City of Tashkent. Publication Types: • •

English Abstract Review

PMID: 17004379 [PubMed - indexed for MEDLINE] 499: Healthc Inform. 2006 Sep;23(9):32. Related Articles, Links

Against all odds. Political unrest creates unique challenges for healthcare organizations in regions of strife. Marietti C. PMID: 17001955 [PubMed - indexed for MEDLINE] 500: Int J Epidemiol. 2006 Oct;35(5):1211-9. Epub 2006 Sep 19. Related Articles, Links

Decomposing socioeconomic inequality in infant mortality in Iran. Hosseinpoor AR, Van Doorslaer E, Speybroeck N, Naghavi M, Mohammad K, Majdzadeh R, Delavar B, Jamshidi H, Vega J. Department of Equity, Poverty and Social Determinants of Health, Evidence and Information for Policy, World Health Organization, Geneva, Switzerland. [email protected] BACKGROUND: Although measuring socioeconomic inequality in population health indicators like infant mortality is important, more interesting for policy purposes is to try to explain infant mortality inequality. The objective of this paper is to quantify for the first time the determinants' contributions of socioeconomic inequality in infant mortality in Iran. METHODS: A nationally representative sample of 108 875 live births from October 1990 to September 1999 was selected. The data were taken from the Iranian Demographic and Health Survey (DHS) conducted in 2000. Households' socioeconomic status was measured using principal component analysis. The concentration index of infant mortality was used as our measure of socioeconomic inequality and decomposed into its determining factors. RESULTS: The largest contributions to inequality in infant mortality were owing to household economic status (36.2%) and mother's education (20.9%). Residency in rural/urban areas (13.9%), birth interval (13.0%), and hygienic status of toilet (11.9%) also proved important contributors to the measured inequality. CONCLUSIONS: The findings indicate that socioeconomic inequality in infant mortality in Iran is determined not only by health system functions but also by factors beyond the scope of health authorities and care delivery system. This implies that in addition to reducing inequalities in wealth and education, investments in water and sanitation infrastructure and programmes (especially in rural areas) are necessary to realize improvements of inequality in infant mortality across society. These findings can be instrumental for the recent 5 year Economic, Social and Cultural Development Plan of Iran, which identified the reduction of inequalities in social determinants of health. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16987848 [PubMed - indexed for MEDLINE] 501: Int J Health Serv. 2006;36(3):623-9. Related Articles, Links

Distortion of some of the basic principles of public health practice in India.

Banerji D. Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India. [email protected] India's political leadership has chosen personnel from the Indian Administrative Service cadre of generalist administrators and from the clinician-dominated cadre of the Central Health Services to run the country's health service system. The personnel's inadequate or distorted understanding of some of the basic principles of public health practice--such as developing an epidemiological approach to solving community health problems, choice of appropriate technology, and optimization of health service systems--has had a very deleterious effect on the health service system. These administrators have become vulnerable to manipulation by personnel from international agencies, who also have questionable public health credentials, to create space for imposition of their technocentric, ill-conceived, and ill-designed agenda. To rationalize adoption of such an obviously faulty agenda, they have to be ahistorical, apolitical, and atheoretical and indulge in misinformation, disinformation, and suppression and manipulation of information. This amounts to what Navarro has termed "intellectual fascism." PMID: 16981635 [PubMed - indexed for MEDLINE] 502: Trans R Soc Trop Med Hyg. 2007 Mar;101(3):216-25. Epub 2006 Sep 18. Related Articles, Links

Accuracy of the health information system on malaria surveillance in Vietnam. Erhart A, Thang ND, Xa NX, Thieu NQ, Hung LX, Hung NQ, Nam NV, Toi LV, Tung NM, Bien TH, Tuy TQ, Cong LD, Thuan LK, Coosemans M, D'Alessandro U. Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. [email protected] The health information system (HIS) is a key component of control programs and its accuracy is necessary for the assessment of disease risks, the formulation of priorities and the evaluation of the cost-effectiveness of different interventions. In order to assess the quality of the HIS in estimating malaria morbidity in Vietnam, we compared data obtained by a 2-year active (ACD) and passive case detection (PCD) study with those routinely collected at the local commune health centres (CHC) at three sites having different malaria epidemiology. The majority of malaria cases (80-95%) detected by ACD were missed by the HIS. Similarly,

most malaria cases (50-90%) detected by PCD were also missed by the HIS, and this was proportional to the number of active private practitioners. Reasons for this low sensitivity are low CHC attendance, high attendance at private health facilities, widespread self-medication and attendance at central health facilities. In conclusion, although malaria has sharply decreased in Vietnam over the past 10 years, the current HIS greatly underestimates the malaria burden. Involvement of the private sector and the establishment of sentinel sites might improve the quality of data and the relevance of HIS in malaria control. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 16979202 [PubMed - indexed for MEDLINE] 503: J Med Syst. 2006 Aug;30(4):269-75. Related Articles, Links

Comparison of computing capability and information system abilities of state hospitals owned by Ministry of Labor and Social Security and Ministry of Health. Tengilimoğlu D, Celik Y, Ulgü M. Educational Faculty of Business and Tourism, Gazi University, Golbasi Campus, Ankara, Turkey. [email protected] The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool. The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles,

and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals. Publication Types: •

Comparative Study

PMID: 16978006 [PubMed - indexed for MEDLINE] 504: J Ayub Med Coll Abbottabad. 2006 Apr-Jun;18(2):64-8. Related Articles, Links

An assessment study of maternal mortality ratio databank in five districts of North Western Frontier Province Pakistan. Farooq N, Jadoon H, Masood TI, Wazir MS, Farooq U, Lodhi MS. Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan. [email protected] BACKGROUND: Maternal mortality ratio is an indicator to measure the summary of information about mother and child health. It is estimated that about 500 maternal deaths occur per 100,000 live births each year in Pakistan. It is a well known fact that all health statistics coming out of the developing countries are calculated "guesstimates" some are perhaps more close to the real figures than the others. There is a dire need to help generate information that can be used by health professionals, health care planners and managers to save women's lives by improving the quality of care provided to turn away maternal mortality. The maternal mortality ratio for Pakistan as well as for NWFP is projected as 533/100,000 live births for the year 1990-91 produced by National Institute of Population Studies, Pakistan. METHODS: This was a retrospective crosssectional quantitative study for the period (2001-2002) conducted in five districts of (NWFP) North Western Frontier Province, Pakistan. RESULTS: National HMIS data opened the maternal mortality ratio for; Haripur as 0.168 and 0.173, Mansehra 00 and 00, Battagram 00 and 00, Swat 0.051. and 0.524 and Swabi 00 and 0.968 per/1000 live births, respectively. The small part exercise outcome (the study) endorsed more shadowy side of the actual maternal mortality ratio for the same period in the same districts. CONCLUSION: In our country there is a urgent need to institute an efficient mode of operation to get accurate maternal mortality database. Verbal Autopsy method is cost effective and feasible approach for implementation in a country like Pakistan. PMID: 16977818 [PubMed - indexed for MEDLINE]

505: BMC Health Serv Res. 2006 Sep 13;6:115. Related Articles, Links

Ethnic minorities and prescription medication; concordance between self-reports and medical records. Uiters E, van Dijk L, Devillé W, Foets M, Spreeuwenberg P, Groenewegen PP. Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands. [email protected] BACKGROUND: Ethnic differences in health care utilisation are frequently reported in research. Little is known about the concordance between different methods of data collection among ethnic minorities. The aim of this study was to examine to which extent ethnic differences between self-reported data and data based on electronic medical records (EMR) from general practitioners (GPs) might be a validity issue or reflect a lower compliance among minority groups. METHODS: A cross-sectional, national representative general practice study, using EMR data from 195 GPs. The study population consisted of Dutch, Turks, Surinamese, Antilleans and Morrocans. Self-reported data were collected through face-to-face interviews and could be linked to the EMR of GPs. The main outcome measures were the level of agreement between annual prescribing rate based on the EMRs of GPs and the self-reported receipt and use of prescriptions during the preceding 14 days. RESULTS: The pattern of ethnic differences in receipt and use of prescription medication depended on whether self-reported data or EMR data were used. Ethnic differences based on self-reports were not consistently reflected in EMR data. The percentage of agreement above chance between EMR data and self-reported receipt was in general relative low. CONCLUSION: Ethnic differences between self-reported data and EMR data might not be fully perceived as a cross-cultural validity issue. At least for Moroccans and Turks, compliance with the prescribed medication by the GP is suggested not to be optimal. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 16970807 [PubMed - indexed for MEDLINE] PMCID: PMC1578560

506: Soc Work Health Care. 2006;43(2-3):115-30. Related Articles, Links

Social workers confront terrorist victims: The interventions and the difficulties. Fraidlin N, Rabin B. Social Services Department, Sapir Medical Center, Meir Hospital, Kfar Saba, Israel. [email protected] The article deals with unremitting stress experienced by social workers dealing with terror victims. The article will describe the activity of social workers responsible for setting up a hospital information center. It will describe how they assist families searching for their loved ones and the process of identifying victims. The process in which the uncertainty is treated, the anxiety is contained, bad news are conveyed and concrete solutions are provided, will be elaborated on. Special emphasis will be placed on the multifaceted complimentary relationship between team members and between the provision of support, role exchange and the opportunity to share difficult experiences. The team is expert in identifying both personal and collective signs of distress. This is of particular significance and importance in connection with compassion fatigue, survival guilt, anxiety, depression and on- going burnout, regarding themselves and their colleagues. The article will propose organizational and clinical solutions, which could also be of service to other frameworks within the health system. PMID: 16956856 [PubMed - indexed for MEDLINE] 507: Spinal Cord. 2006 Sep;44(9):530-4. Related Articles, Links

International Spinal Cord Injury Data Sets. Biering-Sørensen F, Charlifue S, DeVivo M, Noonan V, Post M, Stripling T, Wing P. Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. STUDY DESIGN: Discussion and development of final consensus. OBJECTIVE: Present the background, purpose, and process for the International Spinal Cord Injury (SCI) Data Sets development. SETTING: International. METHODS: An international meeting on SCI data collection and analysis occurred at a workshop on May 2, 2002, before the combined meeting of the American Spinal Injury

Association (ASIA) and the International Spinal Cord Society (ISCoS) in Vancouver, British Columbia, Canada. At this meeting, a process was developed for selection of data elements to be included in International SCI Data Sets. RESULTS: An overall structure and terminology has been developed following the format of the International Classification of Functioning, Disability and Health (ICF). This includes definitions of the Core Data Set, as well as Modules with Basic Questions or Data Sets and Expanded Data Sets. The Core Data Set has been developed and will be presented separately. Working groups for additional modules are being established as well as general guidelines for the development of the modules. CONCLUSION: The presented format should help in developing data sets and modules within various topics related to SCI. Publication Types: • •

Research Support, Non-U.S. Gov't Review

PMID: 16955072 [PubMed - indexed for MEDLINE] 508: Soc Sci Med. 2006 Dec;63(11):2899-911. Epub 2006 Sep 6. Related Articles, Links

Targeted intervention for the ultra poor in rural Bangladesh: Does it make any difference in their health-seeking behaviour? Ahmed SM, Petzold M, Kabir ZN, Tomson G. BRAC, Dhaka, Bangladesh. [email protected] It is now well recognised that regular microcredit intervention is not enough to effectively reach the ultra poor in rural Bangladesh, in fact it actively excludes them for structural reasons. A grants-based integrated intervention was developed (with health inputs to mitigate the income-erosion effect of illness) to examine whether such a targeted intervention could change the health-seeking behaviour of the ultra-poor towards greater use of health services and "formal allopathic" providers during illness, besides improving their poverty status and capacity for health expenditure. The study was carried out in three northern districts of Bangladesh with high density of ultra poor households, using a pre-test/post-test control group design. A pre-intervention baseline (2189 interventions and 2134 controls) survey was undertaken in 2002 followed by an intervention (of 18 months duration) and a post-intervention follow-up survey of the same households in 2004. Structured interviews were conducted to elicit information on health-seeking behaviour of household members. Findings reveal an overall change in health-seeking behaviour in the study population, but the intervention

reduced self-care by 7 percentage units and increased formal allopathic care by 9 percentage units. The intervention increased the proportion of non-deficit households by 43 percentage units, as well as the capacity to spend more than Tk. 25 for treatment of illness during the reference period by 11 percentage units. Higher health expenditure and time (pre- to -post-intervention period) was associated with increased use of health care from formal allopathic providers. However, gender differences in health-seeking and health-expenditure disfavouring women were also noted. The programmatic implications of these findings are discussed in the context of improving the ability of health systems to reach the ultra poor. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16954049 [PubMed - indexed for MEDLINE] 509: Saudi Med J. 2006 Sep;27(9):1306-10. Related Articles, Links

On the Ottoman consent documents for medical interventions and the modern concept of informed consent. Kara MA, Aksoy S. Department of History of Medicine and Deontology, Ege University Medical School, 35100 Bornova, Izmir, Turkey. [email protected] Information for patients prior to medical intervention is one of the principles of modern medical practice. In this study, we looked at an earlier practice of this principle. Ottoman judges had record books called sicil. One of the categories in sicils was the consent documents called riza senedi, which was a patient-physician contract approved by the courts. These contracts were especially for the protection of physicians from punishment if the patient dies. It is not clear whether patients were informed properly or not. Consent for minors was obtained from parents. However, a situation where an adult does not have the capacity to consent, was not clear in these documents. Any sign of free withdrawal of consent was not found in these records. Due to the legal system of Ottoman State, these contracts were related to Islamic law rather than modern civil law. We aim, in this paper, to present a legal practice, which is possible to consider as an early example of the informed consent practice. Publication Types: •

Historical Article

PMID: 16951763 [PubMed - indexed for MEDLINE] 510: Int J Qual Health Care. 2006 Oct;18(5):346-51. Epub 2006 Sep 1. Related Articles, Links

Comparison of health care professionals' and surveyors' opinions on problems and obstacles in implementing quality management system in Thailand: A national survey. Pongpirul K, Sriratanaban J, Asavaroengchai S, Thammatach-Aree J, Laoitthi P. International Health Policy Program (IHPP-Thailand), Quality of Care, Ministry of Public Health, Nonthaburi, Thailand. [email protected] OBJECTIVE: To explore problems and obstacles of hospitals in Thailand implementing quality management systems according to the hospital accreditation (HA) standards. DESIGN: Questionnaire survey. SETTING: Thirty-nine hospitals in all 13 regions of Thailand. PARTICIPANTS: A total of 728 health care professionals and 41 surveyors of the national accreditation program. MAIN OUTCOME MEASURES: Health care professionals' and surveyors' opinions on problems and obstacles in 24 items representing Thailand HA standards. RESULTS: The response rates were 94.9 and 73.2% in health care professionals and surveyors, respectively. More than 90% of both groups thought that there had been problems in the items such as 'quality improvement (QI) activities' and 'integration and utilization of information'. The items considered by health care professionals as major obstacles included 'adequacy of staff' (34.6%) and 'integration and utilization of information' (26.6%), for example. For surveyors, 'integration and utilization of information' was ranked highest as presenting a major obstacle (43.9%), followed by 'discharge and referral process' (31.7%) and 'medical recording process' (29.3%). The rank orders for the 24 items as problems and major obstacles were similar in both groups (Spearman's rank correlation 0.436, P = 0.033 and 0.583, P = 0.003, respectively). Surveyors had a higher degree of concern and paid more attention to care-related items than health care professionals. CONCLUSIONS: Health care professionals have been facing many problems with multidisciplinary process-related issues of the accreditation standard, whereas surveyors might have had some difficulties in conveying the core QI concepts to them. The findings might be explained by the effects of health care reform on the underlying accreditation principles. One of the strategies to respond to the situation was presented. Publication Types: •

Comparative Study

•

Research Support, Non-U.S. Gov't

PMID: 16950804 [PubMed - indexed for MEDLINE] 511: Biol Trace Elem Res. 2006 Summer;111(1-3):1-9. Related Articles, Links

Serum levels of trace elements and iron-deficiency anemia in adult Vietnamese. Van Nhien N, Khan NC, Yabutani T, Ninh NX, Kassu A, Huong BT, Do TT, Motonaka J, Ota F. Department of Preventive Environment and Nutrition, Systems of Nutritional Sciences, Graduate School of Health Biosciences Research, Hanoi, Vietnam. This study was aimed at assessing the serum levels of vitamin A, copper, zinc, selenium, and iron among adult Vietnamese with and without iron-deficiency anemia. Blood was collected from adult Vietnamese living in the midland of northern Vietnam. One hundred twenty-three subjects in the age range 20-60 yr were included in the study. Anemia, where the concentration of hemoglobin in whole blood is less than 120 g/L in females and 130 g/L in males, was found in 30% (37/123) of the study population. The levels of vitamin Aand selenium in the sera of anemic subjects (n = 37) were significantly lower than that in nonanemic group (n = 86). On the other hand, no significant differences were observed in the concentrations of copper and zinc between the two groups. This study was the first to show serum levels of trace elements in adult Vietnamese, providing useful baseline information for further studies. PMID: 16943592 [PubMed - indexed for MEDLINE] 512: PLoS Med. 2006 Aug;3(8):e268. Related Articles, Links

Core verbal autopsy procedures with comparative validation results from two countries. Setel PW, Rao C, Hemed Y, Whiting DR, Yang G, Chandramohan D, Alberti KG, Lopez AD. MEASURE Evaluation/Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA. [email protected]

BACKGROUND: Cause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. Neither facility-based information systems nor vital registration provide adequate or representative data. The expansion of sample vital registration with verbal autopsy procedures represents the most promising interim solution for this problem. The development and validation of core verbal autopsy forms and suitable coding and tabulation procedures are an essential first step to extending the benefits of this method. METHODS AND FINDINGS: Core forms for peri- and neonatal, child, and adult deaths were developed and revised over 12 y through a project of the Tanzanian Ministry of Health and were applied to over 50,000 deaths. The contents of the core forms draw upon and are generally comparable with previously proposed verbal autopsy procedures. The core forms and coding procedures based on the International Statistical Classification of Diseases (ICD) were further adapted for use in China. These forms, the ICD tabulation list, the summary validation protocol, and the summary validation results from Tanzania and China are presented here. CONCLUSIONS: The procedures are capable of providing reasonable mortality estimates as adjudged against stated performance criteria for several common causes of death in two countries with radically different cause structures of mortality. However, the specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death. These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings. Publication Types: • • • •

Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16942391 [PubMed - indexed for MEDLINE] PMCID: PMC1502154

513: Yonsei Med J. 2006 Aug 31;47(4):524-33. Related Articles, Links

The perceived care needs of breast cancer patients in Korea. Hwang SY, Park BW.

Department of Social Welfare, Duksung Women's University College of Social Sciences, Seoul, Korea. By analyzing the data of 459 patients who completed the Supportive Care Needs Survey (SCNS), the prevalence, medical and non-medical predictors of unmet needs were investigated. Breast cancer patients in Korea experienced high levels of unmet needs across the needs domains, particularly in the health system and information domain (56.9%). Various medical and non-medical variables were identified as significant predictors of unmet needs in each domain. By multivariate analyses, several predictors were identified across the domains including; less education (< or = 9 years) in the psychologic, chemotherapy, short post-surgical interval, and less education in the physical and daily living, younger age (< 50 years) in the sexuality, larger tumor size (> 2 cm) and younger age in the health system and information, and more education (> or = 13 years) in the care and support domain. The results of this study suggest medical professional should consider the complexity and dynamics of meeting patients' needs in providing supportive care services. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16941743 [PubMed - indexed for MEDLINE] 514: Pediatrics. 2006 Oct;118(4):e1055-60. Epub 2006 Aug 28. Related Articles, Links

The incidence of anemia in an Israeli population: a population analysis for anemia in 34,512 Israeli infants aged 9 to 18 months. Meyerovitch J, Sherf M, Antebi F, Barhoum-Noufi M, Horev Z, Jaber L, Weiss D, Koren A. Research and Health Planning Department, Health Planning and Policy Division, Clalit Health Services, 101 Arlozorov St, PO Box 16250, Tel Aviv 62098, Israel. [email protected] OBJECTIVES: The purpose of this work was to use the comprehensive computerized database of Clalit Health Services to analyze the prevalence and contributing factors of anemia among the population of Clalit Health Servicesinsured Israeli infants aged 9 to 18 months, characterized by ethnic sector. METHODS: This was a cross-sectional retrospective study for the year 2003 using the computerized database of Clalit Health Services for 34,512 infants aged 9 to 18 months insured by the Clalit Health Services sick fund. Children with

abnormal white blood counts at the time of the hemoglobin test and with chronic diseases were excluded. The data were analyzed for age, infant hemoglobin level, ethnic origin, district distribution, type of clinic where the infant received treatment, the number of iron prescriptions dispensed to each child, and the mother's last hemoglobin level before giving birth. Anemia was defined as a hemoglobin level <105 g/L. RESULTS: The prevalence of anemia among Israeli infants is 15.5%. The prevalence is significantly higher in the non-Jewish population (22.5%) as compared with the Jewish population (10.5%). The lowest prevalence of anemia was found in pediatric health centers (10.7%). A significant correlation was found between the presence of anemia in infants and the presence of anemia found in their mothers. Infants with anemia used significantly less iron preparations. CONCLUSIONS: This study is one of the first studies to use a comprehensive computerized database to perform a population-based analysis of anemic infants. We found a considerable percentage of infants to be anemic and identified a specific population to be at high risk for anemia. We describe 2 factors that have the potential to be altered through intervention: improving compliance of iron intake and maternal anemia. Major national efforts should be made to minimize the prevalence of anemia, especially in the non-Jewish population, and to learn more about the causes of iron-deficiency anemia in this group. This study provides a base for an intervention study. PMID: 16940163 [PubMed - indexed for MEDLINE] 515: BMC Public Health. 2006 Aug 25;6:218. Related Articles, Links

Acute symptoms related to air pollution in urban areas: a study protocol. Yunesian M, Asghari F, Vash JH, Forouzanfar MH, Farhud D. School of Public Health & Centre for Environmental Research, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, P.O. Box 141556446, Tehran, Iran. [email protected] BACKGROUND: The harmful effects of urban air pollution on general population in terms of annoying symptoms are not adequately evaluated. This is in contrast to the hospital admissions and short term mortality. The present study protocol is designed to assess the association between the level of exposure to certain ambient air pollutants and a wide range of relevant symptoms. Awareness of the impact of pollution on the population at large will make our estimates of the pertinent covert burden imposed on the society more accurate. METHODS/DESIGN: A cross sectional study with spatial analysis for the addresses of the participants was conducted. Data were collected via telephone interviews administered to a representative sample of civilians over age four in

the city. Households were selected using random digit dialling procedures and randomization within each household was also performed to select the person to be interviewed. Levels of exposure are quantified by extrapolating the addresses of the study population over the air pollution matrix of the city at the time of the interview and also for different lag times. This information system uses the data from multiple air pollution monitoring stations in conjunction with meteorological data. General linear models are applied for statistical analysis. DISCUSSION: The important limitations of cross-sectional studies on acute effects of air pollution are personal confounders and measurement error for exposure. A wide range of confounders in this study are controlled for in the statistical analysis. Exposure error may be minimised by employing a validated geographical information system that provides accurate estimates and getting detailed information on locations of individual participants during the day. The widespread operation of open air conditioning systems in the target urban area which brings about excellent mixing of the outdoor and indoor air increases the validity of outdoor pollutants levels that are taken as exposure levels. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16934138 [PubMed - indexed for MEDLINE] PMCID: PMC1569380

516: Mil Med. 2006 Aug;171(8):691-7. Related Articles, Links

The Navy-Marine Corps Combat Trauma Registry. Galarneau MR, Hancock WC, Konoske P, Melcer T, Vickers RR, Walker GJ, Zouris JM. Naval Health Research Center, San Diego, CA 92186-5122, USA. The U.S. military services, drawing on the experiences of civilian trauma systems in monitoring trauma care delivery, have begun to implement their own registries, emphasizing injury incidence and severity in a combat environment. This article introduces and describes the development of the U.S. Navy-Marine Corps Combat Trauma Registry and presents several preliminary inquiries of its database regarding combat injury patterns and casualty management during Operation Iraqi Freedom. The Navy-Marine Corps Combat Trauma Registry is composed of data sets describing events that occur from the point of injury through the medical chain of evacuation and on to long-term rehabilitative outcomes. Data were

collected from Navy-Marine Corps level 1B, 2, and 3 medical treatment facilities. Data from the official combat period were analyzed to present a variety of preliminary findings that indicate, among other things, how many and for what type of injury casualties were evacuated, specific mechanisms of injury, and types of injuries treated at the medical treatment facilities. Publication Types: •

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16933807 [PubMed - indexed for MEDLINE] 517: Blood Press Monit. 2006 Oct;11(5):257-67. Related Articles, Links

The economic impact of the introduction of home blood pressure measurement for the diagnosis and treatment of hypertension. Funahashi J, Ohkubo T, Fukunaga H, Kikuya M, Takada N, Asayama K, Metoki H, Obara T, Inoue R, Hashimoto J, Totsune K, Kobayashi M, Imai Y. Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Tokyo, Japan. OBJECTIVES: To investigate the economic consequences resulting from introduction of home blood pressure measurement in diagnosis of hypertension instead of casual clinic blood pressure measurement. METHODS: We constructed a decision tree model using data from the Ohasama study and a Japanese national database. The Ohasama study provided the prognostic value of home blood pressure as compared with clinic blood pressure measurement. RESULTS: It is predicted that the use of home blood pressure for hypertension diagnosis results in a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related medical costs in Japan. Most of this was attributable to medical costs saved by avoiding the start of treatment for untreated individuals who were diagnosed as hypertensive by clinic blood pressure but whose blood pressures were in the normal range when based on home blood pressure; that is, the so called white-coat hypertension. Furthermore, it could be expected that adequate blood pressure control mediated by the change in the diagnostic method from clinic to home blood pressure measurement would improve the prognosis for hypertension. We estimated that the prevention of hypertensive complications resulted in a reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In addition, stroke prevention due to adequate blood pressure control based on home blood pressure measurement reduced annual long-term care costs by 39 million

US dollars (4.2 billion yen). A per-person break-even cost for introducing home blood pressure monitoring was calculated as 409 US dollars (44,580 yen). CONCLUSIONS: The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16932035 [PubMed - indexed for MEDLINE] 518: Int J Med Inform. 2007 Sep;76(9):688-700. Epub 2006 Aug 23. Related Articles, Links

Building a reference functional model for EHR systems. Sumita Y, Takata M, Ishitsuka K, Tominaga Y, Ohe K. Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. [email protected] INTRODUCTION: Our aim was to develop a reference functional model for electric health record systems (RFM). Such a RFM is built from functions using functional descriptive elements (FDEs) and represents the static relationships between them. This paper presents a new format for describing electric health record (EHR) system functions. METHODS: Questionnaire and field interview survey was conducted in five hospitals in Japan and one in the USA, to collect data on EHR system functions. Based on survey results, a reference functional list (RFL) was created, in which each EHR system function was listed and divided into 13 FDE types. By analyzing the RFL, we built the meta-functional model and the functional model using UML class diagrams. The former defines language for expressing the functional model, while the latter represents functions, FDEs and their static relationships. RESULTS: A total of 385 functions were represented in the RFL. Six patterns were found for the relationships between functions. The meta-functional model was created as a new format for describing functions. Examples of the functional model, which included the six patterns in the relationships between functions and 11 verbs, were created. DISCUSSIONS: We present the meta-functional model, which is a new description format for the functional structure and relationships. Although a more detailed description is required to apply the RFM to the semiautomatic generation of functional specification documents, our RFM can visualize functional structures and functional relationships, classify functions using multiple axes and identify the similarities and differences between functions. The RFM will promote not only

the standardization of EHR systems, but also communications between system developers and healthcare providers in the EHR system-design processes. 2006 Elsevier Ireland Ltd Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16931129 [PubMed - indexed for MEDLINE] 519: BMC Med Educ. 2006 Aug 22;6:43. Related Articles, Links

Do community medicine residency trainees learn through journal club? An experience from a developing country. Akhund S, Kadir MM. Human Development Programme, Aga Khan University, Karachi, Pakistan. [email protected] BACKGROUND: Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction. METHODS: Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September 1999September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. RESULTS: The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. CONCLUSION: CMR-JC fulfils criteria for effective

journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience. PMID: 16925800 [PubMed - indexed for MEDLINE] PMCID: PMC1564014

520: Genomics. 2006 Nov;88(5):535-40. Epub 2006 Aug 17. Related Articles, Links

SNP identification, linkage disequilibrium, and haplotype analysis for a 200-kb genomic region in a Korean population. Kim KJ, Lee HJ, Park MH, Cha SH, Kim KS, Kim HT, Kimm K, Oh B, Lee JY. Center for Genome Sciences, Korean National Institute of Health, Eunpyung-Gu, Seoul 122-701, Korea. Understanding patterns of linkage disequilibrium (LD) across genomes may facilitate association mapping studies to localize genetic variants influencing complex diseases, a recognition that led to the International Haplotype Mapping Project (HapMap). Divergent patterns of haplotype frequency and LD across global populations require that the HapMap database be supplemented with haplotype and LD data from additional populations. We conducted a pilot study of the LD and haplotype structure of a genomic region in a Korean population. A total of 165 SNPs were identified in a 200-kb region of 22q13.2 by direct sequencing. Unphased genotype data were generated for 76 SNPs in 90 unrelated Korean individuals. LD, haplotype diversity, and recombination rates were assessed in this region and compared with the HapMap database. The pattern of LD and haplotype frequencies of Korean samples showed a high degree of similarity with Japanese data. There was a strong correlation between high LD and low recombination frequency in this region. We found considerable similarities in local LD patterns between three Asian populations (Han Chinese, Japanese, and Korean) and the CEPH population. Haplotype frequencies were, however, significantly different between them. Our results should further the understanding of distinctive Korean genomic features and assist in designing appropriate association studies.

Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16919420 [PubMed - indexed for MEDLINE] 521: Bull World Health Organ. 2006 Aug;84(8):629-35. Related Articles, Links

Linking local knowledge with global action: examining the Global Fund to Fight AIDS, Tuberculosis and Malaria through a knowledge system lens. van Kerkhoff L, Szlezák N. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia. [email protected] New global public health institutions are increasingly emphasizing transparency in decision-making, developing-country ownership of projects and programmes, and merit- and performance-based funding. Such principles imply an institutional response to the challenge of bridging the "know-do gap", by basing decisions explicitly on results, evidence and best practice. Using a knowledge systems framework, we examine how the Global Fund to Fight AIDS, Tuberculosis and Malaria has affected the ways in which knowledge is used in efforts to combat these three diseases. We outline the formal knowledge system embedded in current rules and practices associated with the Global Fund's application process, and give three examples that illustrate the complexity of the knowledge system in action: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policy in China; successful applications from Haiti; and responses to changing research on malaria. These examples show that the Global Fund has created strong incentives for knowledge to flow to local implementers, but with little encouragement and few structures for the potentially valuable lessons from implementation to flow back to global best practice or research-based knowledge. The Global Fund could play an influential role in fostering much-needed learning from implementation. We suggest that three initial steps are required to start this process: acknowledging shared responsibility for learning across the knowledge system; analysing the Global Fund's existing data (and refining data collection over time); and supporting recipients and technical partners to invest resources in linking implementation with best practice and research. Publication Types:

•

Research Support, Non-U.S. Gov't

PMID: 16917650 [PubMed - indexed for MEDLINE] 522: Fam Pract. 2006 Dec;23(6):699-705. Epub 2006 Aug 17. Related Articles, Links Comment in: •

Fam Med. 2007 Apr;39(4):288-90.

The use of text messaging to improve attendance in primary care: a randomized controlled trial. Leong KC, Chen WS, Leong KW, Mastura I, Mimi O, Sheikh MA, Zailinawati AH, Ng CJ, Phua KL, Teng CL. Department of Family Medicine, International Medical University Puchong, Jalan Rasah, Malaysia. [email protected] BACKGROUND: Non-attendance is common in primary care and previous studies have reported that reminders were useful in reducing broken appointments. OBJECTIVE: To determine the effectiveness of a text messaging reminder in improving attendance in primary care. DESIGN: Multicentre threearm randomized controlled trial. SETTING: Seven primary care clinics in Malaysia. Participants. Patients (or their caregivers) who required follow-up at the clinics between 48 hours and 3 months from the recruitment date. Interventions. Two intervention arms consisted of text messaging and mobile phone reminders 24-48 hours prior to scheduled appointments. Control group did not receive any intervention. Outcome measures. Attendance rates and costs of interventions. RESULTS: A total of 993 participants were eligible for analysis. Attendance rates of control, text messaging and mobile phone reminder groups were 48.1, 59.0 and 59.6%, respectively. The attendance rate of the text messaging reminder group was significantly higher compared with that of the control group (odds ratio 1.59, 95% confidence interval 1.17 to 2.17, P = 0.005). There was no statistically significant difference in attendance rates between text messaging and mobile phone reminder groups. The cost of text messaging reminder (RM 0.45 per attendance) was lower than mobile phone reminder (RM 0.82 per attendance). CONCLUSIONS: Text messaging reminder system was effective in improving attendance rate in primary care. It was more cost-effective compared with the mobile phone reminder. Publication Types:

• •

Multicenter Study Randomized Controlled Trial

PMID: 16916871 [PubMed - indexed for MEDLINE] 523: ANZ J Surg. 2006 Aug;76(8):704-9. Related Articles, Links

Outcome after pancreatic necrosectomy: trends over 12 years at an Indian centre. Reddy M, Jindal R, Gupta R, Yadav TD, Wig JD. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. BACKGROUND: Pancreatic necrosectomy for necrotizing pancreatitis is a formidable operation. There are limited data from the Indian subcontinent regarding outcome and recent trends in management. METHODS: Patients undergoing pancreatic necrosectomy over a 12-year period were identified from a prospective database. Data regarding the hospital course, complications and outcome were extracted by case file review. Descriptive statistics were used to present the data. An attempt was made to identify trends in management and outcome over the study period. RESULTS: One hundred and eighteen patients underwent necrosectomy. The median age was 39.5 years (interquartile range, 3246). Median Acute Physiology And Chronic Health Evaluation II score at admission was 8 (interquartile range, 6-10). Thirty-nine patients (33%) had organ failure at admission. Patients underwent surgery a median of 23 days (interquartile range, 14-34) after onset of illness. There was high incidence of loco-regional complications (68/118, 58%) and organ failure (88/118, 75%) in the postoperative period. The mortality rate was 38%. There was an increase in the median onset to surgery interval (17 vs 25.5 days; P = 0.001), increased use of percutaneous interventions (20 vs 36%; P = 0.05) and decreased mortality (47 vs 29%; P = 0.052) in the later half of the study period. CONCLUSION: Pancreatic necrosectomy continues to be associated with significant morbidity and mortality in India. A trend towards increased use of percutaneous interventions and delayed surgery is evident. PMID: 16916387 [PubMed - indexed for MEDLINE] 524: ANZ J Surg. 2006 Aug;76(8):683-7. Related Articles, Links

Cleft surgery in East timor: the first four years. Moore MH, Fernandes AL. Overseas Specialist Surgical Association of Australia, Adelaide, South Australia. [email protected] BACKGROUND: Following the vote for independence in 1999, this team commenced the first coherent reconstructive surgical service in East Timor. The aim of this paper is to report the cleft lip and palate surgical experience during the 4 years since independence. METHODS: From June 2000, a record of all cleft surgical procedures carried out by our team in East Timor has been maintained. This has been reviewed to identify the clinical experience, procedures carried out and the outcomes of the cleft population in this, the poorest and newest, nation in Asia. RESULTS: From the 519 reconstructive surgical procedures carried out by this team in East Timor during the first 4 years, 267 were for cleft lip and palate deformity. Cleft lip and nose repairs were most commonly undertaken, although over the period of the study increasing numbers of cleft palate repairs were evident, reflecting the developing confidence in the service by the local population. CONCLUSION: The establishment of a regular, consistent cleft lip and palate surgical team in East Timor has not only seen the successful correction of a large number of untreated cleft patients, but has also contributed to a restoration of trust in the newly developing health system in East Timor. PMID: 16916383 [PubMed - indexed for MEDLINE] 525: J Clin Nurs. 2006 Sep;15(9):1179-87. Related Articles, Links

Turkish nurses' information about, and administration of, chemotherapeutic drugs. Kosgeroglu N, Ayranci U, Ozerdogan N, Demirustu C. Osmangazi University, School of Health, Meselik, Eskisehir, Turkey. AIM: The aim of this study was to determine both the level of information that nurses possessed and the method of administration nurses used during chemotherapeutic drug preparation and administration. BACKGROUND: While compliance with the regulations related to chemotherapeutic drug preparation and administration seems to be very difficult, it is at the same time vital. METHODS: This descriptive study was conducted between 1 May 2002 and 1 May 2003 in the chemotherapy administration units of all hospitals in Eskisehir, west Turkey. The

sample consisted of 121 nurses. Data were obtained first via questionnaire forms developed by the researchers to learn the level of awareness concerning exposure to chemotherapy. This was then followed up by the completion of observation forms during drug administrations. RESULTS: The average score for information levels pertaining to nurses' protection of the environment was 7.82 +/- 0.38 of a total of 14 points, and that of self-protection was 7.94 +/- 0.24 of a total of 11 points. Nurses showed that their actual administration method was insufficient according to their level of information, with average administration evaluations of 5.46 for protection of the environment and 6.59 for self-protection. The ratio for nurses' usage of the safety cabinet during the preparation of chemotherapeutic drugs was very low at 14.2%. Only 7.4% of nurses had received in-service education about chemotherapeutics. CONCLUSION: In order to ensure the taking of sufficient preventive precautions during the preparation and administration of chemotherapeutic agents, hospitals should be required to provide sufficient equipment and to give this precedence in hospital politics. RELEVANCE TO CLINICAL PRACTICE: Healthcare workers who prepare and administer chemotherapeutic drugs may experience the cytotoxic effects of the drugs through direct skin contact, respiratory and digestive system exposure, and these effects are vital to human life. Thus, it has been recognized that nurses' information and administrations during preparation and administration of chemotherapeutic drugs are of utmost vital importance in removing the harmful effects of chemotherapeutic agents. PMID: 16911059 [PubMed - indexed for MEDLINE] 526: CMAJ. 2006 Aug 15;175(4):385. Related Articles, Links Comment on: •

CMAJ. 2006 Jan 3;174(1):52-4.

ADRs and smart health cards. Hsu MH, Li YC, Liu CT. Publication Types: • •

Comment Letter

PMID: 16908903 [PubMed - indexed for MEDLINE]

PMCID: PMC1534097

527: Int J Med Inform. 2007 Jan;76(1):66-77. Epub 2006 Aug 8. Related Articles, Links

Mobile computing acceptance factors in the healthcare industry: a structural equation model. Wu JH, Wang SC, Lin LM. Department of Information Management, National Sun Yat-sen University, 70 Lien-Hai Road, Kaohsiung 804, Taiwan. [email protected] OBJECTIVE: This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals. METHOD: Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model. RESULTS: The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS selfefficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported. CONCLUSION: This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16901749 [PubMed - indexed for MEDLINE] 528: Int J Health Geogr. 2006 Aug 10;5:33. Related Articles, Links

Investigation of geo-spatial hotspots for the occurrence of tuberculosis in Almora district, India, using GIS and spatial scan statistic. Tiwari N, Adhikari CM, Tewari A, Kandpal V. Department of Statistics, Kumaon University, S.S.J.Campus, Almora, Uttaranchal, India. [email protected] BACKGROUND: The World Health Organization has declared tuberculosis a global emergency in 1993. It has been estimated that one third of the world population is infected with Mycobacterium tuberculosis, the causative agent of tuberculosis. The emergence of TB/HIV co-infection poses an additional challenge for the control of tuberculosis throughout the world. The World Health Organization is supporting many developing countries to eradicate tuberculosis. It is an agony that one fifth of the tuberculosis patients worldwide are in India. The eradication of tuberculosis is the greatest public health challenge for this developing country. The aim of the present population based study on Mycobacterium tuberculosis is to test a large set of tuberculosis cases for the presence of statistically significant geographical clusters. A spatial scan statistic is used to identify purely spatial and space-time clusters of tuberculosis. RESULTS: Significant (p < 0.05 for primary clusters and p < 0.1 for secondary clusters) high rate spatial and space-time clusters were identified in three areas of the district. CONCLUSION: There is sufficient evidence about the existence of statistically significant tuberculosis clusters in Almora district of Uttaranchal, India. The spatial scan statistics methodology used in this study has a potential use in surveillance of tuberculosis for detecting the true clusters of the disease. PMID: 16901341 [PubMed - indexed for MEDLINE] PMCID: PMC1557839

529: Ann Surg Oncol. 2006 Sep;13(9):1182-8. Epub 2006 Aug 5. Related Articles, Links

Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country. Lin HC, Xirasagar S, Lee HC, Chai CY. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. [email protected]

BACKGROUND: Using 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections. METHODS: The study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was inhospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality. RESULTS: The adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in veryhigh-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality. CONCLUSIONS: After adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with highervolume hospitals. PMID: 16897270 [PubMed - indexed for MEDLINE] 530: Transcult Psychiatry. 2006 Jun;43(2):259-74. Related Articles, Links

Characteristics of Vietnamese patients attending an anxiety clinic in Australia and perceptions of the wider Vietnamese community about anxiety. Wagner R, Manicavasagar V, Silove D, Marnane C, Tran VT. University of New South Wales Australia. [email protected] This article examined the causes underlying low utilization of mental health services by Vietnamese immigrants in Australia. Study 1 examined cases of Vietnamese patients who had attended an anxiety disorders clinic, while Study 2 surveyed Vietnamese people in the community on their knowledge and attitudes towards common mental problems. Results from Study 1 showed that Vietnamese patients had significantly higher attrition rates, and presented with a larger number of nonanxiety disorders than their Australian-born counterparts. Study 2

results indicated that many Vietnamese people did not differentiate clearly between the terms 'stress', 'anxiety' and 'depression'. Additionally, many participants felt that there was a generally negative cultural attitude towards people suffering from these problems and the mental health system itself. These outcomes suggest the importance of education for ethnic communities regarding available mental health facilities and treatments offered, as well as specific information on mental illness to help remove stigma. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16893875 [PubMed - indexed for MEDLINE] 531: Prehosp Disaster Med. 2006 May-Jun;21(3):204-10. Related Articles, Links

Prehospital care of tsunami victims in Thailand: description and analysis. Schwartz D, Goldberg A, Ashkenasi I, Nakash G, Pelts R, Leiba A, Levi Y, Bar-Dayan Y. Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel. INTRODUCTION: On 26 December 2004 at 09:00 h, an earthquake of 9.0 magnitude (Richter scale) struck the area off of the western coast of northern Sumatra, Indonesia, triggering a Tsunami. As of 25 January 2005, 5,388 fatalities were confirmed, 3,120 people were reported missing, and 8,457 people were wounded in Thailand alone. Little information is available in the medical literature regarding the response and restructuring of the prehospital healthcare system in dealing with major natural disasters. OBJECTIVE: The objective of the study was to analyze the prehospital medical response to the Tsunami in Thailand, and to identify possible ways of improving future preparedness and response. METHODS: The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research delegation to study the response of the Thai medical system to the 2004 earthquake and Tsunami disaster. The delegation met with Thai healthcare and military personnel, who provided medical care for and evacuated the Tsunami victims. The research instruments included questionnaires (open and closed questions), interviews, and a review of debriefing session reports held in the days following the Tsunami. RESULTS: Beginning the day after the event, primary health care in the affected provinces was expanded and extended. This included: (1) strengthening existing primary care facilities with personnel and equipment; (2) enhancing communication and transportation capabilities; (3) erecting healthcare facilities in newly constructed evacuation

centers; (4) deploying mobile, medical teams to make house calls to flood refugees in affected areas; and (5) deploying ambulance crews to the affected areas to search for survivors and provide primary care triage and transportation. CONCLUSION: The restructuring of the prehospital healthcare system was crucial for optimal management of the healthcare needs of Tsunami victims and for the reduction of the patient loads on secondary medical facilities. The disaster plan of a national healthcare system should include special consideration for the restructuring and reinforcement prehospital system. PMID: 16892886 [PubMed - indexed for MEDLINE] 532: Nippon Koshu Eisei Zasshi. 2006 Jun;53(6):448-56. Related Articles, Links

[Analysis of an adult measles outbreak in the eastern part of Ehime prefecture in Japan] [Article in Japanese] Tomita N. Saijo Public Health Center, Ehime. PURPOSE: An outbreak of adult measles occurring in the eastern part of Ehime prefecture in Japan was analyzed, and the future directions of measures against infectious diseases in public health centers was studied. METHOD: An outbreak of adult measles (in individuals more than 18 years old) occurred in the eastern part of Ehime prefecture between October 2002 and July 2003. During this outbreak, provisional surveillance of adult measles as well as pediatric measles (less than 18 years old) was performed by all clinics and hospitals in addition to that by The Ehime Epidemiological Surveillance of Infectious Diseases (sentinel surveillance). Furthermore, identification of viral genes was performed from pediatric and adult measles patient samples. RESULTS: 112 cases of measles in adults and 200 cases in children were reported in Ehime between October 2002 and July 2003, and the rates for the eastern part of the prefecture accounted for 89.7% and 94.1% respectively. The relation between the pediatric measles and adult measles could be followed by change in the outbreak number of patients week by week. The genotype of the measles viruses isolated was type H1, which is prevalent in China and Korea. The results of an epidemiological survey showed that 59.3% of adult and 84.1% of pediatric cases had not been vaccinated. The measles vaccination rates for adult and pediatric cases were 21.9% and 11.4%, respectively. While the number of measles cases detected by sentinel pediatric surveillance comprised 32.0% of the measles cases reported by all pediatricians, the figure for adult measles cases was only 11.6% of those reported by all clinics and hospitals. CONCLUSIONS: It was suggested that improvement in the vaccination rates and revaccination rates mainly among school children or young

people is necessary to prevent measles outbreaks. The surveillance system must be strengthened to increase the number of sentinel hospitals because an outbreak may not be detected with the current approach, especially for measles among adults. Positive information exchange between public health centers and medical institutions also appear to be particularly important. Publication Types: •

English Abstract

PMID: 16881533 [PubMed - indexed for MEDLINE] 533: Int Nurs Rev. 2006 Sep;53(3):197-204. Related Articles, Links

A comparison of sexual satisfaction and post-natal depression in the UK and Taiwan. Huang YC, Mathers NJ. Department of Nursing, Fu-Jen Catholic University, Shin-Juang, Taipei County, Taiwan. AIM: To compare the sexual expression and sexual satisfaction of women in the UK and Taiwan before and after childbirth, to determine if there is an association between self reported sexual satisfaction and postnatal depression (PND) and the main sources of sexual information for women during this period. METHOD: A comparative survey of postnatal women in the UK and Taiwan using a selfadministered questionnaire, a semi structured interview and the Edinburgh Postnatal Depression Scale (EPDS) to investigate sexual satisfaction, sexual expression and main sources of information as well the prevalence of postnatal depression. RESULTS: Seventy per cent of the UK women and 89% of the Taiwanese women were generally satisfied with their sex life during the postnatal period although in both countries women thought that sexual expression was not as important to themselves as to their partner. There were differences in ranking criteria for physical and emotional sexual satisfaction in the two countries. Eighty-three per cent of UK women had sufficient information about sex during the postnatal period compared to 60% of Taiwanese women. There was no significant difference in the prevalence of PND (18% UK, 19% Taiwan p < 0.01 ANOVA) but significant negative associations (correlation coefficient) between 'sexual self-confidence' and PND in the UK (p < 0.01) and Taiwan (p < 0.05). UK Women with an unsatisfactory sex life (p < 0.05), insufficient sexual information (p < 0.05) and sexual worries after birth (p < 0.05) were more likely to have symptoms of PND. There was a strong association between a poor relationship

with her partner and PND (p < 0.001). CONCLUSIONS: These associations may be either a consequence of or a contributing factor to PND. The observed differences between the two countries may be attributed to cross cultural factors and differences in health care systems although further investigation is required. Publication Types: •

Comparative Study

PMID: 16879182 [PubMed - indexed for MEDLINE] 534: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(2-3):267-86. Related Articles, Links

Assessing doctors' compliance with guidelines on diabetes management. Tan KB. Ministry of Health, Singapore. [email protected] PURPOSE: In 2002 the Singapore Ministry of Health (MOH) audited doctors' compliance with diabetes clinical practice guidelines in public healthcare institutions and attempted to postulate factors that influenced the degree of conformity. This study aims to address this issue. DESIGN/METHODOLOGY/APPROACH: A retrospective cross-sectional chart review of diabetes patient records sampled from hospital specialist outpatient clinics (SOCs) and polyclinics was performed. Childhood, gestational and secondary diabetes cases were excluded. The nine audit parameters used were process measures concerning the assessment of HbA1c, weight, blood pressure, urinary protein, serum creatinine, serum lipids, electrocardiography, retina and feet. Age-standardised prevalence rate ratios of parameter adherence were calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases, 94 per cent were analysed. FINDINGS: Adherence to ECG and foot assessment parameters was poor among SOC cases, while poor adherence to weight and foot assessment parameters was seen in the polyclinics. There was poorer adherence to blood pressure and ECG parameters in the SOCs, but better adherence was seen for weight assessment. Among the SOC cases, Cluster A fared better than Cluster B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment parameters. ORIGINALITY/VALUE: Based on pre-existing information on local diabetes care, certain system, physician, patient and guideline factors are postulated to explain clinical practice guideline non-compliance among doctors. PMID: 16875107 [PubMed - indexed for MEDLINE]

535: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(2-3):195-220. Related Articles, Links

Clinical practice guidelines: a critical review. Tan KB. Ministry of Health, Singapore. [email protected] PURPOSE: Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this. DESIGN/METHODOLOGY/APPROACH: A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome). FINDINGS: A total of 57 CPG compliance assessment studies were reviewed. Almost two-thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four-fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures. PRACTICAL IMPLICATIONS: Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance. ORIGINALITY/VALUE: This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance. Publication Types: •

Review

PMID: 16875099 [PubMed - indexed for MEDLINE] 536: Lancet Infect Dis. 2006 Aug;6(8):508-21. Related Articles, Links Comment in:

•

Lancet Infect Dis. 2007 Mar;7(3):178-9.

Containing HIV/AIDS in India: the unfinished agenda. Chandrasekaran P, Dallabetta G, Loo V, Rao S, Gayle H, Alexander A. Avahan-India AIDS Initiative, The Bill & Melinda Gates Foundation, New Delhi, India. India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity. Publication Types: •

Review

PMID: 16870529 [PubMed - indexed for MEDLINE] 537: J Adv Nurs. 2006 Aug;55(4):487-96. Related Articles, Links

Adopting a personal digital assistant system: application of Lewin's change theory. Lee TT. National Taipei College of Nursing, Taipei, Taiwan. [email protected]

AIM: This paper reports a study exploring nurses' perceptions of adopting an information system using handheld computers (personal digital assistants) in their daily practice. BACKGROUND: Handheld computers have recently been used in nursing information systems for patient care, but few studies have explored their impact on users. By understanding clinicians' experiences of using this technology, strategies can be implemented to smooth the change process in adopting their use, thus achieving optimal patient outcomes. METHOD: A descriptive, exploratory approach was used to study nurses' perceptions of using personal digital assistants as part of a hospital information system. A purposive sample of 15 nurses participated in one-to-one, in-depth interviews from February to March 2004. Nurses' perceptions of the adoption process were analysed using Lewin's force field theory of change as a framework. FINDINGS: Nurses initially resisted using the personal digital assistant system (unfreezing stage), then came around to using it (moving stage), and finally adopted the system in their daily practice (re-freezing stage). However, an anticipatory stage also occurred and this could serve as a feedback mechanism to improve the system for current and future use. CONCLUSION: Educational programmes should be provided and strategic planning should be done in the early stage of implementing a policy to adopt new technology. In addition, the adoption process and learning period could be shortened by improving the system's content design. During this transition stage, dual charting should be used as a backup only for a limited time to avoid adding extra work to nurses' already heavy workload. Finally, the concept of confidentiality should be reinforced and stressed early in the educational programme to protect patient data, which can easily be accessed in computerized systems. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16866844 [PubMed - indexed for MEDLINE] 538: Cult Health Sex. 2005 Jul-Aug;7(4):319-32. Related Articles, Links

Knowledge of personal and sexual development amongst young people in Pakistan. Hennink M, Rana I, Iqbal R. Division of Social Statistics, University of Southampton, UK. [email protected] Pakistan has one of the largest cohorts of young people in its history, yet research

on their circumstances and needs is still relatively new. In this study, twenty four focus group discussions were conducted to explore young peoples' experiences of gaining knowledge of personal and sexual development. Young women typically gained information from a limited number of sources within the home, while young men accessed a wide variety of information sources outside the home. Gaining information was frequently event-based, whereby specific events (i.e. puberty, marriage) trigger information provision to young people, however often too late to be educative. Overall, young people were critical of the quality of information they received, which often led to confusion and stress in understanding sexual development. Findings highlight a gap in formal systems of information provision. Although young people highlighted the merits of schoolbased information delivery, low school attendance and high drop-out rates amongst girls mean that alternative mechanisms of reaching young Pakistani women need to be identified. PMID: 16864206 [PubMed - indexed for MEDLINE] 539: Oncol Nurs Forum. 2006 Jul 1;33(4):E71-8. Related Articles, Links Comment in: •

Oncol Nurs Forum. 2006 Nov;33(6):1053.

Filipino American women's perceptions and experiences with breast cancer screening. Wu TY, Bancroft J. School of Nursing, Eastern Michigan University, Ypsilanti, USA. [email protected] PURPOSE/OBJECTIVES: To determine information about Filipino American women's perceptions of breast cancer, the most frequently diagnosed cancer and number-one killer of Asian American women, and their experiences with screening. DESIGN: A qualitative, exploratory approach with focus groups. SETTING: Suburban Filipino American communities in the midwestern United States. SAMPLE: 11 Filipino American women aged 45-80 years who shared their experiences with breast cancer screening. METHODS: Focus groups were conducted, and the meetings were recorded on audiotape, transcribed, and analyzed using constant comparison techniques. MAIN RESEARCH VARIABLES: Breast cancer screening, experiences, motivators, and barriers. FINDINGS: Avoidance was the main theme for Filipino American women in dealing with a cancer diagnosis in the Filipino American culture. Facilitators of

Filipino American women's screening practices were support from family members, recommendations from familiar physicians, health insurance reinforcement, and personal attributes of physical symptoms, family history, past diagnosis, and health literacy. Barriers identified were different mind-sets and healthcare systems in the Philippines in regard to early detection, unpleasant experiences with mammography, cultural beliefs, and difficulties accessing services. CONCLUSIONS: Results of the focus group discussions provide useful information about facilitators and barriers that affect Filipino American women's screening practices. IMPLICATIONS FOR NURSING: The findings of the study can be used to develop tailored interventions for addressing culturally specific barriers and promoting screening practices in the Filipino American community. Publication Types: • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16858450 [PubMed - indexed for MEDLINE] 540: Climacteric. 2006 Aug;9(4):305-11. Related Articles, Links

Menopausal symptoms and health problems of women aged 50-65 years in southern Jordan. Shakhatreh FM, Mas'ad D. University of Jordan, Faculty of Medicine, Family and Community Medicine, Amman, Jordan. OBJECTIVES: To identify menopausal symptoms and health disorders of women aged 50-65 years in under-privileged areas of southern Jordan. METHOD: A multistage, random-sampling design was applied to select a sample of households from three governorates. A total of 143 women were eligible to be included in the analysis. Women were asked about a list of symptoms (somatic, psychological and genitourinary) and about a list of morbidities such as hypertension, diabetes mellitus and urinary tract infection. Ever-screening by mammogram, regular breast self-examination, ever-screening by cervical smear, general medical checkup, physical activity, smoking habit, and ever-receiving information about menopause were also investigated. RESULTS: The median age of onset of natural menopause was 50 years; 77% of women were illiterate, and 59% of the couples were relatives. The most frequently reported somatic symptoms were joint aches/stiffness (89%), bone pains (74%) and paresthesia in the extremities (51%). Hot flushes were experienced by 62% and urinary incontinence by 30%. Almost

62% reported irritability and mood changes, 56% had high blood pressure, and 18% and 14% suffered from urinary tract infection and reproductive tract infection, respectively. Eight percent and 11% reported ever-screening by mammogram and cervical smear, respectively, and 11% reported performing breast self-examination regularly. Regular physical exercise was reported by 8%, and 81% were overweight or obese. One-quarter received information on menopause, and 58% reported the need to know 'everything' about menopause. CONCLUSION: Women in southern Jordan experienced multiple menopauserelated symptoms and morbidities. The majority of them did not receive any health education about this phase of life. Preventive health practices and healthpromoting behaviors are relatively uncommon. Effective health-care delivery systems responsive to menopausal women's health needs are highly recommended. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16857661 [PubMed - indexed for MEDLINE] 541: Health Promot Int. 2006 Dec;21(4):266-73. Epub 2006 Jul 19. Related Articles, Links

Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities network. Donchin M, Shemesh AA, Horowitz P, Daoud N. Braun School of Public Health, Hadassah and the Hebrew University, Jerusalem. [email protected] The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4

where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension. Publication Types: •

Evaluation Studies

PMID: 16855012 [PubMed - indexed for MEDLINE] 542: Eur J Contracept Reprod Health Care. 2006 Jun;11(2):132-7. Related Articles, Links

Assessing knowledge, exploring needs: a reproductive health survey of adolescents and young adults in Pakistan. Shaikh BT, Rahim ST. Health Systems Division, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. [email protected] RATIONALE & OBJECTIVE: The sexual and reproductive health (SRH) needs of adolescents have increased over the last few years, but are largely unmet. Lack of involvement of youth in the programs and limitations of the mass media in a conservative milieu are some of the issues. Our objectives were to assess the baseline SRH knowledge and to suggest interventions based on needs with regard to SRH promotion, so that the level of existing services could be upgraded. METHODS: A cross-sectional survey was conducted in 20 villages of Lahore, in which 400 adolescents and young adults were interviewed using a semi-structured questionnaire. Respondents were equally divided in gender in all villages, using stratified random sampling. RESULTS: Adolescents and young adults do have some knowledge of SRH issues. Males are relatively more knowledgeable than females about puberty (M = 68%; F = 58%), pregnancy (M = 55%; F = 43%), family planning (M = 62%; F = 50%) and sexually transmitted infections (M = 56%; F = 44%). Yet, a large majority needs clarification on their concepts and

perceptions. They believe that having sound SRH knowledge will promote mother & child health and family health. CONCLUSION: Peers, media and a family doctor could be the acceptable source of information on SRH. Life skills programs to increase unmarried girls' cognitive skills and young men's involvement in such programs is a must. Involving families and communities will enhance the effectiveness of youth programs. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16854688 [PubMed - indexed for MEDLINE] 543: Int J Nurs Terminol Classif. 2006 Apr-Jun;17(2):108-17. Related Articles, Links

Comparison of nursing interventions performed by medical-surgical nurses in Korea and the United States. Lee E, Lee M. College of Nursing, Kyungpook National University, Daegu, Korea. [email protected] PURPOSE: To compare the Nursing Interventions Classification (NIC) interventions used in two countries, Korea and the United States. METHODS: Data were collected from 167 nurses working in eight hospitals in Korea and analyzed with descriptive statistics. FINDINGS: Korean nurses selected 202 interventions, nine of which were used by more than 50% of nurses surveyed. In comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United States identified 68 interventions as core interventions. Among the top ranked 68 interventions selected by Korean nurses, 29 (43%) matched those selected by U.S. nurses. CONCLUSIONS: The nursing interventions selected by Korean nurses were more heavily focused on the physiologic domain than those selected by the U.S. nurses. PRACTICE IMPLICATIONS: The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and educational curricula for nursing students. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 16848881 [PubMed - indexed for MEDLINE] 544: Water Sci Technol. 2006;53(9):247-52. Related Articles, Links

Estimation of reduced and increasing health risks by installation of urban wastewater systems. Aramaki T, Galal M, Hanaki K. School of Environment, Resources and Development, Asian Institute of Technology, Pathumthani, Thailand. [email protected] This paper aims to propose a methodological framework for quantifying the reduction and increase of health risks associated with urban wastewater systems. A risk assessment model was used to quantify reduction in disease burden while a life cycle assessment approach was used to quantify increasing risks by environmental loading. Disability adjusted life years (DALYs) was used to quantify health risks. This framework was applied to a hypothetical watershed to evaluate health risks by installation of wastewater treatment systems. In this hypothetical case, 55 DALYs per year of health risk would be reduced for 200,000 people in the downstream community by constructing wastewater systems for 200,000 people, while a range from 1.9 to 22 DALYs per year of health risks would be generated by materials and energy consumption for construction and operation of wastewater systems. However, this result would significantly change, depending on the parameters used in this analysis. The proposed methodology should be improved to obtain more precise results, but it will suggest useful information to discuss the overall effects due to the installation of various types of urban wastewater systems. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16841749 [PubMed - indexed for MEDLINE] 545: Asian Pac J Cancer Prev. 2006 Apr-Jun;7(2):279-82. Related Articles, Links

The accuracy of midwives' clinical breast examination in detection of breast lumps. Kaviani A, Delavar B, Noparast M, Hatmi Z, Najafi M, Haghighat S, Majd

M. Department of Surgery, Imam Hospital, Tehran University of Medical Sciences, Toohid Sq., Tehran, Iran. [email protected] BACKGROUND: Screen-detected breast cancers are usually diagnosed at earlier stages. Therefore, countries with limited resources are recommended to implement clinical breast examination (CBE) as a screening method in conjunction with mammography. Since there are so many limitations to performance of CBE by surgeons in the health system and CBE by midwives is more feasible, this study was conducted to test the agreement of CBE by midwives and surgeons. METHODS: One thousand and twenty seven patients with no personal history of breast cancer received breast physical examination by both a midwife and a surgeon and designed forms including patients' general information, cause of referral and abnormal physical findings were completed for each patient. RESULTS: The inter-observer agreement (kappa) for mass detection was 36 % (95% CI= 31% to 41%), indicating a "fair" agreement exists between the midwife's and the surgeon's physical examination. Sensitivity, specificity, positive and negative predictive values of "midwife's physical examination" to detect abnormal breast masses in comparison to "surgeon's physical examination" as the gold standard were 75, 67, 48, and 87 percent respectively. CONCLUSIONS: The results of this study do not justify the replacement of general surgeons by midwives in the health care system as the first examiner for clinical breast screening. Decisions about this issue need more comprehensive studies considering cost-effectiveness and training procedures. PMID: 16839223 [PubMed - indexed for MEDLINE] 546: Nature. 2006 Jul 13;442(7099):114-5. Related Articles, Links

Family tragedy spotlights flu mutations. Butler D. Publication Types: •

News

PMID: 16837983 [PubMed - indexed for MEDLINE] 547: Stud Fam Plann. 2006 Jun;37(2):111-22. Related Articles, Links

Validating neonatal mortality and use of NGO reproductive health outreach services in rural Bangladesh. Mercer A, Uddin N, Huq NL, Haseen F, Khan MH, Larson CP. Health Systems and Economics Unit, International Centre for Diarrhoeal Disease Research Centre for Health and Population Research, Health Systems and Infectious Diseases Division, Bangladesh. [email protected] Although the neonatal mortality rate (NMR) in Bangladesh remained steady between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence from the management information system (MIS) of a large nongovernmental organization (NGO) program indicates that the NMR declined by about 50 percent between 1996 and 2002 in the area served. This study aims to validate the recording of neonatal deaths among the cohort of children registered as born in 2003 and to assess the evidence of a decline in the NMR. It also measures the coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs that have provided services in the same areas since 1996. Field-workers' registers, verbal autopsy reports, and immunization records were checked to confirm infants' survival. Interviews were conducted with 142 mothers of children who died within 28 days postpartum and with a random sample of 109 women with registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal deaths were found, compared with 194 deaths that were reported in the MIS for 2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because underreporting of neonatal deaths was probably higher in 1996 when the MISreported NMR was 39 deaths per 1,000 live births, the decline in the NMR is likely to have been genuine. Publication Types: • •

Research Support, Non-U.S. Gov't Validation Studies

PMID: 16832985 [PubMed - indexed for MEDLINE] 548: Pharm World Sci. 2006 Apr;28(2):107-14. Epub 2006 Jul 4. Related Articles, Links

Inhaler technique in Turkish people with poor English: a case of information discrimination? Goodyer L, Savage I, Dikmen Z.

Department of Pharmacy, King's College London, 150 Stamford Street, London, SE1 9NN, UK. OBJECTIVES: (a) To compare metered dose inhaler (MDI) technique in users with poor English and fluent English, (b) to evaluate two interventions: a translated patient information leaflet (PIL) plus support from an translator (PIL + verbal) and a multimedia touch screen system (MTS) using video clips and ownlanguage instruction. METHODS: (a) Inhaler technique was videotaped and key steps rated blind for 105 fluent English-speakers (FE) and 69 Turkish-speakers with poor English (EP). (b) The EP group was randomised to receive information by MTS (n = 34) or PIL + verbal (n = 35). Inhaler technique was videotaped before and after information. MAIN OUTCOME MEASURES: (a) Global inhaler technique; (b) breathing-in time; (c) co-ordination of inspiration and inhaler actuation. RESULTS: Global technique, co-ordination and breath-holding were all significantly worse in MDI users with poor English. Only 17% of that group had adequate technique compared to over half (62%) of FE. The EP group were significantly less likely than the FE group to report ever seeing the practice nurse about their asthma. After information, global technique was rated as improved in 50% of the MTS group compared to 28% of those given a translated PIL. A further six people (17%) in the PIL group improved after subsequent verbal advice in their own language. Both information methods significantly increased inhaler shaking and mouthpiece checking, but co-ordination only improved in a small number of people. CONCLUSIONS: The study suggests that Turkishspeaking MDI users with poor English may be disadvantaged in terms of access to medicines information in the UK. The acceptability of pharmacy-based support services for this, and other specific language groups should be explored. Multimedia offers an alternative to a translator for brief explanations, particularly for first-time users, but improving poor co-ordination requires individualised "hands on" teaching from health professionals. Publication Types: • •

Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 16819595 [PubMed - indexed for MEDLINE] 549: Nature. 2006 Jun 29;441(7097):1028. Related Articles, Links

Action stations. [No authors listed]

Publication Types: •

Editorial

PMID: 16810208 [PubMed - indexed for MEDLINE] 550: Health Policy. 2007 Apr;81(1):93-101. Epub 2006 Jun 27. Related Articles, Links

Hong Kong's health spending projections through 2033. Leung GM, Tin KY, Chan WS. Department of Community Medicine and School of Public Health, Faculty of Medicine Building, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China. [email protected] OBJECTIVE: To derive actuarial projection estimates of Hong Kong's total domestic health expenditure to the year 2033. METHODS: Disaggregating health expenditure by age, sex, unit cost and utilisation level, we estimated future health spending by projecting utilisation (by public/private, inpatient/outpatient care) to reflect demographic changes and associated increase in demand (from higher expectations and greater intensity of care), and then multiplying such by the projected unit costs (incorporating the impact of key cost drivers such as public expectations, technological changes and potential productivity gains) to obtain total expenditure estimates. RESULTS: The model was most sensitive to the excess health care price inflation rate, i.e. the annual price/cost growth of medical goods and services over and above per capita GDP growth. Population ageing and growth per se, without taking into account related technologic innovation for chronic conditions that particularly afflict older adults, contribute relatively little to overall spending growth. Given the model assumptions, it is possible to limit total health spending to below 10% of GDP by 2033, where the public share would gradually decline from the current 57% to between 46% and 49%. CONCLUSIONS: Expenditure control through global budgeting, technology assessment and demand-side constraints should be considered although their effectiveness remains inconclusive. PMID: 16806563 [PubMed - indexed for MEDLINE] 551: Int J Med Inform. 2007 Aug;76(8):614-20. Epub 2006 Jun 21. Related Articles, Links

An investigation into health informatics and related standards in China. Zhang Y, Xu Y, Shang L, Rao K. Institute for Health Information, Fourth Military Medical University, Changle West Road 17#, Xi'an 710032, China. OBJECTIVE: To describe the current status of and future plans for health informatics and related standards in China and analyze the problems raised in the process of standardization for health informatics. METHODS: Data were collected through investigation and interviews, complemented by a comprehensive review of relevant literatures and regulations/law documents about health informatics and related standards in China. RESULTS: Health informatics has been greatly developed in China. Significant resources were committed to construct and improve the health information system. Approximately 35-40% of hospitals have constructed hospital information system. Over 80% of medical organizations above the county/district level, 27% of town level hospitals and all CDC above the county/district level can transmit real-time epidemic situation reporting through public health information system. However, lack of standards became a bottleneck to utilize and improve health informatics. China has adopted some vocabulary, classification, coding standards and message standards. Moreover, several national standardization actions for health informatics have been taken. In the process of standardization, the main barriers consist of financial, technical, cultural and language problems, legal and ethical concerns and others. CONCLUSIONS: Informatics has the potential to play an important role in China's healthcare reform process and standards are the basis for the information sharing and interoperability. Governments and partners of health informatics have realized the importance of standards and taken the initiatives in trying to solve the problem of lacking standards, but much work still needs to be done. PMID: 16793329 [PubMed - indexed for MEDLINE] 552: Arch Environ Health. 2004 Dec;59(12):725-31. Related Articles, Links

Relationship between health status and psychological distress among the inhabitants in a methylmercury-polluted area in Japan. Ushijima K, Miyake Y, Kitano T, Shono M, Futatsuka M. Department of Public Health, Kumamoto University School of Medicine, Kumamoto, Japan. [email protected]

This study examined the relationship between health parameters and psychological distress among inhabitants of methylmercury-polluted areas in Japan. The subjects were 133 inhabitants over the age of 40 yr living in two methylmercury-polluted villages. Information on demographic factors, health status, and mental health was obtained using questionnaires, including the General Health Questionnaire (GHQ). The proportional odds model was used to estimate the adjusted odds ratios of factors associated with a higher GHQ score after adjustment for age, gender, and district. Very poor self-rated health status, a high number (5+) of subjective symptoms, having monthly outpatient visits and medical house calls, and receiving compensation for methylmercury poisoning were significantly associated with psychological distress. Poor physical condition may lead to the development of psychological distress. PMID: 16789483 [PubMed - indexed for MEDLINE] 553: Ann Surg Oncol. 2006 Jul;13(7):977-84. Epub 2006 May 18. Related Articles, Links

Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders. Gelber RP, McCarthy EP, Davis JW, Seto TB. Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Harvard Medical School, 150 S. Huntington Avenue, (151MAV), Boston, Massachusetts 02130, USA. [email protected] BACKGROUND: Little is known about breast cancer management among Asian Americans and Pacific Islanders (AAPI). METHODS: We performed a retrospective analysis of 2030 women (935 Japanese, 144 Chinese, 235 Filipino, 293 Hawaiian, and 423 white; mean age +/- SD, 59 +/- 13 years) with a diagnosis of early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. We linked data from the Surveillance, Epidemiology, and End Results program's Hawaii Tumor Registry to administrative health care claims. We evaluated (1) breast-conserving surgery (BCS); (2) radiotherapy after BCS; and (3) chemotherapy for node-positive disease. We used logistic regression to examine the association between AAPI ethnicity and treatment, adjusting for age, year, rural residence, tumor size, grade, nodal status, receptor status, prior cancer, comorbidity index, health plan type, and income. RESULTS: Overall, 60.3% of women had stage I disease, 36.8% had stage II, and 2.9% had stage IIIA. Only 55.6% received BCS, and 85.1% of these women also received radiation. Of those with nodal involvement (n = 521), 82.7% received chemotherapy. Japanese and Filipino women were significantly less likely than white women to undergo BCS (for Japanese: adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80; for

Filipinos: adjusted odds ratio, 0.47; 95% confidence interval, 0.33-0.66). Filipinos tended to be less likely than white women to receive radiation after BCS (adjusted odds ratio, 0.80; 95% confidence interval, 0.42-1.49). AAPI women were as likely as white women to receive adjuvant chemotherapy for nodal spread. CONCLUSIONS: We found disparities in the management of early-stage breast cancer among AAPI women, particularly among Japanese and Filipinos. Further study is needed to determine the reasons for the observed disparities and to understand their effect on health outcomes. Publication Types: • •

Comparative Study Research Support, U.S. Gov't, P.H.S.

PMID: 16788760 [PubMed - indexed for MEDLINE] 554: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Jun;18(6):346-9. Related Articles, Links

[Retrospective discriminant analysis of the clinical diagnostic criteria for serious contagious severe acute respiratory syndrome] [Article in Chinese] Xu YD, Jiang M, Chen RC, Fang JQ, Xiao ZL, Zhong NS. Guangdong Province SARS Working Group, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, Guangdong, China. OBJECTIVE: To analyze the clinical diagnostic criteria for serious severe acute respiratory syndrome (SARS) in Guangdong retrospectively discriminant with SARS database, and to screen out the sensitive warning factors in predicting the outcome. METHODS: Four hundred and two SARS patients were selected based on the diagnostic criteria for SARS from Ministry of Health, China. Of them, 358 SARS patients were selected as their clinical manifestations conformed to the diagnostic criteria of serious SARS. The study subjects were divided into two groups. One group consisted of the patients with serious SARS (358 patients), and they either underwent invasive or non-invasive mechanical ventilation or died of the disease. The remaining 44 SARS patients constituted the non-serious SARS group. Taking the lowest value of oxygen index (OI) as the main index, the OI was categorized into 3 classes, namely< or =200 mm Hg (1 mm Hg=0.133 kPa) as 1,200-300 mm Hg as 2, and >300 mm Hg as 3. According to this index, the seriousness and the prognosis were analyzed. RESULTS: OI less than 300 mm Hg were identified as the unequivocal serious SARS patients, and the mistake judgement rate was 6.800%. Furthermore mortality and complications were

compared with Logistic regression, and questionable SARS patients were excluded. The results showed that the patients identified with OI less than 300 mm Hg had worse outcome than the original ones diagnosed with criteria of Ministry of Health. CONCLUSION: OI less than 300 mm Hg in patients with ALI meet the diagnostic criteria of serious SARS better, and it can be taken as a prognostic criterion in clinic. Publication Types: • •

English Abstract Research Support, Non-U.S. Gov't

PMID: 16784560 [PubMed - indexed for MEDLINE] 555: Indian J Med Res. 2006 Apr;123(4):553-60. Related Articles, Links

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001. Harit AK, Ichhpujani RL, Gupta S, Gill KS, Lal S, Ganguly NK, Agarwal SP. Directorate General of Health Services, Nirman Bhawan, Maulana Azad Road, New Delhi 110 011, India. [email protected] BACKGROUND & OBJECTIVE: The viral encephalitides caused by animal or human viruses are characterized by sudden outbreaks of neurological disease in both tropical and temperate regions. An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001. This outbreak was investigated by a team of scientists from four major institutions, and the findings are presented here. METHODS: Detailed information about the outbreak was collected with the help of local health authorities. Limited entomological investigations were also done. Samples collected from cases and contacts were sent for analysis. RESULTS: A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus. INTERPRETATION & CONCLUSION: This outbreak highlights the importance and urgency of establishing a strong surveillance system supported by a network of state-of-the-art laboratories

equipped to handle and diagnose new pathogens and including patient isolation techniques, use of personal protective equipment, barrier nursing and safe disposal of potentially infected material in the prevention and control measures for Nipah/Hendra virus infection. PMID: 16783047 [PubMed - indexed for MEDLINE] 556: Eur J Anaesthesiol. 2006 Oct;23(10):882-9. Epub 2006 Jun 19. Related Articles, Links

The implementation of an anesthesia information management system. Eden A, Grach M, Goldik Z, Shnaider I, Lazarovici H, Barnett-Griness O, Perel A, Pizov R. Lady Davis Carmel Medical Center, Department of Anesthesiology and Critical Care Medicine, Haifa, Israel. [email protected] BACKGROUND AND OBJECTIVE: Anaesthesia information management systems, though still not used widely, will inevitably replace handwritten records and may eventually serve as a core for the development of computerized decision support. We investigated staff expectations and the accuracy of data entry in a recently implemented commercially available anaesthesia information management system. METHODS: A structured questionnaire was administered to the staff before and 1 week and 3 months after implementation in order to assess their opinion. The quality of manual data entry, and of automatic data record was evaluated by looking for missing data and the prevalence of artefacts. RESULTS: Despite initial fears the users quickly accepted the system. Both automatic and manual data entry were found to be accurate and reliable while the prevalence of artefacts was relatively low. CONCLUSIONS: A commercially available anaesthesia information management system can be easily implemented and used instead of paper charts. PMID: 16780614 [PubMed - indexed for MEDLINE] 557: AMIA Annu Symp Proc. 2005:1007. Related Articles, Links

Development of an instrument to measure health center (HC) personnel's computer use, knowledge and functionality demand for HC computerized information system in Thailand. Kijsanayotin B, Pannarunothai S, Speedie S.

Health Informatics Program,University of Minnesota, Twin cities, Minnesota, USA.. Knowledge about socio-technical aspects of information technology (IT) is vital for the success of health IT projects. The Thailand health administration anticipates using health IT to support the recently implemented national universal health care system. However, the national knowledge associate with the sociotechnical aspects of health IT has not been studied in Thailand. A survey instrument measuring Thai health center (HC) personnel's computer use, basic IT knowledge and HC computerized information system functionality needs was developed. The instrument reveals acceptable test-retest reliability and reasonable internal consistency of the measures. The future nation-wide demonstration study will benefit from this study. Publication Types: •

Validation Studies

PMID: 16779294 [PubMed - indexed for MEDLINE] PMCID: PMC1560896

558: AMIA Annu Symp Proc. 2005:311-5. Related Articles, Links

Linking primary care information systems and public health vertical programs in the Philippines: an open-source experience. Herman T, Marcelo A, Marcelo P, Maramba I. Medical Informatics Unit, University of the Philippines Manila College of Medicine, Manila, Philippines. Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes.

Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16779052 [PubMed - indexed for MEDLINE] PMCID: PMC1560490

559: Chest. 2006 Jun;129(6):1441-52. Related Articles, Links

Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chen RC, Tang XP, Tan SY, Liang BL, Wan ZY, Fang JQ, Zhong N. Guangzhou Institute of Respiratory Diseases, 151 Yanjiang Rd, Guangzhou, China. [email protected] STUDY OBJECTIVE: To investigate the efficacy and safety profiles of corticosteroid therapy in severe acute respiratory syndrome (SARS) patients. DESIGN: Four hundred one of 1,278 SARS cases treated in Guangzhou China between December 2002 and June 2003 fulfilled the diagnostic criteria issued by the World Health Organization for confirmed identification of SARS. Among them, the diagnosis of critical SARS was defined by criteria of SARS guidelines incorporated with a low oxygenation index (OI) [< 300 mm Hg]. Data of these patients retrieved from a database were retrospectively analyzed by logistic regression and Cox regression for the effect of corticosteroid therapy on death, hospitalization days, and complication presentation. RESULTS: Among the 401 SARS patients studied, 147 of 249 noncritical patients (59.0%) received corticosteroids (mean daily dose, 105.3 +/- 86.1 mg) [+/- SD], and all survived the disease; 121 of 152 critical patients (79.6%) received corticosteroids at a mean daily dose of 133.5 +/- 102.3 mg, and 25 died. Analysis of these 401 confirmed cases did not show any benefits of corticosteroid on the death rate and hospitalization days. However, when focused on 152 critical SARS cases, factors correlated with these end points indicated by univariate analysis included use of corticosteroid, age, rigor at onset, secondary respiratory infections, pulmonary rales, grading of OI, and use of invasive ventilation. After adjustment for possible confounders, treatment with corticosteroid was shown contributing to lower

overall mortality, instant mortality, and shorter hospitalization stay (p < 0.05). Incidence of complications was significantly associated with the need for invasive ventilation but not with use of corticosteroids. CONCLUSION: This Guangzhou retrospective study revealed that proper use of corticosteroid in confirmed critical SARS resulted in lowered mortality and shorter hospitalization stay, and was not associated with significant secondary lower respiratory infection and other complications. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16778260 [PubMed - indexed for MEDLINE] 560: Clin Chem Lab Med. 2006;44(7):867-76. Related Articles, Links

Use of total patient data for indirect estimation of reference intervals for 40 clinical chemical analytes in Turkey. Ilcol YO, Aslan D. Department of Biochemistry, Uludag University Medical School, Bursa, Turkey. [email protected] In the present study we used patient data to calculate laboratory-specific indirect reference intervals. These values were compared with reference intervals obtained for a healthy group according to recommendations of the International Federation of Clinical Chemistry and Laboratory Medicine and manufacturer suggestions. Laboratory results (422,919 records) from all subjects of 18-45 years of age over a 1-year period were retrieved from our laboratory information system and indirect reference intervals for 40 common analytes were estimated using a modified Bhattacharya procedure. Indirect reference intervals for most of the biochemical analytes were comparable, with small differences in lower [alkaline phosphatase (ALP) (male), alanine aminotransferase (ALT), creatine kinase, iron (male), total iron-binding capacity, folic acid, calcium (female), lactate dehydrogenase (LDH), lipoprotein (a) [Lp(a)], thyroid-stimulating hormone (TSH), total triiodothyronine (T(3)), direct bilirubin, apolipoprotein A-I (apoA-I), glucose, homocysteine, total cholesterol, ferritin, total protein, ceruloplasmin, sodium, blood urea nitrogen (BUN) and uric acid (female)] and/or upper limits [albumin, ALP (male), amylase, apoA-I, creatine kinase-MB (CK-MB), total ironbinding capacity, phosphorus, glucose, total cholesterol, gammaglutamyltransferase (gamma-GT), magnesium, total protein, high-density lipoprotein cholesterol (HDL-C), total T(3), ALP (male), ALT, aspartate

aminotransferase (AST) (male), direct bilirubin (male), creatine kinase, iron, folic acid (female), Lp(a), uric acid and triglycerides], to the reference intervals determined for healthy subjects in our laboratory. The indirect reference intervals, with the exception of a few parameters (creatinine, direct total bilirubin, calcium, BUN and potassium), were not similar to the reference intervals suggested by the manufacturers. We conclude that laboratory-specific reference intervals can be determined from stored data with a relatively easy and inexpensive method. Indirect reference intervals derived from stored data may be particularly suitable for the evaluation of results for the presenting population. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16776635 [PubMed - indexed for MEDLINE] 561: Ethn Dis. 2006 Spring;16(2 Suppl 2):S2-2-4. Related Articles, Links

Incidence, prevalence, and treatment of end-stage renal disease in the Middle East. Abboud O. Department of Medicine, Hamad Medical Corporation, Doha, Qatar. [email protected] INTRODUCTION: This article reviews the status of end-stage renal disease in the Middle East, with emphasis on its incidence, prevalence, and treatment. METHODS: Data were obtained from English-language published literature through a Medline search over the past 40 years. Supplementary information was gathered from regional congresses and symposia, websites of specialized nephrology centers, and direct communications. RESULTS: Of the 14 Middle East countries, attention was focused on 10 countries with similar renal care systems: 7 Arabian Peninsula countries and 3 eastern Mediterranean countries. Collectively, they have a population of 72.5 million. Incidence of ESRD ranged between 64 and 212 patients per million population (pmp) with an average of 93 patients pmp. The lowest prevalence was 320, the highest was 462, and the average was 352 patients pmp. Hemodialysis is the preferred dialysis modality and is freely available in all countries for citizens. Non-citizen residents' access to hemodialysis is markedly restricted. Peritoneal dialysis is available on a limited scale. Renal transplantation is available in all countries with variable program activities. Most of the transplants are from living, related donors. Active deceased donor transplant programs exist in four countries. The results from countries with active programs are excellent, with 5-year patient and graft survival of > 90%.

CONCLUSIONS: This review provides information on the incidence, prevalence and treatment modalities of ESRD in 10 Middle East countries. Publication Types: •

Review

PMID: 16774000 [PubMed - indexed for MEDLINE] 562: Health Policy. 2007 Mar;80(3):459-64. Related Articles, Links

Development of a capitation scale for IDF career soldiers in Israel. Magnezi R, Weiss Y, Cohen Y, Shmueli A. Department of Health Systems Management, School of Health Sciences, The Ariel College of Judea and Samaria, [email protected] The Israeli National Health Insurance Law allocates a national healthcare budget to the sickness funds, which provide medical care to civilian population. Medical care for members of the IDF is financed through the budget of the Ministry of Defense and is not included in the national healthcare budget. Benefits provided to soldiers serving in the permanent forces are far more extensive than those provided to civilians. Because of no co-payments, poor management, and the cost-based budget, military healthcare costs in Israel are expected to exceed civilian healthcare costs, adjusting for age and sex. The present paper derives ageand sex-based capitation rates for military personnel, and compares military and civilian age-based expenditure and capitation rates. The study population comprised career soldiers and civilians aged 21-54 years. Expenses of career soldiers were calculated to provide information on the financial costs of medical services for each age group in 2003. Overall expenses for women were higher than for men in all age groups. As anticipated, the older the group, the higher the total expenditure for both men and women. In-patient care represented a higher percentage of the total costs for men (28.3%) than for women (22.1%). Emergency room care was higher for women in the 22-24 age group but comparable to that of men in higher age groups. Specialist visits represented a significantly higher percentage of the total costs for women than for men in the 22-24 and 25-34 age groups (by 6% and 15%, respectively). The difference decreased to 13% in the 35-44 age groups and, in the 45-54 age group, the difference for men was 14% higher than for women. Military costs were similar to civilian costs in the 22-24 age groups, higher in the following two groups, and lower in the 45-54 age group. Like in other organizations, military healthcare services might benefit from outsourcing. The inequality in medical services to

soldiers and civilians, the over-use of the military healthcare system, and the decrease of standards and budgetary resources will compel the establishment of more creative means of providing these services through contracts and agreements, perhaps through the civilian sickness funds. PMID: 16772098 [PubMed - indexed for MEDLINE] 563: Br J Nutr. 2006 Jun;95(6):1150-8. Related Articles, Links

Phyto-oestrogen intake and plasma concentrations in South Asian and native British women resident in England. Bhakta D, Higgins CD, Sevak L, Mangtani P, Adlercreutz H, McMichael AJ, dos Santos Silva I. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Phyto-oestrogens, naturally occurring hormone-like chemicals in plant food, may play a protective role against hormone-related chronic diseases. South Asian migrants in the UK have a lower incidence of hormone-related cancer than their hosts but the extent to which this difference may be due to phytoestrogen intake is not known. The aim was to compare habitual phytoestrogen intake in firstgeneration South Asian migrant women and native British women. South Asian (n 221) and native British women (n 50) were recruited from general practitioner lists and were asked to provide monthly 24 h recalls for a period of 1 year. An enhanced phytoestrogen database was compiled using data from a literature search and unpublished data. A sub-sample of South Asian women (n 100) and the native British women (n 40) also provided blood samples every 3 months during the 1-year period. The median daily intakes (microg/d) of isoflavones (184.2 v. 333.9) and lignans (110.8 v. 148.8) were significantly lower in South Asians than in the native British (P<0.001, P=0.04 respectively). There were no significant differences in mean plasma isoflavone levels (nmol/l) but plasma enterolactone was significantly lower in the South Asians (13.9 (SD 17.5) v. 28.5 (SD 23.3), P<0.001). The main sources of phytoestrogens were bread and vegetables in both ethnic groups. Habitual phytoestrogen intake in South Asian and native British women was below 1 mg/d and was higher in the native British diet. The present study does not support the hypothesis that differences in phytoestrogen intake, or in circulating levels, could explain differences in hormone-related cancer risks between these two populations. Publication Types: •

Comparative Study

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Research Support, Non-U.S. Gov't

PMID: 16768838 [PubMed - indexed for MEDLINE] 564: Euro Surveill. 2005 Apr 21;10(4):E050421.5. Related Articles, Links

New communicable disease notification system launched in Turkey. Bayazit Y, Buyurgan V, Tumay S. Department of Communicable Diseases and Epidemic Control, Ministry of Health), Ankara, Turkey. [email protected] PMID: 16766815 [PubMed - indexed for MEDLINE] 565: Mil Med. 2006 May;171(5):360-4. Related Articles, Links

Quality assessment in primary military clinics of the Israel Defense Forces Northern Command. Riskin A, Reis S, Tamir A, Shemer J. Medical Corps, Israel Defense Forces. OBJECTIVE: To assess the quality of care provided in primary military clinics. METHODS: A standardized assessment tool was used, with medical record audits and tracers (minimal clinical criteria for proper care of common conditions), peerreview observations of medical encounters, assessments of organization and administration, and patient satisfaction and physicians' occupational stress questionnaires. RESULTS: Forty-three clinics and 113 physicians were assessed. Tracers were high for management of upper respiratory infections and low for low back pains and mental problems. The average encounter time was 9 minutes, and 25% of medical encounters resulted in referrals to specialists. Regular physicians performed better than reservists. Surgeons performed worst as primary health care providers. Female physicians did better than male physicians. The integration of new immigrant physicians was successful, and they expressed less occupational stress. Smaller clinics were better, with longer encounter times and better patient satisfaction scores. CONCLUSIONS: Quality assessment of primary health care is feasible in the military system, providing useful information for future improvement.

PMID: 16761882 [PubMed - indexed for MEDLINE] 566: Nippon Koshu Eisei Zasshi. 2006 Apr;53(4):277-84. Related Articles, Links

[Forming network for oral health care of dependent elderly in the community] [Article in Japanese] Fujinaka T. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16761688 [PubMed - indexed for MEDLINE] 567: Am J Epidemiol. 2006 Aug 1;164(3):200-7. Epub 2006 Jun 5. Related Articles, Links Comment in: •

Am J Epidemiol. 2006 Aug 1;164(3):208-11.

Residential exposure to petrochemicals and the risk of leukemia: using geographic information system tools to estimate individuallevel residential exposure. Yu CL, Wang SF, Pan PC, Wu MT, Ho CK, Smith TJ, Li Y, Pothier L, Christiani DC; Kaohsiung Leukemia Research Group. Occupational Health Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA. The authors conducted a population-based, case-control study in Kaohsiung, southern Taiwan, Republic of China, to investigate the association between residential petrochemical exposure and leukemia risk among subjects 29 years of age and younger. Between November 1997 and June 2003, 171 cases and 410 controls matched for age and sex were recruited. Since assessment of petrochemical impacts depends on accurate exposure estimates, the authors

developed a procedure using geographic information system tools to assign subjects' exposure. The resulting individual-level exposure estimates (the exposure opportunity score) are an integrated exposure measure that accounts for subjects' mobility, length of stay at each residence, distance to petrochemical plant(s), monthly prevailing wind direction, and multiple petrochemical pollution sources. Different conditional logistic regression models were fitted for subjects aged 0-19 and 20-29 years to evaluate separately childhood versus adulthood leukemia. No overall association was observed for the younger age group. However, residential petrochemical exposure was a significant risk factor for leukemia for the older age group. For one unit of increase in the log-transformed exposure opportunity score, the adjusted odds ratio was 1.54 (95 percent confidence interval: 1.14, 2.09). This study illustrates the utility of geographic information system tools for providing refined exposure estimates for residential exposure to petrochemical pollution. Publication Types: • •

Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 16754633 [PubMed - indexed for MEDLINE] 568: Logoped Phoniatr Vocol. 2006;31(2):76-88. Related Articles, Links

A Turkish perspective on communication disorders. Topbas S. Education, Research, and Training Centre for Speech & Language Disorders, Anadolu University, Eskisehir, Turkey. stopbas @anadolu.edu.tr The population of Turkey is approximately 65 million people, and another 3 million people of Turkish descent live in Europe and the United States. The purpose of the present paper is to relay information that American or European clinicians who work with Turkish clients should know about their clients' country, including its language, education system, the current status of the profession and organization of professional services for communication disorders. The paper shows that the profession of speech-language pathology is young in Turkey; as a result, the roles of speech-language pathologists in this country are substantially different from those in the United States and in most European countries. It is envisioned that as the profession grows in Turkey its role will increasingly include direct provision of services, in-service training to service providers, and research on communication disorders.

PMID: 16754279 [PubMed - indexed for MEDLINE] 569: Drug Saf. 2006;29(6):537-48. Related Articles, Links

Herbal medicines used during the first trimester and major congenital malformations: an analysis of data from a pregnancy cohort study. Chuang CH, Doyle P, Wang JD, Chang PJ, Lai JN, Chen PC. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. BACKGROUND: Major congenital malformations place a considerable burden on the affected child, the family and society. Any kind of medicine used during pregnancy might have a harmful impact; therefore, such practice has raised concerns. The objective of the current study was to explore the relationship between the use of herbal medicines by pregnant women during the first trimester of pregnancy and the risk of major congenital malformation in their live born infants. METHODS: This was a cross-sectional analysis of data from a prospective pregnancy cohort, which was established between 1984 and 1987. To assemble the cohort, pregnant women of >or=26 weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care were enrolled in the study and interviewed using a structured questionnaire. Detailed information, including herbal medicine use during different periods of pregnancy, was obtained during the interview. Past medical history, current obstetric data and details on conventional medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration and characteristics of live born infants were gathered from the Taiwan national birth register. Congenital malformation information was obtained from multiple sources: the newborn examination record (1984-7); the national death register (1984-2003); and Taiwan National Health Insurance data (1996-2000). Multiple logistic regression was used to estimate the odds ratio [OR] of major congenital malformation by herbal medicines used during the first trimester. RESULTS: A total of 14,551 live births were analysed. After adjustment for confounding factors, taking huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an increased risk of congenital malformations of the musculoskeletal and connective tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30, 95% CI 1.47, 36.18). CONCLUSION: We found evidence for a possible link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We

could not investigate whether the adverse effects were related to direct toxicity from the herbal medicines, or were from misuse, contamination or uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicines during pregnancy, and we suggest that further investigation of these findings is warranted. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16752935 [PubMed - indexed for MEDLINE] 570: Int J Health Geogr. 2006 Jun 4;5:25. Related Articles, Links

The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan. Miwa M, Kawaguchi H, Arima H, Kawahara K. Department of Health Policy Science, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan. [email protected] BACKGROUND: In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes) from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. RESULTS: The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads), and three tertiary care centres and 108 ambulances. CONCLUSION: Regional gaps in the travel time to tertiary care centres were

identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to prefectures with an average time longer than the mean score, to achieve a reduction of travel time. Measures for reducing travel time need to be considered in policy-making to re-evaluate the current locations of tertiary care centres to provide equality of access to emergency medicine. PMID: 16749943 [PubMed - indexed for MEDLINE] PMCID: PMC1534023

571: Health Educ Res. 2006 Jun;21(3):407-15. Epub 2006 Jun 1. Related Articles, Links

School-based smoking prevention programs for adolescents in South Korea: a systematic review. Park E. Nursing, Cheju National University, 66 Jejudaehakro, Ara 1 Dong, Jejusi 690756, Republic of Korea. [email protected] The number of research papers evaluating programs designed to prevent adolescent smoking have increased in the last 13 years in Korea. The purpose of this study was to evaluate these programs, to review the features of the studies and to systemically assess the results on the knowledge about, and attitude to, smoking and smoking behavior. Database searched were national digital library (NDL) and the Research Information Service System, which are major literature search systems for all academic fields in South Korea, and the Research Information Center for Health, which is a database for health field. A total of 11 papers were included. Program contents are described under five categories and the mode of delivery is described. Methodological features were investigated and effect of the size of the study on variables investigated was computed. Knowledge was the main content of the program in most of the studies. Most studies delivered classroom-based instructions that were mainly didactic presentations. School-based smoking programs have not influenced adolescent smoking behavior as much as anticipated. Methodological problems were discussed. Several recommendations are made to improve effectiveness of smoking prevention programs and reduce methodological flaws in future studies. Publication Types:

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Review

PMID: 16740676 [PubMed - indexed for MEDLINE] 572: Health Educ Behav. 2008 Feb;35(1):105-18. Epub 2006 May 31. Related Articles, Links

Knowledge of the effects of indoor air quality on health among women in Jordan. Madanat H, Barnes MD, Cole EC. Department of Community Health, College of Science and Health, Utah Valley State College, Orem 84058, USA. [email protected] OBJECTIVE: To assess the extent of knowledge about symptoms relating to respiratory illnesses and home environments among a random sample of 200 urban Jordanian women. METHOD: This customized, validated, cross-sectional questionnaire evaluated the knowledge of these women about the association between the indoor environment and health, the presence or absence of indoor discomforts, symptoms of respiratory illnesses, and behaviors related to the home environment such as cleaning practices. RESULTS: Results showed an alarming rate of smoking in the homes; the extent of knowledge was moderate but higher among those exhibiting symptoms and those with children. Cleaning practices associated with healthy home environments were reported at a high rate but seemed to be based on cultural influences. CONCLUSIONS: This type of information is crucial to the formation of health education programs and policy recommendations for pollutant source and exposure reductions in homes in the Middle East and other developing countries. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16740512 [PubMed - indexed for MEDLINE] 573: Schizophr Res. 2006 Sep;86(1-3):23-9. Epub 2006 Jun 5. Related Articles, Links

Maternal household crowding during pregnancy and the offspring's risk of schizophrenia.

Kimhy D, Harlap S, Fennig S, Deutsch L, Draiman BG, Corcoran C, Goetz D, Nahon D, Malaspina D. Department of Psychiatry, Columbia University, New York, NY 10032, USA. [email protected] BACKGROUND: Animal models of schizophrenia suggest a link between maternal crowding during pregnancy and increased risk of the offspring to develop physiological, developmental, and behavioral abnormalities that are comparable to those observed in schizophrenia. We tested the hypothesis that a similar link is present in humans. METHOD: We investigated whether prenatal exposure to household crowding was associated with the risk of schizophrenia in a sub-cohort of the Jerusalem Perinatal Study (JPS) consisting 11,015 individuals born between 1964 and 1976. During these years mothers participated in face to face interviews in early pregnancy. The prenatal and birth data, including the number of rooms and individuals living in the mothers' household, was crosslinked with the Israel Psychiatric Registry by ministry personnel. RESULTS: 104 schizophrenia cases were identified in the cohort. Offspring who, while in utero, their mother resided in a household with five or more individuals had RR of 1.47 (95% CI: 0.99-2.16, p=0.05) to develop schizophrenia, compared to those whose mother resided with four or fewer individuals. However, when adjusted for paternal age, the RR was reduced to 1.18 (95% CI: 0.76-1.84, p=0.46). The number of rooms in the household and the household crowding during pregnancy did not significantly impact the offspring's risk to develop schizophrenia. CONCLUSION: The link between maternal household crowding during pregnancy and the offspring's risk of schizophrenia was explained primarily by the impact of paternal age. The authors discuss the results in view of findings from animal and human studies. Publication Types: • • •

Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 16740377 [PubMed - indexed for MEDLINE] 574: Adv Parasitol. 2006;61:509-66. Related Articles, Links

Control of Taenia solium cysticercosis/taeniosis. Willingham AL 3rd, Engels D.

WHO/FAO Collaborating Center for Parasitic Zoonoses, Royal Veterinary and Agricultural University, Frederiksberg, Denmark. Cysticercosis is emerging as a serious public health and agricultural problem in many poorer countries of Latin America, Africa, and Asia. Caused by the pork tapeworm, Taenia solium, this zoonotic disease forms larval cysts in humans and pigs that can lead to epilepsy and death in humans, reduces the market value of pigs and makes pork unsafe to eat. It occurs where pigs range freely, sanitation is poor, and meat inspection is absent or inadequate, and is thus strongly associated with poverty and smallholder farming. Although theoretically easy to control and declared eradicable cysticercosis remains neglected in most endemic countries due to lack of information and awareness about the extent of the problem, suitable diagnostic and management capacity, and appropriate prevention and control strategies. Human neurocysticercosis occurs when the larval cysts develop in the brain. It is considered to be the most common parasitic infection of the human nervous system and the most frequent preventable cause of epilepsy in the developing world. Thus far the infection has not been eliminated from any region by a specific program, and no national control programs are yet in place. We consider the tools available for combating cysticercosis and suggest simple packages of interventions, which can be conducted utilizing existing services and structures in the endemic countries to provide appropriate and sustainable control of the disease. Publication Types: •

Review

PMID: 16735172 [PubMed - indexed for MEDLINE] 575: Comput Methods Programs Biomed. 2006 Jun;82(3):277-82. Epub 2006 May 30. Related Articles, Links

Taiwan's perspective on electronic medical records' security and privacy protection: lessons learned from HIPAA. Yang CM, Lin HC, Chang P, Jian WS. Taipei Medical University School of Healthcare Administration, No. 250, WuHsing Street, Taipei 110, Taiwan. The protection of patients' health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health

information, especially electronic medical records. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The trend of a centralized bill that focuses on managing computerized health information is the part that needs our further attention. Under the sponsor of Taiwan's Department of Health (DOH), our expert panel drafted the "Medical Information Security and Privacy Protection Guidelines", which identifies nine principles and entails 12 articles, in the hope that medical organizations will have an effective reference in how to manage their medical information in a confidential and secured fashion especially in electronic transactions. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16730852 [PubMed - indexed for MEDLINE] 576: MMWR Morb Mortal Wkly Rep. 2006 May 26;55(20):556-9. Related Articles, Links

Tobacco use among students aged 13-15 years--Kurdistan Region, Iraq, 2005. Centers for Disease Control and Prevention (CDC). Tobacco use is one of the major preventable causes of premature death and disease in the world. The Global Youth Tobacco Survey (GYTS), part of the Global Tobacco Surveillance System initiated by the World Health Organization (WHO), CDC, and the Canadian Public Health Association, was developed to monitor tobacco use, attitudes about tobacco, and exposure to secondhand smoke among youths and has been conducted in 140 countries. This report presents findings from the GYTS conducted in the Kurdistan region of Iraq (i.e., Irbil, asSulaymaniyah, and Dahuk governorates) in 2005, which revealed that one in 10 students currently smoked cigarettes or used other tobacco products. Boys (21%) were statistically significantly more likely than girls (2.1%) to smoke cigarettes, but no significant difference was observed between boys and girls in their use of other tobacco products. Public health authorities in the Kurdistan Region of Iraq can use the baseline information from the GYTS to design and implement tobacco-control programs to reduce youth smoking. PMID: 16723966 [PubMed - indexed for MEDLINE] 577: Circ J. 2006 Jun;70(6):679-85.

Related Articles,

Links

Physician and hospital characteristics related to length of stay for acute myocardial infarction patients: a 3-year population-based analysis. Lin HC, Chen CS, Lee HC, Liu TC. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. [email protected] BACKGROUND: The lack of studies on the simultaneous contributions of hospital and physician to the length of stay (LOS) for acute myocardial infarction (AMI) has hampered the development of hospital- and physician-level strategies by clinicians and policymakers. This study used 3 years of population-based data to examine the relationships of physician and hospital characteristics with LOS for AMI patients in Taiwan. METHODS AND RESULTS: Multiple regression analysis was carried out to explore the relationships, using the 2001-2003 National Health Insurance Research Database of the National Health Research Institute, Taiwan. The study samples were identified by a principal diagnosis of AMI (ICD-9-CM code 410), with a total of 19,907 eligible admissions. The mean LOS was 9.1 days. The results revealed that compared with district hospitals, the LOS was significantly longer in both medical centers and regional hospitals (both p<0.001). The LOS among patients attended by cardiologists was 28.0% shorter than those attended by physicians specializing in surgery, family medicine, or emergency medicine. CONCLUSIONS: The results of this study demonstrate that there are wide variations among the different types of physician and levels of hospital in the LOS for AMI patients, which highlights the importance of developing national treatment protocols for AMI in order to reduce variations in hospital and physician behaviors. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16723787 [PubMed - indexed for MEDLINE] 578: Eur J Orthod. 2006 Aug;28(4):393-9. Epub 2006 May 24. Related Articles, Links

A socio-dental approach to assessing children's orthodontic needs. Gherunpong S, Tsakos G, Sheiham A.

Department of Community Dentistry, Chulalongkorn University, Thailand. Traditional methods of assessing orthodontic treatment need using mainly clinical measures are inadequate and would be improved by integrating normative, oral health-related quality of life (OHRQoL), and behavioural propensity measures. This study aimed to develop and test a socio-dental system of orthodontic needs assessment, and to compare normative and socio-dental estimates of orthodontic need. The socio-dental system integrates three types of need: normative need (NN), impact-related need (IRN) and propensity-related need (PRN). A crosssectional survey of all 1,126 children aged 11-12 years in Suphanburi, Thailand, was carried out to test the new system. The dental health component of the Index of Orthodontic Treatment Need was used to assess NN, and the simplified oral hygiene index for oral hygiene status. Oral impacts were assessed using the childOral Impacts on Daily Performances (child-OIDP) index. A self-administered questionnaire recorded information on demographic and oral health-related behaviour. Treatment needs were assessed according to the developed sociodental system. The socio-dental approach to assess orthodontic needs was easy to use and readily accepted by the children. The estimates of orthodontic need assessed normatively and socio-dentally differed markedly. The prevalence of NN and IRN was 35.0 and 10.5 percent, respectively, thus representing a reduction of approximately 70 percent in the volume of treatment need according to the new method. Children with IRN had different levels of propensity for orthodontic treatment, and therefore required appropriate treatment plans according to their PRN. Of the 10.5 percent with IRN, 6.9 percent had high or medium-high PRN, while 3.6 percent were at medium-low and low levels of propensity. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 16723372 [PubMed - indexed for MEDLINE] 579: J Eval Clin Pract. 2006 Jun;12(3):353-64. Related Articles, Links

Evidence-based medical education -quo vadis? Leung GM, Johnston JM. Department of Community Medicine, University of Hong Kong, Hong Kong, China. [email protected]

The evidence base for most educational initiatives, at least until very recently, is largely composed of low-level evidence. Four major barriers underlie this historical observation, namely: (1) perceived ethical and acceptability problems arising from the unequal treatment of learners in experimental designs; (2) limited choice of outcome measures and validated instruments; (3) time and resource constraints; and (4) methodological issues concerning contextual confounding and small sample sizes. We advocate the adoption of a 'balanced scorecard' approach in the evaluation of education interventions that brings together a comprehensive panel of outcomes under one framework. We require a diversity of rigorously applied methods to generate these outcomes, drawing from the quantitative and qualitative disciplines of epidemiology, psychology and economics. We further suggest that the research community discuss and agree on a standardized set of common metrics or benchmarks. We conclude with a case study examining whether a hand-held computer clinical decision support tool improves clerkship learning of evidence-based medicine. The era of Brownian motion in health education research is over. What we demand in terms of burden of proof for educational effectiveness should be no less rigorous than our call for an ever escalating threshold concerning evidence of clinical care. PMID: 16722922 [PubMed - indexed for MEDLINE] 580: Inhal Toxicol. 2006 Jul;18(8):549-54. Related Articles, Links

Air pollution and hospital admissions for asthma in a tropical city: Kaohsiung, Taiwan. Tsai SS, Cheng MH, Chiu HF, Wu TN, Yang CY. Department of Health Care Administration, I-Shou University, Kaohsiung, Taiwan. This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan. Hospital admissions for asthma and ambient air pollution data for Kaohsiung were obtained for the period from 1996 through 2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the singlepollutant models, on warm days (> or = 25 degrees C) statistically significant positive associations were found in all pollutants except sulfur dioxide (SO2). On cool days (< or = 25 degrees C) all pollutants were significantly associated with asthma admissions For the two pollutant models, CO and O3 were significant in combination with each of the other four pollutants on warm days. On cool days NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of

hospital admissions for asthma. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16717026 [PubMed - indexed for MEDLINE] 581: Ann Nucl Med. 2006 Apr;20(3):195-202. Related Articles, Links

Surveillance study for creating the national clinical database related to ECG-gated myocardial perfusion SPECT of ischemic heart disease: J-ACCESS study design. Kusuoka H, Nishimura S, Yamashina A, Nakajima K, Nishimura T. Osaka National Hospital, Saitama Medical School Hospital, Japan. BACKGROUND: ECG-gated myocardial perfusion SPECT is widely applied to diagnose ischemic heart disease, and such findings are useful to predict patient prognosis. However, Japan does not have a database that correlates SPECT image findings with the prognosis of patients who have ischemic heart disease. METHODS: A large-scale clinical study involving 117 medical facilities throughout Japan was established to survey the clinical background and image findings of patients who have undergone ECG-gated stress perfusion SPECT. These patients were followed up for three years to investigate the occurrence of cardiac events. RESULTS: The 4,629 registered patients comprised 2,989 males (age 64.9 +/- 10.3 y, mean +/- SD) and 1,640 females (age 67.2 +/- 9.7 y). The most frequent complication was hypertension (54.5%), followed by hyperlipidemia (47.2%) and diabetes (29.4%). Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) was conducted on 1,925 of the patients. SPECT examinations were ordered for further examination of chest pain (32.8%), periodic follow-up after coronary artery intervention (24.2%), screening for coronary artery disease (15.1%), follow-up of old myocardial infarction (14.9%), more detailed investigation of ECG or echocardiographic abnormalities (13.1%), etiological assessment of heart failure (1.6%), and further inspection for acute coronary syndrome (0.3%). The method of inducing stress was most often exercise loading at 68.8%, and infusion of either dipyridamole (14.6%) or adenosine triphosphate (ATP, 13.8%). The most frequently applied amount of 99mTc-tetrofosmin was an initial dose of 200 to 300 MBq combined with a second dose of 700 to 800 MBq (37.7%). The mean doses were 305 +/- 81 at the initial and 709 +/- 132 MBq at the second administration. A history of angina pectoris (41.2%) was the most frequent, followed by myocardial infarction

(29.5%). CONCLUSIONS: During the two years of follow-up after registration, 46 of the 4,629 subjects have discontinued or dropped out, 134 have died, and 4,449 (97.8%) continue to undergo follow-up investigations. A complete report will be presented when the follow-up data for 3 years have been compiled and analyzed. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 16715950 [PubMed - indexed for MEDLINE] 582: Jpn J Clin Oncol. 2006 May;36(5):280-4. Epub 2006 May 19. Related Articles, Links

The lung cancer database project at the National Cancer Center, Japan: study design, corresponding rate and profiles of cohort. Nakaya N, Goto K, Saito-Nakaya K, Inagaki M, Otani T, Akechi T, Nagai K, Hojo F, Uchitomi Y, Tsugane S, Nishiwaki Y. Psycho-Oncology Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Japan. BACKGROUND: The lung cancer database project was established in 1999 at the National Cancer Center Hospital East, Japan, as an ongoing project to integrate data on various factors in lung cancer patients. The aim of the project was to construct a large-scale cancer registry for lung cancer that would contribute to basic research and clinical research in the future. METHODS: Between July 1999 and July 2004, consecutive lung cancer patients were recruited into this project. The baseline survey consisted of self-administered questionnaires concerning various demographic data, health habits and psychological factors. Medical information was obtained from the patients' medical charts. Urine specimens and blood samples were collected, and DNA was extracted from blood lymphocytes. RESULTS: Out of the 2506 patients who were asked to participate in the project, 2036 (81%) patients with newly diagnosed, untreated primary lung cancer were enrolled. The final analytic cohort consisted of 1995 patients. Virtually all of the 1995 patients (corresponding rate, 99%) completed the questionnaires on demographic data and health habits. The corresponding rates for the questionnaires on psychological factors and dietary habits were 99 and 94%, respectively. In a follow-up survey conducted to determine vital status as of December 2004, a total of 1051 patients (53%) had died and 44 patients (2%) were lost to follow-up. CONCLUSIONS: This paper overviews the rationale for

initiating the lung cancer database project, Japan. This database should prove useful for researchers examining the pathogenesis of lung cancer and may contribute to the formulation of a framework for cancer treatment. Publication Types: • •

Multicenter Study Research Support, Non-U.S. Gov't

PMID: 16714298 [PubMed - indexed for MEDLINE] 583: Vaccine. 2006 Jun 19;24(25):5341-8. Epub 2006 May 2. Related Articles, Links

Use of National Health Insurance database to evaluate the impact of public varicella vaccination program on burden of varicella in Taiwan. Tseng HF, Tan HF, Chang CK. Institute of Medical Research, Chang-Jung Christian University, 396, Sec. l, Chang Jung Rd, Kway Jen, Tainan 711, Taiwan, ROC. [email protected] The aims of this study were to investigate the epidemiology of varicella and evaluate the effect of varicella vaccination on the burden of varicella in Taiwan. The outpatient and hospitalization claims made to the National Health Insurance (NHI) in public and private vaccination areas were compared during 2000-2002. In 2002, the outpatient visit rates for 1- to 5-year-old children in public vaccination areas were 66-78% lower than their counterparts in private vaccination areas. The reduction in outpatient visit rate was the greatest among preschool children. The reductions also occurred in every age group including infants and adults. This study showed significant evidence of vaccine impact with a marked decline in clinical cases in the short term. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16713038 [PubMed - indexed for MEDLINE] 584: Hokkaido Igaku Zasshi. 2006 Jan;81(1):53-65. Related Articles, Links

[Relationship between medical expenses for the aged residing in farming villages and a social support network--documentation using details of medial expenses] [Article in Japanese] Sakakura E. PMID: 16710975 [PubMed - indexed for MEDLINE] 585: Ann Acad Med Singapore. 2006 Apr;35(4):236-41. Related Articles, Links

Modelling the utility of body temperature readings from primary care consults for SARS surveillance in an army medical centre. Chen MI, Tan IB, Ng YY. Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore. [email protected] INTRODUCTION: There is interest in surveillance systems for outbreak detection at stages where clinical presentation would still be undifferentiated. Such systems focus on detecting clusters of syndromes in excess of baseline levels, which may indicate an outbreak. We model the detection limits of a potential system based on primary care consults for the detection of an outbreak of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: Data from an averaged-sized medical centre were extracted from the Patient Care Enhancement System (PACES) [the electronic medical records system serving the Singapore Armed Forces (SAF)]. Thresholds were set to 3 or more cases presenting with particular syndromes and a temperature reading of >or=38oC (T >or=38). Monte Carlo simulation was used to insert simulated SARS outbreaks of various sizes onto the background incidence of febrile cases, accounting for distribution of SARS incubation period, delay from onset to first consult, and likelihood of presenting with T >or=38 to the SAF medical centre. RESULTS: Valid temperature data was available for 2,012 out of 2,305 eligible syndromic consults (87.2%). T >or=38 was observed in 166 consults (8.3%). Simulated outbreaks would peak 7 days after exposure, but, on average, signals at their peak would consist of 10.9% of entire outbreak size. Under baseline assumptions, the system has a higher than 90% chance of detecting an outbreak only with 20 or more cases. CONCLUSIONS: Surveillance based on clusters of cases with T >or=38 helps reduce background noise in primary care data, but the major limitation of such systems is that they are still only able to confidently detect large

outbreaks. PMID: 16710493 [PubMed - indexed for MEDLINE] 586: J Epidemiol. 2006 May;16(3):107-16. Related Articles, Links

Impact of the revision of a nutrient database on the validity of a selfadministered food frequency questionnaire (FFQ). Ishihara J, Inoue M, Kobayashi M, Tanaka S, Yamamoto S, Iso H, Tsugane S; JPHC FFQ Validation Study Group. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan. BACKGROUND: Revision of the national nutrient database in 2000 had a strong impact on the absolute level of estimated nutrient intake in dietary assessments. However, whether it influenced the ranking of individuals by estimated intake, a more important function in epidemiologic studies, has not been investigated. Here, we investigated the effect of this revision of the nutrient database on the validity of a food frequency questionnaire (FFQ) used to estimate nutrient intake in the Japan Public Health Center-based prospective Study (JPHC Study). METHODS: Subjects were a subsample of the JPHC Study who volunteered to participate in the validation study of the FFQ. Validity of the FFQ was evaluated by reference to the 28-day weighed dietary records as a gold standard. Nutrient intake according to the FFQ was recalculated using the revised database, and the results were compared to those using the previous database. Spearman's rank correlation coefficients (CCs) between intakes estimated by the FFQ and dietary records were computed using the revised database, and were compared to CCs computed using the previous database. RESULTS: For most of the nutrients, mean intake increased or decreased significantly using the revised database. However, no notable change was seen for the CC between estimated intake according to dietary records and FFQ when the revised database was used for calculation. Differences in the point estimates of the CCs ranged from -0.14 to 0.15. Likewise, CCs between biomarkers and estimated intake according to FFQ were similar for the two databases. CONCLUSION: Despite changes in intake levels for many nutrients, the validity of our FFQ using rank correlation by nutrient intake was not influenced by revision of the nutrient database in Japan. Publication Types: • • •

Comparative Study Research Support, Non-U.S. Gov't Validation Studies

PMID: 16710079 [PubMed - indexed for MEDLINE] 587: Int J Environ Res Public Health. 2005 Aug;2(2):343-54. Related Articles, Links

Use of multi-objective air pollution monitoring sites and online air pollution monitoring system for total health risk assessment in Hyderabad, India. Anjaneyulu Y, Jayakumar I, Hima Bindu V, Sagareswar G, Mukunda Rao PV, Rambabu N, Ramani KV. Institute of Science and Technology, JNT University, Kukatpally, Hyderabad 500 072, Andhra Pradesh, India. [email protected] A consensus has been emerging among public health experts in developing countries that air pollution, even at current ambient levels, aggravates respiratory and cardiovascular diseases and leads to premature mortality. Recent studies have also presented well-founded theories concerning the biological mechanisms involved and the groups of people that are probably more susceptible to health effects caused or exacerbated by inhalation of ambient particulate matter (PM.). On the basis of prognostic studies carried out in Center for Environment, JNT University, Hyderabad "it has been estimated that in Hyderabad some 1,700 to 3,000 people per year die prematurely as a result of inhaling PM". These figures reflect only the effects of acute exposure to air pollution. If the long-term effects of chronic exposure are taken into account, 10,000-15,000 people a year could die prematurely in Hyderabad. This estimate of the chronic effects is based on other studies, which are not completely comparable with the Hyderabad situation. While the study designs and analyses in these other studies may indeed be different or irrelevant to Hyderabad, the fact they were carried out in other countries is irrelevant. Taking into account these considerations, a model for total health risk assessment for the city of Hyderabad, and its state of Andhra Pradesh in India has been developed using a multi-objective air pollution monitoring network and online and real time air pollution monitoring stations. For the model studies a number of potential monitoring sites were screened for general and sitespecific criteria in a geographic information system (GIS) environment that may, on a local basis, affect the representativeness of the data collected. Local features that may affect either the chemical or meteorological parameters are evaluated to assure a minimum of interference. Finally, for monitoring air pollution, an online and real-time monitoring system was designed using advanced electrochemical sensor systems (sulphur dioxide, oxides of nitrogen, carbon monoxide, hydrocarbons, ozone, mercaptans and hydrogen sulphide) and a particulate matter analyzer (total suspended particulate matter TSPM), PM2.5 and PM10). The sensor and data acquisition systems are programmed to monitor pollution levels at

1/2 hour durations during peak hours and at 1-hour intervals at other times. Presently, extensive statistical and numerical simulations are being carried out at our center to correlate the individuals living in the monitored areas with respiratory infections with air pollution. PMID: 16705838 [PubMed - indexed for MEDLINE] 588: Regul Toxicol Pharmacol. 2006 Nov;46(2):142-8. Epub 2006 May 15. Related Articles, Links

The development and regulation of occupational exposure limits in Taiwan. Shih TS, Wu KY, Chen HI, Chang CP, Chang HY, Huang YS, Liou SH. Institute of Occupational Safety and Health, Council of Labor Affairs, No 99, Lane 407, Heng-Ke Rd., Sijhih City, Taipei, Taiwan. The occupational exposure limits (OELs) in Taiwan was promulgated in 1974 and has been revised five times since then. Many of the OELs were adopted from the most recent ACGIH TLVs and US OSHA PELs. A total of 483 chemicals were listed in the current Taiwan OELs Standard. The procedures of OELs development in Taiwan include the IOSH organized a recommended exposure limits (RELs) Committee to select the target chemicals and to recommend the RELs through literature review based on the health effects in the first stage, then, the CLA put policy needs, economical and technical feasibility into consideration and set up the final OELs at the second stage. A standard operation manual of RELs Committee has been developed. Based on our experience, several issues including the participation of representatives from a comprehensive spectrum, communication/education and training/enforcement, continuous collection of the local exposure data and health hazard information, use of health risk assessment, consideration of economic, and technical feasibility, as well as the globalization and information and experience sharing are critical in developing the appropriate OELs. Three examples including benzene, crystalline silica, and 2-methoxy ethanol are given to demonstrate the operation of system. PMID: 16701932 [PubMed - indexed for MEDLINE] 589: Am J Ind Med. 2006 Aug;49(8):609-16. Related Articles, Links

Respiratory health in Turkish asbestos cement workers: the role of environmental exposure.

Akkurt I, Onal B, Demir AU, Tüzün D, Sabir H, Ulusoy L, Karadağ KO, Ersoy N, Cöplü L. Department of Chest Disease, Cumhuriyet University Medical School, Sivas, Turkey. AIM: Benign and malignant pleural and lung diseases due to environmental asbestos exposure constitute an important health problem in Turkey. The country has widespread natural deposits of asbestos in rural parts of central and eastern regions. Few data exists about the respiratory health effects of occupational asbestos exposure in Turkey. A cross-sectional study was conducted to investigate respiratory health effects of occupational asbestos exposure and the contribution of environmental asbestos exposure. METHODS: Investigations included asbestos dust measurements in the workplace and application of an intervieweradministered questionnaire, a standard posteroanterior chest X-ray and spirometry. Information on birthplace of the workers was obtained in 406 workers and used to identify environmental exposure to asbestos, through a map of geographic locations with known asbestos exposure. RESULTS: Asbestos dust concentration in the ambient air of the work sites (fiber/ml) ranged between 0.2 and 0.76 (mean: 0.25, median: 0.22). Environmental exposure to asbestos was determined in 24.4% of the workers. After the adjustment for age, smoking, occupational asbestos exposure, and potential risk factors environmental asbestos exposure was associated with small irregular opacities grade > or = 1/0 (44.2% vs. 26.6%, P < 0.01), FVC% (97.8 vs. 104.5, P < 0.0001), and FEV1% (92.4 vs. 99.9, P < .0001). Occupational exposure to asbestos was associated with small irregular opacities grade > or = 1/0 (OR: 2.0, 95% CI: 1.3-3.1, per 1 unit increase in the natural logarithm of fiber/ml) and FEV1/FVC% (beta: 1.1, SEM: 0.54; P < 0.05, per 1 unit increase in the natural logarithm of fiber/ml). CONCLUSIONS: Environmental exposure to asbestos could increase the risk of asbestosis and lung function impairment in workers occupationally exposed to asbestos, independent from occupational exposure and smoking. Copyright 2006 Wiley-Liss, Inc. PMID: 16691614 [PubMed - indexed for MEDLINE] 590: Public Health Nutr. 2006 May;9(3):313-9. Related Articles, Links

Breast-feeding and feeding practices of infants in a developing country: a national survey in Lebanon. Batal M, Boulghourjian C, Abdallah A, Afifi R. Department of Nutrition and Food Sciences, American University of Beirut, PO Box 11-0236, Beirut, Lebanon. [email protected]

OBJECTIVE: Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socio-economic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers.DESIGN: The survey was cross-sectional in design and administered over 10 months.SETTING: Information on all variables was collected from mothers at health centres.SUBJECTS: Two-stage sampling was conducted to select participants. A total of 1,000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these.RESULTS: Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration.CONCLUSION: Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16684382 [PubMed - indexed for MEDLINE] 591: Nippon Ronen Igakkai Zasshi. 2006 Mar;43(2):230-5. Related Articles, Links

[Collaboration between university hospitals and local medical communities in Japan evaluated by a questionnaire among doctors] [Article in Japanese]

Tanaka M, Yokode M. Department of Social Service, Kyoto University Hospital. AIM AND METHODS: To provide quality medical service in a society with many elderly, university hospitals should clearly define their roles and contribute to the establishment of an integrated, comprehensive medical system. In this study, we conducted a questionnaire survey of doctors working at Kyoto University Hospital and at private practices in Kyoto about their attitude toward collaboration between the university hospital and private practices and asked their opinions on the role of university hospitals in the local medical community. RESULTS: The survey showed that doctors both at the university hospital and in private practice regarded close collaboration as important, but also highlighted obstacles and problems that block collaboration. CONCLUSION: Overcoming these problems and constructing collaboration models will be a key for university hospitals to fully contribute to the establishment of a quality medical system. Publication Types: •

English Abstract

PMID: 16683658 [PubMed - indexed for MEDLINE] 592: Scand J Work Environ Health. 2006 Apr;32(2):91-8. Related Articles, Links

Life-expectancy estimations and the determinants of survival after 15 years of follow-up for 81 249 workers with permanent occupational disabilities. Ho JJ, Hwang JS, Wang JD. College of Public Health, National Taiwan University, No 17, Hsu-Chow Road, Taipei, Taiwan, R.O.C. OBJECTIVES: This study attempts to estimate life expectancy and explore the determinants of survival for workers with permanent occupational disabilities. METHODS: A database on permanent occupational disabilities occurring between 1986 and 2000 was linked with the national death registry database to construct the survival function. A method with Monte Carlo simulation was used to extrapolate survival for up to 600 months to derive the life expectancy for different disability grades (N=81249). A Cox (proportional hazard) regression was carried out to explore the determinants and to estimate the hazard ratios.

Demographic variables, including age, gender, insured wage, severity of disability, injury causes, and organ-system disability, were included in the model as covariates. RESULTS: The results indicate that the survival period for workers suffering permanent occupational disabilities is shorter than that of the general population, amounting to an estimated loss of life expectancy ranging from 5 to 19 years. After adjustment for age and gender, a higher severity of disability, impairment of vital organs or lower extremities, and a lower insured wage had a significant association with shorter survival. Injury types, including transportation incidents, being struck by sliding objects, or a trip, slip or stumble, and collapse injury, indicated hazard ratios of between 1.24 and 1.34, as compared with injuries such as being trapped or caught in machinery. CONCLUSIONS: The findings identify major determinants for predicting survival for workers with permanent occupational disabilities; these determinants may be of use in improving the equity of the compensation system for workers. Publication Types: •

Research Support, Non-U.S. Gov't

PMID: 16680379 [PubMed - indexed for MEDLINE] 593: Lancet. 2006 May 6;367(9521):1487-94. Related Articles, Links Comment in: •

Lancet. 2006 Jul 8;368(9530):117-8.

Stillbirth rates: delivering estimates in 190 countries. Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. BACKGROUND: While information about 4 million neonatal deaths worldwide is limited, even less information is available for stillbirths (babies born dead in the last 12 weeks of pregnancy) and there are no published, systematic global estimates. We sought to identify available data and use these to estimate the rates and numbers of stillbirths for 190 countries for the year 2000, and provide uncertainty estimates. METHODS: We assessed three sources of stillbirth data according to specified inclusion criteria: vital registration; demographic and health surveys (DHS), based on a new analysis of contraceptive calendar data; and study reports that include published studies identified through systematic

literature searches of more than 30,000 abstracts and unpublished studies. A random effects regression model was developed to predict national stillbirth rates and associated uncertainty intervals. FINDINGS: Data from 44 countries with vital registration (71,442 stillbirths), 30 DHS surveys from 16 countries (2989 stillbirths), and 249 study populations from 103 countries (93,023 stillbirths) met the inclusion criteria. Model-based estimates were used for 128 countries. For 62 countries, the observed values were adjusted by a correction factor derived from the model. The resultant stillbirth rates ranged from five per 1000 in rich countries to 32 per 1000 in south Asia and sub-Saharan Africa. The estimated number of global stillbirths is 3.2 million (uncertainty range 2.5-4.1 million). In light of the data limitations and the conservative approach taken, the real number might be higher than this. INTERPRETATION: The numbers of stillbirths are high and there is a dearth of usable data in countries and regions in which most stillbirths occur, with under-reporting being a major challenge. Although our estimates are probably underestimates, they represent a rigorous attempt to measure the numbers of babies dying during the last trimester of pregnancy. Improving stillbirth data is the first step towards making stillbirths count in public-health action. Publication Types: • • •

Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. Review

PMID: 16679161 [PubMed - indexed for MEDLINE] 594: Suicide Life Threat Behav. 2006 Feb;36(1):97-102. Related Articles, Links

Suicide attempts in israel: age by gender analysis of a national emergency departments database. Levinson D, Haklai Z, Stein N, Gordon ES. Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem, Israel. [email protected] An analysis of all emergency department admissions in Israel classified as an attempted suicide in the years 1996-2002 was done to examine attempted suicide rates by age and gender with particular attention to adolescents and young adults. Gender differences in attempted suicide rates were significant only during adolescence and young adulthood, ages 13 to 26. The highest rate for females was 3 years earlier than the highest rate for males. The results lead to the conclusion that women do not attempt suicide more than men, except for 13-26 year olds.

PMID: 16676630 [PubMed - indexed for MEDLINE] 595: J Med Dent Sci. 2005 Dec;52(4):229-36. Related Articles, Links

Toward secure distribution of electronic health records: quantitative feasibility study on secure E-mail systems for sharing patient records. Gomi Y, Nogawa H, Tanaka H. Department of Bioinformatics, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Japan. [email protected] If the quality and efficiency of medical services are to be ensured, electronic health records (EHR) and EHR-supporting infrastructure must be prevalent. Many hospitals, however, have EHR systems for their internal use only, and the standardization process for the exchange of medical information is still in process. This standardization process addresses information security and is considering public key infrastructure (PKI) as one security measure, but PKI is rarely used by medical practioners because of its poor user-friendliness. Here we propose an effective use of the identity-based encryption (IBE) system as a security measure. This system enables us to send encrypted and signed messages without requiring the receiver to get a public key, and it enables us to deliver secured messages to ambiguous receivers like those to whom letters of reference are sent. We evaluated the feasibility of this technology by using the analytic hierarchy process, which is an effective analysis tool when selection and judgment depend on nonquantitative psychological factors, to analyze the results of an experiment in which medical workers used E-mail agents with and without PKI and IBE. We found that medical practioners and researchers avoid using PKI because of its poor user-friendliness and instead use IBE even though it is harder to install. We therefore think IBE would encourage medical institutions to share patient records. PMID: 16669457 [PubMed - indexed for MEDLINE] 596: Singapore Med J. 2006 May;47(5):376-82. Related Articles, Links

Unintentional injuries in infants in Singapore. Snodgrass AM, Ang A. Department of Paediatric Medicine, KK Women's and Children's Hospital,

Singapore. [email protected] INTRODUCTION: To describe the risk factors, causes and outcome of infant injuries so as to guide the formulation of injury prevention strategies specific for Singapore babies less than one year old. METHODS: Demographical, socioeconomic data, and data on the circumstances of injury, nature, severity of injury and clinical outcome of all infants less than one year old and who sought medical attention for or died from unintentional childhood injuries or poisoning, at the Emergency Departments of three SingHealth hospitals, two SingHealth primary care polyclinics and the Forensic Medicine Department, Health Sciences Authority during a six-month period, were extracted from a larger Childhood Injuries Surveillance database and analysed. RESULTS: 405 cases of accidental injury and poisoning in infants aged less than one year were seen from February to July 2002. 40.5 percent of injuries occurred when infants were left alone. Most infants were aged between nine months to one year (37 percent), male (57.3 percent), first-born (57.3 percent) and Chinese (69 percent), with no past medical history (96.1 percent). 91 percent of the injuries occurred at home, of which 60.5 percent occurred in the bedroom. Falls were the major mechanism of injury (77 percent). A total of 431 injuries were sustained. 63 percent were head injuries mainly stable head injuries, which made up 93.1 percent of all the head injuries. 67.5 percent of the cases were discharged without follow-up, while 17.9 percent required hospital admission, mostly to the general ward (98.6 percent of total admissions), and to the neurosurgery department (84.9 percent of total admissions). There were two fatalities in this study population. The mechanisms and patterns of injury changed with increasing motor ability of the infants. CONCLUSION: Parents and caregivers of infants should be taught and reminded about the age specific measures in injury prevention as their wards go through the various developmental stages in the first year of life. Emphasis should be placed on close caregiver supervision, identifying potential injury hazards in the home, fall prevention, adopting safe infant care practices and the safe use of infant care products. PMID: 16645686 [PubMed - indexed for MEDLINE] 597: BMC Infect Dis. 2006 Apr 26;6:77. Related Articles, Links

Spatial analysis of hemorrhagic fever with renal syndrome in China. Fang L, Yan L, Liang S, de Vlas SJ, Feng D, Han X, Zhao W, Xu B, Bian L, Yang H, Gong P, Richardus JH, Cao W. Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China. [email protected]

BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is endemic in many provinces with high incidence in mainland China, although integrated intervention measures including rodent control, environment management and vaccination have been implemented for over ten years. In this study, we conducted a geographic information system (GIS)-based spatial analysis on distribution of HFRS cases for the whole country with an objective to inform priority areas for public health planning and resource allocation. METHODS: Annualized average incidence at a county level was calculated using HFRS cases reported during 1994-1998 in mainland China. GIS-based spatial analyses were conducted to detect spatial autocorrelation and clusters of HFRS incidence at the county level throughout the country. RESULTS: Spatial distribution of HFRS cases in mainland China from 1994 to 1998 was mapped at county level in the aspects of crude incidence, excess hazard and spatial smoothed incidence. The spatial distribution of HFRS cases was nonrandom and clustered with a Moran's I = 0.5044 (p = 0.001). Spatial cluster analyses suggested that 26 and 39 areas were at increased risks of HFRS (p < 0.01) with maximum spatial cluster sizes of < or = 20% and < or = 10% of the total population, respectively. CONCLUSION: The application of GIS, together with spatial statistical techniques, provide a means to quantify explicit HFRS risks and to further identify environmental factors responsible for the increasing disease risks. We demonstrate a new perspective of integrating such spatial analysis tools into the epidemiologic study and risk assessment of HFRS. Publication Types: • •

Comparative Study Research Support, Non-U.S. Gov't

PMID: 16638156 [PubMed - indexed for MEDLINE] PMCID: PMC1471792

598: J Commun Dis. 2005 Mar;37(1):39-43. Related Articles, Links

Geographical information system (GIS) in investigation of an outbreak. Nisha V, Gad SS, Selvapandian D, Suganya V, Rajagopal V, Suganti P, Balraj V, Devasundaram J. Dept of Community Health, Christian Medical College, Vellore, India. An outbreak of fever in a village in southern India was reported on 1st September,

2001. The first reported case presented with epistaxis and a platelet count of 27000h(1)/mm3. Clinical, laboratory and entomological evidence supported a diagnosis of dengue fever. One third of the village was affected and 3.7 % of the population presented with haemorrhagic symptoms; none were fatal. Five acute cases tested for dengue specific IgM showed that two were positive. The larvae of Aedes aegypti were discovered from domestic water collections in the village. Spatial analysis done with the help of Geographical Information Systems software (GIS) demonstrated a centrifugal spread of cases from the most affected street until it involved the entire village. Spatial analysis revealed that cases occurred in clusters and that these could not have occurred by chance. This was our first experience in producing a geo-referenced map of a village area and in spatial analysis. GIS is a novel and simple tool for outbreak investigations and the spatial analyst adds additional information to the data collected. Control of adult mosquitoes and larvae prevented the outbreak from spreading to an adjacent village. PMID: 16637399 [PubMed - indexed for MEDLINE] 599: Eur J Oral Sci. 2006 Apr;114(2):102-8. Related Articles, Links

World dental research production: an ISI database approach (19992003). Gil-Montoya JA, Navarrete-Cortes J, Pulgar R, Santa S, Moya-Anegón F. Faculty of Dentistry, Granada University, Spain. [email protected] The objective of this study was to obtain a geographic world map of scientific production in dentistry by analysing published papers. Articles and reviews in the Dentistry, Oral Surgery & Medicine category published from 1999 to 2003 were accessed through the ISI database. The data were analyzed quantitatively (number of documents, number of researchers, productivity, interannual variation rate and relative specialization index), qualitatively (weighted impact factor, relative impact factor, citation rate per document and top 5 publications) and socioeconomically (number of documents per inhabitant and per dentist and in relation to the country's GDP). The USA, UK, Japan and Scandinavian countries were found to be the most productive countries (number of publications). Publications from Scandinavian countries were also of high quality as measured by Impact Factor and Citation Rate, while the UK had one of the highest productivity rates (number of documents per researcher). PMID: 16630300 [PubMed - indexed for MEDLINE]

600: Perit Dial Int. 2006 Mar-Apr;26(2):155-61. Related Articles, Links

The Japanese health-care system and reimbursement for dialysis. Naito H. Suzuka University of Medical Science, Suzuka, and Naito Medical Research Institute, Kobe, Japan. [email protected] Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese healthcare system has tended to support resource-intensive treatments because the feefor-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget. PMID: 16623417 [PubMed - indexed for MEDLINE]