His 4

601: Med Eng Phys. 2007 Mar;29(2):199-204. Epub 2006 Apr 18. Related Articles, Links

A remote data access architecture for home-monitoring health-care applications. Lin CH, Young ST, Kuo TS. Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei 106, Taiwan, ROC. With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote homemonitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized. Publication Types: •

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

PMID: 16621655 [PubMed - indexed for MEDLINE] 602: Environ Res. 2007 Jan;103(1):87-98. Epub 2006 Apr 17.

Related Articles,

Links

Estimating the effect of air pollution from a coal-fired power station on the development of children's pulmonary function. Dubnov J, Barchana M, Rishpon S, Leventhal A, Segal I, Carel R, Portnov BA. Haifa District Health Office, Ministry of Health, Israel. [email protected] Using geographical information systems (GIS) tools, the present study analyzed the association between children's lung function development and their long-term exposure to air pollution. The study covered the cohort of 1492 schoolchildren living in the vicinity of a major coal-fired power station in the Hadera sub-district of Israel. In 1996 and 1999, the children underwent subsequent pulmonary function tests (PFT) (forced vital capacity (FVC) and forced expiratory volume during the first second (FEV(1))), and the children's parents completed a detailed questionnaire on their health status and household characteristics. A negative association was found between changes in the results of PFT and the estimated individual levels of air pollution. A sensitivity test revealed a FEV(1) decline from -4.3% for the average pollution level to -10.2% for the high air pollution level. The results of a sensitivity test for FVC were found to be similar. Association with the reported health status was found to be insignificant. As we conclude, air pollution from a coal-fired power station, although not exceeding local pollution standards, had a negative effect on children's lung function development. As argued, previous studies carried out in the region failed to show the above association because they were based on zone approaches that assign average concentration levels of air pollutants to all individuals in each zone, leading to a misclassification bias of individual exposure. PMID: 16618483 [PubMed - indexed for MEDLINE] 603: Twin Res Hum Genet. 2006 Apr;9(2):266-71. Related Articles, Links

Determination of zygosity by questionnaire and physical features comparison in Chinese adult twins. Gao W, Li L, Cao W, Zhan S, Lv J, Qin Y, Pang Z, Wang S, Chen W, Chen R, Hu Y. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China. [email protected]

This study reports on the determination of zygosity in Chinese adult twins by simple questionnaire and physical features comparison. The subjects were 511 twin pairs from two cities and their town areas, consisting of 371 monozygotic (MZ) and 140 same-sex dizygotic (DZ) pairs, identified by ABO blood group and multiplex polymerase chain reaction of several polymorphic short tandem repeat markers. The twins themselves responded to 8 questionnaire items, 4 items on twin similarity, and 4 items on the frequency of mistaking one twin for another by parents, relatives, teachers and strangers when they were 6 to 13 years old. Research assistants responded to 20 items regarding twins' physical features at the moment of interview. A parsimonious model established using stepwise logistic regression analysis of the 28 items showed that the total accuracy of zygosity diagnosis was 90.1%. The accuracy was 89.2% when using only the items dealing with the confusion of twins and 85.4% using only similarity. In the questionnaire, 'facial appearance', 'mistaken by teachers' and 'mistaken by strangers' had stronger discriminating power between MZ and DZ twins. Two physical features--'eyelid' and 'middigital hair'--were informative to some extent. There was no statistically significant sex and area difference in the validity of such questionnaire and physical features comparison-based classification. In conclusion, questionnairebased zygosity assessment in this Chinese adult twin sample could still be regarded as a valid and valuable classification method. Physical features comparison, however, could only provide limited information for zygosity determination. Publication Types: •

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

PMID: 16611497 [PubMed - indexed for MEDLINE] 604: Ind Health. 2006 Jan;44(1):42-7. Related Articles, Links

Networking grassroots efforts to improve safety and health in informal economy workplaces in Asia. Kawakami T. ILO Subregional Office for East Asia, United Nations Building, Rajadamnern Nok Avenue, Bangkok 10200, Thailand. Many workers in Asia are in the informal economy. They often work in substandard conditions, exposed to hazards in the workplace. Learning from the recent successes of participatory training programmes to improve safety and health in Asia, the ILO has strengthened its partnership efforts with local people

to improve safety and health of informal economy workplaces. The target groups were: (1) home workplaces in Cambodia and Thailand, (2) salt fields and fishing villages in Cambodia where many young workers are working, and (3) small construction sites in Cambodia, Laos, Mongolia, Thailand and Vietnam. The walk-through survey results showed that the workers and owners in the target informal economy workplaces had the strong will to improve safety and health at their own initiatives and needed practical support. In the participatory, actionoriented training workshops carried out, the participated workers and owners were able to identify their priority safety and health actions. Commonly identified were clear and safe transport ways, safer handling of hazardous substances, basic welfare needs such as drinking water and sanitary toilets, and work posture. The follow-up visits confirmed that many of the proposed actions were actually taken by using low-cost available materials. These positive changes were possible by applying the participatory training tools such as illustrated checklists and extensive use of photographs showing local good examples and placing emphasis on facilitator roles of trainers. In conclusion, the target informal economy workplaces in Asia made positive changes in safety and health through the participatory, action-oriented training focusing on local initiative and low-cost improvement measures. Local network support mechanisms to share lessons from good practices played essential roles in encouraging the voluntary implementation of practical improvement actions. It is important to increase our joint efforts to reach more informal economy workplaces in industrially developing countries and provide practical support measures focusing on local self-help initiatives. PMID: 16610532 [PubMed - indexed for MEDLINE] 605: J Formos Med Assoc. 2005 Dec;104(12):883-90. Related Articles, Links

Use of diagnosis-based risk adjustment models to predict individual health care expenditure under the National Health Insurance system in Taiwan. Chang RE, Lai CL. Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan. BACKGROUND AND PURPOSE: Diagnostic information has been extensively studied and employed in the prediction of risk adjusted capitation payments in some countries. Nevertheless, few studies have been dedicated to the development of diagnosis-based risk adjusters in Taiwan. The purposes of this study were to develop outpatient diagnosis-based risk adjusters for a model of Taiwan's National Health Insurance (NHI) system and to evaluate the predictability of the risk adjustment models generated utilizing these adjusters. METHODS: Using a 2% random sample of 371,620 NHI enrollees, 5 risk adjustment models--i.e.,

demographic, inpatient diagnostic information outpatient diagnostic information, full diagnostic information, and prior utilization models--were evaluated with respect to predictive R2 and predictive ratios. While inpatient diagnosis-based risk adjusters were borrowed from previous research, outpatient diagnosis-based risk adjusters, referred to as Taiwan Ambulatory Spending Groups (TASGs), were developed based on 1996 claims data. RESULTS: The values of predictive R2 for the 5 risk adjustment models showed that the inclusion of outpatient diagnostic information considerably improved the predictability of the risk adjustment models for Taiwan's NHI system. Moreover, the predictive ratios revealed that the full diagnostic information model would reimburse different risk subgroups more fairly than the demographic, inpatient diagnostic information, and outpatient diagnostic information models and also outperform the prior utilization model with respect to disease risk groups. CONCLUSIONS: The risk adjustment model including the TASG risk adjusters can significantly improve predictability and can be employed to assess the NHI's current and proposed reform measures. PMID: 16607444 [PubMed - indexed for MEDLINE] 606: Foodborne Pathog Dis. 2006 Spring;3(1):68-73. Related Articles, Links

Effectiveness of pulsed-field gel electrophoresis for the early detection of diffuse outbreaks due to Shiga toxin-producing Escherichia coli in Japan. Terajima J, Izumiya H, Iyoda S, Mitobe J, Miura M, Watanabe H. Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan. We applied pulsed-field gel electrophoresis (PFGE) to the investigation of diffuse outbreaks of illness due to Shiga toxin?producing Escherichia coli O157:H7 (STEC O157) in Japan and used these data to develop a database of STEC O157 PFGE patterns and associated clinical and microbiologic information to facilitate the recognition of geographic and temporal clusters of cases based on their PFGE profiles. This project has evolved into a subtyping network called PulseNet Japan that is cooperatively run by National Institute of Infectious Diseases (NIID) and the local Health Institutes and the Ministry of Health, Labor and Welfare. Although our domestic PFGE network that utilized locally developed PFGE protocols was effective in recognizing diffuse outbreaks of STEC O157 within Japan, we decided to adopt the standardized PFGE protocols from PulseNet USA and collaborate closely with the Centers for Disease Control and Prevention (CDC) in the United States to facilitate recognition of international clusters of STEC O157 and their investigations. Publication Types:

•

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

PMID: 16602981 [PubMed - indexed for MEDLINE] 607: Foodborne Pathog Dis. 2006 Spring;3(1):36-50. Related Articles, Links

Building PulseNet International: an interconnected system of laboratory networks to facilitate timely public health recognition and response to foodborne disease outbreaks and emerging foodborne diseases. Swaminathan B, Gerner-Smidt P, Ng LK, Lukinmaa S, Kam KM, Rolando S, Gutiérrez EP, Binsztein N. Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30033, USA. [email protected] PulseNet USA, the national molecular subtyping network for foodborne disease surveillance, began functioning in the United States in 1996 and soon established itself as a critical early warning system for foodborne disease outbreaks, particularly those in which cases may be geographically dispersed. The PulseNet network is now being replicated in different ways in Canada, Europe, the Asia Pacific region, and Latin America. These independent networks work together in PulseNet International allowing public health officials and laboratorians to share molecular epidemiologic information in real-time and enabling rapid recognition and investigation of multi-national foodborne disease outbreaks. Routine communication between the various international PulseNet networks will provide early warning on foodborne disease outbreaks to participating public health institutions and countries. PMID: 16602978 [PubMed - indexed for MEDLINE] 608: East Mediterr Health J. 2005 May;11(3):319-28. Related Articles, Links

Mental health publications from the Arab world cited in PubMed, 1987-2002. Afifi MM. Department of Research and Studies, Ministry of Health, Muscat, Oman.

[email protected] The study aimed to identify mental health publications in Arab countries cited in PubMed from 1987 to 2002 and to analyse the year of publication, journal and field of research, specifically for child and adolescent mental health studies. A PubMedsearch was performed for all mental health publications followed by an analysis of child and adolescent mental health citations. The total number of mental health research citations published in Arab countries over the last 15 years was 338, 1.2% of the total number of citations for biomedical research; 17% were on child and adolescent mental health. The most dynamic fields of mental health research are anxiety and mood disorders and substance abuse. Child psychiatry, especially attention deficit hyperactivity disorder and child autism, are not gaining much interest from Arab researchers. PMID: 16602450 [PubMed - indexed for MEDLINE] 609: Prehosp Disaster Med. 2006 Jan-Feb;21(1):s27-31. Related Articles, Links

Central system of psychosocial support to the Czech victims affected by the tsunami in Southeast Asia. Vymetal S. Psychology Section, The Ministry of Interior of the Czech Republic. [email protected] The tsunami disaster affected several countries in Southeast Asia in December 2004 and killed or affected many tourists, most of them from Europe. Eight Czech citizens died, and about 500 Czechs were seriously mentally traumatized. The psychosocial needs of tourists included: (1) protection; (2) treatment; (3) safety; (4) relief; (5) psychological first aid; (6) connecting with family members; (7) transportation home; (8) information about possible mental reactions to trauma; (9) information about the normality of their reaction; (10) procedural and environmental orientation; (11) reinforcement of personal competencies; and (12) psycho-trauma therapy. The Ministry of Foreign Affairs of the Czech Republic was in charge of general emergency management. General coordination of psychosocial support was coordinated under the Ministry of Interior of the Czech Republic, which is connected to the Central Crisis Staff of the Czech Government. The major cooperative partners were: the Ministry of Foreign Affairs, the Ministry of Defence, the Ministry of Health, Czech Airlines, psychosocial intervention teams of the Czech Republic, and the Czech Association of Clinical Psychologists. The main goals of relief workers were: (1) to bring back home the maximum number of Czech citizens; (2) to provide relevant information to the maximum number of affected Czech citizens; (3) to provide relevant information to rescue workers and professionals; and (4) to

prepare working psychosocial support regional network. Major activities of the Ministry of Interior (psychology section) included: (1) establishing a psychological helpline; (2) running a team of psychological assistance (assistance in the Czech airports, psychological monitoring of tourists, crisis intervention, psychological first aid, assistance in the collection of DNA material from relatives); (3) drafting and distributing specific information materials (brochures, leaflets, address lists, printed and electronic instructions); (4) communicating via the media and advertising, and (5) providing analysis and research studies. Central coordination of psychosocial support has been found as successful in the first phase after the disaster. The plans must be built for preferable cooperation in the psychosocial field in the Czech Republic. Better collaborates with journalists must exist in order to reduce secondary psycho-trauma. There is a need for intensive international cooperation in the psychosocial field and to build the network at the global level. PMID: 16602270 [PubMed - indexed for MEDLINE] 610: J Nurs Manag. 2006 Apr;14(3):222-6. Related Articles, Links

Comparison of risk management in Taiwan and the USA. Lin LC. School of Nursing, University of Texas at Austin, Austin, TX and RN, North Austin Medical Center, Austin, TX 78701, USA. [email protected] AIM: The purpose of this paper is to compare and contrast the systems of risk management between a hospital in the USA and a hospital in Taiwan. BACKGROUND: By comparing both systems, nurses and managers will have a better understanding of risk management improvements and be in a better position to protect their patients and themselves. EVALUATION: Two interviews were conducted and literature were collected and reviewed by the author to support the argument. The gathered information was analysed to demonstrate the strengths and weaknesses of both hospital systems. KEY ISSUES: Although risk management is not difficult to understand, nurses and managers usually pay insufficient attention to it. CONCLUSION: Health care providers should work as a team to complete risk assessment and management in their workplaces. There are weaknesses to be improved and strengths to be continued and addressed in Taiwan and in the USA. Publication Types: • •

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

PMID: 16600011 [PubMed - indexed for MEDLINE] 611: J Ayub Med Coll Abbottabad. 2005 Oct-Dec;17(4):26-30. Related Articles, Links

Assessing the effects of training on knowledge and skills of health personnel: a case study from the family health project in Sindh, Pakistan. Farid-ul-Hasnain S, Israr SM, Jessani S. Department of Community Health sciences, The Aga Khan University, Karachi, Pakistan. [email protected] BACKGROUND: The Family Health Project (FHP) was implemented in the province of Sindh during 1992-99 with the assistance of the World Bank. The project was designed to bring substantial changes in health care system for achieving improvement in the health status by strengthening the quality and integration of primary health care services. One of the major components of the project was to develop the institutional capacity of Ministry of Health in Sindh. This is a comparative analysis to assess the knowledge and skills of health care providers in Area Focus Approach (AFA) health facilities with the ones in nonAFA health care facilities. METHODS: In order to obtain a representative sample, 8 districts were selected which included, Larkana, Khairpur, Nawabshah, Dadu, Tharparkar, Thatta, Karachi South, and Karachi West. A structured questionnaire was designed with various sections to assess the knowledge and skills of various cadres of health facility staff. RESULTS: This comparative assessment has come up with some interesting results; there is a difference between the scores of knowledge and skills between AFA and non-AFA health care providers. This assessment identified some important methodological issues such as the use of base-line information for comparing the results and the selection of a comparable study population for controlling the confounding factors. CONCLUSIONS: These findings can be used as important lessons learned for producing better results of any post training assessment intervention. Publication Types: •

Comparative Study

PMID: 16599030 [PubMed - indexed for MEDLINE] 612: BMC Public Health. 2006 Apr 4;6:86. Related Articles, Links

Organizational aspects and implementation of data systems in largescale epidemiological studies in less developed countries. Ali M, Park JK, von Seidlein L, Acosta CJ, Deen JL, Clemens JD. International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7 dong, Kwanak-gu, Seoul, Korea. [email protected] BACKGROUND: In the conduct of epidemiological studies in less developed countries, while great emphasis is placed on study design, data collection, and analysis, often little attention is paid to data management. As a consequence, investigators working in these countries frequently face challenges in cleaning, analyzing and interpreting data. In most research settings, the data management team is formed with temporary and unskilled persons. A proper working environment and training or guidance in constructing a reliable database is rarely available. There is little information available that describes data management problems and solutions to those problems. Usually a line or two can be obtained in the methods section of research papers stating that the data are doubly-entered and that outliers and inconsistencies were removed from the data. Such information provides little assurance that the data are reliable. There are several issues in data management that if not properly practiced may create an unreliable database, and outcomes of this database will be spurious. RESULTS: We have outlined the data management practices for epidemiological studies that we have modeled for our research sites in seven Asian countries and one African country. CONCLUSION: Information from this model data management structure may help others construct reliable databases for large-scale epidemiological studies in less developed countries. Publication Types: •

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

PMID: 16584571 [PubMed - indexed for MEDLINE] PMCID: PMC1450272

613: Bull World Health Organ. 2006 Mar;84(3):239-45. Epub 2006 Mar 22. Related Articles, Links

Verbal autopsy: current practices and challenges.

Soleman N, Chandramohan D, Shibuya K. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, England. [email protected] Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process. Publication Types: •

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

PMID: 16583084 [PubMed - indexed for MEDLINE] 614: Bull World Health Organ. 2006 Mar;84(3):233-8. Epub 2006 Mar 22. Related Articles, Links

A critical assessment of mortality statistics in Thailand: potential for improvements. Tangcharoensathien V, Faramnuayphol P, Teokul W, Bundhamcharoen K, Wibulpholprasert S. Ministry of Public Health, International Health Policy Program, Nonthaburi, Thailand. [email protected] This study evaluates the collection and flow of mortality and cause-of-death (COD) data in Thailand, identifying areas of weakness and presenting potential approaches to improve these statistics. Methods include systems analysis, literature review, and the application of the Health Metrics Network (HMN) self-

assessment tool by key stakeholders. We identified two weaknesses underlying incompleteness of death registration and inaccuracy of COD attribution: problems in recording events or certifying deaths, and problems in transferring information from death certificates to death registers. Deaths occurring outside health facilities, representing 65% of all deaths in Thailand, contribute to the inaccuracy of cause-of-death data because they must be certified by village heads with limited knowledge and expertise in cause-of-death attribution. However, problems also exist with in-hospital cause-of-death certification by physicians. Priority should be given to training medical personnel in death certification, review of medical records by health personnel in district hospitals, and use of verbal autopsy techniques for assessing internal consistency. This should be coupled with stronger collaboration with district registrars for the 65% of deaths that occur outside hospitals. Training of physicians and data coders and harmonization of death certificates and registries would improve COD data for the 35% of deaths that take place in hospital. Public awareness of the importance of registering all deaths and the application of registration requirements prior to funerals would also improve coverage, though enforcement would be difficult. PMID: 16583083 [PubMed - indexed for MEDLINE] 615: Lancet. 2006 Apr 1;367(9516):1066-74. Related Articles, Links

WHO analysis of causes of maternal death: a systematic review. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham, UK. BACKGROUND: The reduction of maternal deaths is a key international development goal. Evidence-based health policies and programmes aiming to reduce maternal deaths need reliable and valid information. We undertook a systematic review to determine the distribution of causes of maternal deaths. METHODS: We selected datasets using prespecified criteria, and recorded dataset characteristics, methodological features, and causes of maternal deaths. All analyses were restricted to datasets representative of populations. We analysed joint causes of maternal deaths from datasets reporting at least four major causes (haemorrhage, hypertensive disorders, sepsis, abortion, obstructed labour, ectopic pregnancy, embolism). We examined datasets reporting individual causes of death to investigate the heterogeneity due to methodological features and geographical region and the contribution of haemorrhage, hypertensive disorders, abortion, and sepsis as causes of maternal death at the country level. FINDINGS: 34 datasets (35,197 maternal deaths) were included in the primary analysis. We recorded wide regional variation in the causes of maternal deaths. Haemorrhage was the

leading cause of death in Africa (point estimate 33.9%, range 13.3-43.6; eight datasets, 4508 deaths) and in Asia (30.8%, 5.9-48.5; 11,16 089). In Latin America and the Caribbean, hypertensive disorders were responsible for the most deaths (25.7%, 7.9-52.4; ten, 11,777). Abortion deaths were the highest in Latin America and the Caribbean (12%), which can be as high as 30% of all deaths in some countries in this region. Deaths due to sepsis were higher in Africa (odds ratio 2.71), Asia (1.91), and Latin America and the Caribbean (2.06) than in developed countries. INTERPRETATION: Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries. These data should inform evidence-based reproductive health-care policies and programmes at regional and national levels. Capacity-strengthening efforts to improve the quality of burden-of-disease studies will further validate future estimates. Publication Types: • •

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

PMID: 16581405 [PubMed - indexed for MEDLINE] 616: N Engl J Med. 2006 Mar 30;354(13):1426-9; author reply 1426-9. Related Articles, Links Comment on: •

N Engl J Med. 2005 Dec 29;353(26):2779-87.

Clinical trials report card. Tamir O, Lipschitz Y, Shemer J. Publication Types: • •

Comment Letter

PMID: 16575952 [PubMed - indexed for MEDLINE] 617: Med J Malaysia. 2005 Oct;60(4):432-40. Related Articles, Links

Perceived skill and utilisation of information technology in medical

education among final year medical students, Universiti Putra Malaysia. Lim TA, Wong WH, Lim KY. Anaesthesiology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Hospital Kuala Lumpur, Jalan Masjid, 50586 Kuala Lumpur. The objective of this survey was to obtain a self-reported assessment of the use of information technology (IT) by final year medical students. Two hundred and sixty five students responded to a questionnaire survey. 81.5% of students considered their computer skills adequate, while 87.9% had access to computers outside the campus. Most students reported adequate skills at word processing, emailing and surfing the Internet. Fifty three percent of students spent three hours or more each week on the computer. While students indicated a general willingness to access Internet-based materials, further steps need to be taken to increase the use of this method of instruction. PMID: 16570704 [PubMed - indexed for MEDLINE] 618: Natl Med J India. 2006 Jan-Feb;19(1):14-7. Related Articles, Links

Usefulness of an observational database to assess antiretroviral treatment trends in India. Cecelia AJ, Christybai P, Anand S, Jayakumar K, Gurunathan T, Vidya P, Solomon S, Kumarasamy N. YR Gaitonde Cente for AIDS Research and Education, Chennai, Tamil Nadu, India. BACKGROUND: Human immunodeficiency virus (HIV) observational cohorts, which are established worldwide, support comparative studies across different regions. They have played an important role in developing international and country-specific HIV treatment and care guidelines. We describe the YRG CARE Chennai HIV observation database (YCHOD) and highlight its utility in monitoring trends in antiretroviral treatment use and HIV disease outcomes in India. METHODS: The baseline characteristics, time trends in antiretroviral treatment, trends in incidence of acquired immune deficiency syndrome (AIDS)defining illness and mortality following the introduction of highly active antiretroviral therapy (HAART) in India were assessed using YCHOD. RESULTS: Till January 2005, 7647 HIV-positive patients had registered in YCHOD. A majority of the patients were men (69%) and had a mean age of 32 years. At baseline, 14% had an existing AIDS-defining illness. Among patients

who required therapy by the WHO criteria, 14% initiated antiretroviral therapy (ART) in 1996 and 35% in 2000. Since the dramatic cost reduction of generic HAART in 2001, there has been an increase in the proportion of patients receiving ART to 57% in 2004. In patients who were started on HAART, the incidence of at least one AIDS-defining illness was 2% in 2001, and this decreased to 0.48% in 2004. CONCLUSION: We feel observational cohorts are useful as a surveillance tool for monitoring trends in treatment and disease progression. Standardized observational data collected systematically on HIVinfected individuals will help to assess the cost-effectiveness of ART and in planning ART strategies for India. PMID: 16570679 [PubMed - indexed for MEDLINE] 619: Lancet. 2006 Mar 25;367(9515):1000-6. Related Articles, Links Comment in: •

Lancet. 2006 Mar 25;367(9515):968-9.

Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S, Kessler RC. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon. [email protected] BACKGROUND: Mental disorders are believed to account for a large portion of disease burden worldwide. However, no national studies have been undertaken to assess this assumption in the Arab world. METHODS: As part of the WHO World Mental Health (WMH) Survey Initiative, a nationally representative psychiatric epidemiological survey of 2857 adults (aged 18 years) was done in Lebanon between September, 2002, and September, 2003, through a study called LEBANON (Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation). 12-month prevalence and severity of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) disorders, and treatment were assessed with the WHO Composite International Diagnostic Interview (CIDI, version 3.0). Information was also obtained for sociodemographics and exposure to traumatic events in the Lebanon wars. FINDINGS: 308 (17.0%) of respondents met criteria for at least one 12-month DSM-IV/CIDI disorder, 108 (27.0%) of whom were classified serious and an additional 112 (36.0%) moderate. Nearly half of respondents had a history of exposure to war-related traumatic events.

Significantly elevated odds ratios (OR) of mood, anxiety, and impulse-control disorders were associated with two (OR 2.0-3.6) or more (2.2-9.1) war-related traumatic events, resulting in substantially higher proportions of moderate and severe 12-month mental disorders in respondents exposed to multiple war-related traumata (16.8-20.4%) compared with other respondents (3.3-3.5%). Only 47 (10.9%) respondents with 12-month disorders obtained treatment. 85% of people were treated in the general medical sector and the mental-health-care system, and the rest by religious or spiritual advisers, counsellors, herbalists, or fortune-tellers. INTERPRETATION: Mental disorders are common in Lebanon, with a prevalence equivalent to that in Western Europe. However, the number of individuals with mental disorders who are not receiving treatment is considerably higher in Lebanon than in Western countries. Publication Types: • •

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

PMID: 16564362 [PubMed - indexed for MEDLINE] PMCID: PMC2030488

620: BMC Public Health. 2006 Mar 26;6:76. Related Articles, Links

Life time suicidal thoughts in an urban community in Hanoi, Vietnam. Tran Thi Thanh H, Tran TN, Jiang GX, Leenaars A, Wasserman D. Hanoi Medical University, Hanoi, Vietnam. [email protected] BACKGROUND: Suicidal thought is a risk factor and a stage in the suicidal process from planning to attempting and dying by suicide. To date, studies on suicidal thought in the general population, especially in Asian communities, have been limited. METHOD: The WHO SUPRE-MISS (the multisite intervention study on suicidal behaviours) community survey questionnaire was filled in for 2,280 randomly selected residents of the DongDa district of Hanoi, Vietnam by means of face-to-face interviews. This multi-factor questionnaire includes such variables as sociodemographic information, suicidal thought and history of suicide attempts, physical health, alcohol consumption and medication. RESULTS: Prevalence rates for life time suicidal thoughts, suicide plans and suicide attempts were 8.9%, 1.1% and 0.4% respectively. Suicidal thoughts are

associated with multiple characteristics, such as female gender, single/widowed/separated/divorced marital status, low income, lifestyle (use of alcohol, sedatives and pain relief medication), but not with low education or employment status. Having no religion and being a Buddhist appear to be protective factors for suicidal thought. The ratio of suicidal thoughts, suicide plans and suicide attempts on a lifetime basis is 22.3:2.8:1. CONCLUSION: In Vietnam, as in Western and other Asian countries, suicidal thoughts are associated with similar negative psychosocial risk factors, lifestyle and emotional problems, which implies that suicide preventive measure developed elsewhere can be adjusted to Vietnamese condition. Understanding the unique and common risks in a culture may assist in prediction and control. Publication Types: •

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

PMID: 16563173 [PubMed - indexed for MEDLINE] PMCID: PMC1444928

621: Immunohematology. 2006;22(1):1-5. Related Articles, Links

External quality assessment scheme in red blood cell serology: a 5year experience in Thailand. Bejrachandra S, Saipin J, Nathalang O, Siriboonrit U, Rungroung E, Udee S. Department of Transfusion Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. From 2000 to 2004, 36, 58, 72, 78, and 86 laboratories participated in an external quality assessment scheme (EQAS) organized by the Department of Transfusion Medicine, Faculty of Medicine Siriraj Hospital. Each year the staff was requested to perform ABO grouping, D typing, antibody screening, antibody identification, and DATs on eight blood samples. Each participant received information on the correct test results and a coded summary. Regarding ABO grouping, the error rate ranged from 0.3 to 1.3 percent, mostly due to human errors. Error rates in D typing ranged from 0.7 to 5.7 percent, the most problematic being weak D phenotype interpretation. Although every sample was negative by the DAT, error rates due to false positive test results were determined to be 0.4 to 2.1 percent. Antibody screening errors were also found; however, errors steadily decreased from 4.2 percent in 2000 to 0.3 percent in 2004. Only 69.4 to 87.2 percent of laboratories performed antibody identification; however, correct results increased

from 78.4 to 91.0 percent. In conclusion, an EQAS in RBC serology should be used to compare results from different laboratories and to identify those laboratories that need improvement in testing procedures. PMID: 16563044 [PubMed - indexed for MEDLINE] 622: J Adv Nurs. 2006 Apr;54(1):120-31. Related Articles, Links

Dimensions of hospital nurses' quality of working life. Hsu MY, Kernohan G. Institute of Nursing Research, University of Ulster, Newtownabbey, County Antrim, Northern Ireland, UK. [email protected] AIM: This paper is a report of a study describing the quality of working life of nurses in Taiwan. The purpose of the study was to gather data on which to base a questionnaire to be used in further research. BACKGROUND: Nurses often complain of overwork and underpay. Problems persist with nurses' job satisfaction, stress, organizational commitment and intent to leave. 'Quality of working life' is a system of analysing how people experience work: it relates to job satisfaction, intent to leave, turnover rate, personality and work stress. However, reliable information on hospital nurses' quality of working life is limited. METHOD: A descriptive study was carried out with a convenience sample. A total of 16 focus groups in one medical centre and five regional hospitals informed a quality of working life framework. Each group had three to five participants who were Registered Nurses in medical or surgical wards with at least 2 years' nursing experience, and who held a position below assistant nurse manager. The data were collected in 2000. FINDINGS: A total of 56 nurses' quality of working life categories were identified and fitted into six dimensions: socio-economic relevance, demography, organizational aspects, work aspects, human relation aspects and self-actualization. In this paper, we focus on issues emphasized by focus group participants. These were managing shift work within the demands of family life; accommodation; support resources; and nurses' clinical ladder system and salary system. CONCLUSIONS: Further research is needed with other groups of nurses in a wider variety of settings in order to examine strengths and weaknesses in the total healthcare work environment and to develop appropriate strategies for nurses' quality of working life. PMID: 16553697 [PubMed - indexed for MEDLINE] 623: New Genet Soc. 2005 Apr;24(1):57-78. Related Articles, Links

The Harvard case of Xu Xiping: exploitation of the people, scientific advance, or genetic theft? Sleeboom M. Amsterdam School of Social Science Research, University of Amsterdam, The Netherlands. [email protected] A unique history and make-up of a population may make it an attractive research target for population geneticists and pharmaco-genomic investors. The promise of pharmaceutical profits and advances in medical knowledge attracted Harvard researchers and the company Millennium Pharmaceuticals to remote areas in Anhui Province, Central China, leading to international diplomatic disagreements about issues such as the ownership of genetic material and informed consent (IC). This article discusses the role of genomics and genetic sampling in China, the way it is related to population policies (the new eugenics), the national importance of genetic materials and the conflicts it led to between the Chinese government and Harvard University. Here many consider the Xu Xiping case as textbook example of ruthless Western exploitation of development countries, illustrating the cold rationality of science in the process of globalisation. Ten perspectives on this case show that this view is simplistic and contributes little to an understanding of bioethical issues important to the population actually donating the samples. Viewing the Xu Xiping case as the nexus of the intertwinement of international, transnational, national, and local interest groups shows how different interest groups make use of different units of analysis. It also clarifies why the same practice of genetic sampling continues under a different regime, and why the discussion about genetic sampling has shifted from a concern with health care of the poor to an issue of international exploitation, terrorism and development. PMID: 16552917 [PubMed - indexed for MEDLINE] 624: Pediatr Radiol. 2006 Jun;36(6):485-90. Epub 2006 Mar 22. Related Articles, Links

The utilization of pediatric computed tomography in a large Israeli Health Maintenance Organization. Chodick G, Ronckers C, Ron E, Shalev V. Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, Israel. [email protected] BACKGROUND: Concern has been raised about the potential risks related to radiation exposure from CT scans, particularly among children. However, to date,

there are few data available describing the magnitude of pediatric CT utilization. OBJECTIVE: The aim of the study was to explore patterns of CT use in pediatric patients, with respect to time, use of multiple scans, body regions imaged, and medical diagnoses. MATERIALS AND METHODS: Records of 22,223 scans performed on 18,075 people aged < or =18 years over the period 1999-2003, including diagnoses recorded within 21 days after the examination, were obtained from a large Israeli Health Maintenance Organization (1,600,000 members). RESULTS: The highest annual CT examination rate (per 1,000) was recorded in 2001 (10.1) compared to 7.0 and 6.3 in 1999 and 2003, respectively. The lowest rate (three scans per 1,000) was found for 3-year-old children, with increasing rates with age. The head was the most frequently scanned region, both in young children (78%) and adolescents (39%). Symptoms of ill-defined conditions and injuries were documented in 22% and 10% of all scans, respectively. CONCLUSIONS: Although the results suggest that children comprise only 3% of all patients undergoing CT, this important modality must be carefully used because of their increased radiosensitivity, higher effective radiation doses, and longer life expectancy. Publication Types: •

Research Support, N.I.H., Intramural

PMID: 16552588 [PubMed - indexed for MEDLINE] 625: Eur J Gynaecol Oncol. 2006;27(1):81-5. Related Articles, Links

The use of complementary and alternative medicine (CAM) therapies by Turkish women with gynecological cancer. Yildirim Y, Tinar S, Yorgun S, Toz E, Kaya B, Sonmez S, Balsak D. Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of Gynecologic Oncology, Yenisehir, Izmir, Turkey. PURPOSE: To evaluate the prevalence and patterns of complementary and alternative medicine (CAM) utilization among Turkish women with gynecological cancer METHODS: In this cross-sectional study, a total of 156 patients treated between December 2002 and March 2005 at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of Gynecologic Oncology were evaluated. Data regarding CAM use were obtained from patients by means of face-to-face interviews. RESULTS: Sixty women (38.5%) had used CAM having been diagnosed with cancer; herbal medicine was the most common. The age, income, educational level, cancer site, FIGO stage, previous CAM usage, and time since patients were diagnosed with cancer were

associated with CAM usage. The most (40%) commonly cited reason for CAM use was to boost the immune system. Although only 8.3% of CAM users received CAM information from health care professionals or CAM practitioners, this group of patients was more likely to discuss their CAM use with physicians. CONCLUSION: Our data suggest that physicians should increase their knowledge of CAM therapies and ask cancer patients about previous CAM history. Publication Types: •

Comparative Study

PMID: 16550977 [PubMed - indexed for MEDLINE] 626: J Environ Manage. 2006 Dec;81(4):434-40. Epub 2006 Mar 23. Related Articles, Links

Discovering meaningful information from large amounts of environment and health data to reduce uncertainties in formulating environmental policies. Lee IN, Chang WC, Hong YJ, Liao SC. Faculty of Medical Information Management, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan, ROC. This study uses knowledge discovery concepts to analyze large amounts of data step by step for the purpose of assisting in the formulation of environmental policy. We performed data cleansing and extracting from existing nation-wide databases, and used regression and classification techniques to analyze the data. The current water hardness in Kaohsiung, Taiwan contributes to the prevention of cardiovascular disease (CVD) but exacerbates the development of renal stones (RS). However, to focus on water hardness alone to control RS would not be cost effective at all, because the existing database parameters do not adequately allow for a clear understanding of RS. Analysis of huge amounts of data can most often turn up the most reliable and convincing results and the use of existing databases can be cost-effective. PMID: 16549234 [PubMed - indexed for MEDLINE] 627: J Med Syst. 2006 Feb;30(1):17-22. Related Articles, Links

Use of electronic medical records in Oman and physician satisfaction. Al Farsi M, West DJ Jr. MHA Program, University of Scranton, Pennsylvania, USA. The Electronic Medical Record (EMR) is a computerized record of clinical, demographic and management information. EMR is an enabling technology that allows physicians to utilize quality improvement processes in the practice of medicine. Oman is one of the Middle Eastern Countries that has implemented an integrated electronic hospital information system at government health care institutions. The system was first applied in primary health care centers and then implemented in hospitals. Survey research highlights factors that affect physician satisfaction and utilizing of this new technology in a hospital setting. Outcome survey data suggests areas for improvement. Specific concerns about patient confidentiality are discussed as well as quality improvement in patient care. PMID: 16548410 [PubMed - indexed for MEDLINE] 628: Rinsho Byori. 2006 Feb;54(2):145-52. Related Articles, Links

[Summary of an electronic chart system in Anjo Kosei hospital and clinical laboratory system] [Article in Japanese] Ishikawa K. Department of Clinical Laboratory, Anjo Kosei Hospital, Anjo 446-8602. Many companies are introducing PC systems, and management administration can be done more effectively. Management administration was previously paperbased was, but, with improved PC information systems, their adoption is inevitable. This is the situation facing the Mayor of Ministry of Health and Welfare Health Policy Bureau, the medical and pharmaceutical safety chief of the bureau, the guidelines about "saving medical examination and treatment records on electronic media" by the insurance chief of the bureau joint signature notification on April 22, 1999, the spread of the electronic chart system which changes a patient's paper record, aiming at patient's record disclosure, standardization of data, and equalization of medical quality to no longer be an exception in medical care. At this symposium, I presented a summary of the electronic chart system and the inspection system that this House introduced

concentrating on the particularly special functions. Publication Types: •

English Abstract

PMID: 16548235 [PubMed - indexed for MEDLINE] 629: J Nurs Res. 2006 Mar;14(1):75-81. Related Articles, Links

Bibliometric analysis of nursing research in Taiwan 1991-2004. Huang YL, Ho YS, Chuang KY. Department of Public Health, Taipei Medical University, Taiwan. [email protected] This study examined nursing research performance in Taiwan from 1991 to 2004 by conducting bibliometric analysis of papers published by researchers affiliated with nursing institutes in Taiwan. Bibliometric information of papers that were published between 1991 and 2004 and had contact address including the words "Taiwan", and "nursing" were downloaded from the ISI Web of Knowledge website. The information used for this research included number of papers, number of authors, number of references listed, impact factors of publishing journals, times cited, and whether the paper was written through international or domestic collaboration. The information was coded and tabulated. Bibliometric characteristics were compared between 1995- 1999 and 2000-2004. Furthermore, an exponential model was fitted to show the past growth trend in research outputs. The results showed that there was a significant growth in quantity of papers from 1991 to 2004. In general, recent papers had averaged more authors, more domestic collaboration, more international collaboration, higher impact factors, and more references listed than earlier papers. Papers written with collaboration tended to have a higher average number of authors and more references listed, and tended to be published in journals with higher impact factors. The exponential model proved to be in good fit with the past growth pattern. The authors speculate that the recent increase in research collaboration, both internationally and domestically, may have contributed to the significant increase in output. It is not clear whether the growth in quantity of papers will continue or for how long. Based on past data, however, no sign of leveling off has been observed. More research is needed to understand what societal and individual level factors were involved in fueling such a dramatic increase in quantity in the last decade. Furthermore, as the quantity of papers has increased steadily, more focus can be placed on improving the quality of research papers.

Publication Types: •

Review

PMID: 16547908 [PubMed - indexed for MEDLINE] 630: Eur J Epidemiol. 2006;21(3):191-5. Related Articles, Links

Incidence of acute myocardial infarction during Islamic holiday seasons. Zubaid M, Thalib L, Suresh CG. Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, 13110 Safat, Kuwait. [email protected] Some weather and holiday seasons are associated with increased incidence of acute myocardial infarction (AMI). We studied the influence of one such season, Islamic holiday season of "Eid Al-Fitr", on the incidence of AMI in a Muslim country. This was carried out by examining the admissions to the coronary care unit of a large hospital over six consecutive years (from 1997 to 2003), encompassing six consecutive holiday seasons in Kuwait. We compared the admission rates during three time intervals in each of those 6 years; the Eid holiday season, the 2 months before and the 2 months after. A total of 964 AMI admissions occurred, with a mean age of 55 years. When the admission rates were compared, the Islamic holiday seasons were associated with a significant increase in AMI admission rate (45 cases vs. 31 cases, p < 0.01). This increase occurred mainly on the second day of the 4-day holiday season. This finding was confirmed using Locally Weighted Smooth Regression (LOESS) regression models with different smoothing levels. Our finding might have potential implications for preventive health campaigns in Muslim countries. PMID: 16547833 [PubMed - indexed for MEDLINE] 631: Lancet. 2006 Mar 18;367(9514):919-25. Related Articles, Links

Quality of hospital care for children in Kazakhstan, Republic of Moldova, and Russia: systematic observational assessment.

Duke T, Keshishiyan E, Kuttumuratova A, Ostergren M, Ryumina I, Stasii E, Weber MW, Tamburlini G. Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, 3052, Australia. [email protected] BACKGROUND: Major concerns about the quality of basic hospital care for children have been raised in developing countries, but no formal assessment applying international standards has been done in the Commonwealth of Independent States. METHODS: We assessed 17 hospitals in Kazakhstan, the Republic of Moldova, and the Russian Federation with a generic WHO hospital assessment framework adapted for use in the WHO European region. WHO management guidelines for paediatric care in peripheral hospitals were used as standards. FINDINGS: Hospital access for children was generally good. Good health networks existed, and skilled and committed doctors cared for children. Case-fatality rates were low. However, unnecessary and lengthy hospital stays were common, and most children received excessive and ineffective treatment (in one country median number of drugs prescribed concurrently was 5, IQR 2-6). Several conditions were systematically overdiagnosed, especially neurological disease, or overinvestigated, such as acute diarrhoea. Reasons for these practices included absence of clear evidence-based clinical guidelines, regulations tying duration of admission to financial reimbursement, generalisation of diseasecontrol methods from rare problems to common illnesses, and regulations maintaining financial and professional status of some subspecialties. Many disincentives to efficient practice existed. INTERPRETATION: To improve quality of hospital care for children in the Commonwealth of Independent States, several issues must be addressed, including: adoption of international guidelines for inpatient management; complementary guidelines for outpatient management; reforms to health regulations governing admission and discharge criteria; improvement of quality of training, availability of medical information, and systems to promote and certify quality of care. Publication Types: •

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

PMID: 16546540 [PubMed - indexed for MEDLINE] 632: J Cancer Res Clin Oncol. 2006 Jul;132(7):439-43. Epub 2006 Mar 15. Related Articles, Links

Clinical features of American versus non-American gynecologic cancer patients requesting information from a proprietary web-

based decision-support program. Markman M, Markman M, Petersen J, Belland A. University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. [email protected] PURPOSE: As the Internet can potentially substantially reduce geographic barriers to the dissemination of health-related information, it would be interesting to know if non-American women with gynecologic malignancies accessing United States (US)-based cancer Web sites differ from American patients with the same illness. PATIENTS AND METHODS: Aggregate data from individuals providing personal clinical information into one of four proprietary gynecologic cancer (cervix, endometrial, newly diagnosed and recurrent ovarian cancers) decision-support programs (NexProfiler Treatment Option Tools for Cancer; NexCura Inc., Seattle WA, USA) currently embedded within approximately 100 established cancer-related Web sites were examined for differences between American versus non-American patient populations. RESULTS: In this analysis, which included >15,000 patients, American and non-American gynecologic cancer patients were remarkably similar in most clinical characteristics, including age, stage of disease at presentation, overall health, and desire to receive information regarding clinical trials. Notable differences included features suggestive of a more aggressive surgical philosophy in the US (e.g., higher percentage of American recurrent ovarian cancer patients reported they had undergone a secondary surgical procedure; greater use of radiotherapy in nonAmerican cervical cancer patients). CONCLUSION: Despite differences in geographic location and health care delivery systems, American and nonAmerican patients with gynecologic malignancies and with access to Internetbased cancer information exhibit few, but notable, differences in self-reported clinical characteristics. Publication Types: •

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

PMID: 16538516 [PubMed - indexed for MEDLINE] 633: J Epidemiol. 2006 Mar;16(2):57-63. Related Articles, Links Erratum in: •

J Epidemiol. 2006 May;16(3):136-7.

Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding. Kaneko A, Kaneita Y, Yokoyama E, Miyake T, Harano S, Suzuki K, Ibuka E, Tsutsui T, YukoYamamoto , Ohida T. Department of Public Health, School of Medicine, Nihon University, Tokyo, Japan. BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breastfeeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system. PMID: 16537985 [PubMed - indexed for MEDLINE] 634: Patient Educ Couns. 2006 Apr;61(1):134-41. Related Articles, Links

Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Margalit RS, Roter D, Dunevant MA, Larson S, Reis S. Department of Preventive & Societal Medicine, Section on Humanities and Law,

University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, 68198-6075, USA. [email protected] OBJECTIVES: Within the context of medical care there is no greater reflection of the information revolution than the electronic medical record (EMR). Current estimates suggest that EMR use by Israeli physicians is now so high as to represent an almost fully immersed environment. This study examines the relationships between the extent of electronic medical record use and physicianpatient communication within the context of Israeli primary care. METHODS: Based on videotapes of 3 Israeli primary care physicians and 30 of their patients, the extent of computer use was measured as number of seconds gazing at the computer screen and 3 levels of active keyboarding. Communication dynamics were analyzed through the application of a new Hebrew translation and adaptation of the Roter Interaction Analysis System (RIAS). RESULTS: Physicians spent close to one-quarter of visit time gazing at the computer screen, and in some cases as much as 42%; heavy keyboarding throughout the visit was evident in 24% of studied visits. Screen gaze and levels of keyboarding were both positively correlated with length of visit (r = .51, p < .001 and F(2,27) = 2.83, p < .08, respectively); however, keyboarding was inversely related to the amount of visit dialogue contributed by the physician (F(2,27) = 4.22, p < .02) or the patient (F(2,27) = 3.85, p < .05). Specific effects of screen gaze were inhibition of physician engagement in psychosocial question asking (r = -.39, p < .02) and emotional responsiveness (r = -.30, p < .10), while keyboarding increased biomedical exchange, including more questions about therapeutic regimen (F(2,27) = 4.78, p < .02) and more patient education and counseling (F(2,27) = 10.38, p < .001), as well as increased patient disclosure of medical information to the physician (F(2,27) =3.40, p < .05). A summary score reflecting overall patient-centered communication during the visit was negatively correlated with both screen gaze and keyboarding (r = -.33, p < .08 and F(2,27) = 3.19, p < .06, respectively). DISCUSSION: The computer has become a 'party' in the visit that demanded a significant portion of visit time. Gazing at the monitor was inversely related to physician engagement in psychosocial questioning and emotional responsiveness and to patient limited socio-emotional and psychosocial exchange during the visit. Keyboarding activity was inversely related to both physician and patient contribution to the medical dialogue. Patients may regard physicians' engrossment in the tasks of computing as disinterested or disengaged. Increase in visit length associated with EMR use may be attributed to keyboarding and computer gazing. CONCLUSIONS: This study suggests that the way in which physicians use computers in the examination room can negatively affect patientcentered practice by diminishing dialogue, particularly in the psychosocial and emotional realm. Screen gaze appears particularly disruptive to psychosocial inquiry and emotional responsiveness, suggesting that visual attentiveness to the monitor rather than eye contact with the patient may inhibit sensitive or full patient disclosure. PRACTICAL IMPLICATIONS: We believe that training can help physicians optimize interpersonal and educationally effective use of the EMR. This training can assist physicians in overcoming the interpersonal

distancing, both verbally and non-verbally, with which computer use is associated. Collaborative reading of the EMR can contribute to improved quality of care, enhance the decision-making process, and empower patients to participate in their own care. PMID: 16533682 [PubMed - indexed for MEDLINE] 635: East Mediterr Health J. 2005 Jan-Mar;11(1-2):192-8. Related Articles, Links

Health management information system: a tool to gauge patient satisfaction and quality of care. Shaikh BT, Rabbani F. Health Systems Division, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. [email protected] The health management information system (HMIS) is an instrument which could be used to improve patient satisfaction with health services by tracking certain dimensions of service quality. Quality can be checked by comparing perceptions of services delivered with the expected standards. The objective of the HMIS would be to record information on health events and check the quality of services at different levels of health care. The importance of patient assessment is a part of the concept of giving importance to patient's views in improving the quality of health services. Expected benefits include enhancing patient satisfaction through improved communication; greater provider sensitivity towards patients; enhanced community awareness about the quality of services; and overall better use of services in the health system. Publication Types: •

Review

PMID: 16532688 [PubMed - indexed for MEDLINE] 636: Health Place. 2007 Mar;13(1):238-48. Epub 2006 Mar 10. Related Articles, Links

Efficacy calculation in randomized trials: global or local measures? Emch M, Ali M, Acosta C, Yunus M, Sack DA, Clemens JD.

Department of Geography, Saunders Hall, University of North Carolina, Chapel Hill, NC 27599-3220 USA. [email protected] This study tests whether the effect of a vaccine trial varies in space and why. Analytical z-score maps identify unusually high- and low-efficacy values in a trial area. Relationships between neighborhood efficacy and ecological variables are measured to explain why efficacy varies in space. Efficacy was found to vary regardless of neighborhood size and the variation is related to several ecological determinants. Local efficacy measures can help public health practitioners make better decisions about when and where to vaccinate populations. The concepts offered in this study are pertinent for any health intervention trial, not just vaccines. Publication Types: • •

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

PMID: 16529974 [PubMed - indexed for MEDLINE] 637: J Pers. 2006 Apr;74(2):457-78. Related Articles, Links

Monitoring: a dual-function coping style. Shiloh S, Orgler-Shoob M. Department of Psychology, Tel Aviv University, Israel. [email protected] Monitoring (Miller, 1991) is defined as a cognitive coping style characterized by the tendency to seek information about threats. This study found that information seeking in stressful situations is perceived by individuals as related to the emotion-focused more than the problem-focused function of coping and that there is considerable variance among individuals in the perceived functions of information seeking and the relationships among information-seeking reactions and their perceived functions. Information-seeking preferences in a natural stressful situation (a final course examination) were predicted by individual differences in perceived functions of information seeking rather than by generalized behavioral coping styles (monitoring). The results were interpreted in relation to the cognitive-affective system theory (Mischel & Shoda, 1995), and implications for the measurement of coping dispositions were discussed. PMID: 16529583 [PubMed - indexed for MEDLINE]

638: Kekkaku. 2006 Feb;81(2):71-7. Related Articles, Links

[Tuberculosis control in health care facilities for the elderly, from the viewpoint of risk management] [Article in Japanese] Ohmori M, Wada M, Mitarai S, Yanai H, Ito K, Yamauchi Y, Shishido S. Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533, Japan. [email protected] OBJECTIVES: To discuss the optimal TB control system in health care facilities for the elderly where the periodic TB screening is currently not obligatory. METHODS: A study was conducted in three health care facilities for the elderly in Tokyo during the period from 2002 to 2004, and 212 admitted elderly persons were enrolled in this study. Medical charts were analyzed to identify informations about mental and physical conditions and TB risk factors. Questionnaire-based interviews were conducted in 58 residents who had no dementia or no serious conditions. TB mass screening was carried out with a mobile vehicle equipped with computed radiography, financially supported by the Tokyo Metropolitan Government. Since this mobile vehicle is equipped with a special wheelchair for chest X-ray examination, most elderly persons were able to receive chest X-ray examination. Medical chart review and interview were conducted at around the time of TB mass screening. The screening results of 183 elderly residents who received X-ray examination were reviewed. RESULTS: Of the 212 persons admitted to the facilities, 73.1% were women. The mean ages of men and women were 80.7 and 84.2 years, respectively. Mental disorders were observed in 42.9% and dysfunction of extremities in 54.7%. At the time of admission, chest X-ray records were submitted by the attending doctors in 73.1% of the residents, but this proportion differed among facilities. From these records, old TB was found in 12.3%; however this proportion was 20.8% according to the TB mass screening results. A history of TB was more prevalent in the group interviewed than in the non-interview group (24.1% vs. 6.5%; p < 0.001). Two facilities had conducted TB screening for three consecutive years and comparative reading of chest X-ray films could be done in 35.8%. The remaining facility conducted TB screening for the first time, and comparative reading was not possible. The proportion of cases requiring further investigations was higher in the facility where TB screening was conducted for the first time (2.8% vs. 13.0%; p = 0.008). No active TB patient was detected in this study. CONCLUSION: From the viewpoint of risk management for tuberculosis, it is important to establish a system of early case finding for the aged persons admitted to health care facilities for the elderly. Therefore, the information on risk factors should be collected properly at the time of admission, and careful attention should be paid to the residents with risk factors, for the possible development to active disease. X-ray records submitted

by the attending doctors or by screening would provide useful informations for early diagnosis, when abnormal shadows are found on chest X-ray films. Publication Types: •

English Abstract

PMID: 16529008 [PubMed - indexed for MEDLINE] 639: Am J Med Genet A. 2006 May 1;140(9):945-51. Related Articles, Links Comment in: •

Am J Med Genet A. 2006 Nov 15;140(22):2510.

Clinical characteristics and survival of trisomy 18 in a medical center in Taipei, 1988-2004. Lin HY, Lin SP, Chen YJ, Hung HY, Kao HA, Hsu CH, Chen MR, Chang JH, Ho CS, Huang FY, Shyur SD, Lin DS, Lee HC. Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan. Trisomy 18 is the second most common autosomal trisomy in newborns. The birth prevalence of this disorder is approximately 1 in 3,000 to 1 in 8,000, and the life span of the majority of patients is less than 1 year. As information regarding outcome in trisomy 18 is rather fragmentary in the literature, this study is aimed at investigating the survival and natural history of trisomy 18. We also evaluated the survival age and management of trisomy 18 in two different periods, before and after the implementation of National Health Insurance (NHI) program. Thirtynine cases of trisomy 18 were collected in Mackay Memorial Hospital in a 17year period, from 1988 to 2004. Delivery data, survival age, management before and after the implementation of NHI program, structural defects, image findings and cytogenetic results were analyzed by medical and nurse's records. The diagnosis of trisomy 18 was based on the prenatal amniocentesis or postnatal chromosome analysis. Three patients had trisomy 18 mosaicism. Since cardiovascular and central nervous systems are the most common organ systems involved in this disorder, 31 patients received brain ultrasonography and heart ultrasonography for evaluation of their multiple anomalies after admission. All patients except one died in their first year due to severe malformations of the cardiovascular or central nervous systems. The median survival age was 6 days. We found a longer survival with female patients than with male patients (P <

0.05). Implementation of NHI program in the more recent decade of this study period was associated with longer survival of trisomy 18 (P < 0.05). The three most common structural defects were clenched hands (95%), rocker bottom feet (90%), and low set or malformed ears (90%). Low birth weight was present in 90%. By cardiac ultrasonography, the top four heart defects were ventricular septal defect (94%), patent ductus arteriosus (77%) and atrial septal defect (68%). However, ten cases (32%) had complex congenital heart defects. By brain ultrasonography, the most common brain lesion was cerebellar hypoplasia (32%), followed by brain edema (29%), enlarged cisterna magna (26%) and choroid plexus cysts (19%). Although most patients with trisomy 18 die within the first few weeks after birth, it is important to recognize that a small but notable percentage of these patients will survive the first year. When prenatal or postnatal decisions need to be made, the possibility of long-term survival should be included in any discussion to enable families to make the most appropriate decision. 2006 Wiley-Liss, Inc. Publication Types: • •

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

PMID: 16528742 [PubMed - indexed for MEDLINE] 640: Drug Saf. 2006;29(3):261-72. Related Articles, Links

Cardiovascular events associated with long-term use of celecoxib, rofecoxib and meloxicam in Taiwan: an observational study. Huang WF, Hsiao FY, Tsai YW, Wen YW, Shih YT. Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. [email protected] BACKGROUND: Using national data (2001-2003), this study explored the risk of acute myocardial infarction (AMI), angina, stroke and transient ischaemic attack (TIA) in long-term users of rofecoxib and celecoxib in Taiwan and compared this data with that for those using meloxicam. METHODS: Patients included in the study had used celecoxib, rofecoxib or meloxicam for at least 180 days. Data were taken from National Health Insurance database for the period from 2001 to 2003. Main outcome measurements were the occurrence of AMI, angina, stroke or TIA after the initiation of long-term continuous use of these drugs. Person-time exposures and hazard ratios (HRs) were calculated based on data from 9602 eligible patients. RESULTS: In patients without a history of a cardiovascular event within the year before drug treatment began, the overall rates

of AMI, angina, stroke and TIA were 1.1%, 0.6%, 2.0% and 0.6%, respectively. In those with cardiovascular events in the year before treatment began, the overall rates of AMI, angina, stroke and TIA were 5.0%, 4.8%, 6.6% and 5.8%, respectively. Compared with meloxicam users, celecoxib users had lower HRs for the development of AMI (HR 0.78, 95% CI 0.63, 0.96) and stroke (HR 0.81, 95% CI 0.70, 0.93). Rofecoxib users were at no higher risk of cardiovascular events than those receiving meloxicam. Regardless of treatment, having had a cardiovascular event in the year before treatment began played a significant role in the development of the same cardiovascular event during the prescription period; the HRs associated with having had the same cardiovascular event in the past year, versus not having had such an event, were 3.02 (95% CI 1.44, 6.32) for AMI, 5.82 (95% CI 3.19, 10.63) for angina, 2.44 (95% CI 1.79, 3.33) for stroke and 7.16 (95% CI 3.70, 13.87) for TIA. CONCLUSIONS: Patients taking celecoxib had a lower risk of cardiovascular events than those taking meloxicam. Patients taking rofecoxib were not found to be at higher cardiovascular risk than those taking meloxicam. The most significant determinant of cardiovascular risk was a history of such cardiovascular disease in the year preceding treatment initiation. Patients with a history of other medical conditions also appeared to be at higher risk of adverse cardiovascular events. Publication Types: •

Comparative Study

PMID: 16524325 [PubMed - indexed for MEDLINE] 641: Health Policy. 2006 Dec;79(2-3):325-36. Epub 2006 Mar 6. Related Articles, Links

Advanced Asia's health systems in comparison. Gauld R, Ikegami N, Barr MD, Chiang TL, Gould D, Kwon S. Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. [email protected] There is growing interest in comparing patterns of social and health service development in advanced Asian economies. Most publications concentrate broadly on a range of core social services such as education, housing, social security and health care. In terms of those solely focused on health, most discuss arrangements in specific countries and territories. Some take a comparative approach, but are focused on presentation and discussion of expenditure, resourcing and service utilization data. This article extends the comparative analysis of advanced Asian health systems, considering the cases of Japan, South

Korea, Taiwan, Hong Kong and Singapore. The article provides basic background information, and delves into common concerns among the world's health systems today including primary care organization, rationing and cost containment, service quality, and system integration. Conclusions include that problems exist in 'classifying' the five diverse systems; that the systems face common pressures; and that there are considerable opportunities to enhance primary care, service quality and system integration. Publication Types: •

Comparative Study

PMID: 16517000 [PubMed - indexed for MEDLINE] 642: J Manag Care Pharm. 2006 Mar;12(2):152-7. Related Articles, Links

Suboptimal pneumococcal pneumonia vaccination rates among patients at risk in a managed care organization in Israel. Kahan NR, Waitman DA, Blackman S, Chinitz DP. Leumit Health Fund, 23 Schprintsak St., Tel Aviv 64738, Israel. [email protected] OBJECTIVE: Pneumococcal pneumonia is a vaccine-preventable disease that poses a significant threat to immunocompromised patients. Vaccination rates tend to be low despite recommendations for vaccination in several groups of high-risk patients including any person aged 65 years or older. The purpose of this study was to (a) evaluate the vaccination rates among high-risk patients in a managed care setting in Israel and (b) gain a better understanding of the factors associated with suboptimal use of this vaccine. METHODS: Data were extracted from the electronic medical records of the managed care organization for patients with dates of service from January 2000 to December 2004 for whom the vaccine is recommended. Patients were identified via diagnosis codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Vaccination rates were calculated for patients in each disease category. These high-risk patients were contacted to participate in a telephone survey to evaluate the variance in knowledge and awareness levels of the disease between the vaccinated and unvaccinated patients. RESULTS: A total of 672 patients were identified by the ICD-9-CM codes; 140 (20.8%) had been vaccinated and 532 (79.2%) were unvaccinated. Vaccination rates were highest among patients with solid organ transplants (33.3%), followed by nephrotic syndrome (29.4%), bone marrow transplants (10.2%), and human

immunodeficiency virus (HIV, 9%), for an overall rate of 20.8%. Of these patients, survey responses were obtained from 364 (54.2%). Respondents who were unvaccinated tended to be less well informed about which patient populations are at risk for the disease and the availability of the vaccine. CONCLUSION: The pneumococcal vaccination rate among immunocompromised patients in this managed care organization was found to be inadequate, at just 20.8% of the target population. Approaches based on direct contact with the patient, such as by a case manager, may be more successful in the future. Publication Types: •

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

PMID: 16515373 [PubMed - indexed for MEDLINE] 643: Acta Cytol. 2006 Jan-Feb;50(1):41-7. Related Articles, Links

Cervical smear abnormalities in the United Arab Emirates: a pilot study in the Arabian Gulf. Ghazal-Aswad S, Gargash H, Badrinath P, Al-Sharhan MA, Sidky I, Osman N, Chan NH. Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al-Ain, United Arab Emirates. [email protected] OBJECTIVE: To gather epidemiologic data on cervical abnormalities and make recommendations pertaining to a national cervical screening policy in the United Arab Emirates (UAE). STUDY DESIGN: A cross-sectional survey of patients and physicians in the UAE with regard to cervical cytology was carried out. Knowledge, attitudes and practices (KAP) of a group of female primary care physicians on cervical cytology were assessed by a self-administered questionnaire. Pap smears and Chlamydia testing were offered to women attending selected primary care centers and secondary health care facilities. RESULTS: Results of Chlamydia prevalence and KAP were published elsewhere; this report addresses the cytologic aspects of this study. There were 2,013 smears collected from primary health centers and 2,042 from secondary care. The overall rate of cervical screening among women in this survey was 85.5% in primary care and 77% in secondary care. The proportion of unsatisfactory smears was < 5%. The prevalence of cervical abnormalities according to the Bethesda System 2001 was 3.6%. There were 9 (primary care) and 21 (secondary care) cases of low grade squamous intraepithelial lesion (LSILs), for a prevalence of 0.77%. There

were 4 primary care and 17 secondary care cases of high grade squamous intraepithelial lesion (HSIL), for a prevalence of 0.54%. The combined prevalence for LSIL and HSIL is 1.32%. There were 3 cases of glandular abnormalities. The atypical squamous cells of undetermined significance/SIL ratio was 1.71. No cases of squamous cell carcinoma were detected. No tissue follow-up information is available. The prevalence of cervical abnormalities is low in the UAE. We first recommend the institution of a more organized approach to opportunistic screening in the UAE with appropriate clinical follow-up rather than the immediate launch of a cervical mass screening program. Publication Types: •

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

PMID: 16514839 [PubMed - indexed for MEDLINE] 644: Health Policy. 2006 Dec;79(2-3):296-305. Epub 2006 Feb 28. Related Articles, Links

Differences in practice income between solo and group practice physicians. Lin HC, Chen CS, Liu TC, Lee HC. School of Health Care Administration, Taipei Medical University, and Taipei Municipal Wan Fang Hospital, Taiwan. An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal-Wallis test results revealed the existence of significant relationships between practice incomes and practice types (p<0.001) and the number of physicians within a clinic (p<0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group

practices (p<0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices. PMID: 16510207 [PubMed - indexed for MEDLINE] 645: BMC Health Serv Res. 2006 Feb 17;6:11. Related Articles, Links

Referral from secondary care and to aftercare in a tertiary care university hospital in Japan. Toyabe S, Kouhei A. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Asahimachi-dori 1-754, Niigata 951-8520, Japan. [email protected] BACKGROUND: In Japan, all citizens are covered by the national insurance system in which universal free access to healthcare services is promised to everybody. There are no general physicians or gatekeepers in the Japanese healthcare system. METHODS: We studied the pattern of referral of inpatients from secondary care hospitals to a tertiary care university hospital and the reverse referral under the situations using a geographic information system (GIS), taking paediatric inpatients as an example. RESULTS: The results showed that 61.2% of the patients were directly admitted to the hospital without referral from other hospitals or clinics and that 82.8% of the inpatients were referred to the outpatient department of the hospital to which they had been admitted. GIS analysis for the inpatients service area showed the hospital functions as both a secondary care hospital and tertiary care hospital. Patients who lived near the hospital tended to be admitted directly to the hospital, and patients who lived far from the hospital tended to utilize the hospital as a tertiary care provider. There were territorial disputes with other secondary care hospitals. To estimate spatial differences in referral to aftercare, we analyzed the spatial distribution of inpatients with focus on their length of hospital stay (LOS). GIS analysis revealed apparent foci of patients with long LOS and those with low LOS. CONCLUSION: These results suggest that the function of university hospital in Japan is unspecialized and that the referral route from the university hospital to aftercare is also unequipped. PMID: 16503979 [PubMed - indexed for MEDLINE] PMCID: PMC1388212

646: Nutrition. 2006 Mar;22(3):283-7. Related Articles, Links

New Quantitative Index for Dietary Diversity (QUANTIDD) and its annual changes in the Japanese. Katanoda K, Kim HS, Matsumura Y. Division of Health Informatics and Education, National Institute of Health and Nutrition, Tokyo, Japan. [email protected] OBJECTIVE: A diverse diet is recommended in many dietary guidelines. However, because there are no unified standards for measurement methods, objective comparisons across different populations or time points is difficult. This report proposes a new dietary diversity index based on quantitative distribution of consumed foods to allow objective measurement of dietary diversity. METHODS: A Quantitative Index for Dietary Diversity (QUANTIDD) is proposed: QUANTIDD=(1-summation operatorjn prop[j]2)/(1-1/n), where prop(j) is the proportion of food group(s) j that contributes to total energy or nutrient intake, n is the number of food groups, and j = 1,2,...,n. The numerator is the probability that the two foods taken out of an aggregation of consumed foods belong to different food groups. The denominator is its maximum value. The index ranges from 0 to 1. By using the officially released average data from the National Nutrition Survey in Japan from 1957 to 2000, we investigated annual changes in the QUANTIDD. We also investigated the distribution of the index by using individual data from the National Nutrition Survey in Japan in 1996. RESULTS: The QUANTIDD increased from the 1960s to the 1970s. This was the era of rapid economic growth in Japan, during which the dietary habits of the Japanese underwent rapid changes. The distribution of the QUANTIDD was skewed to the left, but logit-transformation decreased this asymmetry and made it similar to a normal distribution. CONCLUSION: Because this index can measure dietary diversity objectively and is suitable for statistical handling, it is useful as a method to compare dietary patterns across different populations or time points. Publication Types: •

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

PMID: 16500555 [PubMed - indexed for MEDLINE] 647: Hong Kong Med J. 2006 Feb;12(1):47-55. Related Articles, Links

Domestic health expenditure in Hong Kong: 1989/90 to 2001/02. Leung GM, Tin KY, Yeung RY, Rannan-Eliya R, Leung ES, Lam DW, Lo SV. Department of Community Medicine and School of Public Health, The University of Hong Kong, Pokfulam Road, Hong Kong. [email protected] OBJECTIVE: To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. METHODS: The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. RESULTS: Total domestic health expenditure was $68,620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. CONCLUSION: These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies. PMID: 16495589 [PubMed - indexed for MEDLINE] 648: Comput Biol Med. 2007 Feb;37(2):206-13. Epub 2006 Feb 21. Related Articles, Links

Using Healthcare IC Cards to manage the drug doses of chronic disease patients.

Lai JT, Hou TW, Yeh CL, Chao CM. National Cheng Kung University, Engineering Science, No. 1 Ta-Hsueh Road, Tainan 701, Taiwan. [email protected] In Taiwan's medical system, the Healthcare IC Card is used as form of secure data storage. This research applies the Healthcare IC Card to record the chronic disease patient's recent drug doses, diagnoses and prescriptions. With the Hospital Information System, this research combines the diagnosis records stored in the Healthcare IC Card to establish a platform which could simulate the procedures of a doctor in examining a patient and checking the circumstances of the patient's repetitive drug doses and drugs interactions. The experiment is based on a data log of about 22,000 items of drug prescribed to 43 diabetes patients and about 88,200 items to 192 high blood pressure patients. The results show that the proposed approach would have reduced the waste of medical resources, strengthened Taiwan's medical system and increased the public's health. Publication Types: •

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

PMID: 16494858 [PubMed - indexed for MEDLINE] 649: Health Care Manage Rev. 2006 Jan-Mar;31(1):11-7. Related Articles, Links

Negotiating time scripts during implementation of an electronic medical record. Bar-Lev S, Harrison MI. Department of Sociology and Anthropology, Bar-Ilan University, Ramat Gan, Israel. [email protected] Practitioners renegotiated time use requirements in an electronic medical record (EMR), thereby improving fit between health information technology (HIT) and clinical practices. The study contains important implications for managing HIT implementation. PMID: 16493268 [PubMed - indexed for MEDLINE] 650: J Occup Health. 2006 Jan;48(1):62-4.

Related Articles,

Links

Relationships between effort-reward imbalance, over-commitment, and fatigue in Japanese information-technology workers. Takaki J, Nakao M, Karita K, Nishikitani M, Yano E. Department of Hygiene and Public Health, Teikyo University School of Medicine, Kaga, Tokyo, Japan. [email protected] PMID: 16484764 [PubMed - indexed for MEDLINE] 651: Int J Med Inform. 2006 Oct-Nov;75(10-11):764-70. Epub 2006 Feb 17. Related Articles, Links

Electronic healthcare communications in Vietnam in 2004. Trân VA, Seldon HL, Hoàng DC, Nguyên KP. Biomedical Electronics Center, Hanoi University Technology, 1 Dai Co Viet Road, Hanoi, Vietnam. BACKGROUND: There is a lack of literature about health information systems (HIS) in "developing" countries, including Vietnam. However, computerization and network development are proceeding in these places, although not in a systematic, transparent way. OBJECTIVE: This is a preliminary overview of HIS's and healthcare communications in Vietnam's four-tiered public healthcare system. It is to indicate the direction that nation might take in order to establish a modern, standards-compliant, national HIS. METHODS: We conducted site visits and interviews in Hanoi and nearby provinces. Additional information was derived from publications of the Vietnamese government and the United Nations. RESULTS: Many of the top-level "central" hospitals have HIS's, although their quality and daily usage varies. Fewer provincial hospitals have networks; district hospitals have a few stand-alone computers, and commune health centers have no computers. Patients often go directly to higher-level providers, due to a widely held perception of better care at such sites. Communications among healthcare units are largely on paper, consisting mostly of administrative matters and some hand-written patient referrals. Telephones are used for discussions of specific matters. Internet connections are almost all dial-up and often belong to individual staff members rather than the healthcare units. Lower-level units derive much of their general medical information from television and newspapers. However, there is considerable interest in computerization among healthcare workers at all levels. CONCLUSION: Familiarization with computerized communications, i.e., training and hardware at all healthcare levels, must be the first step towards a

modern healthcare communications network in Vietnam. The skills to do this already exist. The aim of such a network must be to raise the level of information and quality of care at the lower levels. Adherence to international standards, such as HL7, from the beginning would enable the country to bypass many years of haphazard development. PMID: 16483837 [PubMed - indexed for MEDLINE] 652: J Clin Pharm Ther. 2006 Feb;31(1):73-82. Related Articles, Links

Trends in the use of oral antidiabetic drugs by outpatients in Taiwan: 1997-2003. Chiang CW, Chiu HF, Chen CY, Wu HL, Yang CY. Graduate Institute of Pharmaceutical Science, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan. OBJECTIVE: To define the prescribing patterns of oral antidiabetic drugs (OADs) in Taiwan over a 7-year period (1997-2003) and to critically comment on changes observed. METHODS: A cross-sectional study design was implemented using data from Taiwan's National Health Insurance Research Database between January 1997 and December 2003. Outpatients who were 18 years or older and had at least an OAD claim during the study period were identified. The unit of analysis was each OAD prescription for diabetic outpatient visits. The prescribing trends were described in terms of annual changes in prescribing rates and patterns. RESULTS: The numbers of OAD prescriptions rose 1.23-fold. The sulfonylurea (SU) class was the most commonly used OAD, but the prescribing rates for this class declined over time. The biguanide (BG) class was the second most frequently prescribed OAD class and its prescribing rate initially increased, peaked in 2000, and then substantially decreased. The largest increase in prescribing was for acarbose use. The prescribing rates of two new classes of OAD, meglitinide (MG) and thiazolidinedione (TZD), also significantly increased within a short period of time. A trend towards combination therapy was observed away from monotherapy. The SU class was the most commonly prescribed as monotherapy. SU plus BG was the most commonly prescribed dual therapy. Triple oral therapy showed a significant ninefold increase. CONCLUSION: The prescribing rates of OADs are shifting from the older OADs (i.e. SUs) to newer OADs [i.e. alpha-glucosidase inhibitor (AGI), MGs, and TZDs]. The prescribing patterns of OADs are moving toward combination therapy, especially triple oral therapy. Publication Types:

•

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

PMID: 16476123 [PubMed - indexed for MEDLINE] 653: Int J Tuberc Lung Dis. 2005 Dec;9(12):1398-402. Related Articles, Links

Bovine tuberculosis in Burdur, southern Turkey: epidemiological, pathological and economic study. Ozmen O, Kurşun O, Ozcelik M. Department of Pathology, Faculty of Veterinary Medicine, University of Akdeniz, Burdur, Turkey. [email protected] SETTINGS: Burdur is the most important dairy cattle breeding and milk production area of Turkey, and Burdur slaughterhouse is one of the biggest slaughterhouses in the southern part of the country. No scientific information is available on the prevalence of tuberculosis (TB) in cattle in Burdur. A survey was therefore undertaken to determine the prevalence of disseminated TB infection in cattle in this district. OBJECTIVES: To implement a disease monitoring system in Burdur slaughterhouse to estimate the annual prevalence of disseminated TB in cattle slaughtered and inspected in 2003-2004. DESIGN: Epidemiological survey. RESULTS: Prevalence of bovine TB was investigated in Burdur slaughterhouse from January 2003 to December 2004. All of the affected animals were Holstein breed. The prevalence of disseminated TB in all slaughtered cattle was 0.38% in this period. The value of the condemned meat and organs was calculated to establish economic loss. CONCLUSION: Despite a strict eradication programme, bovine TB is still an important health issue among cattle and remains one of the greatest threats to cattle and human health in southern Turkey. Veterinarians and cattle producers in this region are encouraged to develop and work on herd plans aimed at controlling and eradicating TB. Publication Types: •

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

PMID: 16466064 [PubMed - indexed for MEDLINE] 654: J Hepatobiliary Pancreat Surg. 2006;13(1):2-6. Related Articles, Links

JPN Guidelines for the management of acute pancreatitis: cuttingedge information. Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Kimura Y, Takeda K, Isaji S, Koizumi M, Otsuki M, Matsuno S; JPN. Department of Surgery, Teikyo University School of Medicine, Itabashi-Ku, Tokyo 173-8605, Japan. The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countries. The quality of the evidence was evaluated by the evidence-based classification method used at the Cochrane Library. The levels of recommendation of the individual management methods contained in the Guidelines were determined on the basis of the evaluation of evidence by the consensus of the members of the Working Group (see below). The Japanese Society for Abdominal Emergency Medicine, the Japan Pancreas Society, and the Research Group for Intractable Diseases and Refractory Pancreatic Diseases (which is sponsored by the Japanese Ministry of Health, Labour, and Welfare) were commissioned to produce the JPN Guidelines for the Management of Acute Pancreatitis. A Working Group of 20 physicians specializing in pancreatic diseases and emergency medicine investigated and analyzed 14821 cases retrieved by means of a Medline (1960-2004) search and discussed the available literature on acute pancreatitis (limited to human pancreatitis). The Working Group held many general discussions in order to reach a consensus on the content of the Guidelines. After producing a draft, the Publishing Committee of the JPN Guidelines for the Management of Acute Pancreatitis posted it on a website and asked for comments and criticisms. Subsequently, a final version of the Guidelines was published in Japanese in 2003. The Publishing Committee is now making the Guidelines available to a much wider readership by bringing out an English version. Publication Types: •

Practice Guideline

PMID: 16463205 [PubMed - indexed for MEDLINE]

655: Bull World Health Organ. 2005 Dec;83(12):928-34. Epub 2006 Jan 30. Related Articles, Links

Global surveillance for chemical incidents of international public health concern. Olowokure B, Pooransingh S, Tempowski J, Palmer S, Meredith T. Health Protection Agency Regional Surveillance Unit (West Midlands), Regional Epidemiology Unit, Heartlands Hospital, Birmingham, England. [email protected] OBJECTIVE: In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority. WHO is working towards this objective by developing a surveillance and response system for chemical incidents. This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003. METHODS: Acute chemical incidents were actively identified through several informal (e.g. Internet-based resources) and formal (e.g. various networks of organizations) sources and assessed against criteria for public health emergencies of international concern using the then proposed revised International Health Regulations (IHR). WHO regional and country offices were contacted to obtain additional information regarding identified incidents. FINDINGS: Altogether, 35 chemical incidents from 26 countries met one or more of the IHR criteria. The WHO European Region accounted for 43% (15/35) of reports. The WHO Regions for Africa, Eastern Mediterranean and Western Pacific each accounted for 14% (5/35); South-East Asia and the Americas accounted for 9% (3/35) and 6% (2/35), respectively. Twenty-three (66%) events were identified within 24 hours of their occurrence. CONCLUSION: To our knowledge this is the first global surveillance system for chemical incidents of potential international concern. Limitations such as geographical and language bias associated with the current system are being addressed. Nevertheless, the system has shown that it can provide early detection of important events, as well as information on the magnitude and geographical distribution of such incidents. It can therefore contribute to improving global public health preparedness. Publication Types: •

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

PMID: 16462985 [PubMed - indexed for MEDLINE]

656: Bull World Health Organ. 2005 Dec;83(12):913-9. Epub 2006 Jan 30. Related Articles, Links

Mapping the global distribution of trachoma. Polack S, Brooker S, Kuper H, Mariotti S, Mabey D, Foster A. Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, England. [email protected] OBJECTIVE: We aimed to summarize and map the existing global populationbased data on active trachoma and trichiasis. Detailed distribution maps of various infectious diseases have proved a valuable tool in their control. Such maps play an important role in assessing the magnitude of the problem, defining priority areas for control, monitoring changes, and advocacy. Until now, information on trachoma prevalence at within country levels has not been systematically collated, analysed and reported. METHODS: We gathered the last 18 years' worth of reported data on active trachoma in children aged less than 10 years, and the last 25 years of reported trichiasis in adults aged 15 years and over from 139 population-based surveys in 33 countries. We collated these data into one database using the "district" (second administrative level) as the standard unit of reporting. We used Geographical Information Systems as a database and cartographic tool to generate a global map of the prevalence of trachoma and trichiasis. FINDINGS: We obtained data on active trachoma and trichiasis from 18 countries in the WHO African Region, 6 in the Eastern Mediterranean Region, 3 in the South-East Asia Region, 3 in the Western Pacific Region and 2 in the Region of the Americas. In 23 countries suspected of having endemic trachoma no reliable district-level population-based data were available. In China and India, data were limited to a few districts. The data highlighted important regional differences and marked national variations in prevalence of active trachoma and trichiasis. CONCLUSION: This is the first attempt to summarize and map the existing population-based data on active trachoma and trichiasis. The lack of data in many countries remains an important obstacle to trachoma control efforts. Publication Types: •

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

PMID: 16462983 [PubMed - indexed for MEDLINE] 657: Nippon Koshu Eisei Zasshi. 2005 Dec;52(12):1009-20. Related Articles, Links

[Chronological analysis of individually linked data for patients with intractable disease receiving public financial aid for treatment] [Article in Japanese] Shibazaki S, Nagai M, Fuchigami H, Nishina M, Ohta A, Kawamura T, Ohno Y. Department of Public Health, Saitama Medical School. PURPOSE: Nationwide surveys of intractable disease patients receiving public financial aid for treatment were performed by Research Committee for Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) 4 times in the past, in 1984, 1988, 1992 and 1997. The purpose of the present study was to clarify the features of continuance with intractable disease patients receiving public financial aid for treatment. METHODS: Individual information collected by each nationwide survey was linked using the disease, the residence, the sex, and the birth date. The proportion of intractable disease patients according to receipt duration, kind of medical insurance, sex and age was calculated with reference to the disease and an estimation of the receipt persistence rate was calculated for every year. Moreover, in consideration of variation in the data, average receipt persistence rates over years were also calculated. RESULTS: According to observation on individual patient's follow up, the proportion for which financial aid was discontinued within four years was 25%, while 70% continued receiving aid for at least four years and some 55% for eight or nine years. The proportion of those who continue receiving support longterm is high about the so-called autoimmune diseases, such as systemic lupus erythematosus, Behçet's disease, and the aortic syndrome. In contrast, with diseases having a poor prognosis, such as fulminant hepatitis, amyloidosis, and amyotrophic lateral sclerosis, periods of continuance are short. The proportion needing long-term continuation is higher in women than in men, especially with diseases which have long been eligible for support. However, with diseases for which receipt was started recently, there is a tendency for persistence to be higher in men than in women. CONCLUSION: With reform of insurance systems, including the medical system for intractable diseases, it is predicted that receipt continuation will change with alteration of social factors, and it is necessary to monitor receipt continuation carefully from now on. Publication Types: •

English Abstract

PMID: 16457195 [PubMed - indexed for MEDLINE]

658: J Pak Med Assoc. 2006 Jan;56(1):13-6. Related Articles, Links

Morbidity pattern and utilization of a primary health care center in a low socioeconomic area of Karachi. Anjum Q, Alam E, Rizvi R, Usman J, Shaikh S, Ahmed Y. Department of Family Medicine, Ziauddin Medical University, Karachi. OBJECTIVE: To identify the morbidity pattern according to age, gender and seasonal variation using the ICD coding and the utilization of Primary Health Care (PHC) center services in a demographically defined community. METHODS: The data collected from 2001-2003 was analyzed using the International Classification of Diseases-10 (ICD-10) coding for identifying the morbidity patterns presenting at the PHC Center. The age and gender distribution of the patients and the seasonal variation of few diseases were noted. Only the residents of the area visiting the center for preventive or curative services were included. A structured performa was designed to enter the age, gender, disease and ICD codes. The faculty was trained for using the coding system. RESULTS: A total of 13,519 patients visited the PHC during three-year period. On an average, 376 patients were seen during a month with male to female ratio of 1:2. The most common diseases presented belong to the respiratory system, followed by infections or parasitic infestations and diseases of the reproductive system. The women presented for first visit of antenatal check up were 960 out of 4614 women of reproductive age group. Among the adult population, 391 (6%) presented with hypertension, 64 (1%) were Type 2 diabetics and 86 (1.3%) were asthmatics. The paediatric population analysis showed that 918 (13%) had upper respiratory infections and 1339 (19%) had diarrhoea. CONCLUSION: Problem oriented medical records from health centers, computerized in a uniform standardized way, can give extensive information about the content and burden of health problems in family practice and presumably public health. Publication Types: •

Comparative Study

PMID: 16454128 [PubMed - indexed for MEDLINE] 659: Int J Dent Hyg. 2003 May;1(2):89-97. Related Articles, Links

Dental hygienists in Korea.

Kim SH. Hanseo University, Department of Dental Hygiene 360 Daegok-Ri, Haemi-Myun, Seosan-Si, Chungnam, Republic of Korea 356-706. [email protected] The purpose of this paper is to give basic information about the status of dental hygienists in Korea. This paper examines the changing process of the dental hygiene education system in Korea, from its start in 1965 until the present, 2003, the composition of dental personnel in Korea, the specialised areas and roles of dental hygienists after they receive their licenses, employment of dental hygienists, dental hygiene-related organisations, and the status and direction of dental hygienists in Korea. This paper shows the organisational, educational, governmental and individual efforts to increase the level of professionalism, education and quality of care delivered to Korean citizens nationwide. PMID: 16451528 [PubMed - indexed for MEDLINE] 660: Int J Dent Hyg. 2004 Nov;2(4):179-84. Related Articles, Links

Dental hygiene education in Japan: present status and future directions. Yoshida N, Endo K, Komaki M. School of Oral Health Care Science, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan. [email protected] The aim of this report is to provide basic information about the historical development, current status and future needs of education and training of dental hygienists in Japan. The first formal training of dental hygienists in Japan started at Tokyo in 1949. Restructure and modification of the dental hygiene education system has been reiterated over the years in order to satisfy the needs of the constantly changing society. Although previously only vocational training was provided for dental hygienists, higher-level education has been conducted. The present legislation of dental hygiene has gone through a complicated process. The student should take the dental hygienist licensing examination which is held once a year by the National Board organized by the Ministry of Health, Labour and Welfare. Currently there are 136 dental hygiene schools and the total enrolment is about 7000. The duration of dental hygiene education course has been prolonged from 2 to 3 years since 2001. In 2004, the 4-year course started. The 2-year dental hygiene education program is expected to be replaced with the 3- and 4-year courses by 2010. The dental hygiene education system in Japan will be improved in many ways as dental hygienists are expected to participate in health promotion

and preventive care, and to gain knowledge of the economics and organization of health care in relation to oral hygiene. PMID: 16451493 [PubMed - indexed for MEDLINE] 661: East Mediterr Health J. 2003 Sep-Nov;9(5-6):1019-25. Related Articles, Links Erratum in: •

East Mediterr Health J. 2005 Sep-Nov;11(5-6):887.

Knowledge of and attitudes towards family planning by male teachers in the Islamic Republic of Iran. Tavakoli R, Rashidi-Jahan H. Health Education Department, Faculty of Health, Baghyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran. A cross-sectional study was carried out on knowledge of and attitudes to family planning in male teachers working in the education system in Teheran. We found that 65% of the study population had acceptable knowledge regarding the issue. More than 95% of respondents reported having a favourable attitude towards the implementation of family planning programmes and about 90% believed that decision-making regarding use of contraceptives should be a joint process. To improve the planning and administration of family planning programmes, the main variables identified in this study should be further investigated in different population groups. Addressing men in family planning programmes may improve their success and lead to increased contraceptive use. PMID: 16450532 [PubMed - indexed for MEDLINE] 662: Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(4):380-3. Related Articles, Links

Effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health. Dhital AD, Badhu BP, Paudel RK, Uprety DK. Department of Community Health Nursing, College of Nursing, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. [email protected]

INTRODUCTION: Development of knowledge and attitude takes place during the adolescent period, which can have lifelong effects on the individual, family and society. Proper education in this age group is important for prevention of untoward social and health related problems. OBJECTIVE: To find out the effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health. MATERIALS AND METHODS: An experimental study with pretest - posttest control group design was carried out in four selected schools with similar settings in Dharan town of Nepal. All the subjects were divided into two groups: experimental and control, each comprising of two subgroups of 50 boys and 50 girls. Structured teaching program consisting of information on human reproductive system was used as a tool of investigation for the experimental group, whereas conventional teaching method was used for the control group. RESULTS: A total of 200 Adolescent school students were included in this study. The mean (+/-SD) pretest score of the experimental group on knowledge of reproductive health was 39.83 (+/- 16.89) and of the control group was 39.47(+/- 0.08). The same of experimental group after administration of the structured teaching program (84.60+/-10.60) and of the control group with conventional teaching method (43.93+/-10.08) was statistically significant (p<0.001). Similarly, the post-test scores of knowledge of the groups on responsible sexual behaviour and their attitude towards reproductive health were better in the experimental group than in the control group (p<0.001). CONCLUSION: The knowledge of adolescent school students on reproductive health is inadequate. The use of structured teaching program is effective in improving knowledge and attitude of the adolescents on reproductive health. PMID: 16449840 [PubMed - indexed for MEDLINE] 663: Rinsho Byori. 2005 Dec;53(12):1116-21. Related Articles, Links

[Present conditions and future prospects of the at-home examination system] [Article in Japanese] Uedai M, Kasugai T, Miyake C, Tsuki S. Japan Medical Institute of Studies, Minato-ku, Tokyo 108-0023. It became say the preventive times than a treatment now. We did "the remoteness examination" that it was at home possible for from 1986 while the making of consciousness to "follow one's health by oneself' was demanded. I begin colon cancer examination, and now an examination item menu extends to 58 kinds. Remoteness examination is inspection and a support system of the making of health to assume medical call center a nucleus of 24 hours. Such a system

described the times setting which became necessary and gathered up a role of the at-home examination system which aimed at cancer and a lifestyle-related disease and early discovery and a review of a habit and significance, the future prospects about a problem. Publication Types: • •

English Abstract Review

PMID: 16447683 [PubMed - indexed for MEDLINE] 664: Shokuhin Eiseigaku Zasshi. 2005 Dec;46(6):305-18. Related Articles, Links

[Study of pesticide residues in agricultural products for the "Positive List" system] [Article in Japanese] Akiyama Y, Yoshioka N, Ichihashi K. Hyogo Prefectural Institute of Public Health and Environmental Sciences, 2-1-29, Arata-cho, Hyogo-ku, Kobe 652-0032, Japan. During a 3-year monitoring survey (April 2002-March 2005) of pesticide residues in agricultural products, 592 samples (324 domestic; 268 imported) collected in Hyogo prefecture, Japan were analyzed. The number of pesticides tested increased from 232 in FY 2002 to 323 in FY 2004. The purpose of the study was to clarify the residue status by accumulating information about pesticides detected frequently, to allow effective and efficient regulation under the new "Positive List" legislation to be implemented in FY 2006. Overall, 47% of domestic and 61% of imported samples contained detectable residues and ca. 60% of positive samples contained multiple residues. The limit of quantitation was set at 0.01 microg/g and the limit of detection was 0.001-0.003 microg/ g. Most of the residues were present at low concentrations: 80% of the detections in samples excluding imported citrus fruits were < 0.05 microg/g. More than 5 different pesticides (> 0.01 microg/g) were detected simultaneously in 13 samples. The sum of the ratios of residues to MRLs was calculated as one of the indexes to represent the risk of multiple residues, and they exceeded 100% in 3 imported frozen vegetables; baby kidney bean, spinach, Welsh onion. Samples in violation of the Food Sanitation Law were not found in our survey, but 1.9% of the samples might be in conflict with the new "Positive List" legislation. Publication Types:

•

English Abstract

PMID: 16440795 [PubMed - indexed for MEDLINE] 665: Mil Med. 2005 Oct;170(10):836-40. Related Articles, Links

Linkage between the Israeli Defense Forces primary care physician demographics and usage of secondary medical services and laboratory tests. Levy I, Goldberg A, Vinker S, Shvarts S. Healthcare Management, Ben-Gurion University of the Negev, Bear Sheva, Israel. BACKGROUND: The primary care physicians in the Israeli Defense Forces, as in the Israeli civilian health system, have two major subpopulations. Graduates of Israeli schools of medicine, and graduates of foreign medical schools, most of them in Eastern Europe. OBJECTIVE: To evaluate differences in the referral patterns of primary care physicians according to their graduation institution and demographic characteristics. METHODS: The study took place in one primary care practice in central Israel. The referrals to consultations and laboratory tests over a period of 1 year were evaluated. Physicians that had less than 37 encounters were excluded from the study. Data were extracted from the central computerized databases of the Medical Corps and Israeli Defense Forces. RESULTS: Sixty-eight physicians had a total of 18,402 encounters that resulted in 23,845 outcomes. There were no associations between demographic and training backgrounds of the physicians and their actual referral rates to consultations and laboratory tests. CONCLUSION: The background data of the primary care physicians does not predict their referral patterns and their role as "gate keepers". PMID: 16435754 [PubMed - indexed for MEDLINE] 666: Natl Med J India. 2005 Sep-Oct;18(5):259-62. Related Articles, Links

Methodological issues in setting up a surveillance system for birth defects in India. Suresh S, Thangavel G, Sujatha J, Indrani S. Fetal Care Research Foundation, 203, Avvai Shanmugam Salai, Royapettah,

Chennai 600014, Tamil Nadu. India is undergoing an epidemiological transition--communicable diseases are on the decline due to better living conditions and healthcare delivery. On the other hand, the relative increase in the prevalence of non-communicable, chronic and genetic diseases threatens to be a public health problem in India. One such group of disorders is congenital malformations. Though several studies have been done on congenital malformations in India since the early 1960s, coinciding with the thalidomide tragedy in the West, no uniform methods are available for the surveillance of birth defects. Each study has come out with varying results, not only because of the geographic variation in birth defects but also due to the varying standards adopted by each study in data collection, case definition and other methodological issues. Setting up a mechanism to understand the extent and nature of birth defects would involve the creation of a birth defects registry. The goals and objectives of such a registry should be formulated before it is set up. There are three types of registries-descriptive, analytical and preventive. These can also be classified as population- or hospital-based. Whether a registry is population- or hospital-based depends largely on the movement of mothers for delivery, registration of vital events in an area defined by the programme, as well as the resources available to the registry. Data can be collected in a passive or active manner, which also depends on the resources available to the registry. Every registry should have its own working definition of eligible cases to be reported, depending on the diagnostic services available in that area, and multiple sources of information should be used to improve the ascertainment rate. All the diagnostic terms should be coded and the information collected should be stored in a well-constructed database, preferably a relational type. Registries must evaluate their methods of data collection periodically to estimate the number of false-positive and false-negative reports. Ethical issues, cost and funding for the employment of various specialized professionals should be considered before setting up a registry. PMID: 16433142 [PubMed - indexed for MEDLINE] 667: Int J Paediatr Dent. 2006 Mar;16(2):81-8. Related Articles, Links

A sociodental approach to assessing dental needs of children: concept and models. Gherunpong S, Tsakos G, Sheiham A. Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, UK. OBJECTIVES: Traditional normative methods of assessing dental needs do not

correspond to current concepts of 'health' and 'need'. Although there is dental research on quality of life, evidence-based practice, and oral behaviours, those concepts are rarely applied to dental needs estimation. Dental needs are usually calculated mainly from clinical data and are likely to be inaccurate. A structured comprehensive method for assessing dental needs is required. The objectives of this study are to develop and test a new sociodental system of needs assessment for overall dental needs of primary schoolchildren. Furthermore, normative and sociodental estimates of need are compared. DESIGN: The study developed a theoretical framework and pathway algorithms of sociodental needs assessment and applied them to assessing overall dental needs. Normative dental needs were assessed using standard normative criteria. The child oral impacts on daily performances (Child-OIDP) was used to assess oral impacts, and a selfadministered questionnaire was used to obtain information on demographic variables and oral behaviours. Data were analysed according to the developed algorithms. SETTING: A cross-sectional survey in Suphanburi Province, Thailand. PARTICIPANTS: All 1,126 children aged 11-12 years in a town. MAIN RESULTS: The sociodental approach was acceptable and not costly. In all, 54.4% had normative need under the dental needs model for life-threatening and progressive conditions, but only 16.6% had high propensity-related need; the remaining 37.8% would require dental health education or oral health promotion (DHE/OHP) or both and appropriately adjusted clinical interventions. Under the basic model of dental needs, 45.1% had normative need. Two-thirds of them (30.9%) had impact-related need and the remaining 14.2% did not have oral impacts and therefore should only receive dental health education. Only one-third of those with impact-related need had high propensity and were suitable for evidence-based conventional treatments; the remaining two-thirds should receive DHE/OHP and alternative clinical interventions. CONCLUSIONS: A sociodental system of dental needs assessment was developed and tested on school children. It decreased the estimates of conventionally assessed dental treatment needs and introduced a broader approach to care. PMID: 16430521 [PubMed - indexed for MEDLINE] 668: Eur J Cardiovasc Nurs. 2006 Dec;5(4):311-6. Epub 2006 Jan 19. Related Articles, Links

Patients' knowledge regarding medication therapy and the association with health services utilization. Toren O, Kerzman H, Koren N, Baron-Epel O. Chaim Sheba Medical Center, Nursing Division, Tel Hashomer, 52621 Tel Hashomer, Israel. [email protected] BACKGROUND: Upon discharge from the hospital, patients are significantly

deficient in their knowledge of their medications. Provision of information has been shown to have an effect on health measures such as compliance to medication therapy, quality of life, and utilization of hospitalization services. AIMS: To assess patients' knowledge about their long term medication therapy and to measure the association between knowledge and health service utilization in the community. METHODS: A prospective study was performed, with home telephone interviews conducted 1 week and 1 month after discharge. The study population included 130 patients discharged to the community with new prescriptions for long term medications. RESULTS AND CONCLUSIONS: About 60% of the patients reported receiving no counseling regarding their new medication. About 30% utilized 3 or more types of service (family physician, specialist, nurse, etc.). Eighteen percent (18%) visited the ER during the month after discharge, of whom 35% visited twice or more. Higher levels of patient knowledge predicted higher levels of health services utilization (OR=4.76 95% CI: 1.74-13.06). The younger patients tended to utilize a larger variety of health services compared to the older patients (OR 0.32 95% CI: 0.13-0.79). The results of this study provide that patients with higher levels of knowledge utilized the health care system more often, perhaps indicating greater awareness and self care. PMID: 16427361 [PubMed - indexed for MEDLINE] 669: Int J Health Geogr. 2006 Jan 18;5:6. Related Articles, Links

Web GIS in practice IV: publishing your health maps and connecting to remote WMS sources using the Open Source UMN MapServer and DM Solutions MapLab. Boulos MN, Honda K. Open Source Web GIS software systems have reached a stage of maturity, sophistication, robustness and stability, and usability and user friendliness rivalling that of commercial, proprietary GIS and Web GIS server products. The Open Source Web GIS community is also actively embracing OGC (Open Geospatial Consortium) standards, including WMS (Web Map Service). WMS enables the creation of Web maps that have layers coming from multiple different remote servers/sources. In this article we present one easy to implement Web GIS server solution that is based on the Open Source University of Minnesota (UMN) MapServer. By following the accompanying step-by-step tutorial instructions, interested readers running mainstream Microsoft(R) Windows machines and with no prior technical experience in Web GIS or Internet map servers will be able to publish their own health maps on the Web and add to those maps additional layers retrieved from remote WMS servers. The 'digital Asia' and 2004 Indian Ocean tsunami experiences in using free Open Source Web GIS software are also briefly described.

Publication Types: •

Editorial

PMID: 16420699 [PubMed - indexed for MEDLINE] PMCID: PMC1352347

670: Int J Health Geogr. 2006 Jan 17;5:3. Related Articles, Links

Defining localities of inadequate treatment for childhood asthma: a GIS approach. Peled R, Reuveni H, Pliskin JS, Benenson I, Hatna E, Tal A. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. [email protected] BACKGROUND: The use of Geographic Information Systems (GIS) has great potential for the management of chronic disease and the analysis of clinical and administrative health care data. Asthma is a chronic disease associated with substantial morbidity, mortality, and health care use. Epidemiologic data from all over the world show an increasing prevalence of asthma morbidity and mortality despite the availability of effective treatment. These facts led to the emergence of strategies developed to improve the quality of asthma care. THE OBJECTIVE: To develop an efficient tool for quality assurance and chronic disease management using a Geographic Information System (GIS). GEOGRAPHIC LOCATION: The southern region of Israel. January 1998 - October 2000. DATABASES: Administrative claims data of the largest HMO in Israel: drug dispensing registry, demographic data, Emergency Room visits, and hospitalization data bases. METHODS: We created a list of six markers for inadequate pharmaceutical treatment of childhood asthma from the Israeli clinical guidelines. We used this list to search the drug dispensing registry to identify asthmatic children who received inadequate treatment and to assess their health care utilization and bad outcomes: emergency room visits and hospitalizations. Using GIS we created thematic maps on which we located the clinics with a high percentage of children for whom the treatment provided was not in adherence with the clinical guidelines. RESULTS: 81% of the children were found to have at least one marker for inadequate treatment; 17.5% were found to have more than one marker. Children with markers were found to have statistically significant higher rates of Emergency Room visits, hospitalizations and longer length of stay in

hospital compared with children without markers. The maps show in a robust way which clinics provided treatment not in accord with the clinical guidelines. Those clinics have high rates of Emergency Room visits, hospitalizations and length of stay. CONCLUSION: Integration of clinical guidelines, administrative data and GIS can create an efficient interface between administrative and clinical information. This tool can be used for allocating sites for quality assurance interventions. Publication Types: •

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

PMID: 16417626 [PubMed - indexed for MEDLINE] PMCID: PMC1363718

671: Nippon Koshu Eisei Zasshi. 2005 Nov;52(11):943-56. Related Articles, Links

Competence necessary for Japanese public health center directors in responding to public health emergencies. Tachibanai T, Takemura S, Sone T, Segami K, Kato N. Department of Public Health Administration and Policy, National Institute of Public Health, Saitama, Japan. [email protected] OBJECTIVE: To clarify the "competencies" required of public health center directors in "public health emergency responses." METHODS: We selected as our subjects six major public health emergencies in Japan that accorded with a definition of a "health crisis." Their types were: (1) natural disaster; (2) exposure to toxic substances caused by individuals; (3) food poisoning; and (4) accidental hospital infection. Item analysis was conducted using the Incident Analysis Method, based on the "Medical SAFER Technique." RESULTS: The competencies of public health center directors required the following actions: (1) to estimate the impact on local health from the "first notification" of the occurrence and the "initial investigation"; (2) to manage a thorough investigation of causes; (3) to manage organizations undertaking countermeasures; (4) to promptly provide precise information on countermeasures, etc.; and (5) to create systems enabling effective application of countermeasures against recurrence of incidents, and to achieve social consensus. CONCLUSION: For public health preparedness, public health center directors should have the following competencies: (1) the ability to estimate the "impact" of public health emergencies that have occurred or may occur; (2) be able to establish and carry

out proactive policies; (3) be persuasive; and (4) have organizational management skills. PMID: 16408479 [PubMed - indexed for MEDLINE] 672: Health Place. 2007 Mar;13(1):164-72. Epub 2006 Jan 9. Related Articles, Links

Responses of 6500 households to arsenic mitigation in Araihazar, Bangladesh. Opar A, Pfaff A, Seddique AA, Ahmed KM, Graziano JH, van Geen A. Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA. This study documents the response of 6500 rural households in a 25 km(2) area of Bangladesh to interventions intended to reduce their exposure to arsenic contained in well water. The interventions included public education, posting test results for arsenic on the wells, and installing 50 community wells. Sixty-five percent of respondents from the subset of 3410 unsafe wells changed their source of drinking water, often to new and untested wells. Only 15% of respondents from the subset of safe wells changed their source, indicating that health concerns motivated the changes. The geo-referenced data indicate that distance to the nearest safe well also influenced household responses. Publication Types: • •

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

PMID: 16406833 [PubMed - indexed for MEDLINE] 673: J Med Assoc Thai. 2005 Aug;88(8):1083-91. Related Articles, Links

Extra charge and extra length of postoperative stay attributable to surgical site infection in six selected operations. Kasatpibal N, Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S. Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand. [email protected]

BACKGROUND: Information concerning the economic impact of surgical site infection (SSI) is very rare in Thailand. As the national health care financial system has been changing, the need for such data is critical. OBJECTIVE: The purpose of this study is to estimate the extra charge and excess postoperative hospitalization attributable to SSI in six surgical operative procedures comprising appendectomy, herniorrhaphy, mastectomy, cholecystectomy, colectomy, and craniotomy. MATERIAL AND METHOD: The study population consisted of patients undergoing major operations admitted to Songklanagarind Hospital from January, 1998 to December, 2003. Data were prospectively collected to identify demographic data, surgical operations, development of SSI, and outcomes of SSI. The study used one-to-one matched-pair strategy to compare case (patient with SSI) and controls (patient without SSI). The matching criteria were same final diagnosis, same operative procedure, and same American Society of Anesthesiologists (ASA) score. Data were calculated for mean difference, median difference, and 95% confidence intervals (95% C.I) of hospital charge and postoperative stay. RESULTS: The study could identify 140 matched-pairs of case and control. When compared to matched controls, cases had higher hospital charge and greater postoperative length of stay. Mean of extra hospital charge attributable to SSI was 43,658 (95% C.I; 30,228-57,088) baht and mean of excess postoperative stay was 21.3 (95% C.I; 16.6-26.0) days. Median of extra expenditure was 31,140 (95% CI; 17,327-49,081) baht and median of prolongation of postoperative stay was 14 (95% C.I, 12-18) days. CONCLUSION: This study supports the findings of the previous published reports that patients who have SSI incur enormous excess cost and hospital stay. PMID: 16404836 [PubMed - indexed for MEDLINE] 674: BMC Bioinformatics. 2006 Jan 11;7:13. Related Articles, Links

Construction of a nasopharyngeal carcinoma 2D/MS repository with Open Source XML database--Xindice. Li F, Li M, Xiao Z, Zhang P, Li J, Chen Z. Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China. [email protected] BACKGROUND: Many proteomics initiatives require integration of all information with uniformcriteria from collection of samples and data display to publication of experimental results. The integration and exchanging of these data of different formats and structure imposes a great challenge to us. The XML technology presents a promise in handling this task due to its simplicity and flexibility. Nasopharyngeal carcinoma (NPC) is one of the most common cancers in southern China and Southeast Asia, which has marked geographic and racial

differences in incidence. Although there are some cancer proteome databases now, there is still no NPC proteome database. RESULTS: The raw NPC proteome experiment data were captured into one XML document with Human Proteome Markup Language (HUP-ML) editor and imported into native XML database Xindice. The 2D/MS repository of NPC proteome was constructed with Apache, PHP and Xindice to provide access to the database via Internet. On our website, two methods, keyword query and click query, were provided at the same time to access the entries of the NPC proteome database. CONCLUSION: Our 2D/MS repository can be used to share the raw NPC proteomics data that are generated from gel-based proteomics experiments. The database, as well as the PHP source codes for constructing users' own proteome repository, can be accessed at http://www.xyproteomics.org/. Publication Types: •

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

PMID: 16403238 [PubMed - indexed for MEDLINE] PMCID: PMC1351203

675: Harefuah. 2005 Dec;144(12):848-51, 910. Related Articles, Links

["Wise be aware of your sayings"--about gaps between epidemiological data base, experimental results and decision making in health administration] [Article in Hebrew] Hefer E. When scientific researches are being published one should consider carefully the different possible influences which may change the results. These influences may be of two kinds: Non-Causal explanations, and Casual explanations. Researchers may arrive at their results and not have considered all the causative explanations. Occams's Razor is the basic rule by which most reasonable explanations are chosen. A statistical result and an appropriate simple theory to explain it, is not sufficient to prove causative effect. In many cases though, the media and public tend to accept a statistically significant result as if it was a proven cause and effect relation. There are several conditional demands called Bradford Hill criteria of which epidemiological data and results are only one, the more results arrived by using the Bradford Hill criteria, the better chances exist that the examined variable is the cause for the effect. Finally, there is a gap between a proven causal

factor for disease or the harmful effects of treatment and a "clear cut" health policy. There are several intermediate powerful influences which are involved in the process of stating a new health policy. These influences include among others, the involvement of decision makers, political influences and civil service professionals. As an example three different issues of a well proven clinical research will be presented. The research of Rofecoxib = "Vioxx" cardiac effects, the research of Hormonal Replacement Treatment health effects on post menopausal women and the last of Health risks presented by mobile phone use. Although the results of those researches were proven to be statistically significant, Health Policy in each case is different and less clear. Health Policy is not based solely on figures and statistical results, but rather on a far wider and more complex influences and judgment. Publication Types: • •

Editorial English Abstract

PMID: 16400785 [PubMed - indexed for MEDLINE] 676: Indian J Dermatol Venereol Leprol. 2005 Jan-Feb;71(1):14-9. Related Articles, Links

Comparison of two systems of classification of leprosy based on number of skin lesions and number of body areas involved--a clinicopathological concordance study. Rao PN, Sujai S, Srinivas D, Lakshmi TS. Department of Dermatology, Osmania Medical College, Hyderabad, India. [email protected] BACKGROUND AND AIMS: WHO guidelines classify leprosy patients for therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy based on the number of skin lesions. An alternative system of classification has been in practice in Nepal from 1985 onwards, based on the number of body areas involved in patients of leprosy. We attempted a clinicopathological approach for comparison of these two systems of classification in leprosy patients for their ability to demarcate patients into groups of PB and MB leprosy. MATERIALS AND METHODS: The study included 108 leprosy patients (80 males and 28 females). Complete clinical examination and body charting was carried out in each patient noting the count of skin lesions and the number of body areas involved. Slit skin smears and skin biopsies were taken from an active skin lesion in all patients. RESULTS: On analysis, it was observed that there was good

clinicopathological correlation between patients with 5 or < 5 skin lesions and 2 or < 2 body areas involved. (Clinical 95% and histological 96%) A similar correlation was also observed in the other group of patients with > 5 skin lesions and > 2 body areas involved, (Clinical 94% and histological 96%). There were almost identical numbers of patients represented in these two groups of classification. CONCLUSIONS: Our findings suggest that patients with involvement of 2 or less body areas can be classified as PB leprosy and those with more than 2 body areas involved can be classified as MB leprosy for the purposes of therapy. The study of areas of involvement in leprosy patients not only provides additional patient information but also adds another parameter as a basis for the study of leprosy patients. Publication Types: •

Comparative Study

PMID: 16394354 [PubMed - indexed for MEDLINE] 677: Indian J Pediatr. 2005 Nov;72(11):919-23. Related Articles, Links

The 2001 dengue epidemic in Chennai. Kabilan L, Balasubramanian S, Keshava SM, Satyanarayana K. Centre for Research in Medical Entomology, Indian Council of Medical Research, Chennai, India. [email protected] Dengue is emerging as a serious public health problem in Tamil Nadu. The present surveillance system is unlikely to generate proper information on the epidemiology of the disease, which is essential for planning and development of relevant control/preventive measures against dengue. OBJECTIVE: Between November 2001 and January 2002, a descriptive study was undertaken on children with clinical dengue attending Kanchi Kamakoti Child Trust Hospital (KKCTH, a major private referral pediatric hospital in Tamil Nadu, India) to define the magnitude of dengue burden, the natural history of this disease in terms of clinical presentation, and outcome of the infections in hospitalized children (< 15) with clinical dengue. METHODS: The sera collected from patients analyzed for dengue specific IgM and IgG antibodies by IgM, IgG antibody capture enzyme linked immunosorbent assay (ELISA) using alternatively two commercial kits. World Health Organization clinical case definition was adopted to categorize the dengue confirmed children. RESULTS: Dengue was diagnosed in 74.5% (143) of the 192 hospitalized children with clinical dengue. A considerable proportion (20%) of the total dengue infections were constituted by infants less than 1 yr of age. DF [dengue fever], DHF [dengue hemorrhagic fever] and DSS

[dengue shock syndrome] were diagnosed in 65%, 11.2% and 23.8% of 143 dengue confirmed patients respectively. Though severe dengue (DSS + DHF) was present in 35% of the patients, the mortality rate was low during the study period due to timely diagnosis and clinical management of the patients. CONCLUSION: In developing countries like India, building of laboratory capacity for diagnosis and combat-mode ready preparedness for the management of dengue cases in emergency situation may reduce dengue-related mortality. This can be achieved in a wider scale through an integrated approach through the community, professionals and the public health departments. PMID: 16391444 [PubMed - indexed for MEDLINE] 678: Int J Health Geogr. 2006 Jan 3;5:1. Related Articles, Links

Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. Andersson N, Mitchell S. Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico. [email protected] Evaluation of mine risk education in Afghanistan used population weighted raster maps as an evaluation tool to assess mine education performance, coverage and costs. A stratified last-stage random cluster sample produced representative data on mine risk and exposure to education. Clusters were weighted by the population they represented, rather than the land area. A "friction surface" hooked the population weight into interpolation of cluster-specific indicators. The resulting population weighted raster contours offer a model of the population effects of landmine risks and risk education. Five indicator levels ordered the evidence from simple description of the population-weighted indicators (level 0), through risk analysis (levels 1-3) to modelling programme investment and local variations (level 4). Using graphic overlay techniques, it was possible to metamorphose the map, portraying the prediction of what might happen over time, based on the causality models developed in the epidemiological analysis. Based on a lattice of local site-specific predictions, each cluster being a small universe, the "average" prediction was immediately interpretable without losing the spatial complexity. Publication Types: •

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

PMID: 16390549 [PubMed - indexed for MEDLINE]

PMCID: PMC1352365

679: Am J Prev Med. 2005 Dec;29(5 Suppl 1):102-6. Related Articles, Links

Integrated population-based surveillance of noncommunicable diseases: the Pakistan model. Nishtar S, Bile KM, Ahmed A, Amjad S, Iqbal A. Heartfile, Islamabad, Pakistan. [email protected] The escalating burden of noncommunicable diseases (NCDs) worldwide warrants an urgent public health response. Resource constraints and other factors necessitate an integrated and concerted approach to the range of NCDs. A necessary prerequisite for effective planning, implementation, and evaluation of NCD prevention programs is access to reliable and timely information on mortality, morbidity, risk factors, and their socioeconomic determinants. However, there is limited experience in the setting up of integrated NCD surveillance models in low-resource settings. As part of the National Action Plan for the Prevention and Control of NCDs in Pakistan, an integrated, systematic, and sustainable population-based NCD surveillance system is being established, and will be maintained and expanded over time. This is a common population surveillance mechanism for all NCDs (with the exception of cancer). The model includes population surveillance of main risk factors that predict many NCDs and combines modules on population surveillance of injuries, mental health, and stroke. In addition, the model has been adapted for program evaluation; this will enable it to track implementation processes using appropriate indicators, facilitating an assessment of how interventions work and which components contribute most to success. This paper outlines the first activity in this sequential process, including its merits and limitations. PMID: 16389134 [PubMed - indexed for MEDLINE] 680: Kathmandu Univ Med J (KUMJ). 2003 Oct-Dec;1(4):297-304. Related Articles, Links

Health resources and Internet with reference to HealthNet Nepal. Pradhan MR. HealthNet, Nepal. [email protected]

Technologies with the ability to send information in a fast, efficient and cheap fashion, such as the Internet--can provide dramatic improvements in access to information, advice and care. This article discusses importance of Internet, applications of Internet in providing information services in the health field. The Internet was developed in western countries and the information flow is from North to South. But for decision making within a country, information generated within a country is needed. For this, an organization like HealthNet Nepal is developed. The article discusses the various services of HealthNet Nepal and discusses about its unique features as compared to commercial ISPs. Publication Types: •

Review

PMID: 16388275 [PubMed - indexed for MEDLINE] 681: J Postgrad Med. 2005 Oct-Dec;51(4):312-5. Related Articles, Links

Telemedicine: experience at SGPGIMS, Lucknow. Kapoor L, Mishra SK, Singh K. Telemedicine Centre and Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226 014, India. Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and teleeducational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation

(ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development. PMID: 16388175 [PubMed - indexed for MEDLINE] 682: IEEE Trans Inf Technol Biomed. 2005 Dec;9(4):502-7. Related Articles, Links

Prediction of care class by local additive reference to prototypical examples. Miyano T, Tsutsui T, Seki Y, Higashino S, Taniguchi H. Department of Micro System Technology, Ritsumeikan University, Shiga, Japan. [email protected] The public long-term care insurance program for the elderly in Japan set out in 2000 toward establishing a new system whereby citizens can be assured that they will receive care and be supported by the society as a whole. The insurance program includes computer-aided certification processes to estimate the needs for nursing care for clients. In this work, we show the applicability of an adaptive local nonlinear approximation method associated with the Japanese national database for automatic inference of the care class. Publication Types: •

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

PMID: 16379367 [PubMed - indexed for MEDLINE] 683: Jpn J Clin Oncol. 2005 Dec;35(12):758-9. Related Articles, Links

Comparison of breast cancer mortality in five countries: France, Italy, Japan, the UK and the USA from the WHO mortality database (1960-2000). Kawamura T, Sobue T. Statistics and Cancer Control Division, Research Center for Cancer Prevention and Screening, National Cancer Center.

Publication Types: •

Comparative Study

PMID: 16377739 [PubMed - indexed for MEDLINE] 684: J Telemed Telecare. 2005;11 Suppl 2:S64-6. Related Articles, Links

Transmission of online digital documents for the health assessment component of e-visa applications. MacDermott A, Crowe B. Department of Immigration and Multicultural and Indigenous Affairs, Canberra, Australia. Up to 350,000 health assessments are conducted annually for persons seeking a visa to enter Australia. Health screening is conducted by accredited panel doctors and radiologists in the visa applicant's home country. Their findings are forwarded to the appropriate government department in Australia. The move to an e-visa system, with certain visas being available via the Internet, has seen the introduction of a compatible electronic health assessment system. An online system to support health assessment processing was implemented in two stages. The first, eHealth1, has been in operation since July 2002 and the second, eHealth2, commenced in November 2003. In a pilot trial in Singapore during 2003 and 2004, 5,000 student visa applications (87%) were lodged through the eHealth2 system. The main advantage of the eHealth2 process is the rapid transmission of a digital photograph and X-ray image. This avoids the delay of sending documents and films by post. The success of the pilot has led to the expansion of eHealth2 to other electronic visa sectors, such as working holiday makers, long-stay business people and visitors. The eHealth2 system is fully operational in Singapore, Hong Kong, Japan, South Korea and Taiwan. PMID: 16375801 [PubMed - indexed for MEDLINE] 685: Health Policy Plan. 2006 Mar;21(2):132-42. Epub 2005 Dec 22. Related Articles, Links

Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat.

Sinha T, Ranson MK, Chatterjee M, Acharya A, Mills AJ. Research Coordinator, Vimo SEWA, SEWA Reception Centre, Opposite Victoria Garden, Bhadra, Ahmedabad 380 001, India. [email protected] This paper seeks to examine barriers faced by members of a community-based insurance (CBI) scheme, which is targeted at poor women and their families, in accessing scheme benefits. CBI schemes have been developed and promoted as mechanisms to offer protection to poor families from the risks of ill-health, death and loss of assets. However, having voluntarily enrolled in a CBI scheme, poor households may find it difficult or impossible to access scheme benefits. The paper describes the results of qualitative research carried out to assess the barriers faced in accessing scheme benefits by members of the CBI scheme run by the Self-Employed Women's Association (SEWA) in Gujarat, India. The study finds that the members face a variety of different barriers, particularly in seeking hospitalization and in submitting insurance claims. Some of the barriers are rooted in factors outside the scheme's control, such as illiteracy and financial poverty amongst members, and inadequacies of the transportation and health care infrastructure. But other barriers relate to the scheme's design and management, for example, lack of clarity among scheme staff regarding the scheme's rules and processes, and requirements that claimants submit documents to prove the validity of their claims. The paper makes recommendations as to how SEWA Insurance can address some of the identified barriers and discusses the relevance of these findings to other CBI schemes in India and elsewhere. Publication Types: •

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

PMID: 16373360 [PubMed - indexed for MEDLINE] 686: Huan Jing Ke Xue. 2005 Sep;26(5):28-33. Related Articles, Links

[Assessment on ecological security spatial differences of west areas of Liaohe River based on GIS] [Article in Chinese] Wang G, Wu W. College of Environment and Life in Dalian University of Technology, Dalian 116024, China. [email protected] Ecological security assessment and early warning research have spatiality; non-

linearity; randomicity, it is needed to deal with much spatial information. Spatial analysis and data management are advantages of GIS, it can define distribution trend and spatial relations of environmental factors, and show ecological security pattern graphically. The paper discusses the method of ecological security spatial differences of west areas of Liaohe River based on GIS and ecosystem nonhealth. First, studying on pressure-state-response (P-S-R) assessment indicators system, investigating in person and gathering information; Second, digitizing the river, applying fuzzy AHP to put weight, quantizing and calculating by fuzzy comparing; Last, establishing grid data-base; expounding spatial differences of ecological security by GIS Interpolate and Assembly. Publication Types: • •

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

PMID: 16366465 [PubMed - indexed for MEDLINE] 687: Cell Res. 2005 Nov-Dec;15(11-12):908-13. Related Articles, Links

United Nations system efforts to support the response to AIDS in China. He JL, Rehnstrom J. UNAIDS China, 1-162, Tayuan Diplomatic Office Building, 14 Liangmahe Nanlu, Beijing 100600, China. [email protected] In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations (UN) in supporting and strengthening those responses. Achievements of the United Nations highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of the United Nations system in the near future include strengthening national leadership by supporting the 'three ones', i.e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing

awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups; providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS. PMID: 16354568 [PubMed - indexed for MEDLINE] 688: Cell Res. 2005 Nov-Dec;15(11-12):825-32. Related Articles, Links

The HIV epidemic in China: history, response, and challenge. He N, Detels R. Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China. [email protected] The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly. Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century. Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation. Publication Types: • •

Research Support, N.I.H., Extramural Review

PMID: 16354555 [PubMed - indexed for MEDLINE]

689: Ren Fail. 2005;27(6):663-9. Related Articles, Links

Prognostic value of acute physiology and chronic health evaluation II and organ system failure in patients with acute renal failure requiring dialysis. Wang IK, Wang ST, Chang HY, Lin CL, Kuo HL, Chen TC, Lee CH, Chuang FR. Division of Nephrology, Chang Gung Memorial Hospital at Chiayi, Taiwan. [email protected] BACKGROUND: Despite advances in modern technology of dialysis, prognosis of patients with acute renal failure (ARF) remains poor. To give the clinicians the most useful information, a model that accurately predicts outcome early in the course of ARF is required. However, because ARF is a heterogeneous syndrome and occurs in patients with diverse etiologies and some coexisting diseases, predicting outcome early is hard. The aim of this study is to evaluate prospectively the Acute Physiology and Chronic Health Evaluation (APACHE II) and organ system failure (OSF) models, evaluated prior to dialysis, in predicting hospital mortality. METHODS: From June 2002 to March 2004, ARF patients requiring dialysis at Chang Gung Memorial Hospital, Chiayi, were prospectively recruited for this study. The worst clinical and laboratory data in the 24 hours before initiation of dialysis were prospectively evaluated, and the patients' APACHE II score and OSF number were assessed. RESULTS: A total of 61 patients (40 male and 21 female) were enrolled, of whom 38 (62.3%) died before discharge. By multivariate logistic regression, the APACHE II score (odds ratio 1.3 per increase in one score; P<0.001), or OSF number (odds ratio 1.9 per increase in one OSF; P<0.01) and oliguria (odds ratio 4.2; P=0.04), were found to be statistically significant prognostic factors for hospital mortality. Mortality increased progressively and significantly as OSF number (chi-square for trend; P=0.001) or the APACHE II score (chi-square for trend; P < 0.001) increased. By using Youden's index, the best cut-off value for APACHE II was 24, with 63% sensitivity and 96% specificity. The best cut-off value for OSF number was 2, with a sensitivity of 81.6% and a specificity of 60.9%. The areas under the receiver operating characteristic curves for APACHE II and OSF number were 0.847 (95% confidence interval (CI)=0.752-0.942; P<0.01) and 0.769 (95% CI=0.646-892; P<0.001), respectively, indicating good model discrimination. CONCLUSIONS: This study concludes that APACHE II and OSF number measured prior to initiation of dialysis reliably predict outcomes of ARF patients requiring dialysis. The mortality rates increase as the APACHE II score or OSF number increases. For predicting mortality, the APACHE II score > or = 24 was found to have 63% sensitivity and 96% specificity, and OSF number> or = 2 had 81.6% sensitivity and 60.9% specificity.

Publication Types: •

Comparative Study

PMID: 16350815 [PubMed - indexed for MEDLINE] 690: Seishin Shinkeigaku Zasshi. 2005;107(8):870-6. Related Articles, Links

[Community psychiatric care as viewed by young psychiatrists in Japan] [Article in Japanese] Hashimoto N. PMID: 16350314 [PubMed - indexed for MEDLINE] 691: J Infect. 2006 Sep;53(3):206-10. Epub 2005 Dec 15. Related Articles, Links

TLR4 polymorphism in Iranian patients with brucellosis. Rezazadeh M, Hajilooi M, Rafiei A, Haidari M, Nikoopour E, Kerammat F, Mamani M, Ranjbar M, Hashemi H. Department of Internal Medicine, Sina Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. OBJECTIVE: Brucellosis is a zoonosis of both public health and economic significance in most developing countries. Polymorphisms in Toll-like receptor-4 (TLR4) have been reported to be associated with a blunted immune response to microbial pathogens. Information regarding any association between genetic variation of TLR4 and susceptibility to brucellosis is not available in the literatures. The main purpose of this research is to evaluate the role of polymorphic alleles of TLR4 gene in susceptibility to brucellosis. MATERIALS AND METHODS: In this case-control study, 198 patients with brucellosis and 111 healthy volunteers matched for sex, age and geographic area were evaluated by genotyping for polymorphism in TLR4 gene (Asp299Gly) using amplification refractory mutation system (ARMS)-PCR method. RESULTS: Allele 896G was more prevalent in patients with brucellosis compared to healthy controls (33.6% vs. 20.7%, P=0.000003). Also the frequency of G allele of TLR4 gene was

significantly higher in male patients with brucellosis compared to the same sex in control group (36% vs. 21.7%, P=0.00005). Multiple logistic regression analysis demonstrated that male patients heterozygous at allele G gene had a significantly higher risk for brucellosis with an odds ratio of OR 2.89, 95% CI: 1.79-4.69, P<0.0001). CONCLUSION: This study is the first to show an association between genetic polymorphism in TLR4 gene and susceptibility to brucellosis. PMID: 16343635 [PubMed - indexed for MEDLINE] 692: J Neurol Sci. 2006 Feb 15;241(1-2):83-90. Epub 2005 Dec 15. Related Articles, Links

Neurology in Operation Iraqi Freedom: risk factors for referral, clinical presentations and incidence of disease. Hartmann JE. Neurology Service, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA. [email protected] Six hundred and sixteen patients were referred for consultation to the author who served as the neurologist on the 252nd Neurosurgical Team in Kuwait in support of Operation Iraqi Freedom between April and October, 2003. Demographic and military data were collected. The cohort of neurologic patients showed significant differences from the total population of the United States Army contemporarily deployed to Operation Iraqi Freedom. Versus the deployed personnel, the neurologic cohort was older in age (p<0.001), had a greater percentage of females (p<0.00001), had an excessive representation for the military rank of sergeant (p<0.00001), with a deficit of other ranks (junior enlisted and officers), and were more likely to soldiers from the Reserves (p<0.00001) and National Guard (p=0.0021) than from the Regular Army. Seven categories of chief complaints and ten categories of diagnoses constituted some 80% of patients. The incidence of neurologic disease was calculated to be 634 per 100,000 people/year. This information provides valuable information for military neurologists concerning their anticipated duties in future deployments and for non-neurologists by focusing their skills in the evaluation of common neurologic presentations, yet further research is needed to optimize the neurologist's role in a field environment. Publication Types: •

Comparative Study

PMID: 16343543 [PubMed - indexed for MEDLINE]

693: Am J Epidemiol. 2006 Feb 1;163(3):211-6. Epub 2005 Dec 7. Related Articles, Links

Refined estimate of the incubation period of severe acute respiratory syndrome and related influencing factors. Cai QC, Xu QF, Xu JM, Guo Q, Cheng X, Zhao GM, Sun QW, Lu J, Jiang QW. Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China. Many epidemiologists have agreed that a refined estimate of the incubation period of severe acute respiratory syndrome (SARS) would need a sample size of about 200 cases and appropriate statistical methods enabling the inclusion of cases with defined periods of exposure. However, no such studies have been reported so far. Besides, determinants of the SARS incubation period remain unclear. In this study, 209 probable SARS cases with documented episodes of exposure between March 1 and May 31, 2003, in mainland China were included. A nonparametric method was used to analyze these data with defined periods of exposure to obtain the refined estimate of the SARS incubation period. Furthermore, the authors also explored the influence of various factors on the SARS incubation period by analysis of variance, linear regression analysis, and analysis of covariance. The estimates of mean and variance of the SARS incubation period were 5.29 days and 12.33 days(2), respectively; 90% of patients would have an incubation period of less than 11.58 days with a probability of 0.8, and 99% of patients would have an incubation of less than 22.22 days with a probability of 0.9. The affected area showed a highly significant effect on the incubation period (p < 0.001), but the contact pattern, occupation, gender, and age did not. Publication Types: •

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

PMID: 16339050 [PubMed - indexed for MEDLINE] 694: Sex Health. 2005;2(3):193-202. Related Articles, Links

Female sex work in Yangon, Myanmar. Talikowski L, Gillieatt S.

Centre for International Health, Curtin University of Technology, Perth, Australia. BACKGROUND: Myanmar (Burma), with an upper estimate of 400,000 people living with HIV/AIDS, faces a dangerous and potentially devastating epidemic. Female sex workers in the country are one of the most affected populations, with high prevalence rates of both HIV and sexually transmitted infections (STIs). METHODS: A qualitative study was undertaken in Yangon at the end of 2002 to investigate the social and demographic features contributing to the transmission of HIV among female sex workers in urban Myanmar. Twenty-seven key informants from the government, non-government organisations (NGOs), international nongovernment organisations (INGOs), private sector and the United Nations system agencies and 25 women currently working in the sex trade were interviewed. RESULTS: The sex trade in Yangon is rapidly growing and is characterised by a high degree of complexity. The number of female sex workers is estimated to be between 5,000 and 10,000 and there are approximately 100 brothels operating in various townships around the city. Nearly one-third of the women in the study reported previous imprisonment for offences related to sex work as well as fear of harassment, sexual exploitation, violence and gang rape. Almost half reported using condoms with clients at all times. Contradicting views exist as to the level of awareness about STIs and HIV among Yangon sex workers, with the majority never having been tested for HIV. Only one-quarter of women were regular patients of the limited number of STI clinics operated by INGOs. CONCLUSIONS: Female sex workers in Myanmar remain a highly marginalised group almost inaccessible due to a variety of legal, political, cultural and social factors and are particularly vulnerable to HIV and STIs. It is important to encourage partnerships between INGOs by promoting service coordination and information sharing to increase the availability of services for sex workers and to build political support for an unpopular cause. PMID: 16335547 [PubMed - indexed for MEDLINE] 695: Int J Inj Contr Saf Promot. 2005 Sep;12(3):167-76. Related Articles, Links

Traffic law enforcement in Hyderabad, India. Dandona R, Kumar GA, Dandona L. Health Studies Area, Centre for Human Development, Administrative Staff College of India, Raj Bhavan Road, Hyderabad-500 082, India. [email protected] The aim of the study was to understand traffic law enforcement (TLE) carried out by the police to reduce non-compliance with traffic laws on the roads of Hyderabad city in India for 2001-2003. The Traffic Police database of citations

issued to drivers who violated traffic laws in Hyderabad was analysed for the years 2001-2003 to describe the TLE activities of the police, to describe and compare the TLE activities for the different types of vehicles and to compare the TLE activities for the 3 years. The violations were classified in five categories those related to driving, parking, vehicle, document and others; and TLE into safety and other TLE. A total of 646 161 traffic-law violations were registered in 2001, 904 447 in 2002 and 964 275 in 2003 for Hyderabad. Driving and parking violations were the most common violations registered in all 3 years, with parking violations slightly higher in 2001 (43.5%) and driving violations slightly higher in 2002 (35%) and 2003 (36.4%). Auto-rickshaws (three-wheel commercial passenger vehicles) accounted for the highest violations registered in 2001 (41.4%) whereas motorized two-wheelers had the highest registered violations in 2002 (35.5%) and 2003 (33.2%). Safety TLE activity (detecting and registering driving violations) was only one-third of all the TLE activity performed by the police in the 3 years, and disobeying traffic signals was the most common violation registered under safety TLE. Indian rupees 50 (US$1.1) were collected by way of a fine in 87% of the cases registered. Age and gender of the violators were not recorded in the database. These data can be used for planning, monitoring and evaluating TLE in Hyderabad. These can help identify traffic control and human factors that could lead to traffic noncompliance, and help identify priorities for improving road safety. These data indicate a need to enhance the safety TLE activity of the police, to make TLE more visible in Hyderabad, and to assess the effectiveness of the current legal action as deterrence to improve road safety. Recommendations to enhance TLE within the given resources of the police are made. More effort is needed towards systematic collection and analysis of data on TLE in India to facilitate long-term improvements in TLE for safer roads. Publication Types: •

Comparative Study

PMID: 16335434 [PubMed - indexed for MEDLINE] 696: Int Arch Occup Environ Health. 2006 May;79(5):441-4. Epub 2005 Dec 7. Related Articles, Links

Autonomic nervous activity changes in relation to the reporting of subjective symptoms among male workers in an information service company. Karita K, Nakao M, Nishikitani M, Nomura K, Yano E. Department of Hygiene and Public Health, Teikyo University School of

Medicine, 2-11-1 Kaga, 173-8605, Tokyo, Japan. [email protected]. OBJECTIVES: The objective of the study was to clarify the relationship between major subjective symptoms and autonomic nervous system function by power spectral analysis of heart rate variability (HRV). METHODS: Short-term HRV was examined for 413 male workers in a Japanese information service company aged 19-45 years, and questionnaire survey on subjective symptoms and biochemical measurements were conducted at annual health checkup. RESULTS: The most prevalent subjective symptom (> or =10%) was dullness, followed by fatigue, backache, diarrhea, sleep disorder, and irritation. HRV in high frequency (HF 0.15-0.40 Hz) bands and the coefficient of variance in the electrocardiographic R-R interval (CVrr) were lower in the subjects with any of these six symptoms than in those without the symptoms. Both parameters were negatively associated with the reporting of any of the six symptoms by multiple regression analyses, controlling for the significant effects of age (HF and CVrr) and plasma cortisol levels (HF). CONCLUSION: It was suggested that the reporting of the subjective symptoms is one of good predictors for reduced parasympathetic tones. Publication Types: •

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

PMID: 16333680 [PubMed - indexed for MEDLINE] 697: Pharmacoepidemiol Drug Saf. 2006 Jun;15(6):421-7. Related Articles, Links

Trends in new drug interactions for pharmaceutical products in Japan. Yoshida N, Yamada A, Mimura Y, Kawakami J, Adachi I. Department of Pharmacy, Toyama University Hospital, University of Toyama, Toyama, Japan. PURPOSE: The aim of the present study was to elucidate the trends in drug interactions for pharmaceutical products in Japan by examining safety profile updates. METHODS: All 12 422 prescription drugs currently on the Japanese market were included in the study. Revisions to their product information (or package insert: PI) were investigated from January 2000 to December 2003. The publication 'Drug Safety Update,' which is a summary of the revisions made to the precautions in PIs and is issued by The Society of Japanese Pharmacopoeia and The Federation of Pharmaceutical Manufacturers' Associations of Japan under the

supervision of the Ministry of Health, Labour and Welfare (MHLW), was used as a data source. The revised drug interactions were categorized according to measures, mechanisms, and evidence from published references. RESULTS AND CONCLUSIONS: The results revealed 426 new interactions, including 75 contraindicative combinations, during the survey period. About 45% and 27% of the new interactions involved metabolic and pharmacological processes, respectively, with metabolic interactions involving cytochrome P450 3A4 being the dominant reason for the revision of PIs. Only 37% of the new interactions cited scientific journals and/or books, and 58% of these references cited were published more than 5 years prior to the date of revision. In conclusion, metabolic interactions were the major reasons for the update of safety information after 2000. Published references should be provided in order to assist with clinical management and avoid the undesirable effects of new drug interactions. Publication Types: •

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

PMID: 16331581 [PubMed - indexed for MEDLINE] 698: Eur J Epidemiol. 2005;20(12):1023-9. Related Articles, Links

Relationship between distance of schools from the nearest municipal waste incineration plant and child health in Japan. Miyake Y, Yura A, Misaki H, Ikeda Y, Usui T, Iki M, Shimizu T. Department of Public Health, Kinki University School of Medicine, OsakaSayama, Japan. [email protected] In Japan, the main source of dioxins is incinerators. This study examined the relationship between the distance of schools from municipal waste incineration plants and the prevalence of allergic disorders and general symptoms in Japanese children. Study subjects were 450,807 elementary school children aged 6-12 years who attended 996 public elementary schools in Osaka Prefecture in Japan. Parents of school children completed a questionnaire that included items about illnesses and symptoms in the study child. Distance of each of the public elementary schools from all of the 37 municipal waste incineration plants in Osaka Prefecture was measured using geographical information systems packages. Adjustment was made for grade, socioeconomic status and access to health care per municipality. Decreases in the distance of schools from the nearest municipal waste incineration plant were independently associated with an increased prevalence of wheeze, headache, stomach ache, and fatigue (adjusted odds ratios [95% confidence

intervals] for shortest vs. longest distance categories =1.08 [1.01-1.15], 1.05 [1.00-1.11], 1.06 [1.01-1.11], and 1.12 [1.08-1.17], respectively). A positive association with fatigue was pronounced in schools within 4 km of the second nearest municipal waste incineration plant. There was no evident relationship between the distance of schools from such a plant and the prevalence of atopic dermatitis or allergic rhinitis. The findings suggest that proximity of schools to municipal waste incineration plants may be associated with an increased prevalence of wheeze, headache, stomach ache, and fatigue in Japanese children. Publication Types: •

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

PMID: 16331434 [PubMed - indexed for MEDLINE] 699: Int J Epidemiol. 2006 Apr;35(2):323-9. Epub 2005 Dec 2. Related Articles, Links

Extreme weather events and environmental contamination are associated with case-clusters of melioidosis in the Northern Territory of Australia. Cheng AC, Jacups SP, Gal D, Mayo M, Currie BJ. Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Australia. [email protected] BACKGROUND: Melioidosis, the infection due to the environmental organism Burkholderia pseudomallei, is endemic to northern Australia and South East Asia. It is associated with exposure to mud and pooled surface water, but environmental determinants of this disease are poorly understood. We defined case-clusters in northern Australia, determined their contribution to the observed rate of melioidosis, and explored clinical features and associated environmental factors. METHODS: Using geographical information systems data, we examined clustering of melioidosis cases in time and geographical space in the Top End of the Northern Territory of Australia between 1990 and 2002 using a scan statistic. DNA macrorestriction analysis, resolved by pulsed field gel electrophoresis, was performed on isolates from patients. RESULTS: We defined five case-clusters involving 27 patients that occurred within 7-28 days and/or a radius of 100-300 km. Clustered cases were associated with extreme weather events or environmental contamination; no difference in the clinical pattern of disease was noted from other patients not involved in clusters. Isolates from patients linked to environmental contamination were caused by isolates with similar DNA macrorestriction patterns, but isolates from patients linked to severe weather

events had more diverse DNA macrorestriction patterns. CONCLUSION: Caseclusters of melioidosis where isolates exhibit diverse DNA macrorestriction patterns in our region are linked to extreme weather events and outbreaks where isolates are predominantly of the same DNA macrorestriction pattern are linked with contamination of an environmental source. Publication Types: •

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

PMID: 16326823 [PubMed - indexed for MEDLINE] 700: Arch Med Res. 2006 Jan;37(1):175-7. Related Articles, Links

•

Japanese guidelines-based management of lipid levels in a hypercholesterolemia education class. Kotani K, Katase H, Saiga K, Sakane N. Division of Clinical Laboratory Medicine and Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan. [email protected] The "Japan Atherosclerosis Society (JAS) Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases" proposed the recommended lipoprotein levels in each patient according to some categories classified by the risk factor numbers. Because the categorization is somewhat complex for some patients, we redeveloped the JAS guidelines-based survey into a simple form to easily assess each lipoprotein target level. Forty participants in the hypercholesterolemia education classes were divided into the ordinary approach group (n = 20; mean age 59 years) and the intervention group using the survey (age 58 years). When participants assessed the class by 100-point scales, the intervention group had significantly more understanding levels than the ordinary approach group (86.7 vs. 75.1 points). Our results suggested that the simplified JAS guidelines-based survey system was effectively applicable to transmitting information about lipoprotein target levels among hypercholesterolemic subjects as an educational tool.

PMID: 16314206 [PubMed - indexed for MEDLINE]

701: Jpn J Clin Oncol. 2005 Nov;35(11):690-1. Related Articles, Links

Comparison of prostate cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (19602000). Marugame T, Mizuno S. Statistics and Cancer Control Division, National Cancer Center. Publication Types: •

Comparative Study

PMID: 16306486 [PubMed - indexed for MEDLINE] 702: Soc Sci Med. 2006 May;62(10):2551-64. Epub 2005 Nov 21. Related Articles, Links

Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong. Johnston JM, Leung G, Saing H, Kwok KO, Ho LM, Wong IO, Tin KY. Department of Community Medicine, University of Hong Kong, Hong Kong. This study tests whether socio-economic status (SES), at either the individual or ecologic levels, exerts a direct impact on non-attendance or an indirect impact on attendance through longer waiting time for appointments and/or doctor-shopping behavior at four public specialist outpatient centers in Hong Kong. We collected information through three main sources, namely patients' referral letters, telephone interviews with both open- and closed-ended questions (e.g. doctorshopping data) and hospital administrative databases from a total of 6495 attenders and non-attenders enrolled from July 2000 through October 2001. Individual-level SES was measured by education, occupation and monthly household income. Tertiary planning unit (TPU)-level SES data consisted of proportion unemployed, proportion with tertiary education, median income and Gini coefficient. Direct effects of SES on non-attendance were examined by logistic regression. Indirect contributions mediated through waiting time and doctor-shopping were analyzed by structural equation modeling. We found that SES, at the individual or ecologic level, did not exert a direct effect on nonattendance. Instead, TPU-level SES contributed positively to waiting time

(beta=0.06+/-0.03, p=0.048), i.e. worse-off neighborhoods (and those with greater income inequality) had a shorter waiting time. Individual-level SES was also directly associated with the likelihood of doctor-shopping (beta=0.16+/-0.02, p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time (beta=0.12+/-0.02, p<0.001) and doctor-shopping (beta=0.37+/-0.02, p<0.001) were significantly related to non-attendance. Our findings suggest a highly equitable specialist ambulatory care public system in Hong Kong. Health care resources are appropriately targeted at the socially indigent, and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design. PMID: 16305815 [PubMed - indexed for MEDLINE] 703: Maturitas. 2006 Jun 20;54(3):205-12. Epub 2005 Nov 21. Related Articles, Links

Factors associated with treatment options among menopausal women in Taiwan. Chiou YW, Tai CJ, Chien LY. Institute of Community Health Nursing, National Yang Ming University and Department of Nursing, Taipei Veterans General Hospital, Taiwan. OBJECTIVES: Taiwan has a two-tiered medical system that includes modern medicine and traditional Chinese medicine (TCM). The objectives of this study were to compare the characteristics of menopausal women who did not use any treatment, who used hormone replacement therapy (HRT), and who used TCM to treat their climacteric symptoms. METHODS: The study subjects were 182 women aged 46-55 years (non-treatment: 61, HRT: 60, TCM: 61). Variables used included socio-demographics, climacteric symptoms, other physical symptoms, experiences with the treatment, and attitude toward menopause. Multivariate analyses were performed using multinomial logistic regression. RESULTS: Compared with women in the non-treatment group, employed women were more likely to have received HRT or TCM. Women in the TCM group were more likely to have comorbid non-climacteric physical symptoms and were less likely to have family support for the use of HRT. Women in the TCM group were more likely to have an attitude regarding menopause as a natural phenomenon and as having little impact on attractiveness and sexual life. Severity of current climacteric symptoms was lower in the HRT group, while it was higher in the TCM group. These factors accounted for 66.1% of the model variances. CONCLUSIONS: Women in different treatment groups had different characteristics. Health professionals should be aware of the differences and provide information on treatment options in order to help and support women in making treatment decisions.

PMID: 16303267 [PubMed - indexed for MEDLINE] 704: Prehosp Disaster Med. 2005 Sep-Oct;20(5):290-300. Related Articles, Links

Recommended modifications and applications of the Hospital Emergency Incident Command System for hospital emergency management. Arnold JL, Dembry LM, Tsai MC, Dainiak N, Rodoplu U, Schonfeld DJ, Paturas J, Cannon C, Selig S. Yale University School of Medicine, New Haven, Connecticut, USA. [email protected] The Hospital Emergency Incident Command System (HEICS), now in its third edition, has emerged as a popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the HEICS in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several modifications of the HEICS are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the HEICS to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in the Operations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, and dependents in terrorism-related emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types of patients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems. New uses of the HEICS in hospital emergency management also are recommended, including: (1) the adoption of the HEICS as the conceptual framework for organizing all phases of hospital emergency management, including mitigation, preparedness, response, and recovery; and (2) the application of the HEICS not only to healthcare facilities, but also to healthcare systems. Finally, three levels of healthcare worker competencies in the HEICS are suggested: (1) basic understanding of the HEICS for all hospital healthcare workers; (2) advanced understanding and proficiency in the HEICS for hospital healthcare workers likely to assume leadership roles in hospital emergency response; and (3) special proficiency in constituting the

HEICS ad hoc from existing healthcare workers in resource-deficient settings. The HEICS should be viewed as a work in progress that will mature as additional challenges arise and as hospitals gain further experience with its use. PMID: 16295165 [PubMed - indexed for MEDLINE] 705: Ind Health. 2005 Oct;43(4):623-9. Related Articles, Links

Influence of overtime work, sleep duration, and perceived job characteristics on the physical and mental status of software engineers. Nishikitani M, Nakao M, Karita K, Nomura K, Yano E. Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. To investigate the impact of overtime work, sleep duration, and perceived job characteristics on physical and mental status, a cross-sectional study was conducted on 377 workers (average age; 28 years old) in an informationtechnology (IT) company, engaged in consultation, system integration solution, and data management relevant to IT system. The psychophysical outcomes of overtime work were assessed using the Hamilton Depression Scale (HDS), Profile of Mood Status (POMS), major physical symptoms, and overtime work data for the preceding three-months. Sleep duration was directly asked by a physician. A job strain index was defined as the ratio of job-demands to job-control scores evaluated using the Job Content Questionnaire (JCQ). In a univariate analysis, overtime work was significantly related with HDS scores, POMS anger-hostility scores, and the total physical symptom count in both sexes (all p < 0.05), but not in multiple regression models, after controlling for sleep duration and the job strain index. Sleep duration was negatively related to the symptom count in men and to POMS tension-anxiety scores in women (both p < 0.05); the job strain index was positively related to POMS anger-hostility scores in both sexes and to HDS scores and POMS tension-anxiety scores in men (all p < 0.05). Although overtime work was associated with physical and mental complaints, sleep duration and the job strain index seemed to be better indicators for physical and mental distress in overloaded workers. Publication Types: •

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

PMID: 16294916 [PubMed - indexed for MEDLINE]

706: Health Policy. 2006 Oct;78(2-3):224-34. Epub 2005 Nov 15. Related Articles, Links

The landscape of community health insurance in India: an overview based on 10 case studies. Devadasan N, Ranson K, Van Damme W, Acharya A, Criel B. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. [email protected] The Indian health system is mainly funded by out-of-pocket payments. More than 80% of health care expenditure is borne by individual households. Only about 3% of the population, mostly those in the formal sector, benefit from some form of health insurance. Several Indian Non-Governmental Organisations (NGOs) have initiated Community Health Insurance (CHI) schemes within their existing development programmes. This article describes the principal features of the design and functioning of a selection of 10 CHI schemes and presents a brief overview of the current landscape of CHI in India. The schemes explicitly target the poorest and most vulnerable households in Indian society-scheduled tribes, scheduled castes and poor women. Three CHI management models can be distinguished. The first model consists of local NGOs acting as both insurer and provider. In the second model, the NGO is the insurer but does not itself provide care, which is then purchased from a private provider. In the third model, the NGO neither does provide health care nor acts as an insurer: the NGO, on behalf of a community, links with an insurer and purchases health care from a provider. The benefit packages generally include both primary and secondary care and most of the providers are in the private sector. Most of the schemes require external resources for financial sustainability. There is currently little information on the impact of CHI schemes on the performance of local health systems and more research is warranted in that respect. Publication Types: •

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

PMID: 16293339 [PubMed - indexed for MEDLINE] 707: Reprod Health Matters. 2005 Nov;13(26):54-64. Related Articles, Links

Medical abortion in rural Tamil Nadu, South India: a quiet

transformation. Ramachandar L, Pelto PJ. Department of Anthropology, University of Connecticut, CT, USA. The medical abortion drugs mifepristone and misoprostol are now widely available in rural Tamil Nadu, India, and the practice of abortion is being transformed. This paper reports on current attitudes and practices concerning medical abortion among qualified abortion providers in a rural area of Tamil Nadu. Interviews were carried out with a purposive sample of 40 doctors, 15 informants at chemist shops, 10 village health nurses and 23 women who had recently had an abortion. Twelve of the 37 private doctors who were providing abortions, were providing medical abortion to 70-80% of their patients and 12 others to a selected minority. Eleven had largely rejected it and still used D&C, two had never heard of it. A number of doctors were using misoprostol for cervical dilatation prior to D&C. Some doctors and women who were concerned about incomplete abortion and heavy bleeding did not have a clear idea of what normal bleeding with medical abortion was. Incorrect regimens with second trimester medical abortions might have been responsible for cases of excessive bleeding. Most chemist shops said they were selling the tablets only on prescription, but doctors reported widespread over-the-counter sales. Medical abortion appeared to be quite acceptable to most women, and women were increasingly requesting it. Mechanisms are needed for sharing information about medical abortion among professionals, community health workers and rural families. The state government should develop a comprehensive plan for incorporating medical abortion into the public health system. PMID: 16291486 [PubMed - indexed for MEDLINE] 708: J Clin Epidemiol. 2005 Dec;58(12):1277-81. Related Articles, Links

The Automated Classification of Medical Entities (ACME) system objectively assessed the appropriateness of underlying cause-ofdeath certification and assignment. Lu TH, Tsau SM, Wu TC. Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. BACKGROUND AND OBJECTIVES: To assess the feasibility of using the Automated Classification of Medical Entities (ACME) system to objectively define the appropriateness of tuberculosis (TB) related underlying cause of death

(UCD) certification and the accuracy of UCD assignment. METHODS: All death certificates issued in 2002 in Taiwan in which TB was mentioned were extracted for analysis. Certification of the UCD was defined as inappropriate when ACME used Rule 1 or Rule 2 in assigning the UCD. The assignment of the UCD was defined as inaccurate when the UCD selected by coders was discordant with the UCD selected by ACME. RESULTS: Of the 2,129 death certificates mentioned TB, half (1,067 of 2,129) were inappropriately certified by physicians and 16.5% (351 of 2129) had an inaccurately assigned UCD by coders. The discrepancy rate in UCD assignment between coders and ACME increased when the number of diagnoses increased, TB was listed in Part II, and the certification of UCD was inappropriate. CONCLUSIONS: It is feasible to use the process information in ACME to objectively define the appropriateness of UCD certification and the accuracy of UCD assignment. Inappropriate certification of the UCD and TB being listed in Part II were the two most important factors associated incorrect interpretation of the World Health Organization Selection Rules by coders. Publication Types: • •

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

PMID: 16291472 [PubMed - indexed for MEDLINE] 709: J Clin Forensic Med. 2006 Jan;13(1):21-5. Epub 2005 Nov 10. Related Articles, Links

Review of forensic assessments of female referrals to the branch of legal medicine, Malatya region, Turkey--1996-2000. Celbiş O, Gökdoğan MR, Kaya M, Günes G. Inönü University, Faculty of Medicine, Department of Legal Medicine, Malatya, Turkey. It is well recognized that the most pervasive form in gender violence is violence against women by their intimate male partners. Domestic violence (DV) crosses all cultures, races, and socioeconomic levels, affecting people of all ages and both sexes, but particularly women and children. DV refers to the chronic physical, sexual and psychological maltreatment of one family member against another in order to control. DV represents a significant health threat to women. It may also be an important precipitating factor of female suicide. As the literature has begun to document the extent of interfamilial violence, attention has focused on forensic documentation. The aim of this study is to review female victims presented at the Branch of Legal Medicine of Malatya, Turkey, regarding gender-based violence

and DV in relation towards sexual offenses and suicide attempts. Accordingly, recommendations were presented to increase the awareness of DV by setting policies and in response legislative recommendations. The legal reports of women (n=2245) were reviewed. In respect of the Turkish Penal Code (TPC), paragraph 456/1, 2, 3 and 4, which covers the act of assault and battery, the severity of the injuries have been categorized into three groups according to the Turkish Injury Scale (TIS) covered by TPC 456/1, 2 and 4, into the issues of functional incapacitation according to TPC 456/2 and 3, and with regard to the presence of a mark of an injury on the face according to TPC 456/2 tables. Because of incomplete data, not all results be categorized as positive for DV. Despite the large number of blunt force injuries (699 cases out of 2245) and the high percentage of external lesions, 76% of 1796 files, found, recognition of DV was uncommon. According to TPC 456/4, in cases of small trauma-related injuries, legal proceedings are dependent upon a victim's making a complaint. The percentage of 80.4% (n=2245) represents the need for information regarding legal requirements. The frequency of sexual assault cases, 144 victims out of 162, and in suicide attempts, 95 women out of 145, in the 15-24 year age span may also reflect a society's accusative approach towards women based on moral values. Unless prosecuting DV cases purely on the evidence in regard to victim's safety, withdrawal of complaints will continue. It is essential to identify to 'name' DV when it occurs. Recognizing the serious immediate and future long-term implications for health, multifaceted intervention is important. DV has to undergo some fundamental and far-reaching reformation in Turkey regarding how the legal system deals with it appropriately. PMID: 16289846 [PubMed - indexed for MEDLINE] 710: Childs Nerv Syst. 2006 Apr;22(4):346-51. Epub 2005 Nov 10. Related Articles, Links

Childhood brain tumour information on the Internet in the Chinese language. Lau L, Hargrave DR, Bartels U, Esquembre C, Bouffet E. Paediatric Brain Tumour Programme, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. BACKGROUND: Internet information, now available in many different languages, can become a major source of information for patients and families in their own mother tongue. Chinese represent one of most frequently spoken language in the world. The aims of this study were to critically appraise the quantity and quality of Internet health information in childhood brain tumour in the Chinese language and to identify sufficient quality websites that can

potentially be recommended to Chinese-speaking parents. METHODS: Internet information on six common paediatric brain tumours was searched using six commonly used Chinese search engines. Websites were assessed systematically using two rating tools: DISCERN instrument and Checklist Rating System Instrument. RESULTS: Out of 946 sites accessed, only 13 assessable Chinese websites, displaying Traditional Chinese characters and providing information on brain tumour, were identified. Only four sites included specific discussion on brain tumours in children. Ten websites failed to provide satisfactory information on brain tumour as rated by DISCERN instrument. Overall only 41% of the 13 specific items relevant to brain tumours were mentioned (Checklist Rating System Instrument). CONCLUSION: Only a few satisfactory websites can be recommended to Chinese-speaking families for general information on brain tumour with caution from health care providers that such information may not apply to the child's individual condition. Publication Types: •

Evaluation Studies

PMID: 16283193 [PubMed - indexed for MEDLINE] 711: BMJ. 2005 Nov 12;331(7525):1107. Related Articles, Links

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, Zupan J, Darmstadt GL. Health Systems Financing, Evidence and Information for Policy, World Health Organization, Switzerland. OBJECTIVE: To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. DESIGN: Cost effectiveness analysis. SETTING: Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. DATA SOURCES: Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. MAIN OUTCOME

MEASURES: Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. RESULTS: The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. CONCLUSION: Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well. Publication Types: •

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

PMID: 16282407 [PubMed - indexed for MEDLINE] PMCID: PMC1283271

712: J Epidemiol. 2005 Nov;15(6):199-202. Related Articles, Links

A framework for cancer surveillance in Japan. Kaneko S. Statistics and Cancer Control Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. [email protected] The World Health Organization (WHO) has recommended that countries develop national cancer control programs in order to reduce the number of deaths due to preventable cancers. The national cancer control program should be comprehensive and systematic with evidence-based priority-setting and the efficient use of limited resources. In order to provide evidence-based information, cancer surveillance systems must be established with registration as a focus. Cancer registration monitors the incidence, mortality, survival, and prevalence of cancers. In Japan, however, cancer registration systems have not been either well

developed or standardized until recently. In 2003, the Ministry of Health, Labour and Welfare of Japan launched the Third Term Comprehensive 10-Year Strategy Program for Cancer Control, which gave grants to several projects to enhance the dissemination and standardization of cancer registries. However, the establishment of a cancer registration system is merely the first step in the process to provide a comprehensive surveillance system that leads to a national cancer control program, as proposed by the WHO. To provide the best cancer care services equitably in Japan, cancer surveillance systems should be established without delay. PMID: 16276028 [PubMed - indexed for MEDLINE] 713: Eubios J Asian Int Bioeth. 2000 Jul;10(4):119-25. Related Articles, Links

Attitudes and practices of patients and physicians towards patient autonomy: a survey conducted prior to the enactment of the Patients' Rights Bill in Israel. Sadan B, Chejk-Saul T. Division of Information Systems, Hadassah Medical Organization, Jerusalem 91120, Israel. [email protected] On the surface, it would appear that patients would welcome the opportunity to relinquish their traditional subordination to doctors in therapeutic decision making, and that doctors would be pleased to have partners with whom to share the burden involved in making such fateful decisions. We investigated the attitudes and practices of patients and physicians towards "patient autonomy" in an outpatient clinic of an internal medicine department prior to the enactment of the Patient's Rights Bill in Israel. There were 81 patients randomly chosen from those attending the study clinic and 21 physicians randomly selected from among the physicians treating them. They were all administered the Krantz, the Abramson Health Index, and the Christie Ethical Decision Making pre-tested questionnaires. They were also queried on demographic and background material. The results indicated that the patient sample was neither particularly interested in participating in medical decision making (average score of 3 out of 9 in the Krantz behavioral involvement sub-scale) nor in receiving medical information (average score of 4 out of 7 in the Krantz preference of information sub-scale). The physicians exhibited a willingness to establish equal relations with their patients, and claimed to prefer their taking an active role in decision making. However, when presented with ethical dilemmas, the physicians were not consistent in their attitude in terms of respecting "patient autonomy." The findings of an Israeli survey conducted three years after the bill's passage showed that only one-third of the studied physicians had read the Israel Medical Association booklet's explaining the new law and most of them claimed that the new law had

no affect on their daily encounter with patients, meaning that the law did not affect any change in these physicians' pattern of behavior. We concluded that if the Patient's Rights Bill is to achieve its goals, it will have to be accompanied by a widespread educational campaign to encourage the public to appreciate the value and the importance of the autonomy granted to them, and to guide them in exercising this autonomy to its best advantage. In parallel, the medical profession will need to be aware of the importance of achieving the therapeutic goals while upholding ethical and moral values in health care. PMID: 16273716 [PubMed - indexed for MEDLINE] 714: Int Heart J. 2005 Sep;46(5):855-66. Related Articles, Links

Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs. Yasunaga H, Ide H, Imamura T, Ohe K. Department of Planning, Information & Management, University of Tokyo Hospital, Hongo, Japan. In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPCbased payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine. PMID: 16272776 [PubMed - indexed for MEDLINE]

715: J Adv Nurs. 2005 Dec;52(5):498-507. Related Articles, Links

Responses to advanced cancer: Chinese-Australians. Chui YY, Donoghue J, Chenoweth L. Department of Nursing Studies, The University of Hong Kong, Pokfulam, Hong Kong, China. [email protected] AIM: This paper describes a study identifying the impact of key aspects of Chinese culture on the responses of mid-aged Chinese-Australians to their advanced cancer in order to make recommendations about their care within the health system. BACKGROUND: Studies conducted in the 1960s and 1970s focused on understanding people's psychological responses to their experiences of terminal illness, but the issue of culture was not addressed. In recent years, a few studies have been conducted with Chinese-Australians, but were limited to issues related to their information needs and the disclosure of a cancer diagnosis. There is a lack of understanding of the impact of Chinese culture on the experiences of these patients. METHOD: A grounded theory approach was used to generate a substantive theory to explain how mid-aged Chinese-Australians respond to advancing cancer. Eleven participants were recruited and data were collected from face-to-face interviews, telephone contacts, observation and researcher field notes. Data generation occurred between 1997 and 1999. FINDINGS: Four modes of response to advanced cancer were identified: acute crisis, combat, despondency and waiting for death. This paper deals particularly with the combat mode which incorporated five culturally specific strategies used by participants in their struggle against advanced cancer. These were traditional Chinese medicine, traditional Chinese beliefs on the use of food for health maintenance, qi gong (a form of exercise), feng shui (which involves paying attention to spatial organization) and the worship of ancestors and gods. Deeply entrenched within these responses is the influence of Chinese culture, rooted in the beliefs and practices of traditional Chinese medicine and the philosophy of harmony and balance of yin and yang and qi. CONCLUSION: Health care professionals need to be aware of the cultural practices and beliefs of the different ethnic groups for whom they care, and of the importance of accommodation to and negotiation about these cultural practices. Publication Types: •

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

PMID: 16268855 [PubMed - indexed for MEDLINE]

716: Nippon Koshu Eisei Zasshi. 2005 Sep;52(9):817-23. Related Articles, Links

[Establishment of Healthy Japan 21 Regional plans according to local community type] [Article in Japanese] Katanoda K, Hirota K, Matsumura Y. Division of Health Informatics and Education, National Institute of Health and Nutrition, Japan. OBJECTIVE: To examine the establishment of Health Japan 21 regional plans according to the local community type. METHODS: We sent all the Japanese local governments a questionnaire regarding the establishment of health Japan 21 regional plans with a request to provide a hardcopy of established regional plans. RESULTS: Of the respondent 1954 local communities, the proportions regarding establishment of plans (including "Completed" and "In the course of") according to the community type were: major, middle sized cities and Tokyo metropolitan wards, 100%; other cities, 64.9%; towns, 40.7%; and villages, 38.8%. Of the 500 local communities which answered "Completed establishment", the proportions with release onto the internet (including "Completed" and "In the course of") were: major cities, 100%; middle sized cities, 67.7%; Tokyo metropolitan wards, 85.7%; other cities, 38.8%; towns, 13.5%; and villages, 14.3%. We examined whether each of the 462 collected regional plans included each of the national Health Japan 21's target themes and items, and found a tendency for smaller community' regional plans to be less likely to give comprehensive coverage. CONCLUSION: More support for smaller local governments is necessary to achieve establishment and effective implementation of Health Japan 21 regional plans. Publication Types: •

English Abstract

PMID: 16266083 [PubMed - indexed for MEDLINE] 717: Int Fam Plan Perspect. 2005 Sep;31(3):115-23. Related Articles, Links

Use of family planning services in the transition to a static clinic system in Bangladesh: 1998-2002.

Mercer A, Ashraf A, Huq NL, Haseen F, Uddin AH, Reza M. Health Systems and Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh. [email protected] CONTEXT: In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system. METHODS: Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics. RESULTS: In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time. CONCLUSIONS: Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives. Publication Types: •

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

PMID: 16263528 [PubMed - indexed for MEDLINE] 718: J Health Popul Nutr. 2005 Sep;23(3):215-21. Related Articles, Links

Acceptability of and adherence to dispersible zinc tablet in the treatment of acute childhood diarrhoea. Nasrin D, Larson CP, Sultana S, Khan TU. Health Systems and Infectious Diseases Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh. [email protected] Zinc treatment is now recommended by the World Health Organization as part of

the routine management of acute childhood diarrhoea. A dispersible zinc tablet formulation was developed taking into account the taste, cost, and feasibility to distribute and store. Only limited information is available on the acceptability of and adherence to dispersible zinc tablet. No study has formally assessed whether the formulation is acceptable to children and if caretakers can adhere to the instructions regarding preparation, dosage, and duration of treatment. This community-based study aimed at determining the acceptability of and adherence to a dispersible zinc tablet formulation in a cohort of children (n=320) aged less than five years. Caretakers of children with acute childhood diarrhoea were prescribed zinc tablet treatment and followed up after 2-3 weeks. The formulation was acceptable to children; 90.1% of 303 caretakers perceived that the tablets were equally or even more acceptable to their children compared to other medicines. Ninety-eight percent of the children received the standard dose of one tablet per day, and 55.8% completed the full 10-day course of zinc treatment. Adherence rates did not vary by age or gender of the child. These findings indicate that the tablet formulation is acceptable, but further efforts are required to enhance adherence. Publication Types: •

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

PMID: 16262017 [PubMed - indexed for MEDLINE] 719: Ned Tijdschr Geneeskd. 2005 Oct 15;149(42):2339-43. Related Articles, Links

[Participation in the Dutch national screening programme for uterine cervic cancer higher after invitation by a general practitioner, especially in groups with a traditional low level of attendance] [Article in Dutch] de Nooijer DP, de Waart FG, van Leeuwen AW, Spijker WW. Stichting Bevolkingsonderzoek Baarmoederhalskanker Zuidwest-Nederland (SBKZ), Postbus 3051, 3130 CB Vlaardingen. OBJECTIVE: To gain insight into the differences in participation in the screening programme for uterine cervix cancer between women invited by a general practitioner (GP) and women invited by the local health authority (GGD). Specific attention was given to those groups whose participation is generally below average. DESIGN: Descriptive epidemiological study. METHOD: In the

period 2000-2003, 237,719 women (30-60 years of age) were invited to participate in the national uterine cervix cancer screening programme in the Southwest of the Netherlands; 37.1% of the women were invited by the GP and 62.9% by the GGD. Data were obtained from the Cervix Information System of the GGDs. Differences in attendance between those invited by the GP and those invited by the GGD were tested by linear regression. Participation was defined as the number of women for whom the result of a cervical smear was known, divided by the number invited. RESULTS: Invitation by a GP led to a 7.9% (95% CI: 7.5-8.3) higher attendance rate than invitation by a GGD. This difference in attendance was higher for women born in Morocco, Turkey, Surinam and the Netherlands Antilles/Aruba (17.2%; 95% CI: 15.2-I9.2), young women (11.9%; 95% CI: 10.8-13.0), women with a low socio-economic status (11.6%; 95% CI: 10.4-12.7), and women who lived in highly urban areas (13.0%; 95% CI: 12.313.6). The differences were the greatest among non-western women who were also part of another low-attendance group: 19.0% (95% CI: 16.7-21.2) for women who lived in highly urban areas and 20.8% (95% CI: 16.8-24.9) for those in the youngest age group. Publication Types: •

English Abstract

PMID: 16261714 [PubMed - indexed for MEDLINE] 720: J Bone Miner Metab. 2005;23(6):488-94. Related Articles, Links

Serum 25-hydroxyvitamin D levels and activities of daily living in noninstitutionalized elderly Japanese requiring care. Nakamura K, Nishiwaki T, Ueno K, Yamamoto M. Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 9518510, Japan. [email protected] To date, no study has investigated the nutritional status of vitamin D in frail elderly people living at home. The purposes of this study were to assess serum 25hydroxyvitamin D (25[OH]D) levels and associated factors in noninstitutionalized elderly people who had various levels of physical disability, and to propose an adequate vitamin D nutritional status for the elderly by interpreting the serum 25(OH)D levels in relation to serum parathyroid hormone (PTH) levels in this population. Health examinations were conducted in the winter and summer of 2003. The subjects were 143 elderly people in the winter, and 120 elderly people

in the summer, who all used the long-term care insurance system at home. Serum 25(OH)D concentrations were determined with a chemiluminescence proteinbinding assay, and serum intact PTH concentrations were determined with an immunoradiometric assay. The subjects' disease histories and lifestyle information were obtained through an interview. Activities of daily living (ADL) levels were evaluated using the Barthel index, and grip strength was measured with a digital hand dynamometer. Average serum 25(OH)D levels in the winter and summer were 54.2 nmol/l (SD 29.0) and 53.3 nmol/l (SD 32.3), respectively, and intact PTH concentrations in the winter and summer were 4.2 pmol/l (SD 1.8) and 4.3 pmol/l (SD 1.8), respectively. The proportion of people who had a low 25(OH)D (<30 nmol/l) and high intact PTH levels (>6.9 pmol/l) were 15%-20% and 8%, respectively. Significant predictors of low serum 25(OH)D concentrations were low ADL levels, female sex, and low fish consumption in both seasons. Serum 25(OH)D concentrations of less than 50 nmol/l were associated with elevated serum intact PTH concentrations. In conclusion, elderly people requiring care at home are at high risk of hypovitaminosis D, and their low serum 25(OH)D levels are mainly associated with low ADL levels. In addition, maintenance of serum 25(OH)D concentrations above 50 nmol/l may prevent hypovitaminosis Dinduced hyperparathyroidism. Publication Types: •

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

PMID: 16261457 [PubMed - indexed for MEDLINE] 721: Jpn J Clin Oncol. 2005 Oct;35(10):626-9. Related Articles, Links

Comparison of laryngeal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (19602000). Sano H, Hamashima C. Statistics and Cancer Control Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan. Publication Types: •

Comparative Study

PMID: 16254041 [PubMed - indexed for MEDLINE]

722: Prog Transplant. 2005 Sep;15(3):286-90. Related Articles, Links

Promoting organ donation and transplantation among South Asians in the United Kingdom: the role of social networks in the South Asian community. Randhawa G. Institute for Health Research, University of Luton, United Kingdom. The percentage of South Asians on the kidney transplant waiting list in the United Kingdom is 3 times their percentage in the general population. Obviously, organ donation and transplantation among South Asians in the United Kingdom needs improvement. In recent years, ethnically targeted campaigns in the mass media have specifically attempted to attract donors from the South Asian communities. A number of pilot studies have been done to evaluate the effectiveness of these initiatives in providing information about organ donation to South Asians. Results indicate that detailed information related to transplantation was learned mainly by people within the community receiving transplants and was transmitted through various informal community networks rather than through the resources provided by the Department of Health. This article provides an overview of who South Asians are and how these community networks were established. Transplant professionals must devise effective strategies to access these community networks, thereby raising the consciousness of transplantation among South Asians in the United Kingdom. Publication Types: •

Review

PMID: 16252637 [PubMed - indexed for MEDLINE] 723: AJR Am J Roentgenol. 2005 Nov;185(5):1361-5. Related Articles, Links

The application of the Six Sigma program for the quality management of the PACS. Kang JO, Kim MH, Hong SE, Jung JH, Song MJ. Department of Radiation Oncology, Kyunghee University Medical College,

Kyunghee University Hospital, Hoikidong, Dongdaemungu, Seoul, South Korea. [email protected] OBJECTIVE: We implemented a Six Sigma-based quality management program for the PACS to improve the quality of and lessen the necessary resources for its management. CONCLUSION: With the Six Sigma-based PACS quality management program, we were able to reduce resource requirements while maintaining quality. PMID: 16247165 [PubMed - indexed for MEDLINE] 724: Turk J Gastroenterol. 2005 Sep;16(3):147-9. Related Articles, Links

Can we rely on public data as a source of information for cancer registry in developing countries? Semnani S, Kabir MJ, Besharat S, Abdolahi N, Danesh A, Roshandel D. Department of Gastroenterology, Golestan University of Medical Sciences, Iran. [email protected] BACKGROUND/AIMS: Although a "hospital-based cancer registry" is important in improving patient care, a "population-based cancer registry" with emphasis on epidemiology is important in allocating health care resources and prioritizing public health programs. Because of its reliance on retrieved clinical and paraclinical documents, there is some limitation in registering all cancer incidents in this system, especially in developing countries. In this study we examined the possibility of using public data as a complementary source of information for recording cancers in a population-based cancer registry. METHODS: Along with the annual census in rural areas, a survey was performed in Golestan province in March 2004 to identify public awareness about cancer incidents in the community. Individuals were questioned about history of cancer in their close relatives during the last two years. Those who reported cancer in their relatives were also asked to name the main organ of involvement. A similar list was retrieved from the cancer registry at the Ministry of Health in Gorgan, and cases with upper GI (esophagus and gastric) cancer diagnosis from 21 March 2002 through 20 March 2004 were selected for this study. Finally, these two lists were compared for examining accuracy of the collected data. RESULTS: We included 137 cases in our study with rural residence and known addresses. Only 35 (25.5%) cases were reported by the relatives and among them only 20 (57.1%) relatives correctly reported the tumor location. Although we found a difference in accurate reporting of cancer incidents by year of diagnosis (more correct cases reported during the second versus the first year), the difference was not statistically significant between the two years. CONCLUSION: In this study, we

examined the possibility of using public awareness about cancer incidents as a complementary source of information for a population-based cancer registry. We found that this approach is not ideal for reducing limitations. Therefore, we recommend a nationwide cancer registry to record all cancer-related information at the time of diagnosis. This strategy will reduce the need for performing retrospective surveys in collecting cancer-related information. PMID: 16245225 [PubMed - indexed for MEDLINE] 725: Public Health Nutr. 2005 Sep;8(6A):766-72. Related Articles, Links Comment in: •

Public Health Nutr. 2006 Apr;9(2):275.

The new nutrition science: sustainability and development. Wahlqvist ML. International Union of Nutritional Sciences, Monash University, Melbourne, Victoria, Australia. [email protected] OBJECTIVE: To show that nutrition science is anchored in food systems and is influenced by the social, through the environmental to the cosmological, life's connections and rhythms. To indicate that an integrative approach is now becoming possible with advances in food technology, in the understanding of food choice and of human behaviour, and in a preparedness to recognise nutritional inputs in the full sweep of life-long well-being and health outcomes. METHOD: An analysis of the much broader understanding of nutritionally related diseases from an ecological perspective, with attention to economic development, beginning with poverty alleviation. Recognition that the biological dimension of nutrition science is undergoing a profound reappraisal; that technologies will allow us to change the course of nutritionally related diseases for the better; and that nutrition science will find partners in information technology and telecommunications, food technology and energy technology. CONCLUSION: A new generation of nutrition scientists can help build a new economy that supports development amongst communities, whether close or distant from each other. The opportunities for this kind of development to be realised between Asia, Latin America and Africa are considerable. At all times, however, nutrition scientists must uphold the paramount importance of good governance, conflict resolution and maternal literacy if their work is to achieve its growing potential. Publication Types:

•

Review

PMID: 16236214 [PubMed - indexed for MEDLINE] 726: Eur Urol. 2005 Nov;48(5):712-22; discussion 722-3. Epub 2005 Apr 1. Related Articles, Links

Reversible, non-barrier male contraception: status and prospects. Hoesl CE, Saad F, Pöppel M, Altwein JE. Department of Urology, Hospital Barmherzige Brüder, Technical University Munich, Romanstr. 93, 80639 Munich, Germany. [email protected] OBJECTIVE: Male, non-barrier, contraceptive options are limited to vasectomy and inadequate methods such as withdrawal and periodic abstinence. Herein we give an overview of current research on male contraception by pharmacological means. METHODS: Literature search of PubMed documented publications and abstracts from meetings. RESULTS: Cross-cultural surveys show men's willingness to carry contraceptive responsibility. Clinical trials substantiate that hormonal contraception involving suppression of gonadotropins holds the best promise to provide a male pharmacological contraceptive. Androgens have been demonstrated to induce reversible infertility particularly in combination with certain progestins and GnRH antagonists. Advances in non-endocrine contraception include intervention with triptolide derivatives, alkylated imino sugars, and immunization by eppin. CONCLUSION: The prospect of a pharmacological, male contraceptive has been considerably advanced in recent years. Long-term studies involving a greater number of subjects may result in a safe, reversible and effective means. Asia is likely to be the first market for male, hormonal contraceptive methods. The clinical evaluation of non-endocrine approaches may ultimately lead to an alternative to hormone-based male contraception. Publication Types: •

Review

PMID: 16230226 [PubMed - indexed for MEDLINE] 727: Public Health Nurs. 2005 Sep-Oct;22(5):407-13. Related Articles, Links

Evaluation of a community-based exercise program for elderly Korean immigrants. Sin MK, Belza B, Logerfo J, Cunningham S. College of Nursing, Seattle University, 901 12th Ave, P.O. Box 222000, Seattle, WA 98122-1090, USA. [email protected] OBJECTIVE: To evaluate feasibility and effectiveness of a modified exercise program for elderly Korean immigrants (EKIs). Design and sample: Intervention study with EKI residents of a senior house (n = 13, age range 67-86 years, mean age 77 years), recruited through posted fliers and with help from a Korean social worker. INTERVENTION: A Korean-American instructor taught a modified version of an evidence-based exercise program 3 times weekly, 50 min per session, for 12 weeks. Program was evaluated with the Quality Health Outcomes Model. System and client characteristics were taken into consideration because elderly Koreans have their own values and beliefs, which influence their health management behaviors. Evaluation measures included exercise adherence, preintervention and postintervention health outcomes, and satisfaction with the exercise program. Group discussion was used to evaluate satisfaction with the exercise program. RESULTS: Participants showed improved health outcomes on muscle strength, agility/balance, and blood pressure after the exercise program. All participants were satisfied with the exercise program, and participation rates were good (nine participants attended > or = 80% of classes). CONCLUSIONS: The exercise program was feasible for this sample and should be evaluated in a larger population of EKIs and in populations of other ethnic minorities. Publication Types: • • • •

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

PMID: 16229733 [PubMed - indexed for MEDLINE] 728: Health Policy. 2005 Nov;74(3):247-60. Related Articles, Links

Arsenic poisoning in Bangladesh: spatial mitigation planning with GIS and public participation.

Hassan MM. Jahangirnagar University, Department of Geography and Environment, Savar, Dhaka 1342, Bangladesh. [email protected] A PPGIS (Public Participatory Geographical Information System) has recently been developed in combination with PRA (Participatory Rural Appraisal) and GIS (Geographical Information Systems) methodologies to utilise GIS in the context of the needs of communities that are involved with, and affected by development programmes. The impact of arsenic poisoning in Bangladesh is 'tragic and painful' on patients' health and their social life what was described as the 'worse mass poisoning in human history' in a WHO report. Deep tubewell is said to be a source of arsenic-free safe drinking water and people are mainly interested in deep tubewell water rather than rainwater harvesting, dug-wells, and pond-sandfilters (PSF) approved by the BAMWSP (Bangladesh Arsenic Mitigation Water Supply Project). This paper mainly explores the application and suitability of GIS with local community participation in deep tubewell planning for arsenic mitigation. The relevant data for this study were collected from the field survey. The PRA methods were used to obtain social and resource information; while a GIS was used to organise, analyse, and display the information. Participants from three different focus-groups were asked to determine their 'own priorities' for spatial planning of deep tubewell for arsenic-free water. The study results valuable community perspectives on deep tubewell planning and reveals the suitability of PPGIS in spatial planning for arsenic mitigation with local community mapping overlay. The process of dialogue and preparation of mental mapping within each focus-group participants lead to enhance information about community needs of deep tubewell in the study area. Publication Types: •

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

PMID: 16226137 [PubMed - indexed for MEDLINE] 729: J Forensic Odontostomatol. 2005 Jun;23(1):1-18. Related Articles, Links

Thai tsunami victim identification overview to date. James H. Forensic Odontology Unit, University of Adelaide, Australia. [email protected] The boxing day tsunami of 26 December 2004 caused devastation and loss of life

around the Indian ocean. International disaster victim identification efforts were centred in Thailand, with many odontologists from over 20 countries contributing to the examination of deceased, collection of antemortem information, comparison and reconciliation of data. The contribution of forensic odontology to the identification process conducted in Thailand in response to the tsunami devastation is presented in a composite of short reports focused on the five phases associated with disaster victim identification. To date 1,474 deceased have been identified. Dental comparison has been the primary identifier in 79% of cases and a contributor in another 8%, a total of 87%. PMID: 16224829 [PubMed - indexed for MEDLINE] 730: J Forensic Odontostomatol. 2005 Jun;23(1):19-25. Related Articles, Links

DVI System International: software assisting in the Thai tsunami victim identification process. Andersen Torpet L. Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. [email protected] DVI System International is software that operates on the PC-Windows platform. It is capable of managing aspects of identification in day-to-day cases and major disasters, where it has particular advantages when victims of several nationalities are involved. The system uses Interpol forms as standard protocols for input and transfer of antemortem and postmortem information. Following the Thai Tsunami Disaster of 26 December 2004, Interpol recommended that its member country Thailand use DVI System International software, as it is one of the few internationally approved systems. This paper focuses on the concepts upon which the dental forms, F1 and F2, of the DVI System International are designed, describes how it works and some of the adjustments implemented during the ongoing Thai Tsunami Victim Identification process. PMID: 16223022 [PubMed - indexed for MEDLINE] 731: Food Nutr Bull. 2005 Sep;26(3):255-8. Related Articles, Links

Thirty years of a ban on the sale of noniodized salt: impact on iodine nutrition in children in Himachal Pradesh, India. Kapil U, Sharma TD, Singh P, Dwivedi SN, Kaur S.

Department of Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 1-110029, India. [email protected] BACKGROUND: A survey conducted by the central iodine-deficiency disorders team in Himachal Pradesh, a state in the goiter-endemic belt of India, revealed that 10 of its 12 districts have an endemic prevalence of goiter. The survey was conducted to provide health program managers data to determine whether it would be necessary to initiate intervention measures. OBJECTIVE: To assess the status of urinary iodine excretion and household salt iodization levels after three decades of a complete ban on the sale of noniodized salt in this goiter-endemic state in India as measured by assessment of urinary iodine excretion levels and iodine content of salt at the household level. METHODS: The guidelines recommended by WHO/ UNICEF/ICCIDD for a rapid assessment of salt iodization were adopted. In each of the 12 studied districts, all senior secondary schools were enlisted and one school was selected by using a random sampling procedure. Two hundred fifty children 11 to 18 years of age were included in the study. Urine samples were collected from a minimum of 170 children and analyzed using the wet digestion method. Salt samples were also collected from a minimum of 170 children and analyzed using the spot testing kit. RESULTS: All districts had a median urinary iodine excretion level > 200 microg/L and 82% of the families were consuming salt with an iodine content of 15 ppm or higher. CONCLUSIONS: The results of the present study high-light the successful implementation of the salt iodization program in the state of Himachal Pradesh. This positive impact may be due to the comprehensive strategy adopted by the state government to improve the quality of salt, development of an effective monitoring information system and effective information, education, and communication activities. PMID: 16222915 [PubMed - indexed for MEDLINE] 732: Ann Pharmacother. 2005 Nov;39(11):1918-23. Epub 2005 Oct 11. Related Articles, Links Erratum in: •

Ann Pharmacother. 2005 Dec;39(12):2143. Yeom, Jong Hum [corrected to Yeom, Jong Hun].

Identification of inappropriate drug prescribing by computerized, retrospective DUR screening in Korea. Yeom JH, Park JS, Oh OH, Shin HT, Oh JM.

College of Medicine, Han Yang University, Seoul, Korea. BACKGROUND: In Korea, the drug use process has changed significantly since the new pharmacy law was implemented in 2000, separating the prescribing and dispensing functions between physicians and pharmacists and mandating prospective drug use review (DUR) practice by pharmacists immediately before dispensing medications. However, a high prevalence of inappropriate prescribing has been suspected by the public, pharmacists, and health insurance managers, possibly due to suboptimal DUR practice by pharmacists. OBJECTIVE: To assess overall patterns of drug usage and potential problems of inappropriate use in outpatient settings by analyzing prescription data that were electronically submitted to the national health insurance manager with a computerized DUR system and develop a computerized adjudication system model for drug claims. METHODS: The national prescription drug claims data that were submitted electronically by pharmacies located in the northern part of Korea during 15 days in 2002 were retrospectively screened against the predetermined DUR standards of the selected criteria on drug dosage, duration of therapy, and drug interaction using the DUR screening system. The results of all the DUR conflicts were further validated manually by an expert panel and statistically analyzed to determine drug use patterns. RESULTS: Of 31,994,260 drugs prescribed, 3,325,760 (10.4%) items showed a conflict with at least one of the DUR standards. The average number of drugs prescribed on each prescription was 4.07, and even more troubling was the high incidence of under-dosing, over-dosing, and contraindicated drug prescribing. CONCLUSIONS: It is evident that inappropriate drug prescribing is very common in Korea; thus, a great deal of attention is urgently needed in the country with respect to proper prescribing and supportive interventions. Publication Types: •

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

PMID: 16219902 [PubMed - indexed for MEDLINE] 733: Acta Crystallogr D Biol Crystallogr. 2005 Oct;61(Pt 10):1364-72. Epub 2005 Sep 28. Related Articles, Links

Three-dimensional structure determination of proteins related to human health in their functional context at The Israel Structural Proteomics Center (ISPC). This paper was presented at ICCBM10. Albeck S, Burstein Y, Dym O, Jacobovitch Y, Levi N, Meged R, Michael Y, Peleg Y, Prilusky J, Schreiber G, Silman I, Unger T, Sussman JL.

Department of Structural Biology, Weizmann Institute of Science, Rehovot 76100, Israel. The principal goal of the Israel Structural Proteomics Center (ISPC) is to determine the structures of proteins related to human health in their functional context. Emphasis is on the solution of structures of proteins complexed with their natural partner proteins and/or with DNA. To date, the ISPC has solved the structures of 14 proteins, including two protein complexes. It has adopted automated high-throughput (HTP) cloning and expression techniques and is now expressing in Escherichia coli, Pichia pastoris and baculovirus, and in a cell-free E. coli system. Protein expression in E. coli is the primary system of choice in which different parameters are tested in parallel. Much effort is being devoted to development of automated refolding of proteins expressed as inclusion bodies in E. coli. The current procedure utilizes tagged proteins from which the tag can subsequently be removed by TEV protease, thus permitting streamlined purification of a large number of samples. Robotic protein crystallization screens and optimization utilize both the batch method under oil and vapour diffusion. In order to record and organize the data accumulated by the ISPC, a laboratory information-management system (LIMS) has been developed which facilitates data monitoring and analysis. This permits optimization of conditions at all stages of protein production and structure determination. A set of bioinformatics tools, which are implemented in our LIMS, is utilized to analyze each target. Publication Types: •

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

PMID: 16204888 [PubMed - indexed for MEDLINE] 734: East Mediterr Health J. 2004 Jan-Mar;10(1-2):56-63. Related Articles, Links

Capture-recapture methods for estimation of fertility and mortality in a rural district of Turkey. Aslan D, Ozcebe H, Bertan M, Karaağaoğlu E. Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey. The study used capture-recapture methods to determine if information on births, deaths and family planning use obtained from two data sources provides the same or more complete information than that available from a single source. Five different data sources used were: village heads (mukhtars), community health

volunteers, primary health care centres, maternal and child care units and local administrative units (health group presidencies) in 10 selected villages in a rural area of Turkey from May to October 1999. Although the numbers of deaths and births were estimated, no estimation of the number of women using any family planning method could be made. The study highlights some data collection problems of the surveillance system in Turkey and recommends that the routine surveillance systems be strengthened. Publication Types: •

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

PMID: 16201709 [PubMed - indexed for MEDLINE] 735: Environ Sci Technol. 2005 Sep 15;39(18):7318-28. Related Articles, Links

Site-dependent life-cycle analysis by the SAME approach: its concept usefulness, and application to the calculation of embodied impact intensity by means of an input-output analysis. Nansai K, Moriguchi Y, Suzuki N. Research Center for Material Cycles and Waste Management, and Endocrine Disruptors and Dioxin Research Project, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan. [email protected] This paper describes a practical approach to site-dependent life-cycle analysis (SDLCA) that differentiates site-dependent environmental impacts from a system's processes by considering the geographical conditions of each process. This approach converts an environmental output into its impacts by using sitedependent characterization factors (SDCFs). This approach defines an area-the Spatial Area of iMpact Equivalency (SAME)-within the boundaries of the geographical system during site-dependent life-cycle inventory (SDLCI) analysis and calculates an environmental output from a process for the SAMEs. Each SAME represents a collection of geographical areas with internally homogeneous environmental impacts and can be mapped using a geographic information system. Preparing a SDLCI and SDCFs based on SAMEs facilitates the implementation of SDLCA by permitting the use of fewer regions during SDLCI. To demonstrate application of the SAME approach, an embodied impact intensity was formulated; it quantifies the impact directly and indirectly on the basis of the unit activity of a sector by means of input-output analysis with SDCFs. The validity of using SAMEs for SDLCA is demonstrated through two case studies: one studying suspended particulate matter, and one studying benzene. In both cases, the impact intensities are calculated using the SAME approach and the

results are compared with those of site-generic LCI. PMID: 16201665 [PubMed - indexed for MEDLINE] 736: Ambio. 2005 Aug;34(6):445-9. Related Articles, Links

Toward modeling regionally specific human security using GIS: case study Cambodia. Owen T, Slaymaker O. Centre for the Study of Civil War, International Peace Research Institute, Oslo. [email protected] A new methodology for measuring human security is presented. The three stages of the methodology are: i) threat assessment, ii) data collection and organization, and iii) data visualization and analysis, using Geographic Information Systems. Results from a Cambodia case study are highlighted. The United Nations Development Program's notion of human security, which gives equal weight to economic, health, food, political, personal, and environmental factors, is used. Country-specific threats in each category are determined, and local, spatially referenced data are collected. In this paper, poverty, dengue fever, and tuberculosis are used as examples of the analytic process. Regions of Cambodia exposed to all three of these threats ("hot spots") are located, and spatial correlation between poverty, dengue fever, and tuberculosis is calculated. The methodology i) advances a broad concept of human security, ii) will potentially assist policy and decision makers, and iii) identifies research questions that cannot be resolved using single-sector analysis. PMID: 16201215 [PubMed - indexed for MEDLINE] 737: Clin Nutr. 2006 Feb;25(1):91-101. Epub 2005 Sep 29. Related Articles, Links

The impact of computerization of the nutrition support process on the nutrition support program in a tertiary care hospital in the Philippines: report for the years 2000-2003. Llido LO. Room 315-316, MAB, Nutrition Support Services, St. Luke's Medical Center, E. Rodriguez Sr. Avenue, Quezon City, Metro-Manila, Philippines. [email protected]

BACKGROUND & AIMS: To improve hospital health care delivery by identifying malnutrition in all admitted patients and following up those identified to be malnourished and "at risk of developing malnutrition" a hospital nutrition support program based on the JCAHO system was initiated in 1999. Two major problems were encountered: first, the inability to perform a nutrition surveillance process due to failure by the staff to implement existing nutrition screening tools and second, the lack of awareness and support from the medical staff in this initiative. Two solutions were implemented in 2000: computerization of the nutrition screening and nutrition support process and synchronizing this with the whole nutrition support program. METHODS: A computer program was developed which performs BMI-based nutrition screening, produces lists of all malnourished patients, and computes the different formulas for either nutritional requirement or parenteral and/or enteral formulation. It also generates patient status reports based on encoded data from the nutrition support team, which prioritized these patients for management based on the data output. RESULTS: From 2000 to 2003, improvement was seen in these areas: entry of height and weight in the patient record increased from 30% to 90%; nutrition surveillance shows nutritional status distribution to be: normal (58%), underweight (9%), overweight (25%), and obese (8%), referrals to the nutrition support team based on the screen notification increased from 37% to 100%, patient coverage by nutrition support services increased from 7374 (38.8%) in 2000 to 11,369 (83%) in 2003, and critical care patients seen increased from 10% in 2000 to 99% in 2003. More improvement is needed in physician response to nutrition support recommendations, which still remains low (11.2-24%). CONCLUSIONS: Computerization helps to improve nutrition support delivery in the hospital, but more cooperation and support from the medical staff is still needed for better results. PMID: 16198450 [PubMed - indexed for MEDLINE] 738: Science. 2005 Sep 30;309(5744):2156-9. Related Articles, Links

Iraqi science. In the line of fire. Stone R. Publication Types: •

News

PMID: 16195441 [PubMed - indexed for MEDLINE]

739: Bull World Health Organ. 2005 Aug;83(8):604-10. Related Articles, Links

The use of a computerized database to monitor vaccine safety in Viet Nam. Ali M, Canh GD, Clemens JD, Park JK, von Seidlein L, Minh TT, Thiem DV, Tho HL, Trach DD; The Vaccine Safety Datalink Group. International Vaccine Institute, SNU Campus, Seoul, Republic of Korea. Health information systems to monitor vaccine safety are used in industrialized countries to detect adverse medical events related to vaccinations or to prove the safety of vaccines. There are no such information systems in the developing world, but they are urgently needed. A large linked database for the monitoring of vaccine-related adverse events has been established in Khanh Hoa province, Viet Nam. Data collected during the first 2 years of surveillance, a period which included a mass measles vaccination campaign, were used to evaluate the system. For this purpose the discharge diagnoses of individuals admitted to polyclinics and hospitals were coded according to the International Classification of Diseases (ICD)-10 guidelines and linked in a dynamic population database with vaccination histories. A case-series analysis was applied to the cohort of children vaccinated during the mass measles vaccination campaign. The study recorded 107,022 immunizations in a catchment area with a population of 357,458 and confirmed vaccine coverage of 87% or higher for completed routine childhood vaccinations. The measles vaccination campaign immunized at least 86% of the targeted children aged 9 months to 10 years. No medical event was detected significantly more frequently during the 14 days after measles vaccination than before it. The experience in Viet Nam confirmed the safety of a measles vaccination campaign and shows that it is feasible to establish health information systems such as a large linked database which can provide reliable data in a developing country for a modest increase in use of resources. Publication Types: •

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

PMID: 16193545 [PubMed - indexed for MEDLINE] 740: Death Stud. 2005 Jul-Aug;29(6):559-72. Related Articles, Links

Risk factors of violent death in rural Bangladesh, 1990-1999.

Hadi A. Research and Evaluation Division, Bangladesh Rural Advancement Committee, BRAC, 75 Mohakhali, Dhaka 1212, Bangladesh. [email protected] This study attempts to improve our understanding of the prevalence and determinants of violent death in rural Bangladesh. Data came from a demographic surveillance system covering a population of nearly 62,000 in 10 districts of the country. Findings reveal that drowning and homicide were the leading causes of death followed by traffic accident and suicide. Significant sociodemographic differentials in violent death existed. The probability to become the victim of violent death was 61.2 per 100,000 if the person was very young, male, poor, illiterate and Muslim. The author concludes that the public health program should consider the appropriate mechanisms to prevent many avoidable events of death in rural Bangladesh. PMID: 16187479 [PubMed - indexed for MEDLINE] 741: Int Arch Occup Environ Health. 2006 Feb;79(2):115-22. Epub 2005 Sep 27. Related Articles, Links

Negative association between serum dioxin level and oxidative DNA damage markers in municipal waste incinerator workers. Yoshida J, Kumagai S, Tabuchi T, Kosaka H, Akasaka S, Kasai H, Oda H. Department of Environmental Health, Osaka Prefectural Institute of Public Health, Osaka, 1-3-69, Nakamichi, Higashinari-ku, 537-0025, Japan. [email protected] OBJECTIVES: To investigate the effect of dioxin on the formation of oxidative DNA damage and urinary mutagenicity, we measured the concentrations of serum dioxins and lymphocytic 8-hydroxydeoxyguanosine (8-OH-dG) in 57 male waste incinerator workers, urinary 8-OH-dG and urinary mutagenicity in 29 male waste incinerator workers. METHODS: Information about the subjects was obtained from a questionnaire. Concentrations of polychlorinated dibenzo-p-dioxin (PCDD), polychlorinated dibenzofuran (PCDF), and coplanar-polychlorinatedbiphenyl (Co-PCB) in serum samples from the workers were measured with a high-resolution gas chromatograph /high-resolution mass spectrometer. Lymphocytic and urinary 8-OH-dG levels were measured with a highperformance liquid chromatography-electrochemical detector system. The urinary mutagenicity was measured with umu assay. RESULTS: The lymphocytic 8-OHdG level showed a negative association with the serum dioxin level (total value of TEQ-PCDD, PCDF, and Co-PCB). Urinary 8-OH-dG did not show correlation with serum dioxin level, but showed positive correlation with the smoking index.

CONCLUSIONS: With respect to the subjects' serum dioxin level, dioxin did not increase the urinary 8-OH-dG level by oxidative DNA damage, but upregulation of the primary defenses with oxidative damage and/or DNA repair system activity might have occurred. PMID: 16187124 [PubMed - indexed for MEDLINE] 742: Diabetes Care. 2005 Oct;28(10):2514-8. Related Articles, Links

High plasma level of remnant-like particle cholesterol in the metabolic syndrome. Satoh A, Adachi H, Tsuruta M, Hirai Y, Hiratsuka A, Enomoto M, Furuki K, Hino A, Takeuchi T, Imaizumi T. The Third Department of Internal Medicine and The Cardiovascular Institute, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 8300011, Japan. OBJECTIVE: The metabolic syndrome is associated with a high incidence of cardiovascular disease even when the abnormalities present in the syndrome are mild. The underlying mechanism of the metabolic syndrome has not been elucidated. We investigated whether a strong atherogenic lipoprotein, remnantlike particle (RLP) lipoprotein cholesterol, is elevated in the metabolic syndrome. RESEARCH DESIGN AND METHODS: We performed a health examination among the residents of a rural community in Japan. Complete datasets, including fasting RLP cholesterol levels, were obtained in 1,261 subjects (509 men and 752 women) without diabetes and who were not taking lipid-lowering drugs. The subjects' medical history, use of alcohol, and smoking habits were ascertained by a questionnaire. RESULTS: All of the components of the metabolic syndrome were significantly related to RLP cholesterol by univariate analysis. Total cholesterol and smoking habits were also positively associated with RLP cholesterol. The subjects with the metabolic syndrome showed only mild abnormalities of each component. When RLP cholesterol levels were stratified by the number of the components of the metabolic syndrome, there was a strong association between RLP cholesterol levels and the number of components (P < 0.001 and F = 72.7). CONCLUSIONS: RLP cholesterol levels are elevated in the metabolic syndrome, and this elevation may underlie the high incidence of cardiovascular disease in the metabolic syndrome. Publication Types: •

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

PMID: 16186289 [PubMed - indexed for MEDLINE] 743: Bull World Health Organ. 2005 Aug;83(8):618-25. Epub 2005 Sep 22. Related Articles, Links

Evaluating national cause-of-death statistics: principles and application to the case of China. Rao C, Lopez AD, Yang G, Begg S, Ma J. School of Population Health, University of Queensland, Australia. Mortality statistics systems provide basic information on the levels and causes of mortality in populations. Only a third of the world's countries have complete civil registration systems that yield adequate cause-specific mortality data for health policy-making and monitoring. This paper describes the development of a set of criteria for evaluating the quality of national mortality statistics and applies them to China as an example. The criteria cover a range of structural, statistical and technical aspects of national mortality data. Little is known about cause-of-death data in China, which is home to roughly one-fifth of the world's population. These criteria were used to evaluate the utility of data from two mortality statistics systems in use in China, namely the Ministry of Health-Vital Registration (MOHVR) system and the Disease Surveillance Point (DSP) system. We concluded that mortality registration was incomplete in both. No statistics were available for geographical subdivisions of the country to inform resource allocation or for the monitoring of health programmes. Compilation and publication of statistics is irregular in the case of the DSP, and they are not made publicly available at all by the MOH-VR. More research is required to measure the content validity of causeof-death attribution in the two systems, especially due to the use of verbal autopsy methods in rural areas. This framework of criteria-based evaluation is recommended for the evaluation of national mortality data in developing countries to determine their utility and to guide efforts to improve their value for guiding policy. Publication Types: • • •

Evaluation Studies Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.

PMID: 16184281 [PubMed - indexed for MEDLINE]

744: Bull World Health Organ. 2005 Aug;83(8):611-7. Epub 2005 Sep 22. Related Articles, Links

Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics. Setel PW, Sankoh O, Rao C, Velkoff VA, Mathers C, Gonghuan Y, Hemed Y, Jha P, Lopez AD. Department of Epidemiology and MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27516, USA. [email protected] Registration of births, recording deaths by age, sex and cause, and calculating mortality levels and differentials are fundamental to evidence-based health policy, monitoring and evaluation. Yet few of the countries with the greatest need for these data have functioning systems to produce them despite legislation providing for the establishment and maintenance of vital registration. Sample vital registration (SVR), when applied in conjunction with validated verbal autopsy procedures and implemented in a nationally representative sample of population clusters represents an affordable, cost-effective, and sustainable short- and medium-term solution to this problem. SVR complements other information sources by producing age-, sex-, and cause-specific mortality data that are more complete and continuous than those currently available. The tools and methods employed in an SVR system, however, are imperfect and require rigorous validation and continuous quality assurance; sampling strategies for SVR are also still evolving. Nonetheless, interest in establishing SVR is rapidly growing in Africa and Asia. Better systems for reporting and recording data on vital events will be sustainable only if developed hand-in-hand with existing health information strategies at the national and district levels; governance structures; and agendas for social research and development monitoring. If the global community wishes to have mortality measurements 5 or 10 years hence, the foundation stones of SVR must be laid today. 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. Research Support, U.S. Gov't, P.H.S.

PMID: 16184280 [PubMed - indexed for MEDLINE]

745: Altern Lab Anim. 2005 Apr;33(2):111-8. Related Articles, Links

The use of live apes in research in the twenty-first century. Hagelin J. [email protected] A literature-based survey was conducted on the use of live apes in research between 2000 and 2003. The 599 studies identified and considered were grouped according to area of research, taxonomy and geographic location of the work. The results suggested that behaviour/cognition, conservation and various applications related to virology (most notably, hepatitis and HIV) were the most frequent areas of research. Of the studies, 73% were classified as non-invasive, whereas 27% were classified as invasive. Among the invasive studies, 39% were scored as of mild severity, and 61% were scored as of moderate/substantial severity. Pan species were involved in 65% of the studies, Gorilla species in 15%, Pongo species in 12%, and Hylobates species in 8%. Most of the invasive research was conducted in the USA (60%). The majority of the non-invasive research was conducted in the USA (31%), Japan (13%), or in the animals natural habitats in Africa (35%) and Asia (8%). Publication Types: •

Historical Article

PMID: 16180986 [PubMed - indexed for MEDLINE] 746: J UOEH. 2005 Sep 1;27(3):279-93. Related Articles, Links

[Actual condition survey on inclusive child day-care--a questionnaire survey of child day-care facilities in K city] [Article in Japanese] Kawachi S, Hamada Y, Fukuzawa Y. Department of Nursing Science and Arts, School of Health Sciences, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 8078555, Japan. The purpose of this questionnaire survey is to gather information on actual

conditions of inclusive child day-care in K City in order to qualify what support we can provide as part of the community. The questionnaire was sent to 148 child-care facilities (day nurseries) in date, of which 116 provided sufficient data for analysis. Of these 116 facilities, 104 (89.7%) accepted children with disabilities, while 12 (10.3%) did not. The number of disabled children accepted by the 104 facilities over a 2.5-year period was 275. Mental retardation (including children with multiple disabilities) was the most common type of disability; autism, physical disability and cerebral palsy were also seen. Thus, nursery staff, whose training is largely geared toward education and child development, is faced with a particularly difficult task. What we envisage as one of our future roles is to train and provide nursing experts with a specialized knowledge of medical rehabilitation, day-to-day medical care, training and support of children with various types of disabilities. Such nurses could then be introduced to child daycare facilities to provide individualized child-care services, which would take into account all factors relating to the child's condition and developmental stage. The results of our survey also suggest that close coordination and partnership with specialized/related agencies and institutions should be pursued in order to both enrich the support systems of child day-care facilities and to enhance their inclusiveness. Publication Types: •

English Abstract

PMID: 16180515 [PubMed - indexed for MEDLINE] 747: J Med Syst. 2005 Aug;29(4):391-400. Related Articles, Links

Dolphin project--cooperative regional clinical system centered on clinical information center. Takada A, Guo J, Tanaka K, Sato J, Suzuki M, Suenaga T, Kikuchi K, Araki K, Yoshihara H. Medical Information Technology, Kumamoto University Hospital, Honjo 1-1-1, Kumamoto, Japan. [email protected] In 2001, a system was created to improve patient service, improve the quality of medical care, and achieve efficient medical care. A Data Center was established to accumulate and manage clinical information in the regions and share clinical information safely and appropriately. The system has already been in operation for 3 years. Even though a patient may have been examined at multiple hospitals, his medical record information will be integrated at the Center. This ensures medical care continuity and enables the patient to view his own medical records at

home. Its usefulness in obtaining informed consent has been demonstrated as well. XML instances established in the MML standards (MML (Medical Markup Language): http.//www.medxml.net/E_mml30/mmlv3_E_index.htm Accessed July 2004; Jpn. J. Med. Informatics (JJMI) 17(3):203-207, 1997; J. Med. Syst. 24(3):195-211, 2000; J. Med. Syst. 27(4):357-366, 2003; J. Med. Syst. 28(6):523533, 2004) are used for Electronic Medical Record System data exchange between the Data Center and each medical institution. The openness provided by XML makes it possible to connect diverse electronic medical records to the Center. As of the year 2004, over 10 types of electronic medical records have an MML interface, enabling connection to the Center. PMID: 16178336 [PubMed - indexed for MEDLINE] 748: Indian J Med Res. 2005 Aug;122(2):137-42. Related Articles, Links

Utilization of indigenous systems of medicine & homoeopathy in India. Singh P, Yadav RJ, Pandey A. Institute for Research in Medical Statistics (ICMR), Ansari Nagar, New Delhi 110-029, India. BACKGROUND & OBJECTIVE: Very little information is available on the utilization of Indian systems of medicine and homoeopathy (ISM&H) in India. A study was undertaken on the usage and acceptability of indigenous systems of medicine to provide estimate of utilization of different indigenous systems of medicine in the country along with the reasons for preferences as well as the cost of treatment. METHODS: The study covered 35 districts spreading over 19 States of the country. From 16 major States, two districts each were selected randomly one from the list of districts with high utilization level and another with low level of utilization. From other 3 States, one district each was selected randomly. From each selected district, 1000 households with at least one sick person were covered. This was achieved by selecting 50 Urban Frame Surveys (UFS)/villages and 20 sick persons each per village/UFS. Allocation of 50 First Stage Units (FSUs) among rural and urban sectors was made in proportion to rural-urban population of the district. From selected FSUs, 20 households with at least one sick person was selected randomly. The data were collected on the health seeking behaviour of persons who were sick (with common or serious ailments) in the last three months before survey including at the time of survey. RESULTS: About 45,000 sick persons from 33,666 households from 35 districts of the country were covered. The preference of ISM&H for common ailment was about 33 per cent while only 18 per cent preferred to use these systems in case of serious ailments in the country. The sick persons actually availing ISM&H treatment were about

14 per cent. Of those who preferred ISM&H, the reasons were mainly "no side effect" and low cost of treatment. Slow progress was the main reason for not preferring the indigenous systems. INTERPRETATION & CONCLUSION: The findings of this study showed that about 14 per cent sick persons utilizing indigenous system of medicine. Slow progress and non availability of practitioners were the main reasons for not preferring the ISM & H treatment. Publication Types: •

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

PMID: 16177471 [PubMed - indexed for MEDLINE] 749: Chin J Traumatol. 2005 Oct;8(5):259-62. Related Articles, Links

Development of the trauma emergency care system based on the three links theory. Jiang GY, Shen WF, Gan JX. Emergency Center, the Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou 310009, China. The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians. Publication Types: •

Review

PMID: 16176754 [PubMed - indexed for MEDLINE] 750: Bull World Health Organ. 2005 Jul;83(7):534-40. Related Articles, Links

An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries. Daniels N, Flores W, Pannarunothai S, Ndumbe PN, Bryant JH, Ngulube TJ, Wang Y. Harvard School of Public Health, Department of Population and International Health, Boston, MA 02115, USA. [email protected] The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability. By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades. Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels. Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators. In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation aboutwhich aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms. This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure. Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put. Collaboration across sites can yield a catalogue of indicators that will facilitate further work. Publication Types: • •

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

PMID: 16175828 [PubMed - indexed for MEDLINE] 751: Soc Sci Med. 2006 Apr;62(7):1685-96. Epub 2005 Sep 19. Related Articles, Links

Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Lee S, Chiu MY, Tsang A, Chui H, Kleinman A. Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong. [email protected] This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers' control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients' lives. Publication Types: •

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

PMID: 16174547 [PubMed - indexed for MEDLINE] 752: Childs Nerv Syst. 2006 Apr;22(4):352-62. Epub 2005 Sep 17. Related Articles, Links

Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control. Mukhida K, Sharma MR, Shilpakar SK. Division of Neurosurgery, University of Toronto, Toronto, Canada. [email protected] OBJECTS: There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs. METHODS: The clinical records of patients
Are they being used safely? A retrospective cross-sectional tertiary health care survey of selective serotonin reuptake inhibitors prescribing practice in Singapore. Xie F, Tan CH, Li SC. Department of Pharmacy, National University of Singapore, Singapore.

OBJECTIVES: To determine the prescribing pattern of the SSRIs and to evaluate the safety of current utilization of SSRIs associated with concomitant psychotropic medications in Singapore. METHODS: The average prescribed daily dose (PDD) for each SSRI was calculated and compared with the defined daily dose (DDD). Pearson's chi2 test, one-way analysis of covariance (ANCOVA) and multinomial logistic regression were performed to examine the impacts of variables such as age, gender, patient type and concomitant psychotropic medications on the utilization of SSRIs. Safety issues were discussed by examining the potential metabolic drug interactions between the SSRIs and concomitant psychotropic medications. RESULTS: The most frequently prescribed SSRI was fluoxetine and the PDDs were slightly more than the DDDs for all these SSRIs except fluvoxamine. The SSRIs were mainly prescribed to the patients who were younger, female and outpatients. Psychotropics were more likely concomitantly used with fluvoxamine, sertraline and paroxetine, relative to fluoxetine. CONCLUSION: The prescribing pattern of SSRIs in a tertiary health center in Singapore is generally consistent with the accepted practices, although some safety concerns in terms of metabolic drug interactions were raised. This study provides useful baseline information for further in-depth studies for SSRIs usage both locally and for international comparison. (c) 2005 John Wiley & Sons, Ltd. PMID: 16158447 [PubMed - indexed for MEDLINE] 754: J Clin Virol. 2005 Oct;34(2):87-96. Related Articles, Links

Implementation of the community network of reference laboratories for human influenza in Europe. Meijer A, Valette M, Manuguerra JC, Pérez-Breña P, Paget J, Brown C, van der Velden K; Virology Working Group of the European Influenza Surveillance Scheme. European Influenza Surveillance Scheme Co-ordination Centre, Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands. [email protected] BACKGROUND: The increased need for accurate influenza laboratory surveillance data in the European Union required formalisation of the existing network of collaborating national influenza reference laboratories participating in the European Influenza Surveillance Scheme (EISS). OBJECTIVE: To establish a Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). METHODS: Virologists in EISS defined the objective and tasks of the CNRL. Performance of the laboratories in the tasks was monitored by

questionnaire-based inventories and quality control assessments (QCA). Subsequently, actions were defined to improve the performance of the CNRL. RESULTS: The CNRL started in April 2003 and included as of May 2004 32 laboratories in 24 European countries. The objective is to provide high quality reference services for human influenza surveillance, early warning and pandemic preparedness in Europe. The defined basic tasks are direct detection, culture, typing, subtyping and strain characterisation of influenza virus, diagnostic influenza serology and storage of clinical specimens and virus isolates. The questionnaire-based inventories and QCAs revealed that the majority of CNRL laboratories perform well in most of the basic tasks, although improvements are needed in certain areas of virus testing. Therefore, task groups have been established to further improve the methods used in the network. The CNRL has proven its usefulness during the 2003-2004 season by the reporting of accurate data concerning the flu epidemic caused by A/Fujian/411/2002 (H3N2)-like viruses and by the rapid sharing of information, protocols and reagents during the A(H5N1) and A(H7N3) epizootics in Asia and Canada. CONCLUSION: EISS has established a functioning Community Network of Reference Laboratories for Human Influenza in Europe and laid the foundation for further enhancement and collaborations. Important next steps include improving the laboratories to carry out all basic tasks and collaboration with the European Centre for Disease Prevention and Control. Publication Types: •

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

PMID: 16157259 [PubMed - indexed for MEDLINE] 755: Prehosp Emerg Care. 2005 Jul-Sep;9(3):355-60. Related Articles, Links

Limitations of secondary data sets for road traffic injury epidemiology: a study from Karachi, Pakistan. Razzak JA, Laflamme L. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. [email protected] OBJECTIVES: To evaluate the completeness of descriptive information and accuracy of ambulance data when compared with two other secondary sources of data, namely, medical examiners' reports and medical records, in the city of Karachi, Pakistan. METHODS: A retrospective chart review was carried out of all road traffic injury (RTI) victims transported by an ambulance service in Karachi

from January 1 to December 31, 2003. Information on the name, age, and gender of the victim, date, time, and place of injury, and type of injury and its outcome was obtained, and then compared with medical examiners' data and inpatient medical records. The variables missing in the ambulance service database were identified. RESULTS: The ambulance service transported 1,245 RTI patients during 2003, 81% of whom were taken to one of three trauma centers. Twenty percent died before reaching hospital. There were missing variables in 340 (27%) cases, the majority of which were the unique identifiers such as name and age (67%). Data on other variables were reported in 95% or more cases. None of the medical examiners' reports or inpatient medical records contained a description of event of injury. The agreement rate for the variables available in the three data sets ranged from 61% to 100%. CONCLUSION: Secondary data on injuries, such as ambulance reports, medical examiners' reports, and medical records, have significant limitations. In Karachi, except with regard to unique identifiers, ambulance data seem to provide information just as accurate as that in medical examiners' and inpatient medical records. PMID: 16147489 [PubMed - indexed for MEDLINE] 756: Jpn J Clin Oncol. 2005 Aug;35(8):488-91. Related Articles, Links

Comparison of oral and pharyngeal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO Mortality Database (1960-2000). Tanaka S, Sobue T. Statistics and Cancer Control Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 1-1 Tsujiki 5-chome, Chuo-ku, Tokyo 104-0045, Japan.. Publication Types: •

Comparative Study

PMID: 16145198 [PubMed - indexed for MEDLINE] 757: Health Policy Plan. 2005 Nov;20(6):366-74. Epub 2005 Sep 2. Related Articles, Links

Community-based health insurance in poor rural China: the

distribution of net benefits. Wang H, Yip W, Zhang L, Wang L, Hsiao W. Global Health Division, Yale University School of Public Health, 60 College Street, Suite 315, New Haven, CT 06520-8034, USA. [email protected] The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study. Publication Types: •

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

PMID: 16143589 [PubMed - indexed for MEDLINE] 758: Forensic Sci Int. 2005 Oct 29;153(2-3):161-7. Epub 2004 Nov 11. Related Articles, Links

Malpractice and system of expertise in anaesthetic procedures in Turkey.

Ozdemir MH, Cekin N, Can IO, Hilal A. Faculty of Medicine, Dokuz Eylul University, Department of Forensic Medicine, Izmir, Turkey. [email protected] Deaths which occur during the administration of anaesthetics require medicolegal investigations. The objective of this study is to form a database for future comparisons related to anaesthetic-associated malpractice claims and also to investigate the system of expertise, pertaining to such procedures. The decisions of the Supreme Health Council, whose expert opinion is requested by legal authorities (judges, prosecutors) for health workers brought to trial in a criminal court, were examined retrospectively over the period 1995-1999. In 21 (2.3%) of the 888 decision reports prepared by the council the team members (the anaesthesiologist , the anaesthetic assistant, the anaesthetic technician, the nurse) were directly interrogated. Data concerning these 21 council decisions were evaluated within the scope of this study. It was found that 57% of the 21 decisions were related to medical procedures carried out in state hospitals. Of the 21 cases, 62% were males, 38% females. General anaesthesia was applied to 19 of the cases while one received regional (local) anaesthesia and one axillary blockade. Twenty died of complications associated with anaesthesia. Autopsy was performed on 11 (55%) of the dead. Health workers were found to have different degrees of liability in the 16 (76%) of the 21 decision reports. In their medical practices, anaesthesiologists , like other specialists, are subject to legal procedures in the country where they perform their duties, to national and international principles of ethics, and to diagnostic and curative standards/procedures relevant to the scientific level of the country concerned. In anaesthetic malpractice claims, certain standards need to be followed in inquiries and approaches so as to determine the real reasons behind the disabilities and/or deaths which occur. In order that sound evaluations could be made in such cases, the experts as well as the system of expertise should be efficient and authorized. PMID: 16139105 [PubMed - indexed for MEDLINE] 759: IEEE Trans Inf Technol Biomed. 2005 Jun;9(2):266-75. Related Articles, Links

Managing knowledge integration in a national health-care crisis: lessons learned from combating SARS in Singapore. Devadoss PR, Pan SL, Singh S. Department of Information Systems, School of Computing, National University of Singapore, Singapore 17543, Singapore . [email protected] The outbreak of Severe Acute Respiratory Syndrome is the first severe and

readily transmissible disease to emerge in the 21st century. Often one new infection meant tracing of several people to monitor their health conditions as well. In Singapore, several agencies coordinated their efforts to quickly bring the outbreak under control. The current breed of health-care information systems (HCIS) was not sufficient to handle new information-sharing needs during the crisis. In this paper, we take a look at the measures taken during the crisis in Singapore through a knowledge integration perspective. This perspective reveals interesting implications for HCIS. PMID: 16138543 [PubMed - indexed for MEDLINE] 760: IEEE Trans Inf Technol Biomed. 2005 Jun;9(2):193-204. Related Articles, Links

A knowledge creation info-structure to acquire and crystallize the tacit knowledge of health-care experts. Abidi SS, Cheah YN, Curran J. Faculty of Computer Science, Dalhousie University, Halifax, NS B3H IW5, Canada. [email protected] Tacit knowledge of health-care experts is an important source of experiential know-how, yet due to various operational and technical reasons, such health-care knowledge is not entirely harnessed and put into professional practice. Emerging knowledge-management (KM) solutions suggest strategies to acquire the seemingly intractable and nonarticulated tacit knowledge of health-care experts. This paper presents a KM methodology, together with its computational implementation, to 1) acquire the tacit knowledge possessed by health-care experts; 2) represent the acquired tacit health-care knowledge in a computational formalism--i.e., clinical scenarios--that allows the reuse of stored knowledge to acquire tacit knowledge; and 3) crystallize the acquired tacit knowledge so that it is validated for health-care decision-support and medical education systems. PMID: 16138536 [PubMed - indexed for MEDLINE] 761: Biomed Environ Sci. 2005 Jun;18(3):153-8. Related Articles, Links

Assessment of impacts of public health interventions on the SARS epidemic in Beijing in terms of the intervals between its symptom onset, hospital admission, and notification. Liang WN, Liu M, Chen Q, Liu ZJ, He X, Pan Y, Xie XQ.

School of Health Management and Education, Capital University of Medical Sciences, Beijing 100054, China. [email protected] OBJECTIVES: To assess the impacts of public health interventions on the outbreak of SARS in Beijing by analyzing the intervals between symptom onset, hospital admission and notification of its cases. METHODS: Data of SARS cases reported from the Beijing Municipal Centers for Disease Prevention and Control (BCDC) were collected and analyzed by descriptive epidemiology. RESULTS: In the early epidemic period, the intervals between the disease onset and the hospital admission seemed irregular, so was the intervals between the hospital admission and the notification. After the middle ten days of April, the intervals turned out to be more regular, and the disordered situation in terms of the hospital admission and the case notification was gradually brought under control. CONCLUSIONS: Public health interventions against SARS has revealed positive impacts on SARS control program in Beijing. The timing and sensitivity of epidemic information reporting systems has been greatly improved in Beijing as a result of successful fight against this disease. PMID: 16131016 [PubMed - indexed for MEDLINE] 762: Int J Med Inform. 2006 May;75(5):369-83. Epub 2005 Aug 29. Related Articles, Links

Health information system for community-based multiple screening in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 3). Chiu YH, Chen LS, Chan CC, Liou DM, Wu SC, Kuo HS, Chang HJ, Chen TH. Institute of Public Health and Institute of Health Informatics and Decision Making, National Yang-Ming University, Taipei, Taiwan. BACKGROUND: Community-based multiple screening for common cancers and chronic diseases has increasingly gained attention. However, as infrastructure and evaluation system are more diversified and complicated compared with single screening, the development of a novel health information system is paramount. METHODS: The main goal of our health information system was to support the multiple screening program not only from technical aspect but also from a broad range of perspectives including quality assurance system, organized features appertaining to screening, economic evaluation (cost-effectiveness or cost-utility analysis), epidemiological applications, behavior risk factor surveillance system, and social impact due to the introduction of the Keelung Community-Based Integrated Screening (KCIS) program. RESULTS: Health information system was designed and programmed on the basis of the demand derived from KCIS within

which five cancers and three chronic diseases were included. In addition to the detailed description of infrastructure and process, design, relevant database and security involved in health information system, an innovative and extensive evaluation system in accordance with the main goals was included in our health information system. CONCLUSION: Our information system proposed several aspects regarding organized screening system that has never been addressed in computerized system supporting for single screening. These included quality assurance system, organization features, co-morbidity profiles, epidemiological applications and social and economic considerations. Publication Types: •

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

PMID: 16129660 [PubMed - indexed for MEDLINE] 763: Diabetes Res Clin Pract. 2005 Oct;70(1):71-80. Epub 2005 Apr 9. Related Articles, Links

Hypertension in type 2 diabetes mellitus in Isfahan, Iran: incidence and risk factors. Janghorbani M, Amini M. Isfahan Endocrinology and Metabolism Research Centre, Isfahan University of Medical Sciences and Health Services, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan, Iran. [email protected] BACKGROUND: Evidence on the long-term incidence of and risk factors of hypertension in diabetic patients is scarce and mainly derived from studies in developed countries. Evidence from developing countries is required for planning a well-co-ordinated approach to this public health problem in these countries. OBJECTIVE: The objectives of present study were to estimate the incidence of and risk factors for the development of hypertension in people with type 2 diabetes mellitus using routinely collected data from a clinical information system at Isfahan Endocrinology and Metabolism Research Centre, Iran. METHOD: During the mean (standard deviation (S.D.)) follow-up period of 2.9 (2.5) (range 1-11) years, 3202 diabetic patients (1315 male and 1887 female) from Isfahan Endocrinology and Metabolism Research Centre out patient clinics, Iran have been examined. The mean (S.D.) age of participants was 48.3 (10.6) years with a mean (S.D.) duration of diabetes of 6.5 (6.7) years at initial registration. Blood pressure was measured by standardised protocols, and hypertension was defined as at least in two consecutive measurements within 2 months a systolic and/or diastolic blood pressure of >or=130 and/or >or=80 mmHg and/or taking anti-

hypertensive medication. RESULTS: Among the 3202 patients free of hypertension at initial registration who attended the clinic at least twice in the period 1992-2004, the incidence of hypertension was 20.8 (20.6 male and 20.9 female) per 100 person-years based on 9403 person-years of follow-up. The ageadjusted incidence rate of hypertension was 22% lower among insulin-treated than non-insulin-treated type 2 diabetes mellitus clinic attenders and it was greater with older age. Using a Cox's Proportional Hazards Model, male gender, and treatment regimen were significant independent predictors of hypertension. Smoking, duration of diabetes, age at diagnosis of diabetes, fasting blood glucose, glycosylated haemoglobin, BMI, proteinuria and creatinine, had no significant independent association with hypertension when other covariates were considered. CONCLUSION: These findings will help the identification of those patients at particular risk of hypertension and strongly support the case for vigorous control of blood pressure on type 2 diabetic patients. PMID: 16126125 [PubMed - indexed for MEDLINE] 764: Int J Med Inform. 2006 Feb;75(2):173-81. Epub 2005 Aug 24. Related Articles, Links

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan. Liu CT, Yang PT, Yeh YT, Wang BL. Graduate Institute of Medical Informatics, Taipei Medical University, 250 WuXing Street, Taipei 107, Taiwan. [email protected] PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center,

regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are. Publication Types: • •

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

PMID: 16125452 [PubMed - indexed for MEDLINE] 765: Clin Ther. 2005 Jun;27(6):970-8. Related Articles, Links

A survey on the extent of medication storage and wastage in urban Iranian households. Zargarzadeh AH, Tavakoli N, Hassanzadeh A. Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Iran. [email protected] BACKGROUND: Prescription and nonprescription medications constitute a substantial proportion of the health care costs of countries. National drug policies and attitudes toward medication use may play a role in irrational prescribing and consumption of medicines, leading to drug wastage. The limited resources of developing countries warrant more careful assessments of current national drug policies. OBJECTIVE: This study quantified the amounts and types of

medications that are stored in a sample of urban Iranian households and estimated the extent of drug wastage in these families. METHODS: A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts for 1966 to 2004 to identify articles on drug utilization and wastage. Randomly selected households in a large city in Iran were visited to determine the amounts and types of medicines stored in these households. A questionnaire was used to collect information about medication use in these families. RESULTS: A total of 512 households were assessed. The mean (SD) family size of household respondents was 4.3 (1.6) members. Mothers were responsible for managing medications in 58.1% (291/501) of families. Presence of chronic illness, insurance coverage, higher economic status, literacy among fathers, and siblings without medically related jobs were the variables that showed a significant relationship with the amount of medicines found in the households. The mean (SD) numbers of unit doses of medicines and of drug products found in these households were 238.5 (198.6) and 22.99 (20.1), respectively. The most common therapeutic classes of medications kept at home were central nervous system agents, anti-infectives, and gastrointestinal medications. The real and potential medication wastage was estimated to be 38.8% and 53.8%, respectively. CONCLUSIONS: Medications were stored in large quantities in these urban Iranian households, and a large percentage was being wasted. Drug-use assessments and a comprehensive evaluation of the current national drug policies are warranted to curtail this problem. Publication Types: •

Comparative Study

PMID: 16117997 [PubMed - indexed for MEDLINE] 766: Med J Malaysia. 2005 Jun;60(2):180-7. Related Articles, Links

An evaluation of information dissemination during the severe acute respiratory syndrome (SARS) outbreak among selected rural communities in Kuala Kangsar. Hazreen AM, Myint Myint S, Farizah H, Abd Rashid M, Chai CC, Dymna VK, Gilbert W, Sri Rahayu S, Seri Diana MA, Noor Huzaimnah H. Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur. To assess the level of knowledge, attitude and practice (KAP) on SARS and its preventive measures among the rural population of Kuala Kangsar district. This KAP study was also done to identify the expectation and preference of rural

population upon obtaining health information. This is a cross-sectional study of 201 households from four villages in Kuala Kangsar. Face-to-face interview was done regarding knowledge, attitude and practice on SARS and its preventive measures. Statistical analyses were performed with SPSS (Version 10.0). A scoring system was used to assess the level of knowledge, attitude and practice towards SARS. Ninety one percent of the study population was aware of SARS. Majority of them have good attitude towards SARS based on the formulated scoring system. Television was found to be the first hand information about SARS and most preferred source of information by the rural population. Knowledge and attitude of respondents concerning SARS were good. Television was found to be the preference among the rural population in obtaining health information. Publication Types: • •

Comparative Study Evaluation Studies

PMID: 16114158 [PubMed - indexed for MEDLINE] 767: Int J Med Inform. 2005 Dec;74(11-12):952-9. Epub 2005 Aug 22. Related Articles, Links

Analysis of nursing records of cardiac-surgery patients based on the nursing process and focusing on nursing outcomes. Kim YJ, Park HA. Asan Medical Center, Seoul, Korea. This study analyzed what nurses wrote in narrative nursing notes for cardiacsurgery patients. The nursing notes of 46 patients were analyzed based on the nursing process. Eight patterns were extracted according to different combinations of nursing process components, of which an assessment alone was the most frequent nursing phrase (45.8%), followed by assessment or diagnosisintervention-outcome (25.9%). The content of the nursing notes was also classified into 15 categories, of which nursing outcomes were recorded more frequently in nursing care driven mainly by physician's order such as diseaserelated symptom management, insomnia care, respiratory care, and pain control, than in independent nursing care such as education and emotional care. A survey on the attitudes of nurses toward the nursing record revealed that they do not document nursing outcomes as much as they think they do. The main reasons for this discrepancy were insufficient time for recording and lack of knowledge about why, how, and what to evaluate. Even though there is room for improvement,

nursing notes represent a useful resource for determining nursing contributions to patient outcomes. PMID: 16112896 [PubMed - indexed for MEDLINE] 768: Diabet Med. 2005 Sep;22(9):1226-33. Related Articles, Links

Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north-west England. McElduff P, Edwards R, Burns JA, Young RJ, Heller R, Long B, Jones G, New JP. Evidence for Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK. [email protected] BACKGROUND: Diabetes and its complications are more prevalent among South Asians than people of European origin and there is some evidence that patients of South Asian origin with diabetes receive poorer quality care. METHODS: Longitudinal study of patients with diabetes in Blackburn, UK. Processes of care indicators [measurement of blood pressure (BP), cholesterol and glycosolated haemoglobin (HbA1c)] and values of these intermediate outcomes were extracted for all patients registered on a diabetes information system for the period 1995-2001. Differences in processes of care indicators and intermediate outcomes between ethnic groups were estimated after adjusting for the potential confounding factors of sex, age and socioeconomic status (SES). Generalized estimating equations were used to model trends and to test for differences in trends over time. RESULTS: Process of care was similar in South Asian and European patients. Mean BP and cholesterol concentration fell during the study period. South Asians had a higher level of HbA1c throughout the study period. South Asians had lower levels of BP and cholesterol in 1995 but the differences diminished or were abolished over time. SES did not explain differences between ethnic groups. Analyses stratified by baseline levels of intermediate outcomes (above or within target) demonstrated improvements among above target patients were greater among European patients. CONCLUSIONS: Processes of care indicators are similar in diabetic patients of South Asian and European origin, irrespective of SES. However, there are worrying differences in improvements over time in the intermediate outcomes, and glycaemic control remained poorer among patients of South Asian origin patients throughout. PMID: 16108853 [PubMed - indexed for MEDLINE]

769: Isr Med Assoc J. 2005 Aug;7(8):483-6. Related Articles, Links

The Western Galilee experience: reducing infant mortality in the Arab population. Strulov A. School of Public Health, Faculty of Social Welfare and Health Studies, Haifa University, Haifa, Israel. [email protected] Until the end of the 1980s almost no intensive intervention plan was applied to narrow the vast gap (over 100%) in infant mortality between Jews and Arabs in the Western Galilee region of Israel. A special committee appointed by the Ministry of Health instituted measures to reduce the gap, including monitoring mortality rates by establishing an online and real-time computerized information system to analyze the information without delay. Based on the epidemiologic findings, an intervention program was implemented, using health education to reduce mortality due to seasonal infections--gastroenteritis in summer and upper respiratory and hyperthermia in winter. Within 1 year these infections had abated, resulting in significantly reduced mortality. The next step was the development of an ultrasound preventive campaign using sophisticated sonography to screen pregnant women in risk groups for lethal congenital defects and convincing them to discontinue the pregnancy. These two measures reduced infant mortality dramatically. The campaign has been widened to the entire northern district and is presently addressing, as a primary prevention, the traditionally difficult problem of consanguineous marriages--the major cause of congenital defects in the Arab population. PMID: 16106770 [PubMed - indexed for MEDLINE] 770: Rinsho Byori. 2005 Jul;53(7):609-16. Related Articles, Links

[Consulting work cited in the hospital laboratory annual progress report of the laboratory information and consulting work and its role in Toyama Medical and Pharmaceutical University Hospital] [Article in Japanese] Yamaguchi K, Tanaka Y, Takamori E, Kitajima I. Department of Clinical Laboratory, Toyama Medical and Pharmaceutical University Hospital, Toyama 930-0194.

Recently, it is difficult for general patients to understand clinical inspection. Therefore we opened the laboratory information and consulting office (called Kensa Yorozu Consulting Room) from April, 2004. It is most characteristic that our office is managed by a clinical laboratory physician. A full time-specialized doctor who is belong to clinical laboratory, is stationed in the office. Duties contents of our office are consultation, publishing laboratory report and information, education and the clinical studies. We don't limit a person of consultation in particular. We accept consultations for 24 hours by coming our office, telephone, Fax or E-mail. The amount of consultations is about 5-10 per one month. The contents are suggesting inspection plan, explanation of pathophysiologic information based on clinical inspect result and so on. The examples compiled it into a database and maintains and their answers information. Because there are clinical laboratory physicians in this office, there are merits that follow. As for the medical technologist, it was not interfered with routine duties. For doctors and co-medical staffs, it is possible for detailed arguments to the diagnosis and treatment considered the condition of a patient and a characteristic of laboratory method. Doctors of outside can talk with us by telephones or emails easily. For patients, they can smoothly talk about their diseases with their physicians knowing more laboratory information. More medical stuffs need our office, because there are many repeaters although the total number is small. Therefore it is important that we let everybody know about our works and that we make good communication environment to talk easily, keeping privacy. We want to compile and share database of laboratory information. Then we can contribute to the area medical care. Publication Types: •

English Abstract

PMID: 16104529 [PubMed - indexed for MEDLINE] 771: J Obstet Gynaecol Can. 2005 Jun;27(6):546. Related Articles, Links

2004 Shanghai international workshop of fetal macrosomia and adult obesity. Wen SW. Publication Types: • •

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

PMID: 16100630 [PubMed - indexed for MEDLINE] 772: Vet Parasitol. 2005 Sep 30;132(3-4):249-72. Related Articles, Links

Disease and health management in Asian aquaculture. Bondad-Reantaso MG, Subasinghe RP, Arthur JR, Ogawa K, Chinabut S, Adlard R, Tan Z, Shariff M. Fisheries Department, Food and Agriculture Organization of the UN, Vialle Terme di Caracalla, 00100 Rome, Italy. [email protected] Asia contributes more than 90% to the world's aquaculture production. Like other farming systems, aquaculture is plagued with disease problems resulting from its intensification and commercialization. This paper describes the various factors, providing specific examples, which have contributed to the current disease problems faced by what is now the fastest growing food-producing sector globally. These include increased globalization of trade and markets; the intensification of fish-farming practices through the movement of broodstock, postlarvae, fry and fingerlings; the introduction of new species for aquaculture development; the expansion of the ornamental fish trade; the enhancement of marine and coastal areas through the stocking of aquatic animals raised in hatcheries; the unanticipated interactions between cultured and wild populations of aquatic animals; poor or lack of effective biosecurity measures; slow awareness on emerging diseases; the misunderstanding and misuse of specific pathogen free (SPF) stocks; climate change; other human-mediated movements of aquaculture commodities. Data on the socio-economic impacts of aquatic animal diseases are also presented, including estimates of losses in production, direct and indirect income and employment, market access or share of investment, and consumer confidence; food availability; industry failures. Examples of costs of investment in aquatic animal health-related activities, including national strategies, research, surveillance, control and other health management programmes are also provided. Finally, the strategies currently being implemented in the Asian region to deal with transboundary diseases affecting the aquaculture sector are highlighted. These include compliance with international codes, and development and implementation of regional guidelines and national aquatic animal health strategies; new diagnostic and therapeutic techniques and new information technology; new biosecurity measures including risk analysis, epidemiology, surveillance, reporting and planning for emergency response to epizootics; targeted research; institutional strengthening and manpower development (education, training and extension research and diagnostic services). Publication Types:

•

Review

PMID: 16099592 [PubMed - indexed for MEDLINE] 773: Health Policy. 2006 Jul;77(2):172-81. Epub 2005 Aug 15. Related Articles, Links

Diagnosis and management of tuberculosis by private practitioners in Manila, Philippines. Auer C, Lagahid JY, Tanner M, Weiss MG. Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstr. 57, CH-4002 Basel, Switzerland. [email protected] SETTING: Private for-profit health care providers are prominent in the health system of the Philippines. OBJECTIVES: To examine the practices of the private practitioners in Malabon, Metropolitan Manila, Philippines, concerning diagnosis and treatment of tuberculosis (TB). DESIGN: Forty-five private practitioners of Malabon who treat adult TB patients were interviewed. RESULTS: For diagnosis, most private practitioners relied on the clinical presentation and result of an Xray. Only 13% of the respondents routinely also asked for sputum examination. Ninety-six percent used X-ray as a tool to monitor treatment. Sixty percent of the respondents prescribed a regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. Except for rifampicin, over-dosage was common. For re-treatment cases, none prescribed the WHO-recommended re-treatment regimen. The private practitioners perceived the main reasons for patient nonadherence to be the patients' lack of finances to buy drugs and patients' perceived well being after a certain period of treatment. Patients' lack of money was seen as the main obstacle to compliance. The only case holding mechanism mentioned was occasional clinic appointments of the TB patients. CONCLUSION: Private practices for diagnosis and treatment of TB typically deviate from guidelines. The quality of care among private practitioners needs improvement. Innovative strategies are required. Publication Types: •

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

PMID: 16099529 [PubMed - indexed for MEDLINE] 774: Int J Med Inform. 2006 Feb;75(2):148-55. Epub 2005 Aug 10. Related Articles, Links

Results of a survey on medical error reporting systems in Korean hospitals. Kim J, Bates DW. Seoul National University, College of Nursing, Research Institute of Nursing Science, 28 Yongon-dong, Chongno-gu, Seoul, 110-799, Seoul, Republic of Korea. [email protected] BACKGROUND: Recent data suggest that medical injuries, or adverse events, represent an important international problem, and that many are caused by errors. Spontaneous reporting is the main tool used to detect errors and adverse events in most countries, and reporting systems are believed to be important for improving patient safety. Increasingly, such reporting can be done using information systems, and information systems are widely used in Korea. However, few data are available regarding the use of electronic medical error reporting systems in Korea. OBJECTIVES: The objectives of this study were to investigate the present status of reporting system of Korean hospitals, and to compare the current status of medical error reporting systems with that of other health information sub systems. METHODS: The chairs of nursing departments of all 283 hospitals nationwide with more than 100 beds were surveyed using a structured questionnaire. The response rate was 35%. In addition, two reports on the national use of health information systems in Korea from 1999 and 2003 were analyzed. RESULTS: Among reporting hospitals (n=99), medical errors were reported on paper in 75 hospitals (77%), verbally in 30 hospitals (30%), using word processing in 13 hospitals (13%), and using the hospital information system in only three hospitals (3%). In contrast, there was widespread and increasing use of health information technology (HIT) in areas such as medication administration, inpatient and outpatient order entry, and radiology. CONCLUSIONS: While HIT is increasingly widely used in Korea in many areas, it is not being used for error reporting. Increasing the use of electronic reporting systems, and systemically evaluating the medical errors and adverse events reported, represent essential steps for reducing systemic errors and improving patient safety. Publication Types: •

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

PMID: 16095963 [PubMed - indexed for MEDLINE] 775: Jpn J Thorac Cardiovasc Surg. 2005 Jul;53(7):337. Related Articles, Links

Managing surgical quality based on database. Takamoto S. Publication Types: •

Editorial

PMID: 16095231 [PubMed - indexed for MEDLINE] 776: J Formos Med Assoc. 2005 Jul;104(7):468-75. Related Articles, Links

Effectiveness of coping strategies used by hospitals in response to implementation of a case-based payment system by the National Health Insurance program. Huang CC, Chung KP, Kuo NC, Hung CL. Department of Health Care Management, National Taipei College of Nursing, Taipei, Taiwan. BACKGROUND AND PURPOSE: The introduction of the case-based payment system by the Bureau of National Health Insurance resulted in greatly increased pressure on the health care industry in Taiwan. This study examined the relationship between the coping strategies adopted and the results attained by accredited teaching hospitals and non-teaching regional hospitals when responding to this regulatory change. METHODS: A cross-sectional survey was conducted using a structured questionnaire to assess the hospitals' characteristics, and coping strategies at the technical, managerial and institutional levels in response to the case-based payment system, and to compare these strategies with self-evaluation of the effectiveness of these strategies. The questionnaire was sent in early October 2000 to the superintendents of the 129 hospitals that were accredited at the medical center, regional hospital, and district teaching hospital levels in the year 2000. Factor analysis was applied to group the strategies into categories and stepwise regression analysis was used to explore the relationship between the reported coping strategies adopted and their effectiveness as evaluated by participants. RESULTS: Among the selected hospitals, 89 responded with complete data, a 69% response rate. The following 7 factors were extracted from 30 coping strategies: information and financial analysis; service shifting and unbundling; service integration and quality improvement; service specialization and strengthening; education and training; financial incentives; and claim submission skill. After adjusting for accreditation level or ownership status, 2

main findings were noted. First, hospitals that implemented financial incentives strategies such as holding physicians responsible for all or part of the shortfall between actual claim submissions and actual reimbursements, and reducing or withholding payment to physicians beyond the standard length of stay, tended to increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented service integration and quality improvement strategies, such as implementing a discharge plan, implementing clinical pathways and periodic review of quality indicators, attained higher patient satisfaction rate (odds ratio, 1.40). CONCLUSIONS: This study suggests that hospitals confronting the implementation of a case based-payment system may benefit by adopting financial incentives strategies and by efforts to improve service integration and quality. Publication Types: •

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

PMID: 16091822 [PubMed - indexed for MEDLINE] 777: J Travel Med. 2005 Jul-Aug;12(4):197-204. Related Articles, Links

Risk of travel-associated typhoid and paratyphoid fevers in various regions. Ekdahl K, de Jong B, Andersson Y. Department of Epidemiology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden. BACKGROUND: Although enteric fever (typhoid and paratyphoid fevers) is a major global public health problem, comparable data on the risks of contracting travel-associated enteric fever in various regions of the world are scarce. METHODS: From the Swedish database on notifiable communicable diseases, we retrieved all case records from 1997 to 2003 on typhoid and paratyphoid fevers. The data set was compared with data on travel patterns obtained from a comprehensive travel database with information from interviews with more than 16,000 Swedish residents with recent overnight travel outside Sweden. RESULTS: The overall risk of being notified with enteric fever after travel was 0.42 in 100,000 travelers. The highest risk for typhoid fever was seen in travelers from India and neighboring countries (41.7 in 100,000), the Middle East (5.91 in 100,000), and Central Africa (3.33 in 100,000), whereas the risk was comparatively low in East Asia (0.24 in 100,000). Almost the same risk areas stood out for paratyphoid fever: India and neighbors (37.5 in 100,000), the Middle

East (3.64 in 100,000), and East Africa (3.33 in 100,000). The epidemiology of paratyphoid fever was considerably affected by a large outbreak of paratyphoid B in a Turkish tourist resort in 1999. The youngest children were at highest risk for typhoid fever (odds ratio 44.2), whereas youths ages 7 to 18 years were at highest risk for paratyphoid fever (odds ratio 9.7). CONCLUSIONS: Detailed risk data for enteric fever after travel could form the basis for travel advice. Vaccination against typhoid fever should always be considered for travelers to the Indian subcontinent, the Middle East, and Africa but should not routinely be given to travelers to the Malay Peninsula. Publication Types: •

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

PMID: 16086894 [PubMed - indexed for MEDLINE] 778: Int J Cardiol. 2006 Mar 22;108(1):89-95. Epub 2005 Aug 8. Related Articles, Links

Plasma triglycerides, an independent predictor of cardiovascular disease in men: a prospective study based on a population with prevalent metabolic syndrome. Onat A, Sari I, Yazici M, Can G, Hergenç G, Avci GS. Turkish Society of Cardiology, Istanbul, Turkey. [email protected] BACKGROUND AND METHODS: We aimed to assess whether fasting plasma triglycerides independently predicted future fatal and nonfatal cardiovascular disease (CVD) in a population having a high prevalence of the metabolic syndrome. In the Turkish Adult Risk Factor Study, a population-based survey, 2682 men and women 20 years of age or over with fasting triglyceride values available and free of CVD at baseline examination in 1990, were prospectively followed up till 2003/04. Triglyceride concentrations were measured by the enzymatic dry chemistry method and stratified into sex-specific quintiles. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health office. Diagnosis of coronary heart disease and stroke among survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. A total of 120 fatal and 221 new nonfatal CVD occurred among adults (mean age 43+/-14) during a mean 9.3 years of follow-up. RESULTS: CVD was significantly and independently predicted by the top versus the bottom fasting triglyceride quintile in logistic regression analyses when adjusted for age, sex, BMI, systolic blood pressure, total cholesterol, lipid-lowering medication, status

of smoking and of glucose regulation (relative risk [RR] in men and all adults 2.38 and 1.79, respectively, p both <0.02). This corresponded to hazard ratios (HR) of 1.43 in men and 1.28 in men and women combined. Adjustment for HDL-cholesterol instead of total cholesterol in the same model gave also significant HRs corresponding to 1.42 in men and 1.32 in sexes combined. CONCLUSIONS: Fasting triglycerides are predictive of future CVD among men with an HR of 1.4, independent of age, diabetes, lipid-lowering medication, traditional risk factors including total cholesterol or HDL-C, in a population in which metabolic syndrome prevails. A modest independent risk increment in women did not reach significance. Publication Types: •

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

PMID: 16085325 [PubMed - indexed for MEDLINE] 779: J Biomed Inform. 2005 Aug;38(4):298-313. Epub 2005 Jan 30. Related Articles, Links

A framework for capturing the interactions between laypersons' understanding of disease, information gathering behaviors, and actions taken during an epidemic. Slaughter L, Keselman A, Kushniruk A, Patel VL. Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, NY, USA. [email protected] This paper provides a description of a methodological framework designed to capture the inter-relationships between the lay publics' understanding of healthrelated processes, information gathering behaviors, and actions taken during an outbreak. We developed and refined our methods during a study involving eight participants living in severe acute respiratory syndrome (SARS)-affected areas (Hong Kong, Taiwan, and Toronto). The framework is an adaptation of narrative analysis, a qualitative method that is used to investigate a phenomenon through interpretation of the stories people tell about their experiences. From our work, several hypotheses emerged that will contribute to future research. For example, our findings showed that many decisions in an epidemic are carefully considered and involve use of significant information gathering. Having a good model of lay actions based on information received and beliefs held will contribute to the development of more effective information support systems in the event of a future epidemic.

Publication Types: • • •

Clinical Trial Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.

PMID: 16084472 [PubMed - indexed for MEDLINE] 780: BMC Health Serv Res. 2005 Aug 6;5:51. Related Articles, Links

Predictors of failed attendances in a multi-specialty outpatient centre using electronic databases. Lee VJ, Earnest A, Chen MI, Krishnan B. Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore. [email protected] BACKGROUND: Failure to keep outpatient medical appointments results in inefficiencies and costs. The objective of this study is to show the factors in an existing electronic database that affect failed appointments and to develop a predictive probability model to increase the effectiveness of interventions. METHODS: A retrospective study was conducted on outpatient clinic attendances at Tan Tock Seng Hospital, Singapore from 2000 to 2004. 22864 patients were randomly sampled for analysis. The outcome measure was failed outpatient appointments according to each patient's latest appointment. RESULTS: Failures comprised of 21% of all appointments and 39% when using the patients' latest appointment. Using odds ratios from the mutliple logistic regression analysis, age group (0.75 to 0.84 for groups above 40 years compared to below 20 years), race (1.48 for Malays, 1.61 for Indians compared to Chinese), days from scheduling to appointment (2.38 for more than 21 days compared to less than 7 days), previous failed appointments (1.79 for more than 60% failures and 4.38 for no previous appointments, compared with less than 20% failures), provision of cell phone number (0.10 for providing numbers compared to otherwise) and distance from hospital (1.14 for more than 14 km compared to less than 6 km) were significantly associated with failed appointments. The predicted probability model's diagnostic accuracy to predict failures is more than 80%. CONCLUSION: A few key variables have shown to adequately account for and predict failed appointments using existing electronic databases. These can be used to develop integrative technological solutions in the outpatient clinic. PMID: 16083504 [PubMed - indexed for MEDLINE]

PMCID: PMC1190171

781: Harefuah. 2005 Jul;144(7):474-9, 527. Related Articles, Links

[Knowledge management in health organizations] [Article in Hebrew] Carasso S, Arbiv T, Yariv I, On E, Ashkenazi I, Levi H. Medical Corps, Israel Defense Forces, Israel. [email protected] BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF) Technology and Logistics Command took a strategic decision to manage knowledge across the organization. The IDF Medical Corps was one of the initiation sites selected. Insights from the process of establishment of a knowledge management (KM) system in the IDF Medical Corps as a health organization (HO) are described. METHODS: IDF's medical services were identified, mapped and their participants interviewed, as were KM personnel in Israeli HOs. Information analysis pointed to the medical rendezvous (MR) as the central process for initiation of KM. The knowledge challenges were identified, and knowledge services and administrative interventions were planned. RESULTS INCLUDING KM CHALLENGES AND RESPONSE: The MR was found to be the process in which most of the clinically and administratively significant decisions in HO's were taken. Practitioners had large clinical and administrative knowledge gaps. Medical and administrative knowledge originated from various sources, in many formats. It could not be retrieved either easily or completely, was usually presented in an inconvenient form for assimilation, and was not always updated. Therefore, the MR was selected as the initial intervention point. Optimally, a comprehensive solution providing access to high quality knowledge can be a knowledge portal, including diagnostic indexing as a key for retrieval of information. Furthermore, indexed clinical, administrative, services list, quality assurance, risk management, and continuing medical education knowledge services, as well as a collegial and administrative feedback, link all entities involved into a knowledge community. This may increase the opportunity for optimal and efficient managed care. Publication Types: •

English Abstract

PMID: 16082898 [PubMed - indexed for MEDLINE]

782: Yakugaku Zasshi. 2005 Aug;125(8):639-42. Related Articles, Links

[An examination in comparison Web site with other root on the revised information of drug package insert] [Article in Japanese] Okuyama K, Terasawa M, Takahashi T, Yamada Y. Hachioji Medical Center, Tokyo Medical University, Hachioji, Japan. [email protected] To obtain revised information on drug package inserts, we evaluated the quality and comprehensibility of such information provided by the Web site of the Pharmaceuticals and Medical Devices Agency (PMDA site), medical representatives (MRS), Drug Safety Updates (DSUS), and informational publications of the wholesale distributor Company F (wholesaler F). In the comparison of the total amount of revised information obtained from April 2003 to March 2004, the PMDA site was 90% or greater of comprehensible. In comparison with the distribution information on the notice of the Ministry of Health, Labor and Welfare, an informational delay or lack occasionally occurred and variations among pharmaceutical companies were observed. Moreover, on the PMDA site, the number of revisions was 1972. Among them, clinically important information, such as warnings, contraindications, adverse effects, and drug interactions, totaled 37%. From these results, it is suggested that there are variations in the information from each pharmaceutical company on the PMDA site although the site is excellent in terms of comprehensibility. Publication Types: • •

Comparative Study English Abstract

PMID: 16079614 [PubMed - indexed for MEDLINE] 783: Sex Transm Infect. 2005 Aug;81(4):345-50. Related Articles, Links

Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales.

Dougan S, Elford J, Rice B, Brown AE, Sinka K, Evans BG, Gill ON, Fenton KA. Department of HIV and Sexually Transmitted Infections, Communicable Disease Surveillance Centre, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London, NW9 5EQ, UK. [email protected] OBJECTIVES: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). METHODS: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E & W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W. Publication Types: • •

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

PMID: 16061545 [PubMed - indexed for MEDLINE] PMCID: PMC1745025 [Available on 08/01/08]

784: J Med Libr Assoc. 2005 Jul;93(3):400-3.

Related Articles,

Links

ParsMedline: establishment of a Web-based bibliographic database related to Iranian health and medical research. Beiki O, Beiki D. Pejouhan Company, Ltd. Number G-02, Yazd Science and Technology Park,Yazd, Iran. [email protected] Publication Types: •

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

PMID: 16059432 [PubMed - indexed for MEDLINE] PMCID: PMC1175808

785: J Am Med Inform Assoc. 2005 Nov-Dec;12(6):642-7. Epub 2005 Jul 27. Related Articles, Links

Computerized physician order entry and electronic medical record systems in Korean teaching and general hospitals: results of a 2004 survey. Park RW, Shin SS, Choi YI, Ahn JO, Hwang SC. Department of Biomedical and Healthcare Informatics, Ajou University School of Medicine, San 5, Youngtong-Gu, Suwon 442-721, Republic of Korea. OBJECTIVE: To determine the availability of computerized physician order entry (CPOE) and electronic medical record (EMR) systems in teaching and general hospitals in the Republic of Korea. DESIGN: A combined mail and telephone survey of 283 hospitals. MEASUREMENTS: The surveys assessed the availability of CPOE and EMRs in the hospitals, as well as inducement, participation, and saturation regarding CPOE use by physicians. RESULTS: A total of 122 (43.1%) hospitals responded to the survey. The complete form of CPOE was available in 98 (80.3%) hospitals. The use of CPOE was mandatory in 92 (86.0%) of the 107 hospitals that responded to the questions regarding the requirement of CPOE use. In 85 (79.4%) of the hospitals in which CPOE was in use, more than 90% of physicians used the system. In addition, physicians entered more than 90% of their total orders through CPOE in 87 (81.3%) hospitals. In

contrast, a complete EMR system was available in only 11 (9.0%) of the hospitals. CONCLUSION: Of the teaching and general hospitals in the Republic of Korea that responded to the survey, the majority (80.3%) have CPOE systems, and a complete EMR system is available in only 9%. Publication Types: •

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

PMID: 16049229 [PubMed - indexed for MEDLINE] PMCID: PMC1294035

786: Health Policy. 2006 Apr;76(2):233-42. Epub 2005 Jul 19. Related Articles, Links

Social capital and farmer's willingness-to-join a newly established community-based health insurance in rural China. Zhang L, Wang H, Wang L, Hsiao W. Department of Health Policy and Management, Beijing University School of Public Health, 38 Xue Yuan Road, Hai Dian District, Beijing 100083, China. [email protected] In 2002, China announced a new funding strategy that would reestablish community-based health insurance (CHI) in rural areas, whereby the Chinese government will entice farmers' participation by providing each participant an annual subsidy of 10-20 Yuan (US 1.25-2.50 dollars). However, there is no evidence demonstrating how many farmers would be willing-to-join (WTJ) such newly developed government subsidized voluntary-based CHI scheme and what factors influence farmers' willingness-to-join. In this study, we examine the probability of farmers' willingness-to-join such CHI under the different scenarios of government subsidy and individual contribution, and also explore factors that influence farmers' willingness-to-join with the emphasis on social capital. The study is based on data collected from a 2002 household survey conducted in Fengsan Township, located in China's Guizhou Province. Logistic regression is used in the analysis. The findings from this study show that even with the government subsidy to the premium, the probability of WTJ the new voluntarybased CHI only reach 50%. The results also indicate that community level social capital, as measured by reciprocity index, and individual level social capital, as measured by trust index, are significantly and positively associated with the probability of farmers' WTJ newly developed government subsidized CHI. Policy

recommendations have been made based on those findings. Publication Types: •

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

PMID: 16046027 [PubMed - indexed for MEDLINE] 787: Parassitologia. 2005 Mar;47(1):105-14. Related Articles, Links

A study of the environmental determinants of malaria and schistosomiasis in the Philippines using Remote Sensing and Geographic Information Systems. Leonardo LR, Rivera PT, Crisostomo BA, Sarol JN, Bantayan NC, Tiu WU, Bergquist NR. College of Public Health, University of the Philippines Manila, Ermita, Manila, Philippines. [email protected] Malaria and schistosomiasis are two water-related parasitic diseases affecting millions of people worldwide particularly tropical and subtropical countries. In the Philippines, malaria is found in 72 out of 78 provinces while schistosomiasis is endemic in 24 provinces. The Anopheles mosquito and the Oncomelania snail involved in the transmission of these diseases depend on certain environmental determinants that support mosquito and snail populations. This study, done for the first time in the Philippines, successfully showed how Remote Sensing (RS) and Geographical Information Systems (GIS) can be effectively used in showing how these environmental factors affect the spatial distribution of these two diseases. The study sites, i.e. the municipalities of Asuncion and Kapalong, are known endemic sites for both malaria and schistosomiasis. Georeferenced data enabled visualization of prevalence data in relation to physical maps thus facilitating assessment of disease situation in the two municipalities. RS and GIS data proved that other factors aside from climate influence the epidemiology of the diseases in the two sites. Topography and slope as main physical factors influence the vegetation cover, land use and soil type prevailing in particular areas. In addition, water sources especially irrigation networks differed in various places in the study sites in turn affecting the magnitude and distribution of malaria and schistosomiasis. Significant correlations found between the diseases and the environmental variables formed the basis for development of models to predict the disease prevalence in the two municipalities. Proximity to snail breeding sites and irrigation networks and the highly agricultural nature of the barangays were identified as the most common factors that define the high prevalence areas for schistosomiasis confirming the fact that conditions that support the snail

populations will in turn favor the presence of the disease. For malaria, the predictive models included temperature, humidity, soil type, predominance of reproduction brush, presence of cultivated areas, distance from deep wells and distance from conventional water source which are in turn influenced by the factor of elevation. Publication Types: •

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

PMID: 16044679 [PubMed - indexed for MEDLINE] 788: Jpn J Clin Oncol. 2005 Jul;35(7):420-3. Related Articles, Links

Comparison of leukemia mortality in five countries: France, Italy, Japan, UK and USA from the WHO Mortality Database (19602000). Imamura Y, Mizuno S. Publication Types: •

Comparative Study

PMID: 16030055 [PubMed - indexed for MEDLINE] 789: Toxicol Appl Pharmacol. 2005 Sep 1;207(2 Suppl):750-4. Related Articles, Links

Lessons learned in building a global information network on chemicals (GINC). Kaminuma T. Center for Quantum Life Science, Hiroshima University, 1-3-1 Kagamiyama, Higashihiroshima-shi, Hiroshima-ken 739-8530, Japan. The Global Information Network on Chemicals (GINC) was a project to construct a worldwide information network linking international, national, and other organizations working for the safe management of chemicals. Proposed in 1993, the project started the next year and lasted almost 10 years. It was begun as a joint

project of World Health Organization (WHO), International Labor Organization (ILO), and United Nations Environment Program (UNEP), and later endorsed by the Intergovernmental Forum on Chemical Safety (IFCS). Asia, particularly East Asia and the Pacific islands, was chosen as the feasibility study region. The author's group then at the National Institute of Health Sciences (NIHS) of Japan led this initiative and hosted numerous meetings. At these meetings, tutorial sessions for communicating chemical safety expertise and emerging new information technologies relevant to the safe management of chemicals were offered. Our experience with this project, particularly the Web-based system and the tutorial sessions, may be of use to others involved with Web-based instruction and the training of chemical safety specialists from both developed and developing countries. PMID: 16023162 [PubMed - in process] 790: Health Care Women Int. 2005 May;26(5):448-55. Related Articles, Links

Perception of health care delivery in Israel: women's voices. Warshawsky-Livne L, Cwikel J, Pliskin J, Avgar A. Ben-Gurion University of the Negev, Beer-Sheva, Israel, and the Israel Association for the Advancement of Women's Health, Jerusalem, Israel. [email protected] In this article, we describe the results of nine focus groups in which women were asked to discuss their perception of the women's health care delivery system in Israel. The focus groups, held in Israel in 2001, included nearly 150 women with diverse demographic characteristics. This project solicited focused input from women of different ages from the periphery as well as highly populated areas. The responses were categorized into designated themes and are presented here to demonstrate the range of women's feelings toward health care. The qualitative findings of this research show that place of residence affects the women's sense of responsibility for their health and their use of private care. Age was found to affect knowledge and use of health information, the frequency of visits to the doctor, and the general level of satisfaction with the system. These findings are important to improve health care delivery and can serve as a basis for forging policy changes in Israel. Publication Types: •

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

PMID: 16020009 [PubMed - indexed for MEDLINE] 791: Int J Neurosci. 2005 Jun;115(6):871-80. Related Articles, Links

Musculoskeletal complaints among a group of Turkish nurses. Tezel A. Health College of Erzurum, Ataturk University, Turkey. [email protected] The aim of the present study was to describe the prevalence and distribution of symptoms of musculoskeletal complaints among Turkish nurses who are practicing general nursing. The study population consisted of 120 nursing staff from four large general hospitals in Erzurum, Turkey. In every hospital six departments (surgery, medical, obstetric and gynecology, psychiatry, pediatric, and neurology) were selected. A Nordic standardized questionnaire described by Kuorinka et al. (1987) about complaints of the musculoskeletal system and a selfadministered questionnaire involved information on the respondent's job and employment history, individual characteristics, physical and psychosocial risk factors at work, and general health status, were used by the researchers. Test data were analyzed for the difference between two population proportion and percentage. In the total population, 90% of all nurses reported at least one musculoskeletal complaint, 60% reported at least two, and 36% reported spells of three complaints in the past 6 months. Low back complaints were the most prevalent of musculoskeletal complaints, reported by 69% of the nurses. Neck complaints were less prevalent than shoulder (46% and 54%, respectively). Nurses with back complaint more often reported neck (28%) and shoulder (34%) complaints. Chronic low back, neck, and shoulder complaints were experienced by 41%, 25%, and 33% nurses, respectively. On the other hand, chronic complaints showed a correlation with working departments. The nurses working in surgery and obstetric and gynecology departments have more chronic complaints than the nurses working in other department (p<.05). The article's findings do not differ from those of other countries. Despite its limitations, this study points to the importance of perceived worked-related physical demands in relation to reported neck, shoulder, and back musculoskeletal complaints in Turkish nurses. But, further inquiries are needed to identify other physical exposures that may be related to musculoskeletal complaints. Publication Types: •

Multicenter Study

PMID: 16019580 [PubMed - indexed for MEDLINE] 792: Ying Yong Sheng Tai Xue Bao. 2005 Apr;16(4):641-6. Related Articles, Links

[Spatial-temporal changes of Taishan Mountains scenery area landscape patterns] [Article in Chinese] Guo L, Yu S. School of Life Sciences, Zhongsan University, Guangzhou 510275, China. By adopting the Landsat images of 1986 and 2001, and through field investigation, this paper studied the characteristics and genesis of the spatialtemporal changes of Taishan Mountains scenery area landscape patterns in Shandong Province of East China since mid-80 s of last century, and approached the effects of anthropogenic disturbances on them. The results showed that the anthropogenic disturbances at that time were the main reasons of inducing the significant changes of landscape patterns, and the large-scale pure forest reconstruction and scenery area construction in late 80s of last century made the forest vegetation patches more fragmented and the superiority of landscape types decreased. The results also showed that the area of Pinus forest significantly decreased, mainly due to its conversion to Quercus and mixed forests. The increase of landscape patches intensified the fragmentation of certain landscape patterns, and in particular, the increase of bare substrate on steep slopes could potentially damage the health of mountain ecosystem. Publication Types: • •

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

PMID: 16011159 [PubMed - indexed for MEDLINE] 793: Mil Med. 2005 Jun;170(6):521-7. Related Articles, Links Comment in: •

Mil Med. 2006 Mar;171(3):xi, 219.

Aeromedical evacuations from Operation Iraqi Freedom: a descriptive study. Harman DR, Hooper TI, Gackstetter GD. Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. OBJECTIVE: To describe health patterns in evacuated military members during Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and postdeployment health information to understand the utility of data collected for aeromedical evacuations. METHODS: We conducted a descriptive analysis of U.S. evacuees from 2003 using data from the U.S. Transportation Command's Regulating and Command & Control Evacuation System and the Defense Medical Surveillance System. RESULTS: The typical patient was an Army male under the age of 29 requiring orthopedic or surgical care. Disease/nonbattle injuries were six times as common as battle injuries and 94% were classified as routine evacuees. Eighty-six percent had health data available in the Defense Medical Surveillance System. Two thirds had pre- and/or postdeployment questionnaire data. CONCLUSIONS: Combining data sources increases our understanding of disease patterns in deployed troops. Targeted preventive interventions can then be implemented. Changes in the U.S. Transportation Command's Regulating and Command & Control Evacuation System database can improve its utility as an epidemiological tool. PMID: 16001605 [PubMed - indexed for MEDLINE] 794: Eur Spine J. 2006 Jun;15(6):834-48. Epub 2005 Jul 6. Related Articles, Links

The prevalence of neck pain in the world population: a systematic critical review of the literature. Fejer R, Kyvik KO, Hartvigsen J. Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark. [email protected] The objective of this study was to determine the prevalence of neck pain (NP) in the world population and to identify areas of methodological variation between studies. A systematic search was conducted in five databases (MEDLINE, EMBASE, CINAHL, OSH-ROM, and PsycINFO), followed by a screening of

reference lists of relevant papers. Included papers were extracted for information and each paper was given a quality score. Mean prevalence estimates were calculated for six prevalence periods (point, week, month, 6 months, year, and lifetime), and considered separately for age, gender, quality score, response rate, sample size, anatomical definition, geography, and publication year. Fifty-six papers were included. The six most commonly reported types of prevalence were point, week, month, 6 months, year, and lifetime. Except for lifetime prevalence, women reported more NP than men. For 1-year prevalence, Scandinavian countries reported more NP than the rest of Europe and Asia. Prevalence estimates were not affected by age, quality score, sample size, response rate, and different anatomical definitions of NP. NP is a common symptom in the population. As expected, the prevalence increases with longer prevalence periods and generally women have more NP than men. At least for 1-year prevalence Scandinavian countries report higher mean estimates than the rest of Europe and Asia. The quality of studies varies greatly but is not correlated with the prevalence estimates. Design varies considerably and standardisation is needed in future studies. Publication Types: •

Review

PMID: 15999284 [PubMed - indexed for MEDLINE] 795: J Trauma. 2005 Jun;58(6):1272-6; discussion 1277. Related Articles, Links

M-study; arguments for regional trauma databases. Joosse P, Goslings JC, Luitse JS, Ponsen KJ. Trauma Unit, Dept. of Surgery, Academical Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands. [email protected] BACKGROUND: The TRISS methodology, in combination with coefficients derived from the Major Trauma Outcome Study (MTOS), is the most widely used outcome prediction model for the care of trauma patients. Utilizing the Mstatistic, different populations of trauma patients can be compared with the population originally enrolled in the MTOS. PURPOSE: We hypothesized that databases outside of North-America would not be well matched to the MTOS study and thus the TRISS methodology would not accurately predict outcome in these different populations. METHODS: All trauma studies utilizing TRISS methodology that were published between 1990-2003 were reviewed and Mstatistics calculated based on the population described in the study. The

populations were grouped by the following geographic locations: Europe, Asia/Africa and North-America. RESULTS: The median M-statistic for Europe was 0.65, compared with 0.88 for Asian/African databases, and 0.90 for NorthAmerican studies. There was a significant difference between European and North-American studies (p < 0.05). CONCLUSION: The trauma populations described in European studies differ significantly from the MTOS with respect to injury severity match, indicating the need for the development of regional trauma databases and modified TRISS coefficients based on the geographic location of the injured population included. Publication Types: •

Comparative Study

PMID: 15995481 [PubMed - indexed for MEDLINE] 796: Comput Methods Programs Biomed. 2005 Oct;80(1):1-15. Related Articles, Links

Development of a deterministic XML schema by resolving structure ambiguity of HL7 messages. Huang EW, Wang DW, Liou DM. Department of Information Management, National Taipei College of Nursing, Taiwan, ROC. Health level 7 (HL7) is a standard for medical information exchange. It defines data transfers for the application systems in the healthcare environment. Alternatively, the extensible markup language (XML) is a standard for data exchange using the Internet. If exchange messages follow the content and the sequence defined by HL7 and are expressed in the XML format, the system may benefit from the advantages of both standards. In creating the XML schema, we found ambiguities in HL7 message structures that cause the XML schema to be non-deterministic. These ambiguous expressions are summarized within 12 structures and can be replaced with equivalent or similar unambiguous structures. The finite state automata are used to verify expression equivalence. Applying this schema, an XML document may eliminate redundant segment group definitions and make the structure simple and easy to reproduce. In this paper, we discuss the methods and our experience in resolving ambiguous problems in HL7 messages to generate a deterministic XML schema. Publication Types:

•

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

PMID: 15993979 [PubMed - indexed for MEDLINE] 797: Sci Total Environ. 2005 Jun 15;346(1-3):184-99. Epub 2005 Jan 7. Related Articles, Links

Estimation of biogenic volatile organic compounds emissions in subtropical island--Taiwan. Chang KH, Chen TF, Huang HC. Graduate School of Engineering Science and Technology (Doctoral Program), National Yunlin University of Science and Technology, 123 University Rd. Sec. 3, Touliu, Yunlin, Taiwan. [email protected] Elevated tropospheric ozone is harmful to human health and plants. It is formed through the photochemical reactions involving volatile organic compounds (VOCs) and nitrogen oxides (NO(x)). The elevated ozone episodes occur mainly in summer months in the United States, while the high-ozone episodes frequently occur during the fall in Taiwan. The unique landscape of Taiwan produces tremendous amounts of biogenic VOCs in the mountain regions that are adjacent to concentrated urban areas. The urban areas, in turn, generate prodigious amounts of anthropogenic emissions. Biogenic VOC emissions have direct influence on tropospheric ozone formation. To explore the air quality problems in Taiwan, this study attempts to develop a biogenic VOC emission model suitable for air quality applications in Taiwan. The emission model is based on the Biogenic Emissions Inventory System Version 2 and coupled with a detailed Taiwan land use database. The 1999 total Taiwan biogenic VOC emissions were estimated at 214,000 metric tons. The emissions of isoprene, monoterpenes, and other VOCs were about 37.2%, 30.4%, and 32.4% of total biogenic VOC emissions, respectively. The annual total biogenic VOC emission per unit area was more than two times the value of that in any European country, implying that detailed emissions estimates in any size of region will benefit the global biogenic emission inventories. Publication Types: •

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

PMID: 15993693 [PubMed - indexed for MEDLINE] 798: Nat Cell Biol. 2005 Jul;7(7):639.

Related Articles,

Links

Databases in peril. [No authors listed] Publication Types: •

Editorial

PMID: 15990889 [PubMed - indexed for MEDLINE] 799: Indian J Med Sci. 2005 Jun;59(6):243-52. Related Articles, Links

Correlates of tobacco-use pattern amongst adolescents in two schools of New Delhi, India. Kotwal A, Thakur R, Seth T. Management Information Systems Organization, Army Headquarters, New Delhi, India. BACKGROUND: As adolescent tobacco use has been found to be a major predictor of future use, preventive efforts need to be focused on this section of population. OBJECTIVES: To assess the role of knowledge regarding tobacco, risk-taking attitude, peers, and other influencers on tobacco and areca nut use, amongst adolescents. SETTINGS AND DESIGN: A school-based cross-sectional study covering two schools. Students of classes IX and XI, of selected schools, participated in the study (n = 596). METHODS: A pretested and validated, close ended, self-administered questionnaire was used. Sociodemographic factors, awareness regarding tobacco, risk-taking attitudes, role of peers and other influencers, and tobacco, areca nut and alcohol use, were studied. STATISTICAL ANALYSIS: Point estimates, 98% Confidence Intervals, tests of significance, bivariate and multivariate analysis (multiple logistic regression). RESULTS: Almost 42% of tobacco users started before the age of 12 years. Peer pressure, general stress, and media were important influencers. Logistic regression analysis showed that students in public school were using more tobacco [Odds ratio (OR) = 1.85, P = 0.174] and tobacco/areca nut (OR = 1.14, P = 0.02). The difference in use between the genders and class in which studying was statistically not significant. Lesser proportion of those possessing adequate knowledge regarding tobacco used it as compared to those without adequate knowledge (OR = 0.13, P < 0.001) however, possession of adequate knowledge was not a good predictor of

areca nut consumption (OR = 0.86, P = 0.585). The most important correlate for tobacco use (OR = 6.41, P < 0.001) and areca nut use (OR = 11.17, P < 0.001) was risk-taking attitude. CONCLUSION: Multi-pronged and concerted efforts targeting children at an early age are required to prevent tobacco and areca nut use among adolescents. PMID: 15988094 [PubMed - indexed for MEDLINE] 800: Hu Li Za Zhi. 2005 Jun;52(3):10-4. Related Articles, Links

[Caring for teenage girls: from the perspective of establishing women's health consultations on campuses] [Article in Chinese] Tsao LI, Yu SH, Kao CH. Department of Research and Development, Graduate Institute of Integration of Traditonal Chinese Medicine with Nursing, National Taipei College of Nursing. Women's health problems are increasing among teenage girls in modern society. However, there are only a few programs related to women's health consultation on campuses. Three issues are explored in this paper - the health rights of teenage girls, women's health consultations, and teenage girls' subjective views about the establishment of a women's health consultation service on their campus. In the course of our research of teenage girls' subjective views, three hundred and eighty-seven young girl students responded to questionnaires and seven volunteer students among them were invited to do in-depth interviews. Most students (98.2%) thought that it was necessary to set up a women's health consultation service on campus, because they hoped to get personal health information that could not be found in a textbook. Three hundred and five (78.8%) students perceived that they had women's health problems. Their health problems are ranked as follows: dysmenorrhea, irregularity of menstrual periods, unusual vaginal secretions and questions of contraception and urinary system health. They suggested that campus consultation centers should have the following characteristics: protection of students' privacy, provision of multiple channels for consultation, strict limitation on numbers of people in the consulting office, and a non-discriminatory policy towards all clients. Hopefully, an information database can provide a good reference for establishing a women's health consultation service on campus in the near future. Publication Types: •

English Abstract

PMID: 15986296 [PubMed - indexed for MEDLINE]