His 5

901: Health Promot Int. 2005 Mar;20(1):61-8. Epub 2005 Jan 24. Related Articles, Links

The spread of drug abuse in rapidly urbanizing communities in Vientiane, Lao People's Democratic Republic. Fujiwara T, Takano T, Nakamura K. Health Promotion/International Health Division of Public Health, Graduated School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. To determine the prevalence of drug abuse in city neighborhoods in a developing country undergoing rapid urbanization, we performed a household survey on the spread of drug abuse in Vientiane, Lao People's Democratic Republic. A total of 1497 households from 17 villages were selected by the stratified random sampling method from urban districts in the city of Vientiane. Participatory style research was employed to increase both the sensitivity of detection and the reliability of information gathered. Local key players shared in the participatory process in this study. We worked with national and city officers and community leaders, as well as with neighborhood leaders who had received previous training for this survey, and conducted household surveys using face-to-face interviews. We inquired about the spread of drug abuse by asking if the families interviewed recognized drug abuse problems in their community. To examine the extent of urbanization of individual villages, the urban index was calculated by principle component analysis from the following eight indicators: income, occupation, parents' educational histories, diffusion of telephones, ownership of livestock, diffusion of plumbing for running water and distance from the Vientiane city center to the village. Distance was calculated by the Geographic Information System. Among the 17 villages included in the study, the average percentage of recognition of drug abuse in the community was 63.2%. The relationship between recognition of cases of drug abuse in the community and the urban index showed a significant correlation, with a Spearman coefficient of 0.650 (p < 0.01). The high reliability of participatory style surveys is also discussed. In conclusion, city neighborhoods in a developing country undergoing rapid urbanization showed evidence of the spread of drug abuse, which was associated with the urban index. Participatory style research activity was recommended to help raise awareness of community participation in anti-drug-abuse activities. PMID: 15668213 [PubMed - indexed for MEDLINE] 902: J Clin Pharm Ther. 2005 Feb;30(1):21-37. Related Articles, Links

A literature search on pharmacokinetic drug interactions of statins and analysis of how such interactions are reflected in package inserts in Japan. Saito M, Hirata-Koizumi M, Urano T, Miyake S, Hasegawa R. Division of Medicinal Safety Science, National Institute of Health Sciences, Kamiyoga, Setagaya-ku, Tokyo, Japan. [email protected] BACKGROUND AND OBJECTIVES: Statins (HMG-CoA reductase inhibitors) are one of the most widely prescribed classes of drugs throughout the world, because of their excellent cholesterol-lowering effect and overall safety profile except for rare but fatal rhabdomyolysis arising either directly or indirectly by pharmacokinetic interactions with certain other drugs. As package inserts in pharmaceuticals are the primary source of information for health care providers, we carried out a literature search to examine how crucial information was provided in package inserts of five statins approved in Japan (simvastatin, atorvastatin, fluvastatin, pravastatin and pitavastatin). METHODS: A MEDLINE search from 1996 to June 2004 was carried out to identify studies on clinical pharmacokinetic drug interactions for the five statins. We mainly collected information on area under plasma concentration (AUC) following coadministration of statins with other drugs. The current package inserts used in Japan were obtained from the website of the Pharmaceutical and Medical Device Agency whereas USA package inserts were obtained from the Food and Drug Administration website. RESULTS: The majority of package inserts listed the drugs that interacted with statins with most describing the risk of rhabdomyolysis because of the possibility of increases in blood concentration. However, quantitative information such as change in AUC was provided in only a few cases. Instructions for dosage adjustment are seldom provided in the Japanese package inserts. USA package inserts list almost identical drug interactions as the Japanese package inserts, although they contain more quantitative data, especially for typical cytochrome P450 (CYP) inhibitors. CONCLUSION: All pharmacokinetic drug interactions including relevant quantitative data for potential effectors and details on mechanisms of interaction need to be given in package inserts as soon as the information becomes available, to ensure safe and proper use of the drugs concerned. Including such information in the package insert will be an extremely valuable aid for health care providers. Publication Types: • •

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

PMID: 15659001 [PubMed - indexed for MEDLINE] 903: Nippon Naika Gakkai Zasshi. 2004 Dec 10;93(12):2594-8. Related Articles, Links

[Home care services covered by long-term care insurance system in Japan] [Article in Japanese] Funatani F. Publication Types: •

Review

PMID: 15658490 [PubMed - indexed for MEDLINE] 904: Rinsho Byori. 2004 Nov;52(11):906-14. Related Articles, Links

[Development of the reimbursement system based on DPC] [Article in Japanese] Nakamura K. Medical Economics Division, Health Insurance Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo 100-8916. In the health insurance system of Japan, a fee-for-service system has been applied to individual treatment services, but this fee system involves a structural problem of causing increases in examinations and drug administration. Various attempts have been made to solve this structural problem in several treatment fields, in which a flat payment system can be introduced with the fee for-service system as the basis. The diagnosis procedure combination (DPC) system introduced in April 2003, which is a flat payment system using a diagnosis classification, is the first large scale revision of the medical fee system of Japan. This diagnosis classification is considered to be effective for simplifying the medical fee system, within the framework of EBM, and for providing patients with information. However, since there are also structural problems in the flat payment system, such as examination and treatment of low quality, selection of patients, and upcoding, its introduction should be performed with sufficient caution. We will make more

efforts to establish a better medical fee system by evaluating these problems. Publication Types: •

English Abstract

PMID: 15658470 [PubMed - indexed for MEDLINE] 905: J Clin Nurs. 2005 Jan;14(1):28-34. Related Articles, Links

SARS (severe acute respiratory syndrome): reflective practice of a nurse manager. Lau PY, Chan CW. Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong. AIMS AND OBJECTIVES: This paper describes the reflective practice of a nurse manager in Hong Kong in supporting frontline nurses to overcome the crisis of SARS. BACKGROUND: SARS infection was a crisis for everyone in endemic areas because of its threat to physical and emotional health. Hong Kong was the second leading endemic area in the world. Inadequate supplies of protective devices and the death of a nurse infected with SARS triggered nurses' negative emotions. METHODS: A model of structured reflection was adopted to examine one's practice. A problem-solving model for crisis intervention was integrated into the reflective stage of structured reflection. RESULTS: Promotion of nurses' safety and emotional stability were the major goals in handling the crisis. Strategies were employed including self-awareness, empowerment and team building, information sharing, provision of personal protective equipment and emotional support for frontline nurses. CONCLUSIONS: SARS infection threatens the physical and emotional health of nurses. From a positive perspective, such a crisis created an opportunity to learn and grow in terms of ethical, personal and aesthetic arenas. RELEVANCE TO CLINICAL PRACTICE: SARS epidemic raised worldwide attention and challenged the Hong Kong's health care system. Reflective practice is useful to guide and examine nurses' professional action during the crisis, and to put the experience into a learning perspective. PMID: 15656845 [PubMed - indexed for MEDLINE] 906: J Chin Med Assoc. 2004 Oct;67(10):500-5.

Related Articles,

Links

Comment in: •

J Chin Med Assoc. 2004 Oct;67(10):494-5.

Multiple sclerosis in Taiwan. Tsai CP, Yuan CL, Yu HY, Chen C, Guo YC, Shan DE. Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. [email protected] BACKGROUND: There is only 1 report about multiple sclerosis (MS) prevalence in Taiwan, and this was published in 1976 and involved only 25 patients. The clinical features and prevalence of MS in Taiwan still remain to be clarified. The aim of this study was to determine the prevalence and delineate the clinical features of MS in Taiwanese patients. METHODS: We retrospectively identified 43 ethnic Chinese multiple sclerosis (MS) patients over a 14-year period. The MS prevalence in Taiwan was estimated based on Bureau of National Health Insurance (BNHI) data. The clinical data (gender, family history, age at onset, initial symptoms, clinical course, disability and laboratory findings, evoked response and neuroimaging) were recorded, collected and analyzed. RESULTS: The MS prevalence in Taiwan was as low as 1.9 per 100,000. The distribution of most of the clinical features of our patients, like those in other Asian series, was different from Western series except for the percentage of the conventional form and sensory disturbances. Cerebrospinal fluid analysis for IgG index and OCB seemed to be less sensitive in the diagnosis of MS in our series. CONCLUSIONS: The prevalence of MS in Taiwan, as in other Asian countries, was low; the opticspinal form occurred very often, but predominant spinal cord involvement was not unusual, as well as there being less functional disability. A larger, prospective study is needed to provide more conclusive information. Publication Types: •

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

PMID: 15648284 [PubMed - indexed for MEDLINE] 907: J Toxicol Clin Toxicol. 2004;42(7):965-75. Related Articles, Links

Pattern of acute poisonings in Mashhad, Iran 1993-2000.

Afshari R, Majdzadeh R, Balali-Mood M. Scottish Poisons Information Bureau, The Royal Infirmary, University of Edinburgh, UK. Drugs and chemicals are almost easily available in Iran. Natural toxins as poisonous plants and animals also exist in most parts of the country. Therefore, acute poisonings, either intentional or accidental and also drug abuse/addiction are common in Iran. In spite of these difficulties there is no center for poison control and surveillance in this country to gather information and analyse data. The files of a systematic randomised ten percent of all hospital-referred poisoned patients from 21 March 1993 to 20 March 2000 in Imam Reza (p) University Hospital of Mashhad (71589 cases) were screened retrospectively. Young adults (40.3%) and school children (22.9%) were the most vulnerable group. Mean age was 22.3 (S.D. 14.38) years with a minimum of less than one and a maximum of 98 years old. A female predominance was found (53.4%). Intentional poisoning was more common (54.4%) than accidental exposures (45.2%). Fourteen cases were classified as criminal poisoning. 79.7% of exposures were via ingestion, followed by dermal exposures (14.1%), and inhalation (6.2%). The majority (83.7%) of patients were from urban areas. Most patients (68.6%) were treated in the Emergency Toxicology Clinic and discharged, 19.2% were temporarily hospitalized and 11.3% were hospitalized for 24 hr. Main groups of poisons were pharmaceuticals (61.4%), chemicals (22.8%), and natural toxins (16.6%). The overall number of poisoned patients was higher in spring and summer (62.8%). In conclusion, acute poisonings, particularly self-poisonings, are common in Iran. Since medical documentation is not routinely provided in this country the results of this retrospective study can be used for surveillance. Establishment of fluent data gathering and analysis within the local health system are challenges for the future. Publication Types: • •

Clinical Trial Randomized Controlled Trial

PMID: 15641642 [PubMed - indexed for MEDLINE] 908: Natl Med J India. 2004 Sep-Oct;17(5):243-5. Related Articles, Links

Use of complementary and alternative medicine by patients with diabetes mellitus. Mehrotra R, Bajaj S, Kumar D.

Motilal Nehru Medical College, 16/2 Lowther Road, Allahabad 211002, Uttar Pradesh, India. BACKGROUND: A wide variety of alternative medicines have been traditionally used for the treatment of diabetes in India. We did a cross-sectional study to assess the use of complementary and alternative medicine by patients with diabetes attending our outpatient department. METHODS: Four hundred and ninety-three patients attending the outpatient endocrine clinic for allopathic treatment were included. They were interviewed to assess their knowledge, awareness and methods of practice of non-allopathic forms of therapy. Information on the patients' background characteristics, family history of disease, existing knowledge of their disease and therapy was obtained. RESULTS: The user rate of complementary and alternative medicine was 67.8% and this was not significantly associated with the educational or socioeconomic status of the patients. Desire for early and maximum benefit was the most common reason (86.8%) for using these remedies. The patients felt that acupressure followed by naturopathy were the most beneficial alternative therapies, while homeopathy was felt to have the least benefit in the control of diabetes. CONCLUSION: There was widespread use of complementary and alternative systems of medicine by our patients. It is therefore necessary to obtain objective data to assess the improvement in blood sugar level with, and side-effects of, these methods of treatment. PMID: 15638303 [PubMed - indexed for MEDLINE] 909: Biofactors. 2004;22(1-4):259-63. Related Articles, Links

Intake of phytochemicals among Japanese, calculated by the new FFF database. Kita J, Tada J, Ito M, Shirakawa M, Murashima M, Zhuo XG, Watanabe S. Department of Nutritional Science, Tokyo University of Agriculture 1-1-1, Sakuragaoka, Setagaya, Tokyo 156-8502, Japan. Effects of phytochemicals on human health are suggested from various animal experiments, but human studies remain insufficient. We have constructed a database of various phytochemicals (polyphenols, carotenoids, and sulphur compounds) (http://www.life-science.jp/fff/) and estimated the amount of intake among Japanese population. The subjects were volunteers (16 males and 63 females, averagely aged 71 and 61, respectively) in Iwate city. Average BMI was 23 in both sexes. Intake of 36 phytochemicals was calculated from one-day dietary records of all intake, by multiplying concentrations of each phytochemical in foods. Phytochemicals with average intake of at least 10 micromole per day

were catechin, isoflavones, isothiocyanate, ferulic acid, quercetin, cinnamic acid and chlorogenic acid. Chief component analysis yielded 12 factors (80%). Publication Types: •

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

PMID: 15630294 [PubMed - indexed for MEDLINE] 910: Genomics Proteomics Bioinformatics. 2003 Nov;1(4):304-9. Related Articles, Links

HLA-A gene polymorphism defined by high-resolution sequencebased typing in 161 Northern Chinese Han people. Yan C, Wang R, Li J, Deng Y, Wu D, Zhang H, Zhang H, Wang L, Zhang C, Sun H, Zhang X, Wang J, Yang H, Li S. The State Laboratory of the Ministry of Health for Forensic Sciences, Xi'an 710061, China. Human leukocyte antigen (HLA) system is the most polymorphic region known in the human genome. In the present study, we analyzed for the first time the HLA-A gene polymorphisms defined by the high-resolution typing methodssequence-based typing (SBT) in 161 Northern Chinese Han people. A total of 74 different HLA-A gene types and 36 alleles were detected. The most frequent alleles were A*110101 (GF=0.2360), A*24020101 (GF=0.1646), and A*020101 (GF=0.1553); followed by A*3303 (GF=0.1180), A*3001 (GF=0.0590), and A*310102 (GF=0.0404). The frequencies of following alleles, A*0203, A*0205, A*0206, A*0207, A*030101, A*2423, A*2601, A*3201, and A*3301, are all higher than 0.0093. The homozygous alleles include A*020101, A*110101, A*24020101 and A*310102. Heterozygosity (H), polymorphism information content (PIC), discrimination power (DP) and probability of paternity exclusion (PPE) of HLA-A in the samples were calculated and their values were 0.8705, 0.8491, 0.6014, and 0.9475, respectively. These results by SBT analysis of HLAA polymorphism in Northern Chinese Han population, especially the allele subtypes character, will be of great interest for clinical transplantation, diseaseassociated study and forensic identification. Implementation of high-resolution typing methods allows a significantly wider spectrum of HLA variation including rare alleles. This spectrum will further be extensively utilized in many fields. Publication Types: •

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

PMID: 15629059 [PubMed - indexed for MEDLINE] 911: Wkly Epidemiol Rec. 2003 Sep 26;78(39):346-7. Related Articles, Links

Joint WHO HQ/SEAROP/WPRO meeting on DengueNet implementation in South-East Asia and the Western Pacific, Kuala Lumpur, 11-13 December 2003. [Article in English, French] [No authors listed] PMID: 15622835 [PubMed - indexed for MEDLINE] 912: Br J Ophthalmol. 2005 Jan;89(1):45-9. Related Articles, Links

Routine monitoring of visual outcome of cataract surgery. Part 1: Development of an instrument. Limburg H, Foster A, Gilbert C, Johnson GJ, Kyndt M. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London. UK. [email protected] AIM: To develop a system for routine monitoring of visual outcome after cataract surgery. METHODS: Staff from eight eye centres in Asia and Africa defined the data collection form and report formats to be used for monitoring visual outcome after cataract surgery. Several operational research questions were raised and methods developed to address them. The system was field tested for 6 months and the operational studies undertaken. The system was finalised based upon the experience gained. FINDINGS: Two different systems for data collection were developed: a manual paper tally system and a computer system (cataract surgery record forms (CSRF)). Both systems report on operative complications; the proportion with good outcome (can see 6/18) and poor outcome (cannot see 6/60); and causes of poor outcome. Data are collected at discharge and at specified time intervals at follow up. Both systems were well accepted. CONCLUSION: The major problem in field testing was data entry errors in centres using the computerised system. Routine monitoring of cataract outcome should be used by individual surgeons or centres to follow trends in their own results over time, and not to compare surgeons, in an atmosphere of trust and support. Visual acuity at discharge, which can readily be collected on all patients, can be used providing it

is appreciated that the final results will be much better. Rapid feedback of results can enhance the consciousness of the eye surgeons to causes of poor outcome. Accuracy in data entry and an efficient flow of record forms are essential. Publication Types: • • • •

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

PMID: 15615745 [PubMed - indexed for MEDLINE] PMCID: PMC1772455

913: Respirology. 2004 Nov;9(4):466-73. Related Articles, Links

Cost impact of COPD in Japan: opportunities and challenges? Nishimura S, Zaher C. Kyoto University, Sakyo-ku, Kyoto, Japan. OBJECTIVE: The Global Initiative for Obstructive Lung Disease highlights the importance of COPD from public health, health policy and clinical perspectives. In countries such as the USA, the economic impact of COPD exceeds that of many chronic conditions. There is a paucity of data on the economic burden of COPD in Japan. METHODOLOGY: Based upon publicly available information, a prevalence-based approach was used to construct a deterministic model to estimate the total direct and indirect costs of care for COPD in Japan. Data sources included a spirometry-based epidemiological study, the peer-reviewed literature, and governmental and industrial surveys. The most current data that addressed direct and indirect costs of care were utilized. RESULTS: In Japan, the estimated total cost of COPD is 805.5 billion yen (US 6.8 billion dollars) per year; 645.1 billion yen (US 5.5 billion dollars) in direct costs and 160.4 billion yen (US 1.4 billion dollars) in indirect costs. In direct costs, inpatient care accounted for 244.1 billion yen (US 2.1 billion dollars), outpatient care 299.3 billion yen (US 2.5 billion dollars), and home oxygen therapy 101.7 billion yen (US 0.9 billion dollars). The average annual total cost per patient for moderate/severe COPD is estimated to be 435,876 yen (US 3694 dollars); 349,080 yen (US 2958 dollars) per COPD patient in direct costs and 86,797 yen (US 795 dollars) in indirect costs. CONCLUSION: COPD imposes a high economic burden on the Japanese

healthcare system. Health policy makers should direct urgent attention to increasing prevention, early diagnosis, and appropriate treatment of COPD. PMID: 15612957 [PubMed - indexed for MEDLINE] 914: Environ Biosafety Res. 2003 Jul-Sep;2(3):145-60. Related Articles, Links

Databases on biotechnology and biosafety of GMOs. Degrassi G, Alexandrova N, Ripandelli D. Biosafety Unit, International Centre for Genetic Engineering and Biotechnology, Area Science Park, Padriciano 99, 34012 Trieste, Italy. [email protected] Due to the involvement of scientific, industrial, commercial and public sectors of society, the complexity of the issues concerning the safety of genetically modified organisms (GMOs) for the environment, agriculture, and human and animal health calls for a wide coverage of information. Accordingly, development of the field of biotechnology, along with concerns related to the fate of released GMOs, has led to a rapid development of tools for disseminating such information. As a result, there is a growing number of databases aimed at collecting and storing information related to GMOs. Most of the sites deal with information on environmental releases, field trials, transgenes and related sequences, regulations and legislation, risk assessment documents, and literature. Databases are mainly established and managed by scientific, national or international authorities, and are addressed towards scientists, government officials, policy makers, consumers, farmers, environmental groups and civil society representatives. This complexity can lead to an overlapping of information. The purpose of the present review is to analyse the relevant databases currently available on the web, providing comments on their vastly different information and on the structure of the sites pertaining to different users. A preliminary overview on the development of these sites during the last decade, at both the national and international level, is also provided. Publication Types: • •

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

PMID: 15612413 [PubMed - indexed for MEDLINE] 915: Nucleic Acids Res. 2005 Jan 1;33(Database issue):D174-7. Related Articles, Links

TPMD: a database and resources of microsatellite marker genotyped in Taiwanese populations. Chang YH, Su WH, Lee TC, Sun HF, Chen CH, Pan WH, Tsai SF, Jou YS. Division of Molecular and Genomic Medicine, National Health Research Institutes, Taipei 115, Taiwan. Taiwan Polymorphic Marker Database (TPMD) (http://tpmd.nhri.org.tw/) is a marker database designed to provide experimental details and useful marker information allelotyped in Taiwanese populations accompanied by resources and technical supports. The current version deposited more than 372,000 allelotyping data from 1425 frequently used and fluorescent-labeled microsatellite markers with variation types of dinucleotide, trinucleotide and tetranucleotide. TPMD contains text and map displays with searchable and retrievable options for marker names, chromosomal location in various human genome maps and marker heterozygosity in populations of Taiwanese, Japanese and Caucasian. The integration of marker information in map display is useful for the selection of high heterozygosity and commonly used microsatellite markers to refine mapping of diseases locus followed by identification of disease gene by positional candidate cloning. In addition, our results indicated that the number of markers with heterozygosity over 0.7 in Asian populations is lower than that in Caucasian. To increase accuracy and facilitate genetic studies using microsatellite markers, we also list markers with genotyping difficulty due to ambiguity of allele calling and recommend an optimal set of microsatellite markers for genotyping in Taiwanese, and possible extension of genotyping in other Mongoloid populations. Publication Types: •

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

PMID: 15608171 [PubMed - indexed for MEDLINE] PMCID: PMC540056

916: Accid Anal Prev. 2005 Jan;37(1):137-41. Related Articles, Links

Epidemiological profile of mortality due to injuries in three cities in the Guangxi Province, China.

Yang L, Lam LT, Liu Y, Geng WK, Liu DC. School of Public Health, Guangxi Medical University, Nanning, Guangxi, China. This study aimed to provide epidemiological information on injury mortality in three major cities in Guangxi Province of South Western China. This was a population-based descriptive study utilising surveillance and field-gathered data. Data were obtained from the disease surveillance information system and record on each death certificate. Mortality rates were compared between sex and among different age groups for different causes of injury. Regression modelling was applied to examine for any increasing trend of injury mortality within the study period. Drowning was a severe problem for boys and girls younger than 5 years. Among all estimated mortality rates (per 100,000 person-years) for all sex, age groups, and categories of death, they were the highest with a rate of 29.8 (95%CI = 16.7-42.9) for boys and 29.6 (95%CI = 15.9-43.3) for girls. The overall mortality rates of motor vehicle and other transport-related injury was also similar to those developed countries. There was a marginally significant trend of increasing injury mortality within the study period. Publication Types: •

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

PMID: 15607284 [PubMed - indexed for MEDLINE] 917: East Mediterr Health J. 2002 Jul-Sep;8(4-5):645-53. Related Articles, Links

Organization of the Saudi health system. Al-Yousuf M, Akerele TM, Al-Mazrou YY. General Directorate of Health Centres, Ministry of Health, Riyadh, Saudi Arabia. Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health. Publication Types:

•

Review

PMID: 15603048 [PubMed - indexed for MEDLINE] 918: J Clin Gastroenterol. 2004 Nov-Dec;38(10 Suppl 3):S153-7. Related Articles, Links

Cost of chronic hepatitis B infection in South Korea. Yang BM, Kim CH, Kim JY. School of Public Health, Seoul National University, Seoul 110-799, South Korea. GOALS: To estimate the direct medical costs of chronic hepatitis B (CHB) infection and its liver disease sequelae in South Korea. BACKGROUND: Korea is a hepatitis B-endemic area with 5.79% to 10.87% of males and 1.51% to 4.44% of females over 20 years of age carrying the virus. It is estimated that 25% of carriers will develop serious hepatitis B virus (HBV)-related complications. While vaccination programs have reduced the prevalence of hepatitis B in people younger than 20 years, significant CHB-related morbidity will continue to occur for the next 15 to 30 years until the benefits of the vaccination programs take effect. STUDY: Direct medical costs for six CHB-related disease states, including hepatocellular carcinoma and liver transplant, were estimated for the year 2001. METHODS: Four data sources were used to gather information: the National Health Insurance Corporation database, patients' medical charts, expert opinion, and patient survey data. RESULTS: In 2001, the total medical costs of six CHBrelated diseases were 250 million Korean Won (KRW) (equivalent to U.S. 208.6 million dollars), based on an exchange rate of KRW 1200 = US 1 dollar. Annual treatment costs per patient ranged from KRW297,392 (US 248 dollars) for chronic hepatitis B to KRW 80.6 million (U.S. 67,156 dollars) for liver transplant. The cost of treatment rose continuously with liver disease progression. The main cost driver was inpatient hospitalizations (including surgical costs). CONCLUSION: CHB-related diseases are a significant cost burden to the South Korean healthcare system. In addition to the obvious clinical benefits, the prevention or delay of chronic hepatitis B liver disease progression in South Korea could result in substantial economic benefits to the whole society. Publication Types: •

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

PMID: 15602164 [PubMed - indexed for MEDLINE]

919: Psychiatry Clin Neurosci. 2004 Dec;58(6):611-8. Related Articles, Links

Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan, 1996-2001. Chien IC, Chou YJ, Lin CH, Bih SH, Chou P, Chang HJ. Community Medicine Research Center and Institute of Public Health, Taipei, Taiwan. As many as 96% of all residents of Taiwan have been enrolled in the National Health Insurance (NHI) program since 1996. The NHI database was used to examine the prevalence and incidence of schizoprenia. The National Health Research Institute provided a database of 200 432 random subjects, about 1% of the population, for study. By means of exclusion criteria, a random sample of 136 045 subjects as a fixed cohort dated from 1996-2001 was obtained. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified. The cumulative prevalence increased from 3.34 per 1000 to 6.42 per 1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000/year to 0.45 per 1000/year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25-44 and 45-64 age groups, insurance amount less than US$640, the eastern region, and suburban areas. Lower incidence was associated with the 45-64 age group. Higher incidence was associated with insurance amount less than US$640, and the eastern region. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation. PMID: 15601385 [PubMed - indexed for MEDLINE] 920: US News World Rep. 2004 Nov 29;137(19):38-43. Related Articles, Links

A long journey home. For the wounded, medical miracles are just the beginning. Shute N. Publication Types:

•

News

PMID: 15600148 [PubMed - indexed for MEDLINE] 921: J Prof Nurs. 2004 Nov-Dec;20(6):396-402. Related Articles, Links

Professional nursing in Iran: an overview of its historical and sociocultural framework. Nasrabadi AN, Lipson JG, Emami A. School of Nursing and Midwifery, Tehran University of Medical Sciences, Tohid Square, Tehran 141118, Iran. nikbakht2sina.tums.ac.ir Nursing in Iran has progressed from the apprenticeship style of nurse training to the higher education sector, with the baccalaureate degree required for registered nurses. Despite these many changes since the Islamic Revolution, nursing is still striving for acceptance and recognition as a profession. This article describes how nursing is conceptualized and practiced in Iran and provides insight into underlying sociocultural forces that have affected the profession in recent years. Nursing education and research, the current status of nursing in the health care system, and the public image of nursing are described based on combining information from several sources: clinical experience, academic experience, and selected qualitative research findings on Iranian nurses' experiences and perceptions of their work. Because knowledge of modern Iranian nursing was inaccessible in English until very recently, this description adds to the literature on the nursing profession cross-nationally. It shows that in Iran, as in other West and East Asian countries, the image of nurses has not changed despite advances in nursing practice, education, and research, necessitating professional socialization and policy changes. Publication Types: •

Review

PMID: 15599874 [PubMed - indexed for MEDLINE] 922: Fam Community Health. 2004 Jul-Sep;27(3):193-203. Related Articles, Links

Evidence of the effectiveness of health sector preparedness in

disaster response: the example of four earthquakes. Bissell RA, Pinet L, Nelson M, Levy M. Department of Emergency Health Services, University of Maryland Baltimore County, Baltimore, MD 21250, USA. [email protected] In this article, evidence that health sector preparedness improves response performance in disasters was examined. Case fatality and survival data were compared for four earthquakes, in relation to health sector emergency preparedness levels. Vast differences in performance were found. The two California systems, with a high preparedness index, had low case fatality rates (about one death per 100 injuries). Kobe, Japan, with mixed levels of preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness index) had 167. Public health and health sector preparedness made a significant difference in the ability to respond effectively to meet patient needs in disasters, although it is only one of several factors that determine the health outcome of disaster victims. Publication Types: •

Comparative Study

PMID: 15596966 [PubMed - indexed for MEDLINE] 923: Ophthalmic Epidemiol. 2004 Dec;11(5):347-58. Related Articles, Links

Cataract in type 2 diabetes mellitus in Isfahan, Iran: incidence and risk factors. Janghorbani M, Amini M. Department of Epidemiology Isfahan Endocrinology & Metabolism Research Center, Isfahan University of Medical Sciences and Health Services Isfahan Iran. [email protected] BACKGROUND: Evidence on the incidence of and risk factors for cataract in type 2 diabetes mellitus is scarce and mainly derived from studies in developed countries. Locally derived evidence is required for planning a well co-ordinated approach to this public health problem in developing countries. OBJECTIVE: The objective of the present study was to estimate the incidence of and risk factors for the development of cataract in type 2 (insulin-treated and non-insulin-treated) diabetes using routinely collected data from a clinical information system at

Isfahan Endocrinology and Metabolism Research Center, Iran. METHOD: During the mean (standard deviation (SD)) follow-up period of 3.6 (2.7) (range 1-11) years, 3888 diabetic patients (1348 male and 2540 female) from Isfahan Endocrinology and Metabolism Research Center outpatient clinics have been examined. The mean (SD) age of the participants was 52.0 (10.5) years with a mean (SD) duration of diabetes of 12.6 (7.5) years at initial registration. RESULTS: Among the 3888 patients who were free of cataract at initial registration with at least one follow-up visit between 1992 and 2004, the incidence of cataract was 33.1 (95% confidence interval (CI): 30.2, 36.1) (64.8 (95% CI: 57.7, 72.0) in males and 17.9 (95% CI: 15.2, 20.5) in females per 1000 person-years based on 14012 person-years of follow-up. The age-adjusted incidence rate of cataract was 20% greater among insulin-treated than noninsulin-treated type 2 diabetes mellitus clinic attenders and it increased with age. Using a Cox's Proportional Hazards Model for insulin and non-insulin-treated type 2 diabetes separately, age, age at diagnosis of diabetes, duration of diabetes, and smoking were significant predictors of cataract for insulin and non-insulintreated type 2 diabetes patients. When all variables were entered in the model, fasting blood glucose and insulin treatment were significant predictors of cataract. In the insulin-treated group, fasting blood glucose was a significant predictor of cataract. Systolic and diastolic blood pressure, gender, HbA(1), proteinuria, body mass index, cholesterol, triglyceride and creatinine had no significant independent association with cataract when other covariates were considered. CONCLUSION: These data suggest that cataract in this population of Iranian type 2 diabetic patients is common. With an estimated incidence of 33.1 per 1000 person-years of observation after mean 3.6 years' follow-up, diabetic cataract clearly poses a formidable health threat to Iranian diabetic patients. The results of this study highlight the need for regular eye examination in people with diabetes. Publication Types: •

Comparative Study

PMID: 15590582 [PubMed - indexed for MEDLINE] 924: Appl Nurs Res. 2004 Nov;17(4):231-8. Related Articles, Links

Nurses' adoption of technology: application of Rogers' innovationdiffusion model. Lee TT. Nursing Department, National Taipei College of Nursing, Taiwan. [email protected]

This qualitative study applied Everett Rogers' innovation-diffusion model to analyze nurses' perceptions toward using a computerized care plan system. Twelve nurses from three respiratory intensive care units in Taiwan voluntarily participated in a one-on-one, in-depth interview. Data were analyzed by constant comparative analysis. The content that emerged was compared with the model's five innovation characteristics (relative advantage, compatibility, complexity, trialability, and observability), as perceived by new users. Results indicate that Rogers' model can accurately describe nurses' behavior during the process of adopting workplace innovations. Related issues that emerged deserve further attention to help nurses make the best use of technology. Publication Types: •

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

PMID: 15573331 [PubMed - indexed for MEDLINE] 925: Psychiatr Serv. 2004 Dec;55(12):1427-30. Related Articles, Links

Use of health care services and costs of psychiatric disorders among National Health Insurance enrollees in Taiwan. Chien IC, Chou YJ, Lin CH, Bih SH, Chang HJ, Chou P. Institute of Public Health, National Yang Ming University, Taipei, Taiwan. The National Health Insurance (NHI) database in Taiwan was used to detect the use of health care services and the costs of psychiatric disorders among NHI enrollees. Data were analyzed for 126,146 enrollees. Four categories were used for enrollees: no psychiatric disorder, a minor psychiatric disorder, a major psychiatric disorder without catastrophic illness registration, and a major psychiatric disorder with catastrophic illness registration (which eliminates copayments). Compared with enrollees with a minor psychiatric disorder, those with a major psychiatric disorder, either with or without catastrophic illness registration, had higher use and costs of mental health care services. Compared with enrollees without a psychiatric disorder, those with a minor psychiatric disorder or a major psychiatric disorder without catastrophic illness registration had higher use and costs of non-mental health care services. Both the mental and general health care of persons with psychiatric disorders are important. PMID: 15572572 [PubMed - indexed for MEDLINE]

926: Osteoporos Int. 2004 Dec;15(12):981-91. Epub 2004 Jul 31. Related Articles, Links

Reference database of biochemical markers of bone turnover for the Japanese female population. Japanese Population-based Osteoporosis (JPOS) Study. Iki M, Akiba T, Matsumoto T, Nishino H, Kagamimori S, Kagawa Y, Yoneshima H; JPOS Study Group. Department of Public Health, Kinki University School of Medicine , 377-2 OonoHigashi, Osaka-Sayama, 589-8511 Osaka, Japan. [email protected] The present study was conducted as a part of the Japanese Population-based Osteoporosis (JPOS) Study to establish reference values on the biochemical markers of bone turnover in the general Japanese female population over an applicable age range. The study recruited 3250 women aged 15-79 years, randomly selected from five municipalities throughout Japan, and obtained measurements of serum osteocalcin (OC) and bone-specific alkaline phosphatase (BAP); free and total forms of immunoreactive deoxypyridinoline, free pyridinolines and type I collagen cross-linked C-terminal telopeptide (CTx) in urine; serum intact parathyroid hormone (PTH) and 1,25 dihydroxy vitamin D (1,25 (OH)2D); and bone density at the spine, hip and distal forearm. After excluding subjects with apparent or suggested abnormalities affecting bone mass, 2535 (78%) subjects were further analyzed. The authors presented 5-year agespecific mean values of the markers and mean marker levels derived from women aged 30-44 years with normal bone density as a healthy young adult reference. Values of the markers decreased with increasing age before the age of 40, increased steeply among subjects in their 50s, and remained elevated in the elderly. Serum calcium, phosphorus, PTH and 1,25 (OH)2D levels were higher in postmenopausal women than in premenopausal women. However, 1,25 (OH)2D was lower among early postmenopausal subjects. The levels of OC, BAP, CTx, PTH and 1,25(OH)2D were significantly greater for women with osteoporosis than for those without. The diagnostic value of the markers was limited as the sensitivity and specificity ranged from 55% to 60%. These findings will aid health professionals in the correct assessment of bone turnover status in Japanese women over a wide range of age. Publication Types: •

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

PMID: 15570414 [PubMed - indexed for MEDLINE]

927: Nippon Hoshasen Gijutsu Gakkai Zasshi. 2004 Nov;60(11):1491-9. Related Articles, Links

[Brief explanation of discussion by Committee on Health Information Network Infrastructure] [Article in Japanese] Shinoda H. Publication Types: •

Review

PMID: 15568000 [PubMed - indexed for MEDLINE] 928: BMC Public Health. 2004 Nov 25;4:55. Related Articles, Links

The lack of public health research output from India. Dandona L, Sivan YS, Jyothi MN, Bhaskar VS, Dandona R. Centre for Public Health Research, Administrative Staff College of India, Raj Bhavan Road, Hyderabad - 500 082, India. [email protected] BACKGROUND: Systematic assessment of recent health research output from India, and its relation with the estimated disease burden, is not available. This information would help understand the areas in health research that need improvement in India to enhance the health of India's population. METHODS: The health research output from India during 2002, which was accessible in the public domain, was assessed by searching PubMed and other internet health literature databases, and was related to the disease burden suggested by the Global Burden of Disease Study. The main outcome measures were number of health papers with abstracts in basic, clinical and public health sciences; quality-adjusted research output based on the impact factors of journals in which the papers were published; classification of papers in disease/condition categories and comparison of research output with the estimated disease burden in each category. Comparison of the health papers from India during 2002 included in PubMed was done with those from Australia during one quarter of 2002. RESULTS: Of the 4876 health papers from India in 2002 in PubMed, 48.4%, 47.1% and 4.4% were in basic, clinical and public health sciences, respectively. Of the 4495 papers based on original research, only 3.3% were in public health. Quality-adjusted

original research output was highest for non-communicable diseases (62% of total). Of the total quality-adjusted original research output, the proportions in injuries (0.7%), cardiovascular diseases (3.6%), respiratory infections (0.2%), diarrhoeal diseases (1.9%), perinatal conditions (0.4%), childhood cluster diseases (0.5%), unipolar major depression (0%), and HIV/AIDS (1.5%) were substantially lower than their proportional contribution to the disease burden in India. Human resources, health policy, health economics, and impact assessment of interventions were particularly poorly represented in public health research. The Australia-India ratio for quality-adjusted health research output per unit gross domestic product was 20 and for public health research output was 31. CONCLUSIONS: Good-quality public health research output from India is grossly inadequate, and strategic planning to improve it is necessary if substantial enhancement of population health were to be made possible. There is inordinately low relative research output in several diseases/conditions that cause major disease burden in India. PMID: 15563377 [PubMed - indexed for MEDLINE] PMCID: PMC539252

929: Int J Epidemiol. 2005 Apr;34(2):397-402. Epub 2004 Nov 23. Related Articles, Links Comment in: •

Int J Epidemiol. 2005 Apr;34(2):403-4.

Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972-2001. Shibuya K, Yano E. Measurement and Health Information Systems, World Health Organization, CH1211 Geneva 27, Switzerland. [email protected] BACKGROUND: In Japan, higher mortality rates from hepatocellular carcinoma (HCC) have been observed than in any other industrialized country and the reported numbers of deaths due to HCC have increased significantly in recent years. We assessed whether there was a real increase in mortality from HCC and which factors contributed to the recent increasing trends of the number of deaths from HCC. METHODS: Poisson regression models were used to analyse panel data for the period 1972-2001. RESULTS: In both sexes, age-standardized mortality rates from HCC increased significantly over the past three decades.

Among males the annual percentage increase in age-adjusted mortality rates was approximately 1-3% during the period 1972-96. On the other hand, female mortality trends were less clear. The estimated birth cohort effects suggested that there was a peak in the mortality risk among the cohorts born during the period 1927-36, which corresponded to those aged between 50-64 years during the period 1987-96. This was the period when a large increase of both age-specific mortality rates among older age groups and age-standardized mortality rates were observed particularly among males. CONCLUSIONS: This study shows that an upward trend of mortality from HCC in Japan was primarily due to the effects among birth cohorts born around 1930, which are consistent with the pattern of past exposure to hepatitis C virus. The cohort effects have contributed to a large increase in mortality from HCC in recent years and the number of deaths from HCC is expected to increase by 2010-15. Publication Types: •

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

PMID: 15561746 [PubMed - indexed for MEDLINE] 930: Health Serv Res. 2004 Dec;39(6 Pt 2):2135-53. Related Articles, Links

Effects of global budgeting on the distribution of dentists and use of dental care in Taiwan. Hsueh YS, Lee SY, Huang YT. OBJECTIVE: To examine the effects of global budgeting on the distribution of dentists and the use and cost of dental care in Taiwan. DATA SOURCES: (1) Monthly dental claim data from January 1996 to December 2001 for the entire insured population in Taiwan. (2) The 1996-2001 population information for the cities, counties and townships in Taiwan, abstracted from the Taiwan-Fukien Demographic Fact Book. STUDY DESIGN: Longitudinal, using the autocorrelation model. PRINCIPAL FINDINGS: Results indicated decline in dental care utilization, particularly after the implementation of dental global budgeting. With few exceptions, dental global budgeting did not improve the distribution of dental care and dentist supply. CONCLUSIONS: The experience of the dental global budget program in Taiwan suggested that dental global budgeting might contain dental care utilization and that several conditions might have to be met in order for the reimbursement system to have effective redistributive impact on dental care and dentist supply. PMID: 15544648 [PubMed - indexed for MEDLINE]

PMCID: PMC1361116

931: Med J Malaysia. 2004 Mar;59(1):84-93. Related Articles, Links

Developing the Malaysian health system to meet the challenges of the future. Merican MI, Rohaizat Y, Haniza S. General of Health Malaysia (Research and Technical Support) Ministry of Health, Malaysia. The Malaysian health care system is a success story among countries of equivalent socio-economic status. However there are numerous challenges faced by the nation, which create the need for changes and reform. There is rising consumer demands and expectations for high technology and high cost medical care due to improved standards of living, changing disease patterns and demographic changes, inadequate integration of health services, maldistribution of resources and the threats as well as opportunities of globalisation and liberalisation. The changes in health policy, priorities and planning for the country are guided by the country's development policies, objectives and the challenges of Vision 2020, Vision for Health and the goals of the health system in ensuring universal access, improving equity and efficiency and the quality of life of the population. The essential services in the health system of the future are information and education of individuals to empower support for the wellness paradigm. There is also a need to restructure the national health care financing and the health care delivery system. The present roles and responsibilities of MOH also need to be reviewed. PMID: 15535341 [PubMed - indexed for MEDLINE] 932: Nippon Rinsho. 2004 Oct;62 Suppl 10:36-43. Related Articles, Links

[History and practice of gynecological cancer registration] [Article in Japanese] Okuda H, Nakatsuka M. Faculty of Health Sciences, Okayama University Medical School. Publication Types:

•

Review

PMID: 15535202 [PubMed - indexed for MEDLINE] 933: Pharmacoepidemiol Drug Saf. 2005 Jan;14(1):41-6. Related Articles, Links

A pilot study to build a database on seven anti-hypertensive drugs. Fujita T, Miura Y, Mayama T. Department of Epidemiology, National Institute of Public Health, Saitama, Japan. PURPOSE: In Japan, all patients are able to see freely any clinics or hospitals. So clinical data of all patients have been stored at clinics, hospitals and medical institutes respectively. These patients' clinical course data stocks have not been combined with one another. There is no large-scale database, which has been available and has played its role in complementing spontaneous adverse drug reaction (ADR) reporting system. We tried to build an original database using anti-hypertensive drugs' data from Drug Use Investigation conducted for the Japanese Drug Re-examination application by every pharmaceutical manufacturer in conformity with Japanese Pharmaceutical Affairs Law and Related Regulation. METHODS: The 43 565 case data of seven anti-hypertensive drugs (one Caantagonist, one alpha-blocker, two beta-blockers, three ACE inhibitors) were kindly offered from seven manufacturers who were members of RAD-AR Council, Japan. After examining the data items and categories, they were standardized into common codes based on Japanese Drug Category Classification (JDCC), International Classification of Diseases 9 (ICD-9) and Japanese Adverse Drug Reaction Terminology (J-ART). As each manufacturer had a different coding method in accordance to manufacturer's own practice of data management, the original forms were divided into several datasets. The data processing and statistical analysis were conducted using Statistical Analysis System (SAS). RESULTS: (1) Technology and know-how to combine data coded by different methods were established for building a database that had never been tried in Japan. (2) The following are the by-products of the study: a) Onset of ADR concentrated in the early stage but onset of some disorders prevailed equally throughout the investigation period. b) Although the number of collected cases of anti-hypertensive drugs was 43 565, total number of administrated antihypertensive drugs reached to 70 714 because additional anti-hypertensive drugs were often used with subject drugs. CONCLUSION: There is no large-scale database of patients' clinical course in Japan. However, since the Japanese Drug Re-examination System started in 1979, almost eight million cases of Drug Use Investigation on about 700 drugs have been collected with enormous human power and huge expenditure for Japanese Drug Re-examination application by

pharmaceutical manufacturers. New and more appropriate information will be detected by the database, built using Drug Use Investigation data that were collected only for the Japanese Drug Re-examination application. Copyright (c) 2004 John Wiley & Sons, Ltd. Publication Types: •

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

PMID: 15534857 [PubMed - indexed for MEDLINE] 934: Spine. 2004 Sep 1;29(17):1931-7. Related Articles, Links

The effect of previous low back surgery on general health status: results from the National Spine Network initial visit survey of patients with low back pain. Hee HT, Whitecloud TS 3rd, Myers L. Tulane University Medical Center, New Orleans, LA, USA. [email protected] STUDY DESIGN: A cross-sectional study on 18,325 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 to April 2000. OBJECTIVES: To examine whether patients who had previous low back surgeries had poorer general health status than patients with no surgery. SUMMARY OF BACKGROUND DATA: Several studies have described the role of psychological abnormalities in patients with chronic low back pain. Some of these patients have had previous spinal surgeries performed. No study has examined the effects of previous low back surgery on the general health status. METHODS: The Short Form Health Survey 36 was administered to the initial visit NSN patients. Of the 18,325 patients enrolled, 3,632 had previous low back surgeries. RESULTS: Patients who had previous lumbar surgeries fared significantly poorly in all 10 scores of the SF-36 health survey, even after adjustment for confounding factors. Among these patients, decompression achieved significantly higher scores for General Health, Role-Physical, and Mental Component Summary scales. Patients who had decompression as their most recent surgery had higher scores for General Health, Role-Physical, RoleEmotional, and Mental Component Summary scales, when compared to those who had other surgeries. Patients who had instrumentation as their most recent surgery had higher scores for Bodily Pain and Physical Component Summary scores. There is a positive correlation between time since last surgery and the SF36 outcomes. CONCLUSIONS: Previous back surgery is associated with

significantly worse general health status than those without surgery. Among patients who had previous surgeries, decompression seems to exert better effects on SF-36 health status. There is a positive correlation between time since last surgery and the SF-36 outcomes, although the SF-36 scores are significantly lower than those without previous surgery. Publication Types: • •

Comparative Study Multicenter Study

PMID: 15534419 [PubMed - indexed for MEDLINE] 935: Public Health. 2004 Dec;118(8):559-64. Related Articles, Links

Arsenicosis in Bangladesh: prevalence and socio-economic correlates. Hadi A, Parveen R. Research and Evaluation Division, Bangladesh Rural Advancement Committee, 75 Mohakhali, 1212 Dhaka, Bangladesh. [email protected] The potential effects of arsenic-contaminated drinking water on health are of concern, but our understanding of the risk factors of arsenicosis remains limited. This study assessed the prevalence of and socio-economic differentials in arsenicassociated skin lesions in a rural community in Bangladesh. Data were collected from a village where the Bangladesh Rural Advancement Committee has operated a health surveillance system and a community-based arsenic mitigation project since 1999. In total, 1654 residents in the study village were examined in May 2000 for arsenic-associated lesions on their skin. Socio-economic information was extracted from the surveillance system database covering the village. Nearly 2.9% of the study population had clinical manifestations of arsenic poisoning. The prevalence of arsenicosis was associated with age, sex, education and the economic status of the household. Multivariate analysis identified age and economic status as significant predictors of arsenicosis controlling for education and gender. In conclusion, a clear understanding of the socio-economic distribution of arsenicosis in different demographic and socio-economic groups will be useful in identifying the high-risk groups from arsenic-affected communities. More studies are needed to design effective interventions to mitigate the effects of arsenic in Bangladesh. Publication Types:

•

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

PMID: 15530935 [PubMed - indexed for MEDLINE] 936: Twin Res. 2004 Oct;7(5):430-4. Related Articles, Links

Characteristics of a Japanese adult twin database of high school graduates. Ooki S, Okazaki Y, Asaka A. Department of Health Science, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan. [email protected] This paper profiles a unique cohort of adult Japanese twins. The database contains more than 700 twin pairs, aged 18 to 66 years, who are all graduates of the secondary school attached to the faculty of education of the University of Tokyo. This school was established in 1948, when the study of twins was burgeoning in Japan, and about 10 to 20 pairs of twins have been admitted there every year to participate in studies on twins in education and in related projects. The zygosity of all twins was determined carefully on the basis of various sources. Data from the perinatal period to adulthood were linkable using ID numbers. Follow-up surveys in the field of medical genetics were performed in 1985, 1989 and 1999. For the third survey, which was sent and received exclusively by mail, the distribution and collection process was also assessed in detail. The response rate was around 40%, which statistically was influenced mainly by previous participation and sex. The limitation of this cohort is its selection bias concerning socioeconomic status and its imbalance in favor of monozygotic pairs. Publication Types: • •

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

PMID: 15527658 [PubMed - indexed for MEDLINE] 937: Sangyo Eiseigaku Zasshi. 2004 Sep;46(5):181-7. Related Articles, Links

[Interview study on autonomous chemical management system and

the contribution of occupational health specialists in companies] [Article in Japanese] Mori K, Takebayashi T. Occupational Health Training Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 8078555, Japan. [email protected] Under the circumstance that autonomous risk management for chemicals is required in Japan, it is necessary to define fundamental steps for developing chemical management system that are applicable in various types of companies and to understand the effective contribution of chemical or occupational health specialists to the system. For the purposes, we conducted interviews with companies which have an advanced chemical management system in Japan. As the result, each company had a certain policy about detailedness level of collected hazard and exposure information, and also had an efficient risk management system to ensure workers' health in depending on the business type and situations. Moreover, it was commonly observed that the specialists played major roles in developing tools for risk assessment and control, and then business lines led execution of the risk management with their supports. Based on the interviews, we showed a hypothesis of basic steps in introducing autonomous chemical risk management system at the workplaces. It is necessary to verify the hypothesis and to develop a simple system that is applicable to middle or small size companies as the next step. Publication Types: • •

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

PMID: 15526775 [PubMed - indexed for MEDLINE] 938: Cancer Nurs. 2004 Sep-Oct;27(5):407-12. Related Articles, Links

Breast cancer knowledge assessment in female Chinese immigrants in New York. Chen WT, Bakken S. Department of Community Health Systems, University of California San Francisco-School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA.

[email protected] The purpose of this study was to examine the relationships between acculturation level and perceptions of health access, Chinese health beliefs, Chinese health practices, and knowledge of breast cancer risk. This descriptive, correlational cross-sectional study used a survey approach. The sample included 135 Chinese women from the New York City metropolitan area. Data were analyzed using correlational techniques and polytomous regression. There were no significant relationships between acculturation and health access, Chinese health beliefs, Chinese health practices, and breast cancer risk knowledge. Only "years of education," "marital status," and "household income" significantly predicted breast cancer risk knowledge level. The data indicate that women with a better knowledge of breast cancer risk are twice as likely to have higher income and have more education. The most knowledgeable women are less likely to be married and less likely to have partners compared to least knowledgeable group. Providers need to promote health knowledge and provide information about as well as access to preventive health practices to the immigrant population, given that acculturation to the new dominant society is inevitable. Publication Types: • •

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

PMID: 15525869 [PubMed - indexed for MEDLINE] 939: Comput Inform Nurs. 2004 May-Jun;22(3):145-52. Related Articles, Links

Integration of Internet-based learning and traditional face-to-face learning in an RN-BSN course in Korea. Yom YH. Department of Nursing, Hallym University, Chunchon City, Kangwon Province, South Korea. [email protected] This article describes the development of and student satisfaction with a distance learning course using both online and face-to-face methods in an RN-BSN program in Korea. Four steps were used for course development: (1) assessment of students' learning needs and determination of objectives of the course, (2) designing of module/assignment instructions, (3) development of the Internetbased learning platform, and (4) evaluation of course and Internet-based learning platform. Student satisfaction was evaluated by using a 4-point Likert-type

questionnaire. Forty-eight (92.3%) questionnaires were returned. Overall satisfaction with this course was high (X = 3.29). Appropriateness of learning methods (X = 3.35) was rated the most satisfactory, followed by appropriateness of content (X = 3.31). Most of the students enjoyed the course and they wanted more nursing courses to be offered through the online and on-site format. On the basis of the findings, additional courses using both online and face-to-face methods for RN-BSN students should be developed and implemented for RNBSN nursing programs in Korea. Publication Types: •

Evaluation Studies

PMID: 15520584 [PubMed - indexed for MEDLINE] 940: Indian J Med Res. 2004 Oct;120(4):207-12. Related Articles, Links

Genomics of Mycobacterium tuberculosis: old threats & new trends. Ahmed N, Hasnain SE. Centre for DNA Fingerprinting and Diagnostics, ECIL Road, Nacharam, Hyderabad 500-076, India. Tuberculosis (TB) has been declared as a global health emergency by the World Health Organization (WHO). This has been mainly due to the emergence of multiple drug resistant strains and the synergy between tubercle bacilli and the human immunodeficiency virus (HIV). Genomic analysis of strains for outbreak investigations is in vogue for about a decade now. However, information available from whole genome sequencing efforts and comparative genomics of laboratory and field strains is likely to revolutionize efforts towards understanding molecular pathogenesis and dissemination dynamics of this dreaded disease. Genomic information is also going to fuel discovery projects where new targets will be identified and explored towards a new drug for TB. Besides this, efforts of information technologists, chemists, population biologists, freelance workers, media persons, non-governmental organizations and administrators to needed to handle the problem of tuberculosis to prevent it from becoming a pandemic. Publication Types: • •

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

PMID: 15520478 [PubMed - indexed for MEDLINE] 941: Ophthalmic Epidemiol. 2004 Oct;11(4):291-9. Related Articles, Links

Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman. Khandekar R, Mohammed AJ. Department of Ophthalmology, Eye & Ear Health Care, NCD, DGHA, P.O. Box 393, Pin: 113, Muscat, Oman. [email protected] BACKGROUND AND OBJECTIVE: The data from a national survey of blindness and common eye diseases in Oman in 1996 were reviewed. The objective was to compare the calculation of cataract surgery services coverage on a per eye and per person basis. The advantages and limitations of both methods of program management are evaluated. METHODS AND MATERIALS: The information on cataract status, visual status and past history/evidence of cataract surgery was collected for 11,415 Omani subjects. The coverage of existing cataract services was calculated per eye and per person. The rates by gender, age groups, regional groups and type of cataract were also compared. RESULTS: The cataract surgery services could address more than 60% of the reported persons with blinding cataract (vision less than 3/60) and more than half of the eyes with blinding cataract. The services could cover more than one-fourth of the persons with cataract (with any grade of vision defect) and less than one-fourth of the eyes with cataract. If the coverage of cataract services for blinding cataract is calculated using persons as the denominator, it is nearly 10% higher than that calculated using eyes as the denominator. CONCLUSIONS: The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services. A national program should implement a system for reporting the visual and cataract status of the fellow eye so that coverage rates could be calculated by person and by eye and the impact of the cataract services in relation to time, place, gender and resources could be reviewed. Publication Types: •

Comparative Study

PMID: 15512991 [PubMed - indexed for MEDLINE]

942: J AHIMA. 2004 Oct;75(9):50-2, 54. Related Articles, Links

Creating an HIM profession in the Sultanate of Oman. Mogli GD. Oman Medical Record Institute, Ministry of Health, Sultanate of Oman. [email protected] PMID: 15508322 [PubMed - indexed for MEDLINE] 943: Technol Health Care. 2004;12(4):347-57. Related Articles, Links

Patient Record Information System (PaRIS) for primary health care centers in Indonesia. Pambudi IT, Hayasaka T, Tsubota K, Wada S, Yamaguchi T. Department of Bioengineering and Robotics, Tohoku University, Sendai 9808579, Japan. This study explores the Patient Record Information System (PaRIS) for primary health care centers in a developing country such as Indonesia. The specific geography of the thousand islands country Indonesia is the reason for transportation difficulties as well as communication problems. This causes a serious adverse effect on the public healthcare service especially in the rural area within the country. Hence, a sustainable system is required that makes use of appropriate Information and Communication Technology (ICT). We developed a clinical information system with modest communication technology combined with a unique database distribution system. The Internet and its free software are the main tools for this system. It is a good opportunity for a developing country such as Indonesia to apply open free software in regard to the healthcare sector. This cost effective and sustainable system can enhance the work of physicians in order to provide better and applicable public health care service. Publication Types: •

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

PMID: 15502286 [PubMed - indexed for MEDLINE]

944: Indian J Med Res. 2004 Sep;120(3):131-2. Related Articles, Links

Women's health biobank in India. Kennedy S. Publication Types: •

Editorial

PMID: 15489547 [PubMed - indexed for MEDLINE] 945: Eur J Clin Nutr. 2005 Feb;59(2):246-54. Related Articles, Links

Folate intake estimated with an updated database and its association to blood folate and homocysteine in Korean college students. Han YH, Yon M, Hyun TH. Department of Food and Nutrition, Chungbuk National University, Gaeshin-dong, Cheongju, Korea. OBJECTIVE: To measure folate content in cooked foods commonly consumed in Korea for evaluating its relation to folate nutriture of college students. DESIGN: Folate content in 32 raw and cooked foods was measured by microbiological assay after trienzyme extraction. These values and the previously published values of 110 raw foods commonly consumed in Korea were used to update the currently available food tables to estimate dietary folate intake of 106 students based on a 3-day 24-h recall. The association of folate intake with blood folate and homocysteine concentrations was evaluated. SETTING: Cheongju, Korea. SUBJECTS: Healthy college students aged 18 to 27 y old (44 males and 62 females). RESULTS: The average folate loss in 32 foods caused by cooking was 29%. The mean daily dietary folate intakes estimated with an updated database were 406 and 305 mug in males and females, respectively. About 10% of both male and female students showed low serum folate (<6.8 nmol/l). Folate intake was positively correlated with serum and erythrocyte folate concentrations in female students (r=0.27 and 0.29, respectively, P<0.05), and negatively correlated with serum homocysteine in male students (r=-0.41, P<0.05). CONCLUSIONS: Mean dietary folate intake was higher than those of previous studies since the database was updated using values obtained with trienzyme extraction. Folate intake for the general population should be re-evaluated using reliable food folate

values obtained with trienzyme extraction. PMID: 15483632 [PubMed - indexed for MEDLINE] 946: Trop Med Int Health. 2004 Oct;9(10):1081-90. Related Articles, Links

Malaria epidemiology in a rural area of the Mekong Delta: a prospective community-based study. Erhart A, Thang ND, Bien TH, Tung NM, Hung NQ, Hung LX, Tuy TQ, Speybroeck N, Cong LD, Coosemans M, D'Alessandro U. Institute of Tropical Medicine Prince Leopold, Antwerp, Belgium. [email protected] Over the past 10 years, the Mekong Delta region in Vietnam has experienced fast socio-economic development with subsequent changes in malaria vectors ecology. We conducted a 2-year prospective community-based study in a coastal rural area in the southern Mekong Delta to re-assess the malaria epidemiological situation and the dynamics of transmission. The incidence rate of clinical malaria, established on 558 individuals followed for 23 months by active case detection and biannual cross-sectional surveys, was 2.6/100 person-years. Over the 2-year study period, the parasite rate and malaria seroprevalence (Plasmodium falciparum and P. vivax) decreased significantly from 2.4% to almost 0%. Passive case detection (PCD) of clinical cases and serological follow-up of newborns carried out in a larger population confirmed the low and decreasing trend of malaria transmission. The majority of fever cases were seen in the private sector and most were unnecessarily treated with antimalarials. Training and involvement of the private sector in detection of malaria cases would greatly improve the quality of health care and health information system. Publication Types: •

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

PMID: 15482400 [PubMed - indexed for MEDLINE] 947: J Clin Pharm Ther. 2004 Oct;29(5):417-24. Related Articles, Links

Beliefs of chronically ill Japanese patients that lead to intentional non-adherence to medication.

Iihara N, Tsukamoto T, Morita S, Miyoshi C, Takabatake K, Kurosaki Y. Department of Pharmacy, Kagawa University Hospital, Ikenobe Miki-cho, Kitagun, Japan. [email protected] OBJECTIVE: To identify factors, associated with personal beliefs, involved in intentional non-adherence to prescribed medication of Japanese patients with chronic diseases. METHODS: A cross-sectional study of Japanese subjects with chronic, primarily liver, gastrointestinal, or nervous system diseases who had been prescribed oral medicines for regular use, was performed. The subjects were admitted to a university hospital and were interviewed face-to-face on admission. Intentional non-adherence was defined as experience of deliberate adjustment of self-managed prescription medicines during the few months prior to hospital admission. Patients' beliefs about taking medicines were assessed from the perspective of what the patient valued in order to take medicines without anxiety; whether the patient valued information about the medication such as its function and side-effects and/or mutual reliance on doctors. Using logistic multivariate regression analyses, factors associated with intentional non-adherence were identified. RESULTS: Among 154 subjects, 51 showed intentional nonadherence. Intentional non-adherence was associated with the following three factors: (a) the patients' beliefs with respect to taking medicines without anxiety, especially putting no value on mutual reliance on the patient-doctor relationship (P < 0.001) and putting great value on knowing the drug's side-effects (P < 0.001), (b) poor comprehension of general aspects of medication (P for trend < 0.001), and (c) being in the prime of life (40-59 years) (P = 0.011). Comprehension of the function of each medicine, experience of side-effects, anxiety about taking medicines, and the number of types of medicines taken, were not associated with non-adherence. CONCLUSIONS: Beliefs on which individual Japanese patients with chronic diseases attach value in order to take medicines without anxiety were potential factors for intentional non-adherence. This emphasizes the necessity of a patient-oriented approach to take account of patients' personal beliefs about medicines to increase adherence rate in Japan. PMID: 15482384 [PubMed - indexed for MEDLINE] 948: Int J Cancer. 2005 Jan 10;113(2):339-41. Related Articles, Links Comment on: •

Int J Cancer. 2004 May 1;109(5):777-81.

Trends in colorectal cancer mortality in Japan, 1970-2000.

Bosetti C, Malvezzi M, Chatenoud L, Negri E, Levi F, La Vecchia C. Publication Types: • • •

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

PMID: 15476201 [PubMed - indexed for MEDLINE] 949: Gen Hosp Psychiatry. 2004 Sep-Oct;26(5):359-66. Related Articles, Links

Hospital preparedness for possible nonconventional casualties: an Israeli experience. Schreiber S, Yoeli N, Paz G, Barbash GI, Varssano D, Fertel N, Hassner A, Drory M, Halpern P. Department of Psychiatry, Tel Aviv Sourasky Medical Center, Weizmann Street 6, Tel Aviv, Israel. [email protected] Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of teamtraining sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stressmanagement techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military

units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite appropriate preparedness programs. PMID: 15474635 [PubMed - indexed for MEDLINE] 950: Isr Med Assoc J. 2004 Oct;6(10):583-7. Related Articles, Links

Electronic medical record systems in Israel's public hospitals. Lejbkowicz I, Denekamp Y, Reis S, Goldenberg D. Galil Center for Medical Informatics and Telemedicine, Technion Faculty of Medicine, Haifa, Israel. [email protected] BACKGROUND: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems. OBJECTIVES: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use. METHODS: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues. RESULTS: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%. CONCLUSIONS: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations. Publication Types: •

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

PMID: 15473582 [PubMed - indexed for MEDLINE]

951: Acad Emerg Med. 2004 Oct;11(10):1102-4. Related Articles, Links

A multicasualty event: out-of-hospital and in-hospital organizational aspects. Avitzour M, Libergal M, Assaf J, Adler J, Beyth S, Mosheiff R, Rubin A, Feigenberg Z, Slatnikovitz R, Gofin R, Shapira SC. Department of Orthopedic Surgery, Trauma Unit, Hadassah Medical Organization, School of Public Health, PO Box 12000, Jerusalem 91120, Israel. [email protected]. In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. OBJECTIVES: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. METHODS: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. RESULTS: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. CONCLUSIONS: During this MCE, the authors observed "rotating" bottleneck phenomena within out-ofhospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions. Publication Types: •

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

PMID: 15466156 [PubMed - indexed for MEDLINE]

952: J Nutr. 2004 Oct;134(10):2592-602. Related Articles, Links

Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 metaanalyses. Ramakrishnan U, Aburto N, McCabe G, Martorell R. Department of International Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. [email protected] Meta-analyses of randomized controlled intervention trials were conducted to assess the effects of vitamin A, iron, and multimicronutrient interventions on the growth of children < 18 y old. A PubMed database search and other methods identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies that met the design criteria. Weighted mean effect sizes and CI were calculated using a random effects model for changes in height and weight. Tests for homogeneity and stratified analyses by predefined characteristics were conducted. Vitamin A interventions had no significant effect on growth; effect sizes were 0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight. Iron interventions also had no significant effect on child growth. Overall effect sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30) for weight. The results were similar across categories of age, duration of intervention, mode and dosage of intervention, and baseline anthropometric status. Iron interventions did result in a significant increase in hemoglobin (Hb) concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51). Multimicronutrient interventions had a positive effect on child growth; the effect sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for weight. Interventions limited to only vitamin A or iron did not improve child growth. Multimicronutrient interventions, on the other hand, improved linear and possibly ponderal growth in children. Publication Types: • • • •

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

PMID: 15465753 [PubMed - indexed for MEDLINE] 953: Stud Health Technol Inform. 2002;90:821-5.

Related Articles,

Links

A framework for a diabetes mellitus disease management system in southern Israel. Fox MA, Harman-Boehm I, Weitzman S, Zelingher J. The Goldman Health Sciences Faculty, Ben Gurion University of the Negev, Israel. Chronic diseases are a significant burden on western healthcare systems and national economies. It has been suggested that automated disease management for chronic disease, like diabetes mellitus (DM), improves the quality of care and reduces inappropriate utilization of diagnostic and therapeutic measures. We have designed a comprehensive DM Disease Management system for the Negev region in southern Israel. This system takes advantage of currently used clinical and administrative information systems. Algorithms for DM disease management have been created based on existing and accepted Israeli guidelines. All data fields and tables in the source information systems have been analyzed, and interfaces for periodic data loads from these systems have been specified. Based on this data, four subsets of decision support algorithms have been developed. The system generates alerts in these domains to multiple end users. We plan to use the products of this information system analysis and disease management specification in the actual development process of such a system shortly. Publication Types: •

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

PMID: 15460806 [PubMed - indexed for MEDLINE] 954: Saudi Med J. 2004 Sep;25(9):1153-9. Related Articles, Links

Health hazards of cement dust. Meo SA. Department of Physiology (29), College of Medicine, King Khalid University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. [email protected] Even in the 21st century, millions of people are working daily in a dusty environment. They are exposed to different types of health hazards such as fume, gases and dust, which are risk factors in developing occupational disease. Cement industry is involved in the development of structure of this advanced and modern

world but generates dust during its production. Cement dust causes lung function impairment, chronic obstructive lung disease, restrictive lung disease, pneumoconiosis and carcinoma of the lungs, stomach and colon. Other studies have shown that cement dust may enter into the systemic circulation and thereby reach the essentially all the organs of body and affects the different tissues including heart, liver, spleen, bone, muscles and hairs and ultimately affecting their micro-structure and physiological performance. Most of the studies have been previously attempted to evaluate the effects of cement dust exposure on the basis of spirometry or radiology, or both. However, collective effort describing the general effects of cement dust on different organ and systems in humans or animals, or both has not been published. Therefore, the aim of this review is to gather the potential toxic effects of cement dust and to minimize the health risks in cement mill workers by providing them with information regarding the hazards of cement dust. Publication Types: • •

Comparative Study Review

PMID: 15448758 [PubMed - indexed for MEDLINE] 955: Nippon Koshu Eisei Zasshi. 2004 Jul;51(7):507-21. Related Articles, Links

[Evaluation of demographic factors for autonomy of the elderly and their families in selecting long-term care insurance services] [Article in Japanese] Kutsumi M, Ito M, Mikami H. Division of Health Promotion Science, Graduate School of Medicine, Osaka University. PURPOSE: This study was conducted to characterize (1) the autonomy of service users, both frail elderly and of their family caregivers, in selecting Long-term care insurance services, and to evaluate (2) influencing demographic factors. The aim was to propose new directions for the care providing system. METHODS: The subjects were 1,760 users of public Long-term Care Insurance who were randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data were collected through a mailed anonymous self-report questionnaire in October, 2001. The number returned was 1,178 (66.9%). In this study, 723 eligible cases were analyzed in separate models: 146 cases for the elderly model, and 577 for the family model. Multiple regression analysis and two-way analysis of variance

were performed to identify factors which have direct and interactive effects, respectively, on the autonomy. RESULTS: 1) The degree of autonomy of the elderly (3.1 +/- 0.8 (range 1-4)) was high in comparison with the family (2.8 +/0.8). 2) In the elderly model, the ability to collect service information and the level of knowledge about the service contents had a direct effect on the autonomy. In the family model, ability to collect service information and the level of knowledge about the service contents, the degree of informing the provider of own care needs, and good relations among family members had direct effects. 3) In the elderly model significant two-way interactive effects on the autonomy were observed between the level of knowledge about the service contents and the age; attitudes of the service providers and the age or gender of the recipient; the degree of informing the provider of own care needs and the gender. In the family model, significant interactions were noted between the attitudes of the service providers and the age of the family caregiver; the level of congitive disorders of the elderly and the length of service usage. CONCLUSIONS: It was clarified that the score for autonomy of the family was low in comparison with that for elderly, and the essential requisites of service providers for enhancing the autonomy of elderly people and families may vary depending on the basic characteristics or the situation of the user. It was suggested that support to enhance users autonomy should be provided by taking the demographic factors of the user into consideration. Publication Types: • • •

Clinical Trial English Abstract Randomized Controlled Trial

PMID: 15446669 [PubMed - indexed for MEDLINE] 956: Br J Ophthalmol. 2004 Oct;88(10):1237-41. Related Articles, Links

Utilisation of eye care services in rural south India: the Aravind Comprehensive Eye Survey. Nirmalan PK, Katz J, Robin AL, Krishnadas R, Ramakrishnan R, Thulasiraj RD, Tielsch J. Lions Aravind Institute of Community Opthalmology, Aravind Eye Care System, Madurai, India. AIM: To determine utilisation of eye care services in a rural population of southern India aged 40 years or older. METHODS: 5150 subjects aged 40 years

and older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers before ocular examinations. RESULTS: 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%). Increasing age and education were associated with increased utilisation of eye care services. Among the 3323 people who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of individuals with vision impairment, cataracts, refractive errors, and glaucoma had previously utilised services. CONCLUSIONS: A large proportion of people in a rural population of southern India who require eye care are currently not utilising existing eye care services. Improved strategies to improve uptake of services is required to reduce the huge burden of vision impairment in India. Publication Types: • •

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

PMID: 15377541 [PubMed - indexed for MEDLINE] PMCID: PMC1772350

957: Bull World Health Organ. 2004 Aug;82(8):580-6. Epub 2004 Sep 13. Related Articles, Links

Public-private mix for DOTS implementation: what makes it work? Lönnroth K, Uplekar M, Arora VK, Juvekar S, Lan NT, Mwaniki D, Pathania V. Stop TB Department, World Health Organization, Geneva, Switzerland. [email protected] OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. METHODS: Cross-project analysis of secondary data from separate project evaluations was used. Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were

correlated with differences in chosen intervention strategies and structural conditions. FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector. CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement. Publication Types: • •

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

PMID: 15375447 [PubMed - indexed for MEDLINE] 958: J Health Organ Manag. 2004;18(2-3):207-20. Related Articles, Links

A management information system to plan and monitor the delivery of health-care services in government hospitals in India. Ramani KV. Indian Institute of Management, Ahmedabad, India. Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.

PMID: 15366284 [PubMed - indexed for MEDLINE] 959: J Nurs Res. 2004 Sep;12(3):227-36. Related Articles, Links

The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems. Chang P, Hsu YS, Tzeng YM, Sang YY, Hou IC, Kao WF. Institute of Health Informatics and Decision Making, National Yang-Ming University, ROC. [email protected] The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twentythree nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triagebased PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems. Publication Types: • •

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

PMID: 15362014 [PubMed - indexed for MEDLINE] 960: Trop Med Int Health. 2004 Sep;9(9):1016-21. Related Articles, Links

An outbreak of leptospirosis in Orissa, India: the importance of

surveillance. Jena AB, Mohanty KC, Devadasan N. District Health Office, Baripada, Orissa, India. [email protected] OBJECTIVE: To demonstrate the importance of surveillance systems in detecting emerging diseases and highlighting the strengths and weaknesses of an existing one. METHODS: The Orissa multi-disease surveillance system (OMDSS) was introduced in November 1999. Reporting units from the periphery send data to the district on a weekly basis. These reports are analysed regularly. A district task force (DTF) was available to intervene in the event of an outbreak. The OMDSS detected an increasing number of cases with fever and jaundice in June 2002. The DTF investigated this outbreak using clinical, epidemiological and laboratory tools to identify its cause. RESULTS: This outbreak, in a remote corner of India, was detected within 4 days by an existing surveillance system. Action was initiated within 24 h, but it took approximately two more weeks for the causative agent to be diagnosed. A total of 143 people were suspected to have leptospirosis between 23 June 2002 and 31 July 2002. The attack rate was 5.95% and the case fatality ratio (CFR) was 7.69%, both lower than outbreaks reported elsewhere in India. While males were infected more often than females, the CFR was higher among females and among the 6-15 year age groups. Exposure to infected water in a canal was the probable cause of the outbreak. IgM antibodies were positive in 33 of the patients and six patients tested positive for PCR and culture. Leptospirosis interrogans serovar canicola, Leptospirosis interrogans serovar pomona and Leptospirosis interrogans serovar hebdomadis were isolated. CONCLUSIONS: Leptospirosis is a new disease in this region of India. This outbreak was detected and diagnosed because of the surveillance system. The prompt response helped in containing the outbreak early enough. However, the morbidity and mortality could have been further mitigated if the delays in transmitting information had been minimized. An adequate laboratory support would have also helped considerably. We conclude stressing the importance of surveillance as a public health tool. PMID: 15361116 [PubMed - indexed for MEDLINE] 961: Stud Health Technol Inform. 2004;107(Pt 2):1421-5. Related Articles, Links

Development and pilot evaluation of user acceptance of advanced mass-gathering emergency medical services PDA support systems. Chang P, Hsu YS, Tzeng YM, Hou IC, Sang YY. Institute of Health Informatics and Decision Making, National Yang-Ming University, Taipei, Taiwan/ROC. [email protected]

The support systems for the Emergency Medical Services (EMS) in the mass gatherings, such as the local marathon or the large international baseball games, had been underdeveloped. The purposes for this study were to develop triagebased EMS Personal Digital Assistant (PDA) support systems for the massgatherings and to evaluate users' perceived ease of use and usefulness of the systems in terms of Davis' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms-the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. 23 nurses and 6 physicians in the medical center, who had ever served in the mass gatherings, were invited to examine the new systems and answered the TAM questionnaire. The results showed that the PDA systems included as many 450 information items inside 42 screens under 6 categories and the great potential of using triage-based PDA systems in the mass gatherings. Overall, most of the subjects agreed with that the systems were easy to use and useful for the mass gatherings, and they were willing to accept the systems. Publication Types: •

Evaluation Studies

PMID: 15361049 [PubMed - indexed for MEDLINE] 962: Stud Health Technol Inform. 2004;107(Pt 2):1183-6. Related Articles, Links

The Hong Kong Hospital Authority's information architecture. Cheung NT, Fung V, Kong JH. Health Informatics Section, Hospital Authority, Hong Kong, SAR. [email protected] Since 1994, the Hospital Authority has been developing and deploying clinical applications at its constituent 39 hospitals and clinics. The Clinical Management System (CMS) is now used by over 4000 doctors and 20000 other clinicians to document and review care. Since 1999, the territory-wide integrated Electronic Patient Record (ePR) has given clinicians a longitudinal view of the data collected through the CMS and its adjunct systems. The ePR currently has nearly 3TB of data covering 44 million episodes for 6.4 million patients. This paper describes the Hospital Authority's Information Architecture, which allows the ePR to accept and integrate any clinical information from any internal or external system. The ePR operates in a high volume and high performance environment, yet only requires low maintenance, while still retaining the information structure and

semantics required for advanced applications. PMID: 15360999 [PubMed - indexed for MEDLINE] 963: Stud Health Technol Inform. 2004;107(Pt 1):256-62. Related Articles, Links

A database for Chinese outpatients with rheumatic diseases. Tian X, Hersh W, Logan J, Bennett R. Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing 100730, China. Although several databases have been developed in rheumatology aimed at profiling the morbidity pattern of rheumatic diseases, or to capture the detailed clinical and outcome information of patients with a specific rheumatic disease, there is no database in China, as yet, for capturing visit-related health information of all outpatients with rheumatic diseases. In this project, a relational database was developed for the rheumatic outpatient clinic of Peking Union Medical College Hospital (PUMCH). The primary goal of this database is to collect and organize visit-related information of outpatients with rheumatic diseases to meet information needs of clinical research, health care continuity and teaching of rheumatic diseases. The implementation of this database can improve health services, medical records management and clinical research of outpatients with rheumatic disease at PUMCH. Publication Types: •

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

PMID: 15360814 [PubMed - indexed for MEDLINE] 964: Ophthalmology. 2004 Sep;111(9):1778-81. Related Articles, Links

Ocular trauma in a rural south Indian population: the Aravind Comprehensive Eye Survey. Nirmalan PK, Katz J, Tielsch JM, Robin AL, Thulasiraj RD, Krishnadas R, Ramakrishnan R; Aravind Comprehensive Eye Survey. Aravind Medical Research Foundation, Aravind Eye Care System, Madurai,

India. PURPOSE: To determine the rate of ocular trauma in a rural population of southern India and its impact on vision impairment and blindness. METHODS: A population-based cross-sectional study of 5150 persons 40 years or older in a randomly chosen rural population of 3 districts of southern India. Prospective information on trauma, type and agent of injury, setting of injury, and details of treatment sought for the last episode was recorded with questionnaires after faceto-face interviews. All interviewed subjects underwent a comprehensive ocular examination, including vision estimations, slit-lamp biomicroscopy examinations, and dilated posterior segment examinations. RESULTS: We elicited a history of ocular trauma in either eye from 229 (4.5%) persons, including 21 (0.4%) persons with bilateral ocular trauma. Blunt injuries (n = 124; 54.9%) were the major cause for trauma reported in this population. The most common setting where the ocular trauma occurred was during agricultural labor (n = 107; 46.9%). Nearly three quarters (n = 170; 74.2%) of those reporting ocular trauma sought treatment from an eye specialist (n = 104; 57.8%) and one fifth (n = 37; 20.6%) from a traditional healer. The age-adjusted (adjusted to the population estimates for India for the year 2000) prevalence for blindness in any eye caused by trauma was 0.8% (95% confidence interval [CI], 0.4-1.1). The odds ratios (OR) for trauma were higher for males (OR, 2.2; 95% CI, 1.6-3.0) and laborers (OR, 1.7; 95% CI, 1.2-2.4) and lower for literates (OR, 0.7; 95% CI, 0.5- 0.9). Seeking treatment from a traditional eye healer for trauma was not associated with vision impairment (OR, 1.0; 95% CI, 0.3-3.2) or with blindness (OR, 3.4; 95% CI, 0.2-56.5). CONCLUSIONS: Eye care programs may need to consider ocular trauma as a priority in this population, because the lifetime prevalence of ocular trauma is higher than that reported for glaucoma, age-related macular degeneration, or diabetic retinopathy from this population. Simple measures such as education regarding the use of protective eyewear could possibly significantly decrease this preventable cause of visual disability. PMID: 15350336 [PubMed - indexed for MEDLINE] 965: Indian J Med Res. 2004 Aug;120(2):86-93. Related Articles, Links Comment in: •

Indian J Med Res. 2004 Aug;120(2):70-2.

Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India. John TJ, Rajappan K, Arjunan KK.

The Kerala State Institute of Virology & Infectious Diseases, Alappuzha, Kerala, India. [email protected] BACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures. Publication Types: •

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

PMID: 15347857 [PubMed - indexed for MEDLINE] 966: Environ Sci Pollut Res Int. 2004;11(4):209-21. Related Articles, Links

Comment in: •

Environ Sci Pollut Res Int. 2004;11(4):207-8.

Long overlooked historical information on Agent Orange and TCDD following massive applications of 2,4,5-T-containing herbicides, Eglin Air Force Base, Florida. Young AL, Newton M. Institute for Science and Public Policy, Sarkeys Energy Center, The University of Oklahoma, 100 East Boyd Street, Room 510, Norman, Oklahoma 73019, USA. [email protected] BACKGROUND: From 1961-1971, The Air Development Test Center, Eglin Air Force Base (AFB), Florida, developed, tested, and calibrated the aerial spray systems used in support of Operation RANCH HAND and the US Army Chemical Corps in Vietnam. Twenty major test and evaluation projects of aerial spray equipment were conducted on four fully instrumented test grids, each uniquely arrayed to match the needs of fixed-wing, helicopter, or jet aircraft. Each of the grids was established within the boundary of Test Area 52A of the Eglin Reservation. METHODS: The tests, conducted under climatic and environmental conditions similar to those in Vietnam, included the use of the military herbicides (Agents) Orange, Purple, White, and Blue. Approximately 75,000 kg of 2,4,5trichlorophenoxyacetic acid (2,4,5-T) and 76,000 kg of 2,4-dichlorophenoxyacetic acid (2,4-D) were aerially disseminated on an area of less than 3 km2 during the period 1962-1970. Data from the analysis of archived samples suggested that an estimated 3.1 kg of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), present as a contaminant, were aerially released in the test area. Because most of the vegetation had been removed before establishing the test site in 1961, there was an opportunity to follow ground-based residues independent of canopy interception, and the resulting high solar exposure of initial residues. Studies of the soils, fauna, flora, and aquatic ecosystems of the test grids and associated perimeters of Test Area C-52A (an area totally more than 8 km2) were initiated in 1969 and concluded in 1984. RESULTS AND DISCUSSION: Data from soil samples collected from 1974 through 1984 suggested that less than one percent of the TCDD that was present in soil when sampling began persisted through the ten-year period of sampling. More than 340 species of organisms were observed and identified within the test area. More than 300 biological samples were analyzed for TCDD and detectable residues were found in 16 of 45 species examined. Examination of the ecological niches of the species containing TCDD residues suggested each was in close contact with contaminated soil. Indepth field studies, including anatomical, histological and ultrastructural examinations, spanning more than 50 generations of the Beachmouse, Peromyscus polionotus,

demonstrated that continual exposure to soil concentrations of 0.1 to 1.5 partsper-billion (ng/g) of TCDD, had minimal effects upon the health and reproduction of this species. CONCLUSIONS: Since Agent Orange with its associated TCDD contaminant was aerially disseminated on the test grids, Test Area C-52A provided a 'field laboratory' for what may have happened in Vietnam, had there been no intercepting forest cover. However, in Vietnam a 'typical' mission would have disseminated 14.8 kg of 2,4,5-T/ha, most of which was intercepted by the forest canopy, versus the 876 kg 2,4,5-T/ha on the test grid at Eglin. Moreover, each hectare on the Eglin test grid received at least 1,300 times more TCDD than a hectare sprayed with Agent Orange in Vietnam. The disappearance or persistence of TCDD is dependent upon how it enters the ecosystem. Spray equipment test and evaluations missions at Eglin were generally scheduled and conducted with environmental conditions that were optimal for spray operations. This suggests that conditions favorable for dissemination of herbicide were the same conditions favorable for photodegradation of TCDD. It was likely that 99 percent of the TCDD never persisted beyond the day of application. No long-term adverse ecological effects were documented in these studies despite the massive quantities of herbicides and TCDD that were applied to the site. Reviews by the US Environmental Protection Agency and the National Academy of Sciences' Institute of Medicine did not address the fate of Agent Orange and TCDD as described in these studies from Eglin AFB, Florida. Publication Types: • •

Historical Article Review

PMID: 15341310 [PubMed - indexed for MEDLINE] 967: Int J Cardiol. 2004 Oct;97(1):49-55. Related Articles, Links

Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel. Roth A, Kajiloti I, Elkayam I, Sander J, Kehati M, Golovner M. Department of Cardiology, Tel-Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239 Israel. [email protected] Background: Patients with chronic heart failure characteristically have multiple hospital admissions for symptom control, deleteriously affecting their quality of life and imposing a burden on national healthcare costs. We assessed the effect of

a novel transtelephonic monitoring and follow-up program on the admission rate and length of hospital stay as well as changes in their subjectively rated quality of life of patients with chronic heart failure. Methods: This prospective 1-year study was conducted on compliant subscribers to 'SHL', a telecardiological service with >60,000 subscribers, who were admitted > or = 2 times during the previous year for recurrent pulmonary edema or deterioration in heart failure. Their heart rate, blood pressure and body weight measurements were now automatically transmitted daily to 'SHL"s data bank and added to stored and updated medical records. A questionnaire survey acquired information on their quality of life. Results: The study cohort included 118 patients, mean age 75 years (range 49-89 years), 65% males, a II-IV class functional capacity and a 25% (range 10-39%) mean ejection fraction. There was a 66% reduction in the total hospitalization days (from 1623 in the year preceding study entry to 558 during the study period, p<0.0001). Although only 38/118 patients were hospitalized, most participants reported a significant subjective improvement in their quality of life. Conclusions: Data are provided to demonstrate that a transtelephonic system allowing primary care at the patient's home can significantly reduce hospitalization rate and length of stay and significantly enhance the quality of life of patients with chronic heart failure. Copyright 2003 Elsevier Ireland Ltd. PMID: 15336806 [PubMed - indexed for MEDLINE] 968: Tohoku J Exp Med. 2004 Sep;204(1):71-8. Related Articles, Links

A study on the needs of medical, maternal and child health care in Chinese women students at the University of Tokyo. Gu YH, Lee S, Ushijima H. Department of Pediatrics, Teikyo University, Tokyo, Japan. According to the information provided by the University of Tokyo (UT) in 2001, 317 Chinese women students were enrolled in the UT, and 88% of them were graduate students. Although the surveys on the life of international students at the UT had been conducted in 1989 and 1998, the medical and health issues were not included. With the objective of exploring the medical and heath care needs of Chinese women students at the UT a survey was carried out from December 2001 to January 2002. With the cooperation of the International Students Center at the UT a questionnaire in Chinese was sent to each department in which 317 Chinese women students were studying. Out of 104 students responded, eligible subjects were 98. The results of present study revealed some problems, such as the language barrier, preference for a translator in hospitals or health centers, and a medical guidebook with information on vaccinations in Chinese. They also stated their lack of knowledge about the Japanese medical and health system, and their

distress for being separated from their children. In conclusion, the most severe problem was language barrier for Chinese women students in obtaining medical and health care for themselves and their children. It was also noted that lack of knowledge of the Japanese medical and health care system was another obvious problem. Publication Types: •

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

PMID: 15329465 [PubMed - indexed for MEDLINE] 969: Scand J Plast Reconstr Surg Hand Surg. 2003;37(6):325-31. Related Articles, Links

Development of a network system for the care of patients with cleft lip and palate in Thailand. Chowchuen B, Godfrey K. Division of Plastic Surgery, Faculty of Medicine and Project Director of Center for Cleft Lip-Palate and Craniofacial Deformities, Khon Kaen University. Khon Kaen, Thailand. [email protected] Cleft lip and palate are major public health concerns in Thailand, particularly in the north-east. The challenge for a developing country is to adapt to its unique environment the form of multidisciplinary care of patients with clefts in industrialised nations. An epidemiological study of the incidence of clefts was made by reviewing previous studies conducted in Thailand as a guide to development of a prospective multicentre study. As a result, a system for the care of patients with clefts has been developed by the Cleft Center in Khon Kaen University. The new aims of cleft care in Thailand are to establish and develop specialised cleft centres and supportive systems for interdisciplinary management, adopt protocols for long-term guidelines, provide education programmes about clefts, develop a database, and conduct relevant research projects. Other key factors in its success are the multicentre project, collaboration, fund raising, and good public relations. Publication Types: •

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

PMID: 15328770 [PubMed - indexed for MEDLINE]

970: Int J Med Inform. 2004 Sep;73(9-10):675-85. Related Articles, Links

Investigating public health emergency response information system initiatives in China. Liang H, Xue Y. Department of Information Technology and Operations Management, College of Business, Florida Atlantic University, Ft. Lauderdale, FL 33308, USA. [email protected] Infectious diseases pose a great danger to public health internationally. The outbreak of SARS has exposed China's fragile public health system and its limited ability to detect and respond to emergencies in a timely and effective manner. In order to strengthen its capability of responding to future public health emergencies, China is developing a public health emergency response information system (PHERIS) to facilitate disease surveillance, detection, reporting, and response. The purpose of this study is to investigate the ongoing development of China's PHERIS. This paper analyzes the problems of China's existing public health system and describes the design and functionalities of PHERIS from both technical and managerial aspects. Publication Types: •

Review

PMID: 15325324 [PubMed - indexed for MEDLINE] 971: Health Info Libr J. 2004 Sep;21 Suppl 2:69-71. Related Articles, Links

Development of Library Services for disadvantaged people: a Japanese perspective. Nomura M. Information Center & Japanese Society for Rehabilitation of Persons with Disabilities. [email protected] PMID: 15317580 [PubMed - indexed for MEDLINE]

972: Public Health. 2004 Sep;118(6):395-402. Related Articles, Links

Public health improvement in Iran--lessons from the last 20 years. Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Division of Cardiovascular Medicine, Queens Medical Centre, University Hospital, Nottingham NG7 2UH, UK. [email protected] INTRODUCTION: Health services are historically based on providers's and policy makers's understanding of population health status. This does not necessarily reflect the real needs of a population. Health needs assessment (HNA) should improve individual or population health and optimize the way that limited resources are utilized. OBJECTIVES: To review health needs literature and to describe Iranian primary healthcare (PHC) achievements in developing a needsdriven health system. FINDINGS: The Iranian PHC system was established to meet healthcare needs identified through population health status surveys. Since 1984, the PHC system has become highly organized and efficient, resulting in a dramatic decrease in infant, maternal and neonatal mortality rates, population growth, increasing life span and a marked shift towards non-communicable diseases. Through an organized partnership of the general population, volunteers, health workers and health professionals, a needs-oriented healthcare system became central to health policy in Iran. Several information sources were utilized to establish need. Improving death certification was an immediate and important part of this process. COMMENT: Improved knowledge about personal rights, community and environmental health policies, and involvement of the media led to an increased range and depth of needs. Moving towards quality improvement and a needs-driven healthcare system requires continuous needs assessment. Novel methods of HNA, such as postal and telephone surveys, group discussions, surrogates for need such as quality-of-life measurement (commonly used in developed countries) or other locally designed methods such as the basic development needs approach, may be relevant to the Iranian PHC network. PMID: 15313592 [PubMed - indexed for MEDLINE] 973: Gan To Kagaku Ryoho. 2003 Dec;30(1 Suppl):104-8. Related Articles, Links

[Construction of a pharmacy network that supports home medical care] [Article in Japanese] Kushida K.

Showa Pharmaceutical University. Home medical care is recently being promoted thanks to the establishment of the related medical insurance system and by patient choice. Home medical care requires a collaboration of home treatment, home nursing, and drug supply, and within this collaborative network, pharmacists also play the role to supply drugs (dispensing). Drugs that used for home care include injectable agents for pain control or hygiene management. Therefore, pharmacies need to be furnished with clean rooms and clean benches to dispense drugs aseptically. However, because of the enormous costs of capital investment and the uncertainty of the number of patients who will use pharmacies, a very few pharmacies are adequately furnished. The survey has revealed that 76 pharmacies are adequately furnished. It is presumed that home medical care will continously promoted in the future so a network of pharmacies that can dispense injectable drugs must be set up under the home care support system. Publication Types: •

English Abstract

PMID: 15311776 [PubMed - indexed for MEDLINE] 974: Parassitologia. 2004 Jun;46(1-2):67-70. Related Articles, Links

[A minimum medical GIS database (MMDb) for Europe] [Article in Italian] Brianti E, Malone JB, McCarroll JC, Bernardi M, Drigo M, Gruszynski K. Department of Veterinary Public Health, School of Veterinary Medicine, University of Messina, Messina, Italy. Geographic information systems (GIS) and remote sensing (RS) technologies are being used increasingly to study the spatial and temporal patterns of some parasitic diseases of medical and veterinary importance. At the same time, the incorporation of GIS in this field shows the scarcity of the data and images available, which sometime discourage researchers that still look at GIS as a system too difficult and unusable for medical study. Aware of this problem and supported by success of earlier MMDb's for Africa, Asia and South America, the authors' aim is to construct and offer an MMDb for Europe. The initial MMDb is composed with vector images covering an area situated from -11 degrees-70 degrees N to 58 degrees-30 degrees E. Specifically, data layers include: a) Global

Moderate-Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) 16 days at 250 m spatial resolution designed to provide consistent spatial and temporal comparisons of vegetation conditions, supplied in the MMDb as seasonal and annual composite images from 2000 to 2003, b) MODIS Land Surface Temperature (LST) calculated from daytime and nighttime observations at 8 day intervals at 1 km spatial resolution, supplied in the MMDb as seasonal and annual composites images for day (maximum) temperatures, night (minimum) temperatures from 2000 to 2003, c) GTOPO30 Digital Elevation Model (DEM) at 1 km spatial resolution, d) United States Geological Survey (USGS) Land use/land cover scheme, e) USGS actual and potential evapotranspiration supplied for all 12 months as a grid at 50 km spatial resolution, f) USGS precipitation showing the amount of rainfall for all 12 months supplied as a grid at 50 km spatial resolution, g) USGS shapefiles of administrative and political boundaries, cities, towns, villages, lakes, rivers, streams, road, railroads and more. The MMDb projection will be in geographic latitude-longitude, decimal degree format. This global format is most commonly used for public access map database resources and can be readily re-projected as needed for compatibility with various national mapping systems. There is no "required" software, and end users need only common commercial GIS software packages that have mutual import-export functions. Additionally, the MMDb is meant to be a dynamic resource that end users may improve and modify with other regional data. Publication Types: • •

English Abstract Review

PMID: 15305689 [PubMed - indexed for MEDLINE] 975: Cancer. 2004 Aug 15;101(4):796-802. Related Articles, Links

Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma Y, Okita K, Omata M, Takayasu K, Yamaoka Y. Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. [email protected] BACKGROUND: Advances in the diagnosis and surgical treatment of

hepatocellular carcinoma (HCC) have improved the prognosis for patients with HCC who undergo liver resection. The objective of this study was to evaluate prognostic predictors for patients with HCC who underwent liver resection in a Japanese nationwide data base. METHODS: In this study, the authors analyzed 12,118 patients with HCC in a Japanese nationwide data base who underwent liver resection between 1990 and 1999 and compared them with a previous analysis of patients between 1982 and 1989. All patients were evaluated for prognostic factors. RESULTS: During the last decade, the increases in patients who were without hepatitis B virus surface antigen, who had small tumors, and who had portal vein invasion were noted. The 5-year overall survival rates for patients with HCC improved to 50.5%, compared with < 40% in the previous analysis. A multivariate analysis using a stratified Cox proportional hazards model according to associated liver disease indicated that age, degree of liver damage, alpha-fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were independent prognostic predictors for patients with HCC. Operative mortality decreased from 2.3% in 1990-1991 to 0.6% in 1998-1999. CONCLUSIONS: Outcomes and operative mortality rates in patients with HCC improved during the last decade. Age, degree of liver damage, alpha-fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were prognostic factors for patients with HCC who underwent liver resection. Publication Types: •

Comparative Study

PMID: 15305412 [PubMed - indexed for MEDLINE] 976: Fertil Steril. 2004 Aug;82(2):338-42. Related Articles, Links

Predictors of success during the coasting period in high-responder patients undergoing controlled ovarian stimulation for assisted conception. Ulug U, Ben-Shlomo I, Bahceci M. Bahceci Women Health Care Center and German Hospital at Istanbul, Nisantasi, 80200 Istanbul, Turkey. OBJECTIVE: To determine the prognostic factors analyzed during the coasting period that can be used to predict outcomes of IVF cycles. DESIGN:

Retrospective review of data from a single center. SETTING: Referral private IVF center. PATIENT(S): Three hundred forty-six patients who were coasted for the prevention of ovarian hyperstimulation syndrome (OHSS) and 262 patients who were not coasted but having excessive E(2) levels during controlled ovarian hyperstimulation for assisted conception. INTERVENTION(S): Controlled ovarian hyperstimulation, oocyte retrieval, intracytoplasmic sperm injection, and embryo transfer. MAIN OUTCOME MEASURE(S): Number of total oocytes retrieved, oocyte maturity, fertilization, implantation and pregnancy rates (IR and PR, respectively), and incidence of severe OHSS. RESULT(S): No difference was found between early onset coasted patients, late onset coasted patients, and uncoasted patients in terms of fertilization rates, IR, PR, and incidence of severe OHSS. Fertilization and PR did not correlate significantly with decreases in E(2) level during the coasting period. Implantation rates and PR in patients who were coasted > or =4 days were significantly reduced compared with patients who were coasted for 1-3 days. In logistic regression model, the decrease in PR with prolonged coasting was found to be significant; however, there was no correlation between decreased PR and the decrease in E(2) levels during the coasting period. CONCLUSION(S): Coasting can be applied safely to controlled hyperstimulation cycles without compromising the outcome. The duration of coasting seems to be a prognostic factor for the outcome of IVF. The criteria for initiation of coasting should be based on clinical experience and assessment of the patient. PMID: 15302281 [PubMed - indexed for MEDLINE] 977: Ann Epidemiol. 2004 Aug;14(7):453-60. Related Articles, Links

Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study. Manor O, Eisenbach Z, Friedlander Y, Kark JD. School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Ein Karem, Jerusalem, Israel. [email protected] PURPOSE: While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years. METHODS: Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases,

and sudden death. RESULTS: Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership. CONCLUSIONS: Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed. Publication Types: •

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

PMID: 15301781 [PubMed - indexed for MEDLINE] 978: Ned Tijdschr Geneeskd. 2004 Jul 10;148(28):1390-4. Related Articles, Links Comment in: •

Ned Tijdschr Geneeskd. 2004 Sep 4;148(36):1799.

[Surveillance of hepatitis A in the Netherlands 1993-2002] [Article in Dutch] Van Der Eerden LJ, Bosman A, Van Duynhoven YT. Rijksinstituut voor Volksgezondheid en Milieu, Centrum Infectieziekten Epidemiologie, Postbus 1, 3720 BA Bilthoven. [email protected] OBJECTIVE: To survey trends in data on hepatitis A using information from the notification system of the Municipal Medical and Health Services 1993-2002. DESIGN: Retrospective, descriptive. METHOD: Data collected from the notification system of the Dutch Municipal and Medical Services were analyzed. RESULTS: From 1993 to 2002, 64.4%, 6.5% and 11.5% of infections were contracted in the Netherlands, Turkey and Morocco, respectively. Although the absolute number of cases was highest for young people under the age of 16 infected in the Netherlands, incidence rates showed that the children of

immigrants infected in Turkey or Morocco were at highest risk, followed by adult immigrants from Turkey and Morocco. In addition, a seasonal trend was observed starting with an increase in the number of notifications of young travellers infected in Turkey and Morocco during their summer holiday, followed by a steep increase in notifications of young people infected in the Netherlands in autumn. This was followed later in the year by a slight increase in notifications of adults who acquired the infection in the Netherlands. However, between 1993-2002 the total number of notifications was halved. This decrease was mainly restricted to infections acquired in the Netherlands. In recent years, fewer outbreaks have been reported in schools, households and families. In 2001, a peak of notifications from the homosexual scene was observed. There was a continued trend in the rise of the mean age of hepatitis-A onset. CONCLUSION: Risk of hepatitis A is highest for the children of immigrants travelling to Turkey or Morocco in the summer months. Secondary cases in the Netherlands are in strong decline, especially in schools and families. However, the almost stable incidence of infections among young people of Turkish or Moroccan extraction stresses the continued importance of immunization of this group before they travel. The continuing trend in the rise of the mean age of hepatitis-A onset deserves attention because of the increasing risk of mortality of the disease amongst older people. Publication Types: •

English Abstract

PMID: 15291422 [PubMed - indexed for MEDLINE] 979: Hu Li Za Zhi. 2004 Aug;51(4):27-32. Related Articles, Links

[Future trends in nursing education in Taiwan in the light of globalization] [Article in Chinese] Lee S, Lu YC, Yen WJ, Lin SC. School on Nursing, Chung-Shan Medical University, ROC. [email protected] The twenty-first century is the era of the knowledge-based economy. Its information networks developing rapidly, Taiwan has already entered an age of liberalization, diversity and globalization. Competition and change will be the norm. As globalization continues it will pose substantial problems for nursing education. Nursing is a service-oriented activity which has to develop constantly to meet the changing demands of the public as people start to live longer, society becomes more multi-cultural, the nature of diseases and other health problems

changes and public policy, such as that on National Health Insurance, is modified. This article outlines the problems currently facing nursing education (i.e., the complexity of the educational system, shortcomings in the learning environment, curriculum design, the quality of faculty, evaluation methods, and the quality of students' English and Mathematics) to predict likely difficulties (i.e. student recruitment, the running of schools and the quality of clinical nurses) and trends in nursing education. (i.e. changes in the way schools are run in line with the impact of globalization, new teaching methods; faculty training and development, lifelong learning, and the internationalization of education.) The article should be of interest to nursing educators. Publication Types: •

English Abstract

PMID: 15290639 [PubMed - indexed for MEDLINE] 980: Radiology. 2004 Aug;232(2):415-9. Related Articles, Links

Implementation of an international teleradiology staffing model. Kalyanpur A, Neklesa VP, Pham DT, Forman HP, Stein ST, Brink JA. Department of Diagnostic Radiology, Yale University School of Medicine, 789 Howard Ave, TE 2, New Haven, CT 06520-8042, USA. [email protected] Although teleradiology is presently being used extensively in the United Statesfor both overseas subspecialty consultations and overnight coverage of imaging services at domestic medical centers-there has been limited investigation of its potential to help provide staffing support to U.S. medical centers from offshore locations. In this review, the authors describe an empirical assessment of the clinical feasibility and applicability of body computed tomographic (CT) image cases that originated at a U.S. university hospital being interpreted nearly contemporaneously by a staff radiologist in India. During a 3-month period, nonemergent CT cases obtained at a tertiary care institution (Yale-New Haven Hospital) were transmitted daily to a satellite reading facility in Bangalore, India. The cases were interpreted at the satellite reading facility by a faculty member radiologist who maintained hospital privileges and academic appointment at the parent institution in the United States. CT imaging reports were transcribed and uploaded directly to the parent institution's radiology information system. Technical problems temporarily prevented the transfer of image cases twice during the study period. Overall, the project results demonstrated the feasibility

and reliability of an international teleradiology staffing model. Copyright RSNA, 2004 PMID: 15286313 [PubMed - indexed for MEDLINE] 981: Cancer Causes Control. 2004 Sep;15(7):681-7. Related Articles, Links

A comparison of the sources of cancer mortality in China. Yang L, Parkin DM, Li L, Chen Y. Unit of Descriptive Epidemiology, International Agency for Research on Cancer, Lyon, France. OBJECTIVE: To compare the validity of mortality data from available sources in China. MATERIALS, METHODS: Two large-scale surveys have provided accurate national-level rates; the most recent involved deaths occurring in a random 10% sample of the population during 1990-1992. Since then, the only readily available sources are two on-going surveillance systems, which provide annual estimates of mortality--the "Disease Surveillance Points" (DSP) sample survey, and that established by the Center of Health Information and Statistics (CHIS) of the ministry of health, the results of which are published by WHO. They were compared with respect to the representativeness of the populations covered and the rates obtained. RESULTS: Neither source covers a random sample of the Chinese population, with respect to age group, sex, and urban-rural residence, although the DSP population is the more representative of the national population in this respect. Sex and region (urban/rural) specific age-standardized mortality rates from the CHIS dataset were, however, closer to those from the (1990-1992) national survey, than those calculated from DSP data. CONCLUSIONS: The CHIS data is the preferred source for estimation of national mortality, and study of time trends, but requires appropriate weighting (by age, sex, rural/urban residence). The within-stratum estimates are more stable than those of DSP, because of its larger sample size. PMID: 15280626 [PubMed - indexed for MEDLINE] 982: Soc Sci Med. 2004 Oct;59(8):1647-59. Related Articles, Links

Utilization of well-baby care visits provided by Taiwan's National Health Insurance Program. Chen L, Yang WS, Lee SD, Chang HC, Yeh CL.

Division of Health Policy Research, National Health Research Institutes, 2F, 109 Min-Chuan East Road, Sec. 6, Taipei 114, Taiwan. [email protected] In April of 1995, Taiwan's National Health Insurance Program started providing each eligible child a total of six well-baby care visits. The first four are for infancy, the fifth is for the second and the third years of life, and the sixth is for the fourth year. These services are in addition to neonatal screening and a series of primary immunizations that have been publicly financed and utilized conventionally for years. The purposes of this study were to investigate the utilization level of these well-baby care visits, and explore relevant factors. The results reveal that 36% of eligible children did not use any of the first four visits, 58% did not utilize the fifth, and 82% did not use the sixth in the late 1990s. It appears that the take-up of these services is much less than satisfactory. Maternal awareness of and attitudes toward the services appeared to be the most important factors influencing utilization. These two factors not only were most influential, but also significantly contributed to disparities in utilization among different regions and types of residential districts. As a result, they should be the focus of interventions for advancing well-baby care. While these two factors are at the individual level, they are not independent from the health care system because the health care system has impacts on individual factors. Since physicians can serve as a good vehicle for teaching parents about relevant information and correct attitudes, and most physicians in Taiwan complained about the payment scheme, offering stronger incentives for physicians to promote such services might be helpful for achieving a high utilization level of well-baby care. Publication Types: •

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

PMID: 15279922 [PubMed - indexed for MEDLINE] 983: Nagoya J Med Sci. 2004 May;67(1-2):51-8. Related Articles, Links

Associations between disease risk and eight polymorphisms adopted for genotype announcements at Nagoya University Hospital. Nishio K, Nakamura S, Sekido Y, Niwa T, Hamajima N. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Japan. Genetic polymorphisms have the potential to predict disease susceptibility. This may be especially useful among individuals with a high-risk lifestyle, so that the

genotyping could be adopted for disease prevention through modifications toward a lower-risk lifestyle. We started a program of free genotype announcements in a polymorphism study among health checkup examinees at the Nagoya University Hospital on June 9, 2003. Since such announcements remain controversial for fear of unexpected harmful effects and counseling system, the accumulated evidence on the association between disease risk and genotypes announcements in our study was reviewed in this article. The genotypes used were those of alcohol dehydrogenase 2 (ADH2) Arg47His, aldelhyde dehydlrogenase 2 (ALDH2) Glu487Lys, NAD(P)H: quinone oxidoreductase (NQO1) C609T, glutathlione S transferase M1 (GSTM1), glutathione S-transferase T1 (GSTT1), interleukin-1B (IL-1B) C-31T, and tumor necrosis factor A (TNF-A) T-1031C, angiotensin converting enzyme (ACE) Ins/Del. Since showed a potential for widespread use in health checkups, the information on the above polymorphisms seems worth documenting. Although there have been no complaints from the participants to date, careful treatments are requested. PMID: 15279068 [PubMed - indexed for MEDLINE] 984: J Telemed Telecare. 2004;10(4):214-8. Related Articles, Links

Development and evaluation of a teleradiology and videoconferencing system. Kaidu M, Toyabe S, Oda J, Okamoto K, Ozaki T, Shiina M, Sasai K, Akazawa K. Department of Diagnostic Imaging and Internal Medicine, Sado General Hospital, Sado Island, Japan. We developed a teleradiology system linking a general hospital on Sado Island to tertiary care hospitals in Niigata City. The island is 40 km from Niigata City on the mainland and has only one diagnostic radiologist (for 72,000 islanders). Fibre optic cables between Sado Island and Niigata City were used for transmission. The introduction of the teleradiology system facilitated diagnostic and therapeutic consultation with specialists in Niigata City. The performance of the system was evaluated (on a scale of 0-6, with higher scores indicating better performance) by five diagnostic radiologists, who rated 32 features of the system twice, once in April 2002 and once in September 2003. The performance ratings improved from 1.38 to 2.86. While many of the initial problems with the software had been resolved, many still remained. Publication Types: •

Case Reports

•

Evaluation Studies

PMID: 15273031 [PubMed - indexed for MEDLINE] 985: Arch Environ Health. 2003 Aug;58(8):498-504. Related Articles, Links

Atmospheric transport of mold spores in clouds of desert dust. Shinn EA, Griffin DW, Seba DB. U.S. Geological Survey, St. Petersburg, Florida 33701, USA. [email protected] Fungal spores can be transported globally in clouds of desert dust. Many species of fungi (commonly known as molds) and bacteria--including some that are human pathogens--have characteristics suited to long-range atmospheric transport. Dust from the African desert can affect air quality in Africa, Europe, the Middle East, and the Americas. Asian desert dust can affect air quality in Asia, the Arctic, North America, and Europe. Atmospheric exposure to mold-carrying desert dust may affect human health directly through allergic induction of respiratory stress. In addition, mold spores within these dust clouds may seed downwind ecosystems in both outdoor and indoor environments. Publication Types: •

Review

PMID: 15259429 [PubMed - indexed for MEDLINE] 986: ScientificWorldJournal. 2004 Jul 3;4:500-6. Related Articles, Links

Snoezelen: children with intellectual disability and working with the whole family. Nasser K, Cahana C, Kandel I, Kessel S, Merrick J. Lev Hakadosh, Residential Care Center for Children, Haifa, Israel. [email protected] Snoezelen, or controlled multisensory stimulation, was first introduced in Israel in 1993. This paper presents a new concept of working with the whole family in the

Snoezelen room with the participation of a social worker. The purpose was to facilitate family encounters with the child, to enable parents and siblings to become better acquainted with the resident through his/her strengths and special abilities, to encourage parental involvement in the care, to encourage increased visits, to improve quality of life (QOL) for the resident, and to reinforce a better relationship between resident, family, and home. Sessions were divided into two major parts. The first segment (duration 20-40 min) was free activity and the second was more structured (duration 15-30 min). Case stories are presented to illustrate the positive effects of this approach. Snoezelen can be used with the entire family with the participation of a social worker and can add new dimensions to communication. PMID: 15258676 [PubMed - indexed for MEDLINE] 987: J Atheroscler Thromb. 2004;11(3):146-51. Related Articles, Links

Clinical features of familial hypercholesterolemia in Japan in a database from 1996-1998 by the research committee of the ministry of health, labour and welfare of Japan. Bujo H, Takahashi K, Saito Y, Maruyama T, Yamashita S, Matsuzawa Y, Ishibashi S, Shionoiri F, Yamada N, Kita T; Research Committeon Primary Hyperlipidemia of the Ministry of Health, Labour, and Welfare of Japan. Department of Genome Research & Clinical Application, Chiba University Graduate School of Medicine, Chiba, Japan. [email protected] Familial hypercholesterolemia (FH) is one of the most common primary hyperlipidemias, characterized by a heterozygous or homozygous phenotype for a severe serum low-density lipoprotein (LDL)-cholesterol level and advanced atherosclerosis, leading to coronary artery diseases (CAD). Various kinds of mutations in the LDL receptor gene responsible for the genetic disease have been identified since the human LDL receptor gene has been identified. In this study, the clinical features of FH were investigated using a database based on nationwide surveillance for primary hyperlipidemia and related disorders by the Research Committee on Primary Hyperlipidemia. The clinical features and the frequencies of accompanying vascular diseases in 660 cases of FH homozygotes and heterozygotes showed that the incidence of CAD was negatively associated with plasma HDL-cholesterol levels, but not with plasma LDL-cholesterol levels, in 641 FH heterozygotes. Risk factor analyses revealed that hypertension, male, smoking, low HDL-cholesterol levels, age > 50 y, diabetes mellitus, and hypertriglyceridemia were positive risk factors for CAD. The summarized gene analysis in FH heterozygotes showed at least 4 mutations in the LDL receptor gene as common mutations in Japan. The average serum lipids and frequency of

CAD based on each common mutation suggested that their clinical features are in part determined by responsive mutations in the LDL receptor gene. Publication Types: •

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

PMID: 15256765 [PubMed - indexed for MEDLINE] 988: Int J Epidemiol. 2004 Dec;33(6):1329-36. Epub 2004 Jul 15. Related Articles, Links

Population survey to determine risk factors for Mycobacterium leprae transmission and infection. Bakker MI, Hatta M, Kwenang A, Faber WR, van Beers SM, Klatser PR, Oskam L. KIT (Koninklijk Instituut voor de Tropen/Royal Tropical Institute), KIT Biomedical Research, Amsterdam, The Netherlands. BACKGROUND: Not every leprosy patient is equally effective in transmitting Mycobacterium leprae. We studied the spatial distribution of infection (using seropositivity as a marker) in the population to identify which disease characteristics of leprosy patients are important in transmission. METHODS: Clinical data and blood samples for anti-M. leprae ELISA were collected during a cross-sectional survey on five Indonesian islands highly endemic for leprosy. A geographic information system (GIS) was used to define contacts of patients. We investigated spatial clustering of patients and seropositive people and used logistic regression to determine risk factors for seropositivity. RESULTS: Of the 3986 people examined for leprosy, 3271 gave blood. Seroprevalence varied between islands (1.7-8.7%) and correlated significantly with leprosy prevalence. Five clusters of patients and two clusters of seropositives were detected. In multivariate analysis, seropositivity significantly differed by leprosy status, age, sex, and island. Serological status of patients appeared to be the best discriminator of contact groups with higher seroprevalence: contacts of seropositive patients had an adjusted odds ratio (aOR) of 1.75 (95% CI 0.922-3.31). This increased seroprevalence was strongest for contact groups living < or =75 m of two seropositive patients (aOR = 3.07; 95% CI 1.74-5.42). CONCLUSIONS: In this highly endemic area for leprosy, not only household contacts of seropositive patients, but also people living in the vicinity of a seropositive patient were more likely to harbour antibodies against M. leprae. Through measuring the serological status of patients and using a broader definition of contacts, higher risk groups can be more specifically identified.

Publication Types: •

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

PMID: 15256520 [PubMed - indexed for MEDLINE] 989: J Expo Anal Environ Epidemiol. 2004 Jul;14(4):354-62. Related Articles, Links

Exposure opportunity models for Agent Orange, dioxin, and other military herbicides used in Vietnam, 1961-1971. Stellman SD, Stellman JM. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. [email protected] Nearly 19.5 million gallons of herbicides were sprayed on the Republic of Vietnam between 1961 and 1971 for military purposes. Amounts of spray and patterns of applications are available in an electronic file called HERBS that contains records of 9141 defoliation missions, including detailed coordinates of US Air Force Ranch Hand aircraft flight paths, along with chemical agent and gallonage sprayed. Two classes of models for use in epidemiological and environmental studies that utilize the HERBS data for estimating relative exposure opportunity indices are presented: a discrete "hits" model that counts instances of proximity in time and space to known herbicide applications, and a continuous exposure opportunity index, E4, that takes into account type and amount of herbicide sprayed, distance from spray application, and time interval when exposure may have occurred. Both direct spraying and indirect exposure to herbicide (or dioxin) that may have remained in the local environment are considered, using a conservative first-order model for environmental disappearance. A correction factor for dermal versus respiratory routes of entry has been incorporated. E4 has a log-normal distribution that spans six orders of magnitude, thus providing a substantial amount of discrimination between sprayed and unsprayed areas. The models improve on earlier ones by making full use of the geometry of the HERBS spray flight paths of Ranch Hand aircraft. To the extent possible so many decades after the War, the models have been qualitatively validated by comparison with recent dioxin soil and biota samples from heavily contaminated areas of Vietnam, and quantitatively validated against adipose dioxin obtained in epidemiological studies of Vietnamese. These models are incorporated within a geographic information system (GIS) that may be used, as one would expect, to identify locations such as hamlets, villages, and military installations sprayed by herbicide. In a novel application, the GIS also facilitates

quantitative risk assessment in epidemiological and ecological studies by applying the models within a framework of historical reconstruction of exposure history of individuals based upon their location histories. Publication Types: • •

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

PMID: 15254482 [PubMed - indexed for MEDLINE] 990: Oncol Nurs Forum. 2004 Jul 13;31(4):E69-74. Print 2004 Jul. Related Articles, Links

Asian/Pacific Islander American women: age and death rates during hospitalization for breast cancer. Polek C, Klemm P, Hardie T, Wheeler E, Birney M, Lynch K. College of Health and Nursing Sciences, University of Delaware, Newark, USA. [email protected] PURPOSE/OBJECTIVES: To investigate whether differences in age and death rates exist between hospitalized Asian/Pacific Islander American (APIA) women and women of other racial groups. DESIGN: Secondary data analysis of a national data set. SETTING: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data on women with breast cancer based on racial status. A total of 20,507 hospitalization records met the study criteria. SAMPLE: All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization. METHODS: Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups. FINDINGS: Significant differences were found between APIA and Caucasian and Latino women. Significant differences based on race were found between subjects who had died during hospitalization. On average, APIA women were the youngest to die. CONCLUSIONS: APIA women with breast cancer were among the youngest women being hospitalized and the youngest to die during hospitalization. IMPLICATIONS FOR NURSING: Cultural awareness by nurses is critical when discussing methods for prevention and early detection of breast cancer with minority women. Targeting new immigrants is a priority for those who screen and educate women about detection and treatment of breast cancer. Publication Types:

•

Comparative Study

PMID: 15252439 [PubMed - indexed for MEDLINE] 991: Fam Pract. 2004 Aug;21(4):415-9. Related Articles, Links

The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev. Doron Y, Peleg R, Peleg A, Neumann L, Buskila D. Department of Family Medicine, Soroka Medical Center and Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. BACKGROUND: Fibromyalgia (FM) is a common idiopathic chronic, widespread pain syndrome with tenderness in anatomically defined tender points. OBJECTIVES: The purpose of the present study was to describe and characterize the economic and daily work burden of FM compared with diabetes mellitus and hypertension. METHODS: A retrospective study was conducted in 2001 in a primary care clinic, the Kuseife clinic of the Clalit Health Services. Data for the three study groups were obtained from the computerized database of the Kuseife clinic and the Negev District, Israel. The study group included 102 FM patients. The control groups included 102 diabetes patients and 103 patients with hypertension. RESULTS: Hospitalization and hospital day care services were the main expenses incurred by patients in this study. There were no differences among the study groups in any cost parameter examined except for the cost of diagnostic tests (P < 0.01), which was less for FM patients. FM patients were referred to specialists and diagnostic procedures more frequently than the control groups. No statistical difference was found in the total number of clinic visits, but FM patients visited physicians more frequently and visited nurses less frequently than patients in the other two groups (P < 0.05). CONCLUSIONS: FM patients consume health care resources to a similar extent to patients with other chronic diseases such as diabetes mellitus and hypertension, but the latter usually receive much more attention from the health care system. Greater awareness of this disorder can improve management and facilitate planning of health care resources, thus improving quality of care. Publication Types: • •

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

PMID: 15249530 [PubMed - indexed for MEDLINE] 992: J Acquir Immune Defic Syndr. 2004 Aug 15;36(5):1051-6. Related Articles, Links

Study of antiretroviral drug-resistant HIV-1 genotypes in northern Thailand: role of mutagenically separated polymerase chain reaction as a tool for monitoring zidovudine-resistant HIV-1 in resource-limited settings. Saeng-Aroon S, Wichukchinda N, Myint L, Pathipvanich P, Ariyoshi K, Rojanawiwat A, Matsuda M, Sawanpanyalert P, Sugiura W, Auwanit W. National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand. As the number of HIV-1-infected individuals receiving antiretroviral drugs has been rapidly increasing in developing countries, there is an urgent need for drug resistance genotype information of non-B subtype HIV-1 and for the establishment of a practical system of monitoring drug-resistant viruses. This study first sequenced the reverse transcriptase region of HIV-1 in 112 infected individuals who had been treated with zidovudine (AZT)/didanosine or AZT/zalcitabine as dual therapy at a government hospital in northern Thailand and then compared the above sequence method with mutagenically separated polymerase chain reaction (MS-PCR) for detecting M41L and K70R mutations. Concordant rates of detecting M41L and K70R mutations by the 2 methods were 96.9% (93/96) and 92.7% (89/96), respectively. The M41L and K70R MS-PCR could detect 86.4% of AZT-resistant strains with any resistance mutation, which was determined by the sequencing method. Then 292 drug-naive individuals were screened for the presence of drug-resistant HIV-1 by the MS-PCR assay and it was found that 2 individuals (0.7%) carried viruses with either the M41L or K70R mutation. It is feasible to test a large number of samples with MS-PCR, which is sensitive, cheap, and easy to perform and does not require sophisticated equipment. The M41L and K70R MS-PCR is potentially a useful tool to monitor the spread of AZT-resistant HIV-1 in resource-limited countries. Publication Types: • •

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

PMID: 15247558 [PubMed - indexed for MEDLINE]

993: J Cross Cult Gerontol. 2004 Sep;19(3):203-19. Related Articles, Links

The health and health status of older Korean Americans at the 100year anniversary of Korean immigration. Sohn L. VA Special Fellowship Program in Advanced Geriatrics, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. [email protected] There are 28 subgroups in the Asian American Pacific Islander (AAPI) ethnic population. They accounted for 12.5 million persons in the year 2002 or 4.4% of the non-institutionalized US population (Reeves&Bennett, 2003). It is a rapidly growing population in the United States, particularly in Southern California. The Korean American population is the fifth largest ethnic group in the heterogeneous AAPI population. Despite their increasing numbers there lacks data regarding the health status and healthcare utilization of the AAPI population. The aim of this study is to characterize the health status and healthcare utilization of an Asian American ethnic group, the Korean Americans. The data are from the 2000 Korean American Health Survey (KAHS). This survey of 1,660 Korean Americans living in Los Angeles County assessed their health status and medical needs and composed the largest sample recruited for a health study on Korean Americans to date. For the study 208 Koreans Americans aged 65 and over were reported. Descriptive statistics were performed to illustrate the health status and needs of the Korean American older persons. Over one-half of the sample, 69% of the Korean American older persons in the study reported a fair or poor health status. This is in stark contrast to a survey conducted by the Commonwealth Fund, which found that 17% of the minorities and 30% of the Korean Americans rated their health as fair or poor (Commonwealth Fund, 2002). With regards to access to healthcare 21% of the Korean American older adults in the sample lacked health insurance and 31% had never visited a medical doctor within the last 12 months for a check up or consultation. It is felt that an individual's chance of being uninsured varies across the life span and that people 65 years and older have a minimal likelihood of being uninsured due to Medicare (IOM, 2001). However when looking at certain subgroups higher percentages of uninsured are revealed. One out of every three Koreans Americans in the US is uninsured compared to 21% of all AAPI and 14% non-Latino whites. In California the proportion is even higher with almost half of all Koreans being uninsured (Brown et al. 2001). This type of discrepancy compounds the "Model Minority Myth" that AAPI population is a successful minority group and do not have barriers to health care (Chen et al. 1995). One study examining health services research status in the AAPI found that Korean Americans were one of the most understudied populations relative to their size (Andersen et al. 1995). Since the AAPI population and subgroups are often not included in health services research this

results in "myths" or inaccuracies regarding their health. Studies of AAPI populations are needed to provide information regarding the health of the population, educate health care providers to assist them in the care of ethnic populations and seek interventions to remove health disparities in minority populations. Publication Types: •

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

PMID: 15243198 [PubMed - indexed for MEDLINE] 994: Indian J Med Res. 2004 Jun;119(6):273-82. Related Articles, Links Erratum in: •

Indian J Med Res. 2004 Aug;120(2):127.

Performance evaluation of APACHE II score for an Indian patient with respiratory problems. Gupta R, Arora VK. LRS Institute of Tuberculosis & Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India. BACKGROUND & OBJECTIVES: Realising the utility of scoring systems in mortality prediction of critically ill patients admitted to intensive care units (ICUs), studies worldwide have expressed a need to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II score for databases of respective countries. Literature available in this area in the Indian context is scanty. The present study was undertaken to evaluate the performance of APACHE II score in prediction of mortality risk, as well as in determination of model validity in critically ill Indian patients with respiratory problems. METHODS: The study was prospectively carried out over 18 months at respiratory ICU of a tertiary Institute in New Delhi, which admitted consecutive medical (with lung ailments) and surgical (who had undergone any elective thoracic surgical procedure under general anaesthesia) patients. Based on chief indication of ICU admission, the medical patients were further divided into subgroups I (respiratory) and II (non-respiratory). APACHE II points were assigned to all patients for calculating their individual predicted risks of mortality. Standard mortality ratio (SMR) was computed with 95 per cent confidence intervals (CI).

Calibration of model was analysed by calculating Lemeshow and Hosmer goodness of fit X(2) statistic and by plotting calibration curve, whereas discrimination was evaluated by calculating area under a receiver operating characteristic (ROC) curve. RESULTS: Of the 393 consecutive patients admitted to respiratory ICU during the study period, 63 were left out on account of exclusion criteria. Mean APACHE II score of the remaining 330 patients was 12.87+/-8.25 and range from 1 to 47. There were 287 (87%) survivors and 43 (13%) non-survivors, whose mean APACHE II scores, being respectively 11.34+/-6.75 (range 1-37) and 23.09+/-10.01 (range 5-47), were significantly different (P<0.01). The study had a predicted mortality of 7.9 per cent and an SMR value of 1.65 (95% CI from 0.4 to 3.0). Mean APACHE II score of those having medical ailments was significantly higher (P<0.01) than surgical patients. The non-respiratory sub-group had a significantly higher (P<0.01) mean APACHE II score than respiratory sub-group. 59 per cent of patients did not get APACHE II points owing to being <45 yr of age. In addition, against 10 immunocompromised patients, 77 others did not get APACHE II points despite having apparently compromised immunity due to co-existence of tuberculosis (TB), diabetes mellitus, dual pathologies or past history of anti-TB treatment. Observed and predicted mortality rose with 5-point APACHE II score, but did not correlate for patients of any comparable group. Average ICU stay of 16 days for those with medical disease was significantly longer (P<0.01) than 9.5 days for surgical patients. APACHE II scoring system showed a poor calibration and discrimination ability for Indian respiratory patients. INTERPRETATION & CONCLUSION: Despite the rise in observed and predicted mortality with 5-point APACHE II score, predicted mortality did not correlate with observed mortality for critically ill patients admitted to an Indian respiratory ICU. The scoring system also showed a poor calibration as well as discrimination. The model may be more useful for Indian patients by lowering down the cut-off value in allotment of age points and by awarding the weightage to factor like co-existing immunocompromised state. Publication Types: •

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

PMID: 15243165 [PubMed - indexed for MEDLINE] 995: Indian J Lepr. 2003 Oct-Dec;75(4):335-45. Related Articles, Links Comment in: •

Indian J Lepr. 2004 Jan-Mar;76(1):82.

Leprosy situation in endemic states of India and prospects of elimination of the disease. Subramanian M, Showkath Ali MK, Thorat DM, Muthukumar M, Sathiskumar E, Ramadoss C, Ali Khan M. Division of Epidemiology and Statistics, Central Leprosy Teaching and Research Institute, Chengalpattu 603001, Tamil Nadu. In India there is a dramatic fall in the prevalence rate (PR) of leprosy, but the new case-detection rate (NCDR) has not been reduced concomitantly. It is the operational efficiency of the National Leprosy Eradication Programme (NLEP) that has led to a significant reduction in the NCDR in Andhra Pradesh and Tamil Nadu. The ratio of PR to NCDR has been declining in these two states and it reveals that elimination could be reached even with the high NCDR level of 3 to 4 per 10000 population, particularly if single skin lesion (SSL) cases are discharged through single dose treatment of rifampicin, ofloxacin and minocycline (ROM). On the other hand, the significant number of cases detected in Bihar and Orissa during modified leprosy elimination campaigns (MLECs) reveals that there are lacunae in operational activities in new case-detection resulting in a large number of undetected cases in the community. Only one-third of the cases are reporting voluntarily. Awareness of leprosy is not adequate to motivate the patients to report voluntarily and complete their treatment, thus underscoring the need for relying on active case-detection so that transmission can be broken and elimination of leprosy achieved. In addition, the influence of socio-economic factors on continued occurrence of leprosy cannot be ruled out. The establishment of a sentinel surveillance system along with a computerized simplified information system to gain in-depth knowledge on the functioning of the NLEP will ensure operational efficiency. In view of this situation, the NLEP should adopt a more realistic approach towards reaching the elimination goal. PMID: 15242272 [PubMed - indexed for MEDLINE] 996: J Pak Med Assoc. 2004 Apr;54(4):187-91. Related Articles, Links

Prescription and dispensing practices in public sector health facilities in Pakistan: survey report. Hafeez A, Kiani AG, ud Din S, Muhammad W, Butt K, Shah Z, Mirza Z. Department of Pediatrics, KRL Hospital, Islamabad. OBJECTIVES: To gather information on existing prescription practices,

dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province. METHODS: A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups. RESULTS: Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility. CONCLUSIONS: Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort. Publication Types: •

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

PMID: 15241995 [PubMed - indexed for MEDLINE] 997: Cancer. 2004 Jul 15;101(2):421-9. Related Articles, Links

Predictors of place of death for Japanese patients with advancedstage malignant disease in home care settings: a nationwide survey. Fukui S, Fukui N, Kawagoe H. Department of Community Health Nursing, School of Nursing, Tokyo Metropolitan University of Health Sciences, Tokyo, Japan. [email protected] BACKGROUND: Although the place of death for patients with advanced malignancy is influenced by multiple factors, few studies have systematically investigated the determinants of place of death. The objective of the current retrospective study was to clarify the predictors of home death throughout the

duration of home palliative care for Japanese patients with advanced malignant disease. METHODS: In the current nationwide survey, the authors investigated predictors involving patient demographics and clinical profiles, the roles and status of family caregivers, and the support provided by the healthcare system in the introductory phase (during the first week of home care), the stable phase (between the introductory and dying phases), and the dying phase (during the final week before death) of home care service in Japan. RESULTS: Multivariate logistic regression models clarified that 1) patient-related clinical variables (e.g., functional status and rehospitalization); 2) the support of the healthcare system (e.g., provision of information on the dying process and visitation by home care nurses); and 3) the status and roles of family caregivers (e.g., psychologic distress levels, assistance with patient evacuation, etc.) have an effect on place of death throughout all three phases of home palliative care. Overall, the model used in the current study was able to predict 94% of home deaths accurately. CONCLUSIONS: A clearer understanding of factors that may influence place of death for patients with advanced-stage malignant disease would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die in their preferred location. Copyright 2004 American Cancer Society. Publication Types: •

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

PMID: 15241842 [PubMed - indexed for MEDLINE] 998: Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Apr;25(4):302-7. Related Articles, Links

[The 'Beijing clinical database' on severe acute respiratory syndrome patients: its design, process, quality control and evaluation] [Article in Chinese] Beijing Commanding Center For SARS Treatment and Cure Scientific Research Group. OBJECTIVE: To develop a large database on clinical presentation, treatment and prognosis of all clinical diagnosed severe acute respiratory syndrome (SARS) cases in Beijing during the 2003 "crisis", in order to conduct further clinical studies. METHODS: The database was designed by specialists, under the organization of the Beijing Commanding Center for SARS Treatment and Cure, including 686 data items in six sub-databases: primary medical-care seeking, vital signs, common symptoms and signs, treatment, laboratory and auxiliary test, and

cost. All hospitals having received SARS inpatients were involved in the project. Clinical data was transferred and coded by trained doctors and data entry was carried out by trained nurses, according to a uniformed protocol. A series of procedures had been taken before the database was finally established which included programmed logic checking, digit-by-digit check on 5% random sample, data linkage for transferred cases, coding of characterized information, database structure standardization, case reviewe by computer program according to SARS Clinical Diagnosis Criteria issued by the Ministry of Health, and exclusion of unqualified patients. RESULTS: The database involved 2148 probable SARS cases in accordant with the clinical diagnosis criteria, including 1291 with complete records. All cases and record-complete cases showed an almost identical distribution in sex, age, occupation, residence areas and time of onset. The completion rate of data was not significantly different between the two groups except for some items on primary medical-care seeking. Specifically, the data completion rate was 73% - 100% in primary medical-care seeking, 90% in common symptoms and signs, 100% for treatment, 98% for temperature, 90% for pulse, 100% for outcomes and 98% for costs in hospital. CONCLUSION: The number of cases collected in the Beijing Clinical Database of SARS Patients was fairly complete. Cases with complete records showed that they could serve as excellent representatives of all cases. The completeness of data was quite satisfactory with primary clinical items which allowed for further clinical studies. Publication Types: • •

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

PMID: 15231196 [PubMed - indexed for MEDLINE] 999: Asia Pac J Clin Nutr. 2004;13(2):171-7. Related Articles, Links

Economic development and its influences and risks for nutrition, cuisine and health. McKay J. Australian APEC Study Centre, Monash University, Melbourne. [email protected] This paper reviews the evidence on some of the major trends in economic development at a global level and assess their influence on food, nutrition and health. Food and nutrition are themselves broad topics, and each is influenced by a myriad of local and international forces, making them both interesting and important, but also challenging in their complexity. It is especially difficult to deal

with such a vast and complicated terrain in such a short paper, and one must inevitably deal only superficially with a number of complex areas. This paper will review a number of key forces for change in the global system, with a focus on the implications of each for food and nutrition. Each area is central to the experience of economic, social and political development, particularly in the period since 1945, and each is tied in various ways with that complex and interrelated set of changes that we call globalisation. Seven key factors will be explored: global population growth, leading to strong pressures on world availability of arable land and food; increasing integration in the global economy, as measured through such things as trade, financial flows and information exchanges, and with specific implications for the food industry and for trade in food products; growing gaps between rich and poor countries; similar increases in disparities between rich and poor segments within individual countries; the rapid growth of cities in the developing world, resulting in massive challenges for the food supply systems of many nations; the growth within some countries, for example in a number of Asian countries, of a "new middle class" with distinctive patterns of consumption; and, high levels of population movements between countries resulting in the creation of significant communities of immigrants in a number of nations. Examples will be drawn from the two regions familiar to the author, Asia and Sub-Saharan Africa, but with a particular emphasis on East Asia. Publication Types: •

Review

PMID: 15228985 [PubMed - indexed for MEDLINE] 1000: Methods Inf Med. 2004;43(3):268-72. Related Articles, Links

Physicians' choice in using Internet and fax for patient recruitment and follow-up in a randomized controlled trial. Rahman M, Morita S, Fukui T, Sakamoto J. Department of Epidemiological and Clinical Research, Information Management, Kyoto University Graduate School of Medicine, Yoshidakonoe-cho, Shogoin, Sakyo-ku, Kyoto 606-8501, Japan. [email protected] OBJECTIVE: To examine the physicians' preference between Web and fax-based remote data entry (RDE) system for an ongoing randomized controlled trial (RCT) in Japan. METHODS: We conducted a survey among all the collaborating physicians (n = 512) of the CASE-J (Candesartan Antihypertensive Survival Evaluation in Japan) trial, who have been recruiting patients and sending follow-

up data using the Web or a fax-based RDE system. The survey instrument assessed physicians' choice between Web and fax-based RDE systems, their practice pattern, and attitudes towards these two modalities. RESULTS: A total of 448 (87.5%) responses were received. The proportions of physicians who used Web, fax, and the combination of these two were 45.9%, 33.3% and 20.8%, respectively. Multivariate logistic regression analyses revealed that physicians 55 years or younger [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.1-3.3] and regular users of computers (OR = 4.2, 95% CI = 2.1-8.2) were more likely to use the Web-based RDE system. CONCLUSIONS: This information would be useful in designing an RCT with a Web-based RDE system in Japan and abroad. Publication Types: • •

Clinical Trial Randomized Controlled Trial

PMID: 15227556 [PubMed - indexed for MEDLINE] 1001: AAOHN J. 2004 Jun;52(6):230-41. Related Articles, Links

Defining the roles and functions of occupational health nurses in Japan: results of job analysis. Ishihara I, Yoshimine T, Horikawa J, Majima Y, Kawamoto R, Salazar MK. Department of Public Health and Occupational Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan. The purposes of this study were to obtain descriptive information about the job duties and tasks of Japanese occupational health nurses and to compare the roles and functions of occupational health nurses in the United States and Japan. A modified version of a job analysis survey developed by the American Board for Occupational Health Nurses was used to collect data. The findings indicated 62% of Japanese occupational health nurses perform direct care roles, approximately half perform educating or advising and consulting roles, and approximately 40% perform management roles. Details related to specific tasks and differences in nurses with varying preparation also are presented. Although there were many similarities in the types of tasks performed by nurses in Japan and the United States, the proportion of time devoted to specific tasks in the two countries varied. These results support the need for developing an educational system to enhance occupational health nursing practice in Japan. The information derived from the study provides a knowledge base that can be used to provide guidance and direction to the content of occupational health nursing programs.

Publication Types: • •

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

PMID: 15219109 [PubMed - indexed for MEDLINE] 1002: Health Qual Life Outcomes. 2004 Jun 25;2:31. Related Articles, Links

Quality of life assessment and reporting in randomized controlled trials: a study of literature published from Japan. Naito M, Nakayama T, Fukuhara S. Department of Health Informatics, Kyoto University School of Public Health, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, Kyoto 606-8501, Japan. [email protected] BACKGROUND: Standardization of quality of life (QOL) assessment and reporting in clinical trials is an imperative issue. While English-speaking countries have led this movement in standardization, there persists to be a limited amount of information from non-English-speaking including Japan. In this study, we bibliographically analyze the reporting of randomized controlled trials (RCT) conducted in Japan that used a QOL instrument. METHODS: A PubMed search of reports published between 1970-2003 followed by an examination of QOL reporting and its frequency of use in RCTs published from Japan. RESULTS: Percentages of QOL reporting in RCTs have increased between 1970-2003 both worldwide (0% for 1970-1974 to 4.4% for 2000-2003) and in Japan (0% to 1.8% for the identical periods). We found and evaluated 46 RCT reports published from Japan (32 in English, 14 in Japanese). The most commonly studied clinical condition was cancer (26, 56.5%) and the most common intervention was drug therapy (29, 63.0%). QOL was used as the primary endpoint in 10 studies (21.7%). Authors used established QOL instruments in 12 studies (26.1%), developed original instruments in 8 studies (17.5%) and assessed the symptoms or performance status in 10 studies (21.7%). Authors conceptually defined QOL in only 6 studies (13.0%). Neither response rate nor number of respondents for questionnaire surveys was specified in 16 studies (34.8%); furthermore, 11 studies (23.9%) did not describe respondents' attributes. CONCLUSIONS: Findings on relative frequency suggested that Japanese authors of RCT reports have less interest in QOL instruments than other international researchers in Western Europe and North America. Examination of RCT reports published from Japan revealed that there were several points to be improved in reporting QOL

instruments. This study highlights the need to define QOL measures specific to clinical specialty and to examine methodology for assessing and reporting QOL. Publication Types: •

Review

PMID: 15217517 [PubMed - indexed for MEDLINE] PMCID: PMC449732

1003: Health Policy Plan. 2004 Jul;19(4):187-98. Related Articles, Links

Effectiveness of an NGO primary health care programme in rural Bangladesh: evidence from the management information system. Mercer A, Khan MH, Daulatuzzaman M, Reid J. Centre for Health and Population Research, ICDDR,B, Mohakali, Dhaka, Bangladesh. [email protected] This paper considers evidence of the effectiveness of a non-governmental organization (NGO) primary health care programme in rural Bangladesh. It is based on data from the programme's management information system reported by 27 partner NGOs from 1996-2002. The data indicate relatively high coverage has been achieved for reproductive and child health services, as well as lower infant and child mortality. On the basis of a crude indicator of socio-economic status, the programme is poverty-focused. There is good service coverage among the poorest one-third and others, and the infant and child mortality differential has been eliminated over recent years. A rapid decline in infant mortality among the poorest from 1999-2002 reflects a reduction in neonatal mortality of about 50%. Allowing for some under-reporting and possible misclassification of deaths to the stillbirths category, neonatal mortality is relatively low in the NGO areas. The lower child and maternal mortality for the NGO areas combined, compared with estimates for Bangladesh in recent years, may at least in part be due to high coverage of reproductive and child health services. Other development programmes implemented by many of the NGOs could also have contributed. Despite the limited resources available, and the lower infant and child mortality already achieved, there appears to be scope for further prevention of deaths, particularly those due to birth asphyxia, acute respiratory infection, diarrhoeal disease and accidents. Maternal mortality in the NGO areas was lower in 2000-02 than the most recent estimate for Bangladesh. Further reduction is likely to

depend on improved access to qualified community midwives and essential obstetric care at government referral facilities. PMID: 15208275 [PubMed - indexed for MEDLINE] 1004: Med Teach. 2004 May;26(3):215-22. Related Articles, Links

Medical education in China's leading medical schools. Schwarz MR, Wojtczak A, Zhou T. China Medical Board of New York, New York, USA. This article gives a general overview of the evolution and present state of the undergraduate medical education system, programs, evaluation methods and conferred degrees in contemporary China. The publication is based on the information collected from on-site visits to the eight (8) leading medical universities, medical education conferences, visits to Ministries of Health and Education and their staff, and the contribution of Chinese medical education experts. As the Ministry of Education of the People's Republic of China (PRC) approves all tracks and strives for uniformity of educational programs as a cornerstone of quality, this overview reflects the general content of all five- and seven-year medical education programs that have provided the great majority of physicians since the founding of the People's Republic of China. PMID: 15203497 [PubMed - indexed for MEDLINE] 1005: Int J Environ Health Res. 2004 Jun;14(3):185-99. Related Articles, Links

Creating a GIS application for local health care planning in Saudi Arabia. Murad AA. Department of Urban & Regional Planning, King Abdulaziz University, Jeddah, Saudi Arabia. [email protected] The purpose of this paper is to show how Geographical Information Systems can be used to support health planners on a micro-scale. The first part of this paper discusses the issue that affect local health care planning which include monitoring of catchment area and facilities management. The second part defines GIS and its possible uses in the health care field. The relevant GIS functions have also been

explained. The third part of this paper discusses the created GIS application, which is made for a local health centre in Makkah City, Saudi Arabia. In this application, three sets of GIS models have been produced. These are catchment area, patient profile and patient distribution and patient flows models. The created GIS models are produced to help local health planners in their health care decision output. PMID: 15203450 [PubMed - indexed for MEDLINE] 1006: BMC Public Health. 2004 Jun 18;4:23. Related Articles, Links

Exploratory spatial data analysis for the identification of risk factors to birth defects. Wu J, Wang J, Meng B, Chen G, Pang L, Song X, Zhang K, Zhang T, Zheng X. Institute of Geographical Sciences and Nature Resources Research, CAS, Beijing 100101, P. R. China. [email protected] BACKGROUND: Birth defects, which are the major cause of infant mortality and a leading cause of disability, refer to "Any anomaly, functional or structural, that presents in infancy or later in life and is caused by events preceding birth, whether inherited, or acquired (ICBDMS)". However, the risk factors associated with heredity and/or environment are very difficult to filter out accurately. This study selected an area with the highest ratio of neural-tube birth defect (NTBD) occurrences worldwide to identify the scale of environmental risk factors for birth defects using exploratory spatial data analysis methods. METHODS: By birth defect registers based on hospital records and investigation in villages, the number of birth defects cases within a four-year period was acquired and classified by organ system. The neural-tube birth defect ratio was calculated according to the number of births planned for each village in the study area, as the family planning policy is strictly adhered to in China. The Bayesian modeling method was used to estimate the ratio in order to remove the dependence of variance caused by different populations in each village. A recently developed statistical spatial method for detecting hotspots, Getis's 7, was used to detect the high-risk regions for neural-tube birth defects in the study area. RESULTS: After the Bayesian modeling method was used to calculate the ratio of neural-tube birth defects occurrences, Getis's statistics method was used in different distance scales. Two typical clustering phenomena were present in the study area. One was related to socioeconomic activities, and the other was related to soil type distributions. CONCLUSION: The fact that there were two typical hotspot clustering phenomena provides evidence that the risk for neural-tube birth defect exists on two different scales (a socioeconomic scale at 6.84 km and a soil type scale at

22.8 km) for the area studied. Although our study has limited spatial exploratory data for the analysis of the neural-tube birth defect occurrence ratio and for finding clues to risk factors, this result provides effective clues for further physical, chemical and even more molecular laboratory testing according to these two spatial scales. Publication Types: •

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

PMID: 15202947 [PubMed - indexed for MEDLINE] PMCID: PMC441386

1007: Rev Sci Tech. 2004 Apr;23(1):285-95; discussion 391-401. Related Articles, Links

Afghanistan and the development of alternative systems of animal health in the absence of effective government. Schreuder BE, Ward DE. Dutch Committee for Afghanistan, Edelhertweg 15, P.O. Box 72, 8200 AB, Lelystad, The Netherlands. This case study describes the efforts by both non-governmental organisations and United Nations agencies to develop an alternative system for delivering animal health services in Afghanistan, during a period in which there was effectively no government. The authors examine the period from the mid-1980s to the year 2003. During this time, Afghanistan experienced war and severe civil unrest, resulting in the collapse of the veterinary infrastructure. As most trained animal health professionals had fled the country, an initial emphasis was placed on training intermediate and lower-level veterinary auxiliary personnel, as well as on the implementation of emergency treatment and vaccination campaigns. Gradually this programme has developed from an emergency-oriented approach to a more development-oriented process, resulting in a community-based system of animal health care in more than 250 districts (out of approximately 360). Some 500 paraveterinarians, trained for a period of five months, play a pivotal role in this programme, supported in outlying villages by trained vaccinators and basic veterinary workers. In this paper, the authors present an estimation of the impact of this programme. Essential elements of the programme are, as follows: the recruitment of trainees from areas where need has been identified; an emphasis on practical and problem-oriented training; the deployment of staff in so-called 'veterinary field units', supervised by more highly qualified staff and monitors; a

guaranteed supply of veterinary medicines, anthelmintics and vaccines; a gradually increasing rate of cost recovery. The ultimate objective of the programme is to establish a self-sustaining system, based on the 'user-pays' principle. The paper concludes by describing the present-day problems of the animal health infrastructure in Afghanistan. Not only must the new government try to regain its central position, it must also assimilate two decades of development in the veterinary sector, which has occurred largely outside governmental control. Publication Types: •

Review

PMID: 15200103 [PubMed - indexed for MEDLINE] 1008: Can J Cardiol. 2004 May 15;20(7):679. Related Articles, Links

Insourcing and outsourcing. Malik P. Queen's University, Kingston, Ontario, Canada. [email protected] PMID: 15197417 [PubMed - indexed for MEDLINE] 1009: J Adv Nurs. 2004 Jul;47(2):223-9. Related Articles, Links

Characteristics of falls in hospitalized patients. Kerzman H, Chetrit A, Brin L, Toren O. Nursing Research Unit, Nursing Division, Chaim Sheba Medical Center, Tel Hashomer, Israel. [email protected] BACKGROUND: The high incidence of patient falls in a hospital setting is a major concern in any health system. Research findings have reported the risk factors for these falls as age, gender, certain medications, mental status, chronic diseases and environmental factors. Falls may lead to fear, pain, slight or severe injuries, increase the duration of hospital stay, cause patient discomfort and affect quality of life. AIM: The aim of this paper is to report a study of the characteristics of patient falls during hospitalization in 1998 and compare them

with those in the period 1978-1981. METHODS: A retrospective study was performed in a large, 2000-bed medical center in Israel. Reports of 711 fall incidents in 1998 were compared with 328 reports in 1978-1981. Information gathered included age, gender, department, shift, reasons, severity of injury, tests and treatment after injury. RESULTS: The rates of falls per 1000 admissions in psychiatric, elder care and rehabilitation departments in 1998 were statistically significantly higher than in the earlier period. Rates of 115, 91, 85, respectively, per 1000 admissions were reported in 1998 compared with 34, 9, 19, respectively, in the period 1978-1981. The percentage of reported falls in the younger age group (under 50) was higher in the later survey (1998), and a higher proportion occurred outside the patient's room. Most of the reported falls in 1998 occurred during the morning shift (P < 0.001). CONCLUSIONS: The increased number of falls could be an outcome of increased awareness. Nevertheless, the causes and place of falls differ for the two periods. Some of the reasons may be related to an intervention programme carried out after the first survey. The latest survey results will serve as an important basis for a further intervention programme in specific departments to ensure patient safety. Publication Types: •

Comparative Study

PMID: 15196196 [PubMed - indexed for MEDLINE] 1010: Arch Environ Contam Toxicol. 2004 Apr;46(3):413-8. Related Articles, Links

No effects of hematuria and proteinuria in school days, and probably current pregnancy and current lactation also, as risk factors of cadmium-induced renal tubular dysfunction among adult women in general populations in Japan. Tsukahara T, Ezaki T, Moriguchi J, Furuki K, Fukui Y, Ukai H, Okamoto S, Sakurai H, Ikeda M. Kyoto Industrial Health Association, 67 Nishinokyo-Kitatsuboicho, Nakagyoku, Kyoto 604-8472, Japan. This study was initiated to examine if hematuria and proteinuria in school days, current pregnancy, or current lactation are risk factors of cadmium-induced tubular dysfunction for adult women among general populations in Japan. For this purpose, a database of 9,967 never-smoking adult women were reviewed for urinary levels of cadmium (Cd) and three other elements, calcium (Ca), magnesium (Mg), and zinc (Zn), and two tubular dysfunction markers of alpha1-

microglobulin (alpha1-MG) and beta2-microglobulin (beta2-MG); the analyte concentrations were corrected for creatinine (cr) and expressed as, e.g., Cd-Ucr. From the total, 160 cases were selected as those who were informed of urinary abnormality (i.e., proteinuria, hematuria, or both) in their school days (the abnormality being found to be transient, later), and each case was matched by age and prefecture of residence. Separately, seven women with persistent urinary abnormality, seven pregnant women, and six lactating women were identified, and the case was matched with three cases each of the same age and living in the same prefecture. Statistical analyses showed that Cd-Ucr and other markers were not elevated in the transient urinary abnormality group as compared with the matched controls. This was also observed in the subjects with persistent abnormality. In the pregnant women, alpha1-MG-Ucr and possibly beta2-MG-Ucr were elevated, but Cd-Ucr did not increase, suggesting that the observed elevation in alpha1-MG and beta2-MG was not due to the effects of Cd but a part of the physiology of pregnancy itself. There was no change in marker levels in lactating women except for an increase in alpha1-MG. In overall evaluation, it was considered prudent to conclude that urinary abnormality in school days does not increase the risk of Cd-induced nephrotoxicity in adult women, whereas the negative findings with pregnancy and lactation should be taken as preliminary because the numbers of cases studied were limited. Publication Types: •

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

PMID: 15195814 [PubMed - indexed for MEDLINE] 1011: J Clin Nurs. 2004 Jul;13(5):580-8. Related Articles, Links

Kidney transplantation: determination of the problems encountered by Turkish patients and their knowledge and practices on healthy living. Talas MS, Bayraktar N. Ankara University School of Health, 06340 Altindağ Ankara, Turkey. [email protected] BACKGROUND: Although renal transplantations remove many limitations, dialysis can improve quality life in patients with end-stage renal disease, once transplantation has been performed and the patient has been discharged with a functioning graft, life with a chronic illness continues. AIMS AND OBJECTIVES: This study was carried out to define problems encountered by

patients undergoing kidney transplantation and their knowledge and practices on healthy living. DESIGN: This study was designed as a retrospective and descriptive survey. METHODS: This study was performed on 125 patients who were followed at Social Insurance Institute's Ankara Specialty Hospital Transplantation Clinic between March and August 2001. A convenience sample was drawn from the population of renal transplant patients. A questionnaire was prepared based on the literature, which included patients' socio-demographic information, physiological problems, diseases and repeated hospitalizations; sideeffects and usage of immunosuppressive drugs, knowledge and practices of patients regarding healthy living and their knowledge needs. Data were collected through interviews. Percentage and chi-square test were used in evaluation of the data. RESULTS: Physiological problems and diseases after renal transplantations were seen such as 38.4% had infections in urinary and respiratory tract. Some had hypertension (22.4%) hypercholesterolaemia (26.5%) and 5.6% had malignancy. Most (67.2%) developed antirejection drugs side-effects. About 55.2% were admitted to hospital after renal transplantation and 68.8% had not received any training after transplantation from a health professional. Only 35.2% knew the signs and symptoms of rejection entirely or partly. It was determined that 55.2% stated that they avoid sunlight and 56% stated that they exercise regularly. Only 26.8% of female patients do regular breast self-examination. While 52.8% listed the forbidden foods correctly, only 27.2% could list the forbidden beverages accurately. CONCLUSIONS: According to the results, patients undergoing renal transplantation experience various problems that may influence their quality of life adversely and their knowledge and practice is not adequate for them to continue to lead healthy lives. RELEVANCE TO CLINICAL PRACTICE: In accordance with the results of the study, offering continuing education and counselling services, preparing training guides, brochures, video cassettes and CDs for patient education, improving the national web sites to inform the public and creation of a home care system were suggested. PMID: 15189411 [PubMed - indexed for MEDLINE] 1012: Int J Fertil Womens Med. 2004 Mar-Apr;49(2):91-6. Related Articles, Links

Initiating a novel therapy in preventing postpartum hemorrhage in rural India: a joint collaboration between the United States and India. Kodkany BS, Derman RJ, Goudar SS, Geller SE, Edlavitch SA, Naik VA, Patel A, Bellad MB, Patted SS. Human Reproduction Research Collaborating Center (ICMR), J N Medical College, Balgaum, Karnataka, India. BACKGROUND: Maternal mortality rates in India are estimated at 560/100,000

live births and postpartum hemorrhage (PPH) accounts for 35-56% of these deaths. Given that 50% of births in rural India occur at home, oral Misoprostol administered by minimally trained midwives may be an effective uterotonic agent for preventing PPH when the use of other uterotonics is not feasible. While the import for testing the effectiveness of this intervention may be readily obvious, the elements essential for the conduct of a scientific study in rural areas served by indigenous health workers may not be as evident. METHODS: We present the design as well as the preparation and development of an ongoing NICHD sponsored U.S.-Indian collaborative randomized, placebo-controlled, clinical trial (RCT) conducted in four Primary Health Center areas of Belgaum District, Karnataka, India. The primary goal of the trial is to assess the effectiveness of Misoprostol 600 microg orally in reducing the incidence of acute PPH (> or = 500 mL) in women delivering at home or in neighboring sub-centers. 1600 pregnant women will be randomized to receive Misoprostol or placebo immediately postdelivery of the infant. However, beyond testing the scientific merit of the RCT, this study also tests the feasibility of having indigenous midwives regularly using Misoprostol in rural areas as well as the willingness of these communities to accept this intervention. In addition, this paper also explores the international and community collaborations necessary for the conduct of this study. FINDINGS: It is necessary to have several critical elements in place, including international collaboration between the Indian and US research sites, funding through a private/public collaboration and trained scientists, as well as commitment from the community for the successful conduct of such a study. In the development and implementation of a RCT, careful attention must be paid to the training of field personnel involved in the delivery process and developing a data collection and monitoring system to ensure that information gathered is valid. CONCLUSIONS: A joint U.S.-Indian collaboration to test the efficacy and the feasibility of an innovative method to reduce PPH can serve as collaborative model to develop additional interventions to improve maternal mortality and morbidity. If Misoprostol is shown to be sufficiently safe and efficacious in the prevention of PPH, the appropriate government agencies will be encouraged to make the drug available to midwives (ANMs) and rurally located physicians for whom parenteral medications are either not permitted or impractical and/or unavailable. Such a project can serve as a model applicable to rural settings throughout the developing world for improving delivery practices and reducing maternal mortality and morbidity. These are important public health concerns in India and other developing nations. Publication Types: • •

Clinical Trial Randomized Controlled Trial

PMID: 15188836 [PubMed - indexed for MEDLINE]

1013: Vet Parasitol. 2004 Jun 21;122(2):141-9. Related Articles, Links

A geographic information systems model for mapping risk of fasciolosis in cattle and buffaloes in Cambodia. Tum S, Puotinen ML, Copeman DB. Department of Animal Production and Health, 74 Monivong Boulivard, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia. A geographic information systems (GIS) model for mapping the risk of fasciolosis in cattle and buffaloes was developed for the Kingdom of Cambodia using determinants of inundation, proximity to rivers, land use, slope, elevation, and the density of cattle and buffaloes. Determinants were subjectively weighted according to their perceived relative importance before combining them to produce a risk-map of fasciolosis. The model estimates that 28% of Cambodia is potentially at risk of fasciolosis with areas of high and moderate risk concentrated in southern and central Cambodia. The estimates of risk reflect the actual prevalence of fasciolosis in most districts surveyed, suggesting that the epidemiological determinants and weightings used to produce the model were appropriate. These results will be progressively refined as more detailed field surveys are completed to fully validate the model. Publication Types: •

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

PMID: 15177719 [PubMed - indexed for MEDLINE] 1014: J Formos Med Assoc. 2004 Apr;103(4):280-5. Related Articles, Links

Outpatient drug expenditures and prescription policies for diseases with high cost to the National Health Insurance system in Taiwan. Lang HC, Lai MS, Chen GT. Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan. BACKGROUND AND PURPOSE: The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed

a new classification scheme for reimbursing drug cost and estimated its impact on expenditures and health care utilization. METHODS: Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors were used to classify medications: 1) urgency of medications required; and 2) patient's selfcare ability. RESULTS: Among the 10 diseases with the highest number of outpatient department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infections (URIs) and acute nasopharyngitis were the 2 diseases with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' selfcare accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications unsuitable for patients' self-care accounted for 36.8%. CONCLUSIONS: Reducing the medications suitable for patients' self-care and enforcing different levels of payment rates on medications unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute URIs and the common cold, and allow medical resources to be distributed more efficiently. PMID: 15175823 [PubMed - indexed for MEDLINE] 1015: Nippon Rinsho. 2004 Apr;62 Suppl 4:348-54. Related Articles, Links

[Social support network for patients with dementia] [Article in Japanese] Hirono N. Faculty of Health Sciences, Ehime University School of Medicine. PMID: 15174699 [PubMed - indexed for MEDLINE] 1016: Obstet Gynecol. 2004 Jun;103(6):1273-7. Related Articles, Links

Beta-thalassemia minor during pregnancy. Sheiner E, Levy A, Yerushalmi R, Katz M.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel. [email protected] OBJECTIVE: To investigate pregnancy outcome of patients with betathalassemia minor. METHODS: A population-based study comparing all pregnancies of women with and without beta-thalassemia minor was conducted. Deliveries occurred during the years 1988-2002 at Soroka University Medical Center. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with maternal betathalassemia minor. RESULTS: During the study period there were 159,195 deliveries, of which 261 (0.2%) occurred in patients with beta-thalassemia minor. The following conditions were significantly associated with beta-thalassemia minor: oligohydramnios (odds ratio [OR] 2.1; 95% confidence interval [CI] 1.2%, 3.7%), intrauterine growth restriction (IUGR; OR 2.4; 95% CI 1.4%, 4.2%), Jewish ethnicity (OR 1.5; 95% CI 1.2%, 1.9%), and previous cesarean delivery (OR 1.4; 95% CI 1.1%, 2.0%). No significant differences were noted between the groups regarding perinatal outcomes such as birth weight, low Apgar scores, congenital malformations, or perinatal mortality. Patients with beta-thalassemia minor were more likely to have cesarean deliveries than were the nonthalassemic parturients (16.9% and 12.2%, respectively; P =.021). However, while controlling for possible confounders such as IUGR, oligohydramnios, and previous cesarean delivery, with another multivariate analysis with cesarean delivery as the outcome variable, beta-thalassemia minor was not found as an independent risk factor for cesarean delivery (OR 1.3; 95% CI 0.9%, 1.9%). CONCLUSION: The course of pregnancy of patients with thalassemia minor, including perinatal outcomes, is favorable. Because higher rates of IUGR were found, we recommend ultrasound surveillance of fetal weight for early detection of IUGR. LEVEL OF EVIDENCE: II-2 PMID: 15172864 [PubMed - indexed for MEDLINE] 1017: Lancet Infect Dis. 2004 Jun;4(6):327-36. Related Articles, Links

The global distribution and population at risk of malaria: past, present, and future. Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW. TALA Research Group, Department of Zoology, University of Oxford, Oxford, UK. [email protected] The aim of this review was to use geographic information systems in combination

with historical maps to quantify the anthropogenic impact on the distribution of malaria in the 20th century. The nature of the cartographic record enabled global and regional patterns in the spatial limits of malaria to be investigated at six intervals between 1900 and 2002. Contemporaneous population surfaces also allowed changes in the numbers of people living in areas of malaria risk to be quantified. These data showed that during the past century, despite human activities reducing by half the land area supporting malaria, demographic changes resulted in a 2 billion increase in the total population exposed to malaria risk. Furthermore, stratifying the present day malaria extent by endemicity class and examining regional differences highlighted that nearly 1 billion people are exposed to hypoendemic and mesoendemic malaria in southeast Asia. We further concluded that some distortion in estimates of the regional distribution of malaria burden could have resulted from different methods used to calculate burden in Africa. Crude estimates of the national prevalence of Plasmodium falciparum infection based on endemicity maps corroborate these assertions. Finally, population projections for 2010 were used to investigate the potential effect of future demographic changes. These indicated that although population growth will not substantially change the regional distribution of people at malaria risk, around 400 million births will occur within the boundary of current distribution of malaria by 2010: the date by which the Roll Back Malaria initiative is challenged to halve the world's malaria burden. Publication Types: • •

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

PMID: 15172341 [PubMed - indexed for MEDLINE] 1018: Int J Med Inform. 2004 Jun 15;73(5):415-31. Related Articles, Links

Do doctors act on their self-reported intention to computerize? A follow-up population-based survey in Hong Kong. Lai TY, Leung GM, Wong IO, Johnston JM. Department of Community Medicine, Faculty of Medicine Building, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, PR China. BACKGROUND AND OBJECTIVES: We performed a follow-up survey to document changes in the level of computerization among physicians in Hong Kong between 2000 and 2001, specifically examining whether their self-reported intention to computerize various clinical or administrative tasks actually

translated into computerization of these tasks 1 year later. Determining such a relationship will indicate the reliability, and thus the utility of questions regarding self-reported intention to computerize clinical practice. METHODS: A selfcompleted follow-up postal questionnaire was sent to all 949 physicians who responded to the original questionnaire. Pairwise repeated dichotomous responses from 2000 and 2001 on the computerization of specific functions were compared using McNemar test. Wilcoxon sign-ranked test was employed to compare the total number of tasks computerized in the 2 years. Multivariate logistic regression modeling was carried out to determine predictors for the translation of intention to computerize into actual computerization. RESULTS: The response rate was 77.0%. There was a significant increase in the number of tasks computerized for both "corporate" and "individual" practices between 2000 and 2001. The proportion of physicians who intended to computerize and actually computerized ranged from 7.7 to 51.0% for different tasks. For five clinical tasks, more than 50% respondents in corporate practices translated the intention to implementation, compared to fewer than 20% in individual practices. Predictors found to be associated with the translation of intention to computerize into actual computerization included higher number of tasks intended to computerize, higher number of tasks already computerized, and more positive physicians' attitudes on the impact of computerization to clinical practice. CONCLUSIONS: We conclude that physicians' self-reported intention to computerize the clinical practice 12 months previously was moderately associated with actual implementation, with varying degrees of concordance for different clinical and administrative tasks. The identified predictors for the translation of intention to actual computerization may be useful in targeting specific strategies to promote computerization of clinical practice. Publication Types: •

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

PMID: 15171983 [PubMed - indexed for MEDLINE] 1019: Int J Med Inform. 2004 Jun 15;73(5):403-14. Related Articles, Links

Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong. Leung GM, Yeung RY, Lai TY, Johnston JM, Tin KY, Wong IO, Woo PP, Ho LM. Department of Community Medicine, Faculty of Medicine Building, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, PR China.

[email protected] BACKGROUND AND OBJECTIVES: We evaluated factors associated with physicians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valuation to quantify physicians' perceived benefits from computerization in a hypothetical ambulatory, solo clinic. METHODS: We surveyed 949 representative physicians in Hong Kong by post. Factor analysis was performed to summarize similar items into categories. Multivariable loglinear regression models were employed to assess the relationships between different factor scores and the number of functions computerized. We elicited their willingness-to-pay (WTP) for three defined computer systems using contingent valuation techniques. WTP values were estimated using econometric modeling by both, parametric and geometric methods. Sociodemographic, attitudinal, and practice-related predictors of WTP were estimated through regression analyses. RESULTS: Factor analysis revealed a three-factor solution which explained 53% of total variance. The overall mean score (mean = 3.51 +/0.45) showed a generally positive attitude towards the effects of computers on health care. Respondents with a higher level of computer knowledge had significantly higher mean overall (P = 0.002) and factor scores for all three factors (P < 0.01). Higher factor scores on the effects of computers on patient care and clinicians (P = 0.006) and on the health system (P = 0.032) were associated with a higher number of functions computerized. The parametric median WTP values for computerizing administrative, clinical, and both sets of functions were HK dollars 21205 (US dollars 2719), HK dollars 34231 (US dollars 4389), and HK dollars 45720 (US dollars 5862), respectively, which were lower than the estimates obtained from demand curves using the geometric method [HK dollars 43286 (US dollars 5549), HK dollars 59570 (US dollars 7637), and HK dollars 84623 (US dollars 10849), respectively]. Doctors with higher incomes were willing to pay more to computerize the clinic, with strong dose-response gradients demonstrated. Those who worked in corporate settings were also more likely to accept higher WTP values. CONCLUSIONS: Our findings confirm that better knowledge about computers is contributory to a more positive attitude towards the effects of computers on health care, which is in turn significantly associated with higher levels of actual computerization in clinical practice. WTP values represent the likelihood, in monetary terms, of translating doctors' perceived benefits from computerization into investment action. Publication Types: • •

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

PMID: 15171982 [PubMed - indexed for MEDLINE]

1020: J Hum Genet. 2004;49(7):391-5. Epub 2004 May 27. Related Articles, Links

Identification and evaluation of 55 genetic variations in the BRCA1 and the BRCA2 genes of patients from 50 Japanese breast cancer families. Kawahara M, Sakayori M, Shiraishi K, Nomizu T, Takeda M, Abe R, Ohuchi N, Takenoshita S, Ishioka C. Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan. We sequenced approximately 23 kb genomic regions containing all the coding exons and their franking introns of two breast cancer susceptibility genes, BRCA1 and BRCA2, of 55 individuals from 50 unrelated Japanese breast cancer families. We identified 55 single-nucleotide polymorphisms (SNPs) (21 in BRCA1 and 34 in BRCA2) containing nine pathogenic protein-truncating mutations (four in BRCA1 and five in BRCA2 from ten patients). Among the remaining 46 SNPs, allele frequencies of 40 were examined in both the breast cancer patients and 28 healthy volunteers with no breast cancer family history by PCR-RFLP or by direct DNA sequencing. Twenty-eight SNPs were common and were also found in the healthy volunteers and/or a SNP database. The remaining 18 were rare (allele frequency <0.05) and were not found in the healthy volunteers and/or the database. The pathogenic significance of these coding SNPs (cSNPs) remains to be clarified. The SNP information from this study will be useful in the future genetic testing of both BRCA1 and BRCA2 genes in the Japanese population. Publication Types: •

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

PMID: 15168169 [PubMed - indexed for MEDLINE] 1021: J Huazhong Univ Sci Technolog Med Sci. 2004;24(1):103-6. Related Articles, Links

Quantitative analysis on economic contribution of community health service in China. Zhang X, Wang T. Tongji Medical College, Huazhong University of Science and Technology,

Wuhan 430030. In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service. PMID: 15165130 [PubMed - indexed for MEDLINE] 1022: Osteoporos Int. 2004 Dec;15(12):998-1002. Epub 2004 May 20. Related Articles, Links

High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Chie WC, Yang RS, Liu JP, Tsai KS. School of Public Health, College of Public Health, College of Medicine, National Taiwan University, Taipei, Taiwan. The objective of this study was to describe the incidence rate of hip fracture from 1996 to 2000 in Taiwan, based on an inpatient database of the National Health Insurance Program. A total of 54,199 patients, who had a first-time admission for a diagnosis of hip fracture (ICD9 code 820.0 through 820.9, 820.21, 820.22, and 820.31) on discharge from January 1996 through December 2000 and aged 50 to 100 years, were identified and included in the study. The results showed that the age-specific incidence rates of hip fractures were higher with increasing age in both genders, in an exponential manner after 65 years of age. The incidence was 1.6 times higher and rose about 5 years earlier among women than among men. Thus in these 5 years the age-adjusted incidence rates (95% confidence interval) of hip fracture in Taiwan were 225 (95% CI, 188-263) per 100,000 in men and 505 (95% CI, 423-585) per 100,000 in women (adjusted to US white population of 1989), as compared with US white rate of 187 in men and 535 in women. More than half of the fractures were peritrochanteric, and the recorded cause in most cases was a fall on the same level, from slipping, tripping, or stumbling (ICD9 E885). A total of 37.8% patients had hip hemiarthroplasty, 51.2% had open reduction of fracture with internal fixation, and 10.5% had closed reduction of

fracture with internal fixation. We concluded that, using the data from a nationwide health insurance database of Taiwan, we found a high annual incidence rate of hip fracture for both men and women in 5 consecutive years. These incidence rates were higher than other reports on Chinese populations reported in the past 10 years and similar to that of Western countries. With the rapid aging of the populations of Taiwan and other Asian countries in the years to come, our results clearly demonstrated the impact of osteoporosis and hip fracture in this region. Publication Types: •

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

PMID: 15156304 [PubMed - indexed for MEDLINE] 1023: Drug Saf. 2004;27(8):491-7. Related Articles, Links

Risk management from an Asian/Pacific Rim regulatory perspective. McEwen J. Therapeutic Goods Administration, Woden, ACT, Australia. [email protected] This article reviews the state of adverse drug reaction monitoring in five Asian/Pacific Rim countries (Australia, Japan, Malaysia, New Zealand and Singapore). Each country has an active pharmacovigilance programme managed by a national regulatory agency. Current methods for assessing risks and current methods used for risk management and communication are compared with the 'tools' used by the US FDA. Major positive attributes of the programmes in all five countries include active involvement of independent expert clinical advisory committees in identifying and evaluating risks through the assessment of reports of serious and unusual reactions, and regular communications about risks from the national agencies to doctors and pharmacists by means of pharmacovigilance bulletins. Most components of the risk-management toolbox are currently used, in some instances without legislated support. Variations in the way risk-management tools are implemented within individual national health systems are illustrated. Publication Types: •

Review

PMID: 15154822 [PubMed - indexed for MEDLINE] 1024: Rinsho Shinkeigaku. 2003 Nov;43(11):840-2. Related Articles, Links

[Clinical practice guidelines in Japan: toward their appropriate use and diffusion] [Article in Japanese] Nakayama T. Department of Health Informatics, Kyoto University School of Public Health. In Japan, the governmental report on health technology assessment in 1999 referred to the need to develop evidence-based clinical practice guidelines. The Ministry of Health and Welfare established priorities for the development of clinical practice guidelines, and started several projects. About 20 clinical practice guidelines are to be developed by 2004. However, what "guideline" means and how "guidelines" work are unclear because the word "guideline" is ambiguous in Japan. Although it is generally accepted that "directives are stronger than recommendations, which are stronger than guidelines" in the western countries, Japanese people do not usually recognize these distinctions and tend to regard guidelines as mandatory directives even in individual cases. Patients, consumers and legal professionals may overestimate the authority of clinical practice guidelines when they see them. What clinical practice guidelines are, or are not should be clarified appropriately. Autumn 2003, the Japan Council for Quality Health Care will open the information service that provides practice guidelines and related literature. This will be accessible to both healthcare professionals and the general public. Much remains to be done to bring other stakeholders to the table. All of Japanese society can, and needs to, participate in the process of developing a consensus on clinical practice guidelines. Publication Types: • •

English Abstract Review

PMID: 15152480 [PubMed - indexed for MEDLINE] 1025: Br J Cancer. 2004 Jun 1;90(11):2157-66. Related Articles, Links

Estimation and projection of the national profile of cancer mortality in China: 1991-2005. Yang L, Parkin DM, Li LD, Chen YD, Bray F. International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. [email protected] There are no national-level data on cancer mortality in China since two surveys in 1973-1975 and 1990-1992 (a 10% sample), but ongoing surveillance systems, based on nonrandom selected populations, give an indication as to the trends for major cancers. Based on a log-linear regression model with Poisson errors, the annual rates of change for 10 cancers and all other cancers combined, by age, sex and urban/rural residence were estimated from the data of the surveillance system of the Center for Health Information and Statistics, covering about 10% of the national population. These rates of change were applied to the survey data of 1990-1992 to estimate national mortality in the year 2000, and to make projections for 2005. Mortality rates for all cancers combined, adjusted for age, are predicted to change little between 1991 and 2005 (-0.8% in men and +2.5% in women), but population growth and ageing will result in an increasing number of deaths, from 1.2 to 1.8 million. The largest predicted increases are for the numbers of female breast (+155.4%) and lung cancers (+112.1% in men, +153.5% in women). For these two sites, mortality rates will almost double. Cancer will make an increasing contribution to the burden of diseases in China in the 21st century. The marked increases in risk of cancers of the lung, female breast and large bowel indicate priorities for prevention and control. The increasing trends in young age groups for cancers of the cervix, lung and female breast suggest that their predicted increases may be underestimated, and that more attention should be paid to strategies for their prevention and control. PMID: 15150609 [PubMed - indexed for MEDLINE] 1026: Scand J Caring Sci. 2004 Jun;18(2):111-9. Related Articles, Links

Support for family carers who care for an elderly person at home - a systematic literature review. Stoltz P, Udén G, Willman A. School of Health and Society, Malmö University, Malmö, Sweden. [email protected]

Family carers are a major source of help and assistance to the persons they provide care for. They are also major contributors to the welfare system, balancing the national health care expenditure. Increasing attention, in research as well as government policy, is being paid to their role as informal caregivers. Support to family carers seems to be a new 'buzzword' in Swedish Government policy. However, supporting family carers may prove to be a more complex endeavour than one initially might be led to believe. Support could here be understood as any services, assistances, education, information, attitudes, and lay or professional person's provision for the benefit of the family carer. The aim of this systematic review was to identify modes of, and scientific evidence on, support for family carers of cohabiting elderly persons. The method followed a seven-step model: a focused research question was formulated creating a base for deriving search words and inclusion and exclusion criteria for studies. Systematic database searches identified several studies some of which were retrieved, critically appraised and classified by two independent reviewers. A total of 26 articles were finally included, revealing that family carers fear social isolation and wish to network in groups with peers, either for social or for learning needs purposes. Family carers also desire respite care. However, it is unclear whether they actually benefit from any of the above or how service provision should be attempted. Publication Types: • •

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

PMID: 15147473 [PubMed - indexed for MEDLINE] 1027: Public Health Nurs. 2004 May-Jun;21(3):287-94. Related Articles, Links

The evolution of the community health nurse practitioner in Korea. Cho HS, Kashka MS. College of Nursing, Texas Women's University, Dallas, 75235-7299, USA. [email protected] Community health nursing in Korea has undergone dramatic changes since 1980. These changes arose through the efforts of Mo Im Kim, an internationally known leader in Korean nursing, and colleagues who successfully worked to establish a national community health nurse practitioner program. This article will review these changes with the aim of describing the evolutionary process that culminated in a community health care system that is meeting the needs of Korean citizens

who live in rural and isolated areas. The authors believe that the evolution of the community health nurse practitioner in Korea provides a paradigm that can serve as a model for other countries. Health care in Korea is organized differently than that in the United States. However, the plan, process, and political activism can be used for community and public health nursing change in the United States. The information contained in this article is based upon interviews with Mo Im Kim and 20 of her colleagues and associates. Interviewees were selected using a "snowball" sampling technique. Additional data were derived from various professional and personal documents of these individuals. The first author conducted the interviews in both Korea and in the United States. PMID: 15144373 [PubMed - indexed for MEDLINE] 1028: Harefuah. 2004 Feb;143(2):111-5, 167, 166. Related Articles, Links

[Road traffic accidents--severe injuries. Decision-making on the basis of partial data] [Article in Hebrew] Peleg K, Aharonson-Daniel L. BACKGROUND: Road traffic accidents are the cause of approximately one quarter of trauma hospitalizations in Israel. A comparison of figures on severe traffic injuries, as published by the Israeli Central Bureau of Statistics (CBS) and the Israeli Police with data from registries in medical systems, revealed significant disparities. AIMS: To present gaps between registries and the possible consequences that presenting incomplete data to decision makers may have on their ability to set policy for reducing road traffic accidents. RESULTS: The number of severe injuries according to the CBS, the National Council for Road Safety and the Israeli Police ranges from 3,378 to 2,573 per year, for the period 1998-2000. During the same time period, the national trauma registry that recorded data at only eight hospitals (of the 24 hospitals in the country), noted a total of 4,442 to 4,800 patients per year. The Ministry of Health's data, that includes figures from most of the hospitals in the country, reports between 10,290 to 11,009 road traffic accident hospitalizations per year for this same period of time. The CBS data is the formal national data, hence the database which decision makers use when considering the number of casualties due to road accidents consists of less than half of the actual number of cases. Furthermore, it is not a representative sample. When decisions are made without data, one uses common sense and reason. However, when the decision maker is presented with information, he assumes that these are valid, reliable, representative, well established data and relates to the information as such in the decision making process. If data is misleading, decisions may be ill-advised. SUMMARY AND CONCLUSION: Gaps in information are presented, posing a question on the

possible effect that the interpretation of partial data by decision makers may have on the decisions they make. It is strongly advocated that collaboration is needed between police and health agencies and that a system for collecting and analyzing data on road traffic casualties be established to combine health and police data. The existence of a reliable, complete and valid database is essential in order to succeed in the important battle to reduce morbidity and mortality from road traffic accidents. Publication Types: • •

English Abstract Review

PMID: 15143700 [PubMed - indexed for MEDLINE] 1029: Natl Med J India. 2004 Mar-Apr;17(2):74-9. Related Articles, Links

Deaths due to road traffic crashed in Hyderabad city in India: need for strengthening surveillance. Dandona R, Mishra A. Centre for Public Health Research, Administrative Staff College of India, Bella Vista, Raj Bhavan Road, Hyderabad 500082, India. [email protected] BACKGROUND: Road traffic crashes are an important cause of death and disability in India. Reliable and accurate data are necessary to plan strategies to reduce death and disability due to road traffic crashes. We assessed the utility of the available data on deaths due to road traffic crashes for road crash surveillance for a major metropolitan city of southern India. METHODS: We analysed the Department of Police database on deaths due to road traffic crashes for 2002 in Hyderabad, southern India and collected data from a leading newspaper for the same information using a standardized format. RESULTS: A total of 3039 cases of road traffic crashes were recorded in the police database for 2002, including 400 cases (13.2%) in which 411 people were killed. In the same year, 316 cases of road traffic crashes resulting in 353 deaths were reported in the newspaper. The majority of those who died due to these crashes were males. Seventy per cent of those killed were between 16 and 49 years of age. Pedestrians and riders of twowheelers were the most vulnerable. Collision with a vehicle caused 86.4% of all crashes and 60% of the victims died before reaching a hospital. The available data were not comprehensive enough to provide a thorough basis for planning intervention strategies to reduce fatalities due to road crashes. CONCLUSION: Despite the gaps in reporting of fatalities in road traffic crashes in these data sources, they provide insights into the magnitude and nature of deaths resulting

from such crashes in Hyderabad. The available data have limitations and there is a need for strengthening the road traffic crash surveillance system to have reliable, accurate and adequate data on road traffic crashes and the resulting fatalities and injuries. These could then form the basis for planning effective intervention strategies to improve road safety. PMID: 15141599 [PubMed - indexed for MEDLINE] 1030: Am J Emerg Med. 2004 May;22(3):164-70. Related Articles, Links

A geographic information system simulation model of EMS: reducing ambulance response time. Peleg K, Pliskin JS. Trauma and Emergency Medicine Research Unit, The Gertner Institute for Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel. [email protected] Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. All calls that were pinpointed geographically by the GIS were included, and their data were stratified by weekday and by daily shifts. Geographic areas (polygons) of, at most, 8 minutes response time were simulated for each of these subgroups to maximize the timely response of calls. Before using the GIS model, mean response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes, respectively, with 34% and 62% of calls responded within 8 minutes. When ambulances were positioned within the modeled polygons, more than 94% of calls met the 8-minute criterion. The GIS simulation model presented in this study suggests that EMS could be more effective if a dynamic load-responsive ambulance deployment is adopted, potentially resulting in increased survival and cost-effectiveness. Publication Types: • •

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

PMID: 15138950 [PubMed - indexed for MEDLINE]

1031: J Environ Sci (China). 2004;16(2):332-8. Related Articles, Links

An analysis on spatial variation of urban human thermal comfort in Hangzhou, China. Wang WW, Zhu LZ, Wang RC. College of Environmental and Resource Sciences, Zhejiang University, Hangzhou 310029, China. [email protected] Urban human thermal comfort (UHTC) is affected for interacting of weather condition and underlying surface framework of urban area. Urban underlying surface temperature value and Normalized Difference Vegetation Index (NDVI) were calculated using image interpreting and supervised classification technique by ERDAS IMAGE software using 1991 and 1999 Landsat TM images data. Reference to the relational standard of assessing human thermal comfort and other meteorology data of Hangzhou City in summer, air temperature and relative humidity variation of different land types of underlying surface were inversed. By choosing discomfort index as an indictor, the spatial distribution characteristic and the spatial variation degree of UHTC were estimated and mapped on a middle scale, that is, in six districts of Hangzhou. The main characteristics of UHTC spatial variation from 1991 to 1999 were revealed using a GIS-based calculation model. The variation mechanism were analyzed and discussed from the viewpoint of city planning, construction and environmental protection. PMID: 15137665 [PubMed - indexed for MEDLINE] 1032: Rinsho Byori. 2004 Mar;52(3):266-9. Related Articles, Links

[CAP quality management system in clinical laboratory and its issue] [Article in Japanese] Tazawa H. SBS, Inc., Sagamihara 229-1125. The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient

care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory. Publication Types: • •

English Abstract Review

PMID: 15137328 [PubMed - indexed for MEDLINE] 1033: Mil Med. 2004 Apr;169(4):282-7. Related Articles, Links

The patient as a client: a model for evaluation of Israel Defense Forces. Zigdon A, Robinson A, Goldberg A. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. The Israel Defense Forces (IDF) Medical Corps provides medical services-routine and emergency--to all IDF personnel (conscripts, career personnel, and reservists). Despite the fact that there are no differences in prevalence of disease in the IDF compared with the civil sector, health consumer appraisal, in the military, of the medical services they receive during peacetime at IDF medical clinics is not high. The objective of this research was to develop an effective and differential tool for monitoring the quality of medical service at IDF clinics drawn from service quality indexes based on the perspective of the soldier patient. The research tool used was an anonymous questionnaire comprised of five demographic questions and 21 components of quality index measurements that participants were asked to rank in terms of importance during a visit to their IDF

medical clinic. Those categories found to influence the client's perception of quality medical service were accessibility and availability of services, information provided by the clinic, and the efficiency of staff. The factors found to be less influential in the clients' perceptions of quality were staffing and infrastructure. Quality control using these significant indexes will allow monitoring programs to focus on components that are important from the soldier's perspective, without overlooking other significant aspects of the soldier's perceptions of the quality of medical service as a client. PMID: 15132230 [PubMed - indexed for MEDLINE] 1034: Eye. 2004 May;18(5):509-13. Related Articles, Links

Knowledge, self-help and socioeconomic factors in South Asian and Caucasian diabetic patients. Pardhan S, Mahomed I. Department of Optometry and Ophthalmic Dispensing, Anglia Polytechnic University, Cambridge, UK. [email protected] AIMS: We carried out a survey of important nonclinical issues including awareness and self-management of diabetes on a group of South Asian and Caucasian patients attending diabetic clinics within a set period. METHODS: A structured questionnaire examined various issues including demographics, perceived knowledge and awareness of diabetes, perceived self-help/support, and psycho-social factors. A total of 500 patients (268 South Asians and 232 Caucasian) took part. RESULTS: Univariate analysis showed significant differences (P<0.05) with various issues including a lower perceived awareness of diabetes and its complications in South Asians, and of the nutritional content of their diet. Asians also appeared to be less worried in the event of missed clinical appointments and if treatment was not strictly adhered to. CONCLUSIONS: The study provides evidence of the inability of health information systems to convey the importance of diabetic control to the Asian population. In order that this important information reaches the required recipients, more assertive and perhaps more culturally acceptable methods need to be explored. Publication Types: •

Comparative Study

PMID: 15131683 [PubMed - indexed for MEDLINE]

1035: Ind Health. 2004 Apr;42(2):141-8. Related Articles, Links

Occupational health research in India. Saiyed HN, Tiwari RR. National Institute of Occupational Health, Meghani Nagar, Ahmedabad-380016, Gujarat, India. India being a developing nation is faced with traditional public health problems like communicable diseases, malnutrition, poor environmental sanitation and inadequate medical care. However, globalization and rapid industrial growth in the last few years has resulted in emergence of occupational health related issues. Agriculture (cultivators i.e. land owners + agriculture labourers) is the main occupation in India giving employment to about 58% of the people. The major occupational diseases/morbidity of concern in India are silicosis, musculo-skeletal injuries, coal workers' pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis, pesticide poisoning and noise induced hearing loss. There are many agencies like National Institute of Occupational Health, Industrial Toxicology Research Centre, Central Labour Institute, etc. are working on researchable issues like Asbestos and asbestos related diseases, Pesticide poisoning, Silica related diseases other than silicosis and Musculoskeletal disorders. Still much more is to be done for improving the occupational health research. The measures such as creation of advanced research facilities, human resources development, creation of environmental and occupational health cells and development of database and information system should be taken. Publication Types: •

Review

PMID: 15128163 [PubMed - indexed for MEDLINE] 1036: Indian J Public Health. 2003 Oct-Dec;47(4):208-9. Related Articles, Links

Status of leprosy in Uttar Pradesh. Thakor HG, Mall RP, Tiwari R, Kumar A, Johri L. State Leprosy Office, Govt. Health Service, Uttar Pradesh, Swasthya Bhawan, Lucknow.

PMID: 15125563 [PubMed - indexed for MEDLINE] 1037: MMWR Surveill Summ. 2004 Apr 30;53(1):21-34. Related Articles, Links

Malaria surveillance--United States, 2002. Shah S, Filler S, Causer LM, Rowe AK, Bloland PB, Barber AM, Roberts JM, Desai MR, Parise ME, Steketee RW. Epidemic Intelligence Service, Epidemiology Program Office, CDC, USA. PROBLEM/CONDITION: Malaria is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. In the United States, cases can occur through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. PERIOD COVERED: This report covers cases with onset of illness in 2002. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood film are reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS: CDC received reports of 1,337 cases of malaria with an onset of symptoms in 2002 among persons in the United States or one of its territories. This number represents a decrease of 3.3% from the 1,383 cases reported for 2001. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 52.3%, 25.4%, 2.8%, and 2.8% of cases, respectively. Eleven patients (0.8% of total) were infected by > or =2 species. The infecting species was unreported or undetermined in 213 (15.9%) cases. Compared with 2001, the number of reported malaria cases acquired in Asia (n = 171) and Africa (n = 903) increased by 4.3% and 1.9%, respectively, whereas the number of cases acquired in the Americas (n = 141) decreased by 41.2%. Of 849 U.S. civilians who acquired malaria abroad, 317 (37.3%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Five patients became infected in the United States, one through congenital transmission, one probable transfusion-related, and three whose infection cannot be linked epidemiologically to secondary cases. Eight deaths were attributed to malaria. All deaths were caused by P. falciparum. INTERPRETATION: The 3.3% decrease in malaria cases in 2002, compared with 2001, resulted primarily from a marked

decrease in cases acquired in the Americas, but this decrease was offset somewhat by an increase in the number of cases acquired in Africa and Asia. This limited decrease probably represents year-to-year variation in malaria cases, but also could have resulted from local changes in disease transmission, decreased travel to malaria-endemic regions, fluctuation in reporting to state and local health departments, or an increased use of effective antimalarial chemoprophylaxis. In the majority of reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country in which they acquired malaria. PUBLIC HEALTH ACTION: Additional information was obtained concerning the eight fatal cases and the five infections acquired in the United States. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel, and travelers should use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently experiences a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a bloodfilm test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet site at http://www.cdc.gov/travel. PMID: 15123983 [PubMed - indexed for MEDLINE] 1038: Southeast Asian J Trop Med Public Health. 2003 Sep;34(3):517-28. Related Articles, Links Erratum in: •

Southeast Asian J Trop Med Public Health. 2005 May;36(3):801-2.

Use of GIS-based spatial modeling approach to characterize the spatial patterns of malaria mosquito vector breeding habitats in northwestern Thailand. Sithiprasasna R, Linthicum KJ, Liu GJ, Jones JW, Singhasivanon P. Department of Entomology, US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. We sampled 291 bodies of water for Anopheles larvae around three malariaendemic villages of Ban Khun Huay, Ban Pa Dae, and Ban Tham Seau, Mae Sot district, Tak Province, Thailand during August 2001-December 2002 and collected 4,387 larvae from 12 categories of breeding habitat types. We modeled surface slope and wetness indices to identify the extent and spatial pattern of potential mosquito breeding habitats by digitizing base topographical maps of the

study site and overlaying them with coordinates for each larval habitat. Topographical contours and streamlines were incorporated into the Geographical Information System (GIS). We used Global Positioning System (GPS) instruments to locate accurately each field observed breeding habitat, and produced a 30-m spatial resolution Digital Elevation Model (DEM). The slope (of less than 12 degrees) and wetness (more than 8 units) derived from spatial modeling were positively associated with the abundance of major malaria vectors An. dirus, An. maculatus, An. minimus, and An. sawadwongporni. These associations permit real-time monitoring and possibly forecasting of the distributions of these four species, enabling public health agencies to institute control measures before the mosquitos emerge as adults and transmit disease. Publication Types: •

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

PMID: 15115121 [PubMed - indexed for MEDLINE] 1039: Southeast Asian J Trop Med Public Health. 2003 Dec;34(4):919-28. Related Articles, Links

Advantages of trained TBA and the perception of females and their experiences with reproductive health in two districts of the Luangprabang Province, Lao PDR. Sirivong A, Silphong B, Simphaly N, Phayasane T, Bonouvong V, Schelp FP. Provincial Health Department, Luangprabang, Lao PDR. The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the

district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women. Publication Types: • •

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

PMID: 15115111 [PubMed - indexed for MEDLINE] 1040: J Med Internet Res. 2004 Jan 30;6(1):e4. Related Articles, Links

DietPal: a Web-based dietary menu-generating and management system. Noah SA, Abdullah SN, Shahar S, Abdul-Hamid H, Khairudin N, Yusoff M, Ghazali R, Mohd-Yusoff N, Shafii NS, Abdul-Manaf Z. Faculty of Information Science & Technology (F T S M), Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia. [email protected] BACKGROUND: Attempts in current health care practice to make health care more accessible, effective, and efficient through the use of information technology could include implementation of computer-based dietary menu generation. While several of such systems already exist, their focus is mainly to assist healthy individuals calculate their calorie intake and to help monitor the selection of menus based upon a prespecified calorie value. Although these prove to be helpful in some ways, they are not suitable for monitoring, planning, and managing patients' dietary needs and requirements. This paper presents a Webbased application that simulates the process of menu suggestions according to a standard practice employed by dietitians. OBJECTIVE: To model the workflow

of dietitians and to develop, based on this workflow, a Web-based system for dietary menu generation and management. The system is aimed to be used by dietitians or by medical professionals of health centers in rural areas where there are no designated qualified dietitians. METHODS: First, a user-needs study was conducted among dietitians in Malaysia. The first survey of 93 dietitians (with 52 responding) was an assessment of information needed for dietary management and evaluation of compliance towards a dietary regime. The second study consisted of ethnographic observation and semi-structured interviews with 14 dietitians in order to identify the workflow of a menu-suggestion process. We subsequently designed and developed a Web-based dietary menu generation and management system called DietPal. DietPal has the capability of automatically calculating the nutrient and calorie intake of each patient based on the dietary recall as well as generating suitable diet and menu plans according to the calorie and nutrient requirement of the patient, calculated from anthropometric measurements. The system also allows reusing stored or predefined menus for other patients with similar health and nutrient requirements. RESULTS: We modeled the workflow of menu-suggestion activity currently adhered to by dietitians in Malaysia. Based on this workflow, a Web-based system was developed. Initial post evaluation among 10 dietitians indicates that they are comfortable with the organization of the modules and information. CONCLUSIONS: The system has the potential of enhancing the quality of services with the provision of standard and healthy menu plans and at the same time increasing outreach, particularly to rural areas. With its potential capability of optimizing the time spent by dietitians to plan suitable menus, more quality time could be spent delivering nutrition education to the patients. Publication Types: •

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

PMID: 15111270 [PubMed - indexed for MEDLINE] PMCID: PMC1550583

1041: Can J Psychiatry. 2004 Mar;49(3):192-9. Related Articles, Links

Barriers to access to mental health services for ethnic seniors: the Toronto study. Sadavoy J, Meier R, Ong AY. Mount Sinai Hospital, Toronto, Ontario. [email protected]

OBJECTIVE: To identify and describe barriers to access to mental health services encountered by ethnoracial seniors. METHOD: A multiracial, multicultural, and multidisciplinary team including a community workgroup worked in partnership with seniors, families, and service providers in urban Toronto Chinese and Tamil communities to develop a broad, stratified sample of participants and to guide the study. This participatory, action-research project used qualitative methodology based on grounded theory to generate areas of inquiry. Each of 17 focus groups applied the same semistructured format and sequence of inquiry. RESULTS: Key barriers to adequate care include inadequate numbers of trained and acceptable mental health workers, especially psychiatrists; limited awareness of mental disorders among all participants: limited understanding and capacity to negotiate the current system because of systemic barriers and lack of information; disturbance of family support structures; decline in individual self-worth; reliance on ethnospecific social agencies that are not designed or funded for formal mental health care; lack of services that combine ethnoracial, geriatric, and psychiatric care; inadequacy and unacceptability of interpreter services; reluctance of seniors and families to acknowledge mental health problems for fear of rejection and stigma; lack of appropriate professional responses; and inappropriate referral patterns. CONCLUSIONS: There is a clear need for more mental health workers from ethnic backgrounds, especially appropriately trained psychiatrists, and for upgrading the mental health service capacity of frontline agencies through training and core funding. Active community education programs are necessary to counter stigma and improve knowledge of mental disorders and available services. Mainstream services require acceptable and appropriate entry points. Mental health services need to be flexible enough to serve changing populations and to include services specific to ethnic groups, such as providing comprehensive care for seniors. Publication Types: •

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

PMID: 15101502 [PubMed - indexed for MEDLINE] 1042: Int J Gynaecol Obstet. 2004 May;85(2):213-20. Related Articles, Links Comment in: •

Int J Gynaecol Obstet. 2004 May;85(2):201-2.

Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda.

Gill Z, Ahmed JU. Averting Maternal Death and Disability (AMDD) program, Heilbrunn Center for Population and Family Health, Columbia University, NY, USA. [email protected] This paper describes the activities of the Ministry of Health and Family Welfare of the Government of Bangladesh and UNFPA to introduce emergency obstetric care (EmOC) services into the reproductive health care agenda. Working through the existing system of Maternal and Child Welfare Centers (MCWC), the quality and availability of comprehensive Reproductive Health and Emergency Obstetric Care services was improved. Investments in training, infrastructure, management information systems, quality assurance mechanisms and linkages between health care facilities in Bangladesh, have produced positive results in terms of increased utilization of these services. The Ministry of Health first implemented services in one division of the country and later scaled up to include all of the MCWCs nationally. While there are still obstacles to preventing obstetric deaths in Bangladesh, this experience shows that improvements in the quality and expansion of the range of services in existing health systems is an important step toward increasing the use of reproductive health care services by the women who need them most. PMID: 15099796 [PubMed - indexed for MEDLINE] 1043: Eur J Cardiothorac Surg. 2004 May;25(5):683-90. Related Articles, Links

Late outcome of patients with aortic dissection: study of a national database. Yu HY, Chen YS, Huang SC, Wang SS, Lin FY. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan, ROC. OBJECTIVES: The incidence of late mortality and morbidity of aortic dissection remained unchanged during the past 20 years. The present study was to analyze the risk factors of late events for patients with aortic dissection. METHODS: A total of 5654 cases of aortic dissection (3871 males) were collected from the National Health Insurance Databases from 1996 to 2001. Age, gender, Marfan syndrome, and initial treatment modality were the main factors to be investigated. Corrective group was defined by surgical operation with cardiopulmonary bypass and palliative group for the remaining. Late aortic events were defined by late

aneurysmal evolution of diseased aorta needing surgical intervention or death of aortic causes from 6 months to 6 years. RESULTS: The incidence of aortic dissection was 43 per 1000000 population in our country. Corrective group accounted for 19.3% of them and palliative group for 80.7%. Marfan syndrome accounted for 1.5% of all cases (4.3% of corrective surgery group). The rate of freedom from mortality at 1, 6 months, and 6 years was 80.4+/-1.3, 69.0+/-1.5, and 56.5+/-2.9% for corrective group and 89.5+/-0.5, 78.4+/-0.6, and 46.1+/1.35% for palliative group. Nearly half of the late mortalities were attributed to atherosclerosis-related conditions (cardiac, stroke, or aortic causes). The incidence of late aortic events was 2.48% per year on an average, comparable between corrective and palliative groups. This incidence increased since the fourth year after their initial episode. For corrective group, young age was a risk factor of late aortic events (relative risk of 0.60-0.82 per decade, P = 0.037). For palliative group, Marfan syndrome and male gender were risk factors of late aortic events (relative risk of 4.08-10.7, P < 0.001 in the former; relative risk of 1.46-2.1, P = 0.002 in the latter). CONCLUSIONS: Late aortic events were not uncommon for both corrective and palliative groups, and its incidence increased since the fourth year after their initial episodes. Young age for corrective group, Marfan syndrome and male gender for palliative group were risk factors of late aortic events. PMID: 15082267 [PubMed - indexed for MEDLINE] 1044: Eur J Public Health. 2004 Mar;14(1):24-6. Related Articles, Links

Effects of working and residential location areas on air pollution related respiratory symptoms in policemen and their wives in Bangkok, Thailand. Karita K, Yano E, Tamura K, Jinsart W. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. Factors, including air pollution, influencing the prevalence of respiratory symptoms were investigated in a cross-sectional study in policemen and their wives (530 couples) in Bangkok. Information on respiratory symptoms was obtained using the American Thoracic Society Division of Lung Diseases (ATSDLD) questionnaire. Effects of working and residential locations were evaluated using a multiple logistic model adjusted for several potential confounding factors. In the policemen the increased risk of frequent cough or phlegm was related to smoking (OR=2.19, 95% CI: 1.47-3.26) and working in heavy traffic locations (OR=1.27, CI: 1.01-1.61), whereas in their wives it was related to their residential locations (OR=1.53, CI: 1.10-2.13).

Publication Types: •

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

PMID: 15080386 [PubMed - indexed for MEDLINE] 1045: Chudoku Kenkyu. 2004 Jan;17(1):31-6. Related Articles, Links

[The introduction of clinical-pass, interlocked in electronic health record, for acute poisoning patients] [Article in Japanese] Ikegami Y, Okazaki S, Hasegawa Y, Tase C. PMID: 15079919 [PubMed - indexed for MEDLINE] 1046: BMJ. 2004 Apr 3;328(7443):826-30. Related Articles, Links Comment in: •

BMJ. 2004 Jun 19;328(7454):1497.

Importance of health research in South Asia. Sadana R, D'Souza C, Hyder AA, Chowdhury AM. Health Research Systems Analysis Initiative, Research Policy and Cooperation Department, Evidence and Information for Policy Cluster, World Health Organization, CH-1211 Geneva 27, Switzerland. [email protected] Publication Types: •

Review

PMID: 15070643 [PubMed - indexed for MEDLINE] PMCID: PMC383385

1047: J Intensive Care Med. 2004 Mar-Apr;19(2):105-10. Related Articles, Links

Outcome prediction for critically ill cirrhotic patients: a comparison of APACHE II and Child-Pugh scoring systems. Ho YP, Chen YC, Yang C, Lien JM, Chu YY, Fang JT, Chiu CT, Chen PC, Tsai MH. Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors. Publication Types: • • •

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

PMID: 15070520 [PubMed - indexed for MEDLINE] 1048: J Transcult Nurs. 2004 Apr;15(2):114-21.

Related Articles,

Links

The effect of the health belief model in explaining exercise participation among Jordanian myocardial infarction patients. Al-Ali N, Haddad LG. Jordan University of Science and Technology, Irbid, Jordan. This study describes the effect of health belief model (HBM) in explaining exercise participation among Jordanian myocardial infarction (MI) patients. A convenient sample of 98 MI patients was recruited from four governmental hospitals in northern Jordan. A self-reported questionnaire and structured interview were designed to obtain the needed information. Study results indicated that Jordanian MI patients had a high score in perceived severity and a low score in perceived barriers. Results also showed a significant correlation between exercise participation and health belief variables and sociodemographics such as age, annual income, level of education, and physician recommendation. These findings have implications for designing intervention programs aimed at improving physical activity by all MI patients. These programs should consider culture, socioeconomic status, personal system, and demographics. Further research is needed to develop a culturally sensitive instrument that takes into consideration the cultural variation and the specific needs of MI patients. Publication Types: •

Multicenter Study

PMID: 15070493 [PubMed - indexed for MEDLINE] 1049: Food Nutr Bull. 2004 Mar;25(1 Suppl):S78-83. Related Articles, Links

Implementation of the WHO Multicentre Growth Reference Study in Oman. Prakash NS, Mabry RM, Mohamed AJ, Alasfoor D. The World Health Organization (WHO) Multicentre Growth Study (MGRS) Middle East site was Muscat, Oman. A survey in Muscat found that children in households with monthly incomes of at least 800 Omani Rials and at least four years of maternal education experienced unconstrained growth. The longitudinal study sample was recruited from two hospitals that account for over 90% of the city's births; the cross-sectional sample was drawn from the national Child Health

Register. Residents of all districts in Muscat within the catchment area of the two hospitals were included except Quriyat, a remote district of the governorate. Among the particular challenges of the site were relatively high refusal rates, difficulty in securing adherence to the protocol's feeding recommendations, locating children selected for the cross-sectional component of the study, and securing the cooperation of the children's fathers. These and other challenges were overcome through specific team building and public relations activities that permitted the successful implementation of the MGRS protocol. Publication Types: •

Review

PMID: 15069924 [PubMed - indexed for MEDLINE] 1050: Food Nutr Bull. 2004 Mar;25(1 Suppl):S66-71. Related Articles, Links

Implementation of the WHO Multicentre Growth Reference Study in India. Bhandari N, Taneja S, Rongsen T, Chetia J, Sharma P, Bahl R, Kashyap DK, Bhan MK. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site. PMID: 15069922 [PubMed - indexed for MEDLINE] 1051: J Pediatr. 2004 Apr;144(4):496-9.

Related Articles,

Links

Comment in: •

J Pediatr. 2005 Jan;146(1):149-50; author reply 150-1.

Early intravenous gamma-globulin treatment for Kawasaki disease: the nationwide surveys in Japan. Muta H, Ishii M, Egami K, Furui J, Sugahara Y, Akagi T, Nakamura Y, Yanagawa H, Matsuishi T. Department of Pediatrics, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan. [email protected] OBJECTIVE: To determine the optimal period of intravenous gamma-globulin (IVGG) treatment, using the database from nationwide Kawasaki disease surveys in Japan. STUDY DESIGN: We selected patients who first visited a doctor within 3 days of illness and received IVGG treatment within 9 days of illness. We divided these patients into 2 groups: an early group (treated on days 1-4: 4731 cases) and a conventional group (days 5-9: 4020 cases). We compared the rate of additional IVGG and prevalence of cardiac sequelae between these groups. RESULTS: The rate of additional IVGG in the early group was significantly higher than those of the conventional group (OR, 1.12 [95% CI, 1.10-1.16]). There were no significant differences in cardiac sequelae between the two groups. CONCLUSIONS: There is no evidence that IVGG treatment on day 4 or earlier has greater efficacy in preventing cardiac sequelae than treatment on days 5 to 9. In addition, early treatment is likely to result in a greater requirement for additional IVGG. However, there is also no evidence that early treatment increases the prevalence of cardiac sequelae in a clinical practice setting, where additional IVGG can be given to those whose initial treatment fails. Publication Types: • •

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

PMID: 15069399 [PubMed - indexed for MEDLINE] 1052: Int J Med Inform. 2004 Mar 31;73(3):243-9. Related Articles, Links

A clinical management system for patient participatory health care

support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration. Ishikawa K, Konishi N, Tsukuma H, Tsuru S, Kawamura A, Iwata N, Tanaka T. Medical Informatics and Hospital Systems Management, Hiroshima University Hospital, Hiroshima, Japan. We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow. Publication Types: •

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

PMID: 15066554 [PubMed - indexed for MEDLINE] 1053: Int J Med Inform. 2004 Mar 31;73(3):217-27. Related Articles, Links

The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights. Mohan J, Razali Raja Yaacob R. Malaysian Health Informatics Association, Apt 2A, 8 Jalan Perumahan Gurney,

54100 Kuala Lumpur, Malaysia. [email protected] Telehealth refers to the integration of information, telecommunication, humanmachine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia. PMID: 15066550 [PubMed - indexed for MEDLINE] 1054: Harefuah. 2004 Mar;143(3):170-6, 248. Related Articles, Links

[Quality of community-based healthcare services] [Article in Hebrew] Wilf-Miron R, Shemer J. Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer. The recent concern regarding the quality of healthcare services is partly due to the empowerment of health consumers, cost containment measures that may compromise quality, increased complexity of the medical practice and the accelerated growth of data on the magnitude and extent of quality problems. The framework of the delivery of health services, including quality parameters, differs fundamentally in the community as opposed to the hospital setting. In the community, the episode of care lacks geographic and temporal boundaries, and is divided among different facilities and caregivers. Hence, the healthcare systems lack control over the management of care. In the solo practice, the physician lacks

the opportunity to discuss and share medical decisions with his/her peers and physician's reimbursement does not encourage him/her to invest time and effort in the provision of quality care. Furthermore, in the community setting, the patient is expected to take responsibility for compliance to the therapeutic regimen, a condition that may frequently interfere with regular life routines. Therefore, quality promotion should embody the "quality triangle" encompassing patients, caregivers, the healthcare system and appropriate interfaces. Ideally, the voice of the health consumer should be an integral consideration in the design of health policy, care should be patient-centered and physician reimbursement should reflect the quality of care provided. In addition, the design of the healthcare system information technology in supporting decision-making and training "quality leaders" to facilitate quality improvement programs. Consequently, it is pivotal to nurture agreement among policy-makers, patients and caregivers as to the essence of the dilemma: "What is quality in community care?" Meanwhile, we may suggest a primordial definition to community-based health care quality management: An ongoing multidisciplinary effort to identify and respond to the needs of patients, by providing systemic infrastructure that will support the caregivers and help in achieving better outcomes in the six basic dimensions of quality care-safe, timely, effective, efficient, equitable and patient-centered. In conclusion, in light of the medical activities conducted in the community, and the prevalent and ever-growing shortage of resources, there is a need to integrate efforts to develop and implement both unique tools and strategies to manage quality in community-based health services. Publication Types: •

English Abstract

PMID: 15065352 [PubMed - indexed for MEDLINE] 1055: Health Policy. 2004 May;68(2):211-22. Related Articles, Links

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System. Deshpande K, RaviShankar , Diwan V, Lönnroth K, Mahadik VK, Chandorkar RK. Department of Community Medicine, R.D. Gardi Medical College, Ujjain, MP, India. In developing countries like India, official information on private health care

providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources. PMID: 15063020 [PubMed - indexed for MEDLINE] 1056: J Med Assoc Thai. 2004 Feb;87(2):204-12. Related Articles, Links

Prevention of thalassemia: experiences from Samui Island. Sangkitporn S, Chongkitivitya N, Pathompanichratana S, Sangkitporn SK, Songkharm B, Watanapocha U, Pathtong W. National Institute of Health, Department of Medical Sciences, Nonthaburi 11000, Thailand. Thalassemia is one of the most important genetic disorders in Thailand. A model for prevention of thalassemia by combining 4 strategies including education, carrier screening, counseling and prenatal diagnosis was developed by a thalassemia task force. A thalassemia work group was formed in order to develop a mechanism to integrate the model for real use on Samui Island where thalassemia is common and a specific disease oriented program is required. 200 health professionals working on Samui Island participated in the thalassemia educational courses. The specific training courses were also provided for obstreticians, medical technologists and counselors. A team of well-trained health professionals was established to manage public education. Information booklets, posters, brochures and mass media including spot radio and newspapers were used as educational materials. For carrier screening, blood samples of pregnant

women from all health care organizations on Samui Island were collected and screened for thalassemia carriers by using the osmotic fragility (OF) test/the dichlorophenol indophenol precipitation (DCIP) tests at Samui Hospital. Samples with positive results were sent to the Regional Medical Sciences Center in Surat Thani for thalassemia diagnosis. When a carrier was identified, her spouse was offered testing. For at-risk couples, details of the disorder were included in counseling to help them reach a decision that was right to them, in the context of their unique medical, moral and social situations. Amniotic fluid samples were collected for prenatal diagnosis. All patient information was registered by using computer software. After 1 year of integration by using facilities of the Ministry of Public Health service system, a wide range of problems were identified. They underlined the need for effective health service structure co-operation, adequate education of responsible health professionals, explicit policies and a clear line of responsibility at local, regional and national levels for service development and quality management. It is hoped that all information conducted in the present study will be useful to health authorities to develop an explicit policy and promote the health service structure co-operation in the country that will finally lead to successfully reducing the frequency of severe thalassemia in the future. Publication Types: • • •

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

PMID: 15061305 [PubMed - indexed for MEDLINE] 1057: Qual Life Res. 2004 Feb;13(1):81-9. Related Articles, Links

Association between patient education and health-related quality of life in patients with Parkinson's disease. Shimbo T, Goto M, Morimoto T, Hira K, Takemura M, Matsui K, Yoshida A, Fukui T. Department of General Medicine and Clinical Epidemiology, Graduate School of Medicine, Kyoto University, Japan. [email protected] BACKGROUND: Providing patients with disease- and treatment-related information is an important role of medical staff and is now reimbursed in Japan by the national health insurance system under the rubric 'patient education'. Evaluation of the effectiveness of patient education programs is necessary to ensure that limited health care resources are used efficiently. OBJECTIVE: The

objective is to determine whether educating patients with Parkinson's disease (PD) is related to better health-related quality of life (HRQOL). DESIGN: A cross-sectional study was conducted. SETTING: Members of the Japan Association of Patients with Parkinson's disease were randomly selected. PARTICIPANTS: A total of 1200 patients with PD were asked to fill in written questionnaires and replies from 762 (63.5%) were analyzed. MEASUREMENTS: The questionnaire inquired about clinical characteristics, comorbidity, symptoms of PD, complications of therapy, HRQOL, and patient education. SF-36 was used to assess HRQOL. The section on patient education comprised one question each on patient-perceived satisfaction with information provided on (1) disease condition and pathophysiology, (2) effectiveness of drug therapy, (3) adverse drug reactions, (4) publicly available financial and social resources, and (5) rehabilitation and daily activities. Patient education score was defined as the sum of the individual scores for these five questions. The relationships between scores on the SF-36 subscales and the patient education score were examined. RESULTS: More satisfaction with patient education was associated with higher scores in all SF-36 subscales except physical functioning and bodily pain. The difference in score between the most satisfied and the least satisfied patients ranged from 8.4 points on the subscales of general health and 16.7 points on the subscale of role limitation due to emotional problems. CONCLUSION: The conclusion that patient education is associated with better HRQOL in patients with PD is drawn. Publication Types: •

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

PMID: 15058790 [PubMed - indexed for MEDLINE] 1058: Nippon Koshu Eisei Zasshi. 2004 Feb;51(2):79-93. Related Articles, Links

[Role of the social support network which influences age of death and physical function of elderly people: study of trends in and outside of Japan and future problems] [Article in Japanese] Kishi R, Horikawa N. Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo. Concerning associations between the social support network and physical health of the elderly, longitudinal studies have been conducted using various

measurement indexes. The studies indicated that the support network influences on physical function and life expectancy. In this study we compared research papers from Japan and elsewhere that appeared after 1980, from the viewpoint of 1) social support effects, and 2) social network effects, to examine potential problems in the future. The main knowledge obtained was that the receipt of emotional support, wide network size, and participation in social activities reduced the risk of early death and decrease in physical function of elderly people. Sex differences were indicated, and in many cases, the effects were more remarkable in men than women. In addition the positive influence of receiving help from a support network, a major subject of conventional research, the effects of offering help to others and negative findings were also examined. It has been indicated that participation in volunteer groups and offer of support to other people can prevent decrease in physical function or early death. As negative effects, improper instrumental support rather disturbs the mental and physical independence of elderly people. As future issues, it is necessary to focus on both positive/negative and receipt/offer effects of support network, and to clarify how to provide example which best match the life of elderly people by comparing sexes and regions. It is also important to actually apply the knowledge gained from observational studies to prevent the elderly from becoming a condition requiring care, and to develop intervention studies which can increase the social contacts of elderly people at the same time as conducting health education and medical treatment. Publication Types: •

English Abstract

PMID: 15058098 [PubMed - indexed for MEDLINE] 1059: Int J Nurs Pract. 2004 Apr;10(2):64-71. Related Articles, Links

The perceived needs of Jordanian families of hospitalized, critically ill patients. Al-Hassan MA, Hweidi IM. School of Nursing, Jordan University of Science and Technology, Irbid, Jordan. [email protected] The purpose of this study was to identify needs of Jordanian families of hospitalized, critically ill patients. The Critical Care Family Needs Inventory was introduced to 158 family members who were visiting their hospitalized, critically ill relatives. The findings revealed that > or = 80% of the family members

perceived 16 need statements as important or very important. The participants ranked order needs for assurance, information and proximity the highest and needs for support and comfort the lowest. Specifically, the most important needs of the families were to receive information about the patients, to feel that the hospital personnel care about the patients and to have the information given in understandable terms. Results of this study indicated that Jordanian families had specific and identifiable needs. Providing families of critically ill patients clear, simple and updated information about the patients, and assuring them about the quality of care the patients receive, should be essential components of the critical care nursing delivery system. PMID: 15056344 [PubMed - indexed for MEDLINE] 1060: J Environ Monit. 2004 Apr;6(4):254-61. Epub 2004 Mar 19. Related Articles, Links

Determination of arsenic species in fish, crustacean and sediment samples from Thailand using high performance liquid chromatography (HPLC) coupled with inductively coupled plasma mass spectrometry (ICP-MS). Rattanachongkiat S, Millward GE, Foulkes ME. School of Earth, Ocean and Environmental Sciences, University of Plymouth, Plymouth, PL4 8AA, UK. Suitable techniques have been developed for the extraction of arsenic species in a variety of biological and environmental samples from the Pak Pa-Nang Estuary and catchment, located in Southern Thailand, and for their determination using HPLC directly coupled with ICP-MS. The estuary catchment comprises a tin mining area and inhabitants of the region can suffer from various stages of arsenic poisoning. The important arsenic species, AsB, DMA, MMA, and inorganic arsenic (As III and V) have been determined in fish and crustacean samples to provide toxicological information on those fauna which contribute to the local diet. A Hamilton PRP-X100 anion-exchange HPLC system employing a step elution has been used successfully to achieve separation of the arsenic species. A nitric acid microwave digestion procedure, followed by carrier gas nitrogen addition- (N2)-ICP-MS analysis was used to measure total arsenic in sample digests and extracts. The arsenic speciation of the biological samples was preserved using a Trypsin enzymatic extraction procedure. Extraction efficiencies were high, with values of 82-102%(As) for fish and crustacean samples. Validation for these procedures was carried out using certified reference materials. Fish and crustacean samples from the Pak Pa-Nang Estuary showed a range for total arsenic concentration, up to 17 microg g(-1) dry mass. The major species of arsenic in all fauna samples taken was AsB, together with smaller

quantities of DMA and, more importantly, inorganic As. For sediment samples, arsenic species were determined following phosphoric acid (1 M H3PO4) extraction in an open focused microwave system. A phosphate-based eluant, pH 6-7.5, with anion exchange HPLC coupled with ICP-MS was used for separation and detection of AsIII, AsV, MMA and DMA. The optimum conditions, identified using an estuarine sediment reference material (LGC), were achieved using 45 W power and a 20 minute heating period for extraction of 0.5 g sediment. The stability and recovery of arsenic species under the extraction conditions were also determined by a spiking procedure which included the estuarine sediment reference material. The results show good stability for all species after extraction with a variability of less than 10%. Total concentrations of arsenic in the sediments from the Pak Pa-Nang river catchment and the estuary covered the ranges 7-269 microg g(-1)and 4-20 [micro sign]g g(-1)(dry weight), respectively. AsV was the major species found in all the sediment samples with smaller quantities of AsIII. The presence of the more toxic inorganic forms of arsenic in both sediments and biota samples has implications for human health, particularly as they are readily 'available'. Publication Types: •

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

PMID: 15054532 [PubMed - indexed for MEDLINE] 1061: Radiat Med. 2004 Jan-Feb;22(1):17-9. Related Articles, Links

Status of Japanese radiation oncology. Nakano T. Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi-shi, Gunma 371-8511, Japan. PURPOSE: The Japanese status and structure of radiation oncology are reported on the basis of a recent Japanese official survey database compiled by JASTRO. METHODS: This report presents the status of human resources and equipment in regard to radiation therapy, and comprehensive QA of radiation therapy in Japan, mostly based on the database of the JASTRO survey of 2001 status. RESULTS: About 13,000 patients are treated with radiation therapy per year, the leading sites of which were lung, breast, head and neck, prostate, esophagus, and uterus, in that order. There were about 700 radiation therapy institutions in Japan, two-thirds of which consisted of university and public institutions. Approximately, 1,000 fulltime medical doctors, including 700 radiation oncologists, 1,500 technologists,

and 70 medical physicists were working with approximately 700 linacs, 25 microtrons, 55 telecobalts, 200 RALSs (Co-60, 95; Ir-192, 93), and 33 gamma knives with various radiation treatment planning systems. Recently, 160 stereotactic radiotherapy, 10 cyber knives, and 10 IMRT units started operating in Japan. CONCLUSION: One of the main problems in Japanese radiation oncology is the shortage of human resources, including radiation oncologists and medial physicists. Poor awareness of radiation oncology among the public and ignorance of the necessity and importance of medical physicists in the medical field tends to adversely affect QA/QC of recent high-technology radiation therapy. Publication Types: •

Review

PMID: 15053170 [PubMed - indexed for MEDLINE] 1062: Radiat Med. 2004 Jan-Feb;22(1):12-6. Related Articles, Links

Current status of radiotherapy in Vietnam, 2002. To DA, Bui D. Department of Breast and Gynecology Radiotherapy, National Cancer Institute (K Hospital), Hoan Kiem District, Hanoi, Vietnam. PURPOSE: Resources for radiation therapy in Vietnam were analyzed to obtain an understanding of the current status of radiation oncological practice in Vietnam. MATERIALS AND METHODS: Data were obtained through a report on the locations of major equipment and personnel. RESULTS: The availability of both teletherapy and brachytherapy was related to the economic status of the country. Most departments were found to treat patients without simulator or treatment planning systems. CONCLUSIONS: The information in the report is currently available for radiation oncological practices in Vietnam and provides for planning of development programs on radiation oncology. Publication Types: •

Review

PMID: 15053169 [PubMed - indexed for MEDLINE] 1063: Public Health. 2004 Mar;118(2):114-20.

Related Articles,

Links

Injuries among children in Karachi, Pakistan--what, where and how. Razzak JA, Luby SP, Laflamme L, Chotani H. Department of Public Health, Karolinska Institute, Stockholm, Sweden. [email protected] OBJECTIVES: To describe the epidemiology of injuries among children in Karachi, Pakistan. STUDY DESIGN: Retrospective case series.METHODS: Data on children aged < or =15 years who were injured between October 1993 and January 1996 were extracted from the logs of the main provider of emergency medical transportation, and were classified according to the World Health Organization's basic data set for information on injuries. RESULTS: We identified 1320 cases of injuries in children < or =15 years old. The major causes were: motor vehicle crashes (MVC) (80%), falls other than from vehicles (5%), burns (5%) and drowning (3%). One in six of these children (15%) died either at the scene of the accident or during transportation to the hospital. The majority of deaths were either due to MVCs (67%) or drowning (18%) Large vehicles (buses, minibuses and trucks) were involved in 54% of all childhood road traffic injuries. Almost one-third (33%) of burns took place in the kitchen at home, and half (51%) of all drowning cases occurred in the sea. CONCLUSIONS: The majority of children transported by the ambulance service were male and were victims of MVCs. Prevention efforts aimed at stricter enforcement of driving laws and family/child education geared towards pedestrian safety could potentially reduce morbidity and mortality. This study also highlights the role of the prehospital transport system in injury surveillance. PMID: 15037041 [PubMed - indexed for MEDLINE] 1064: Ying Yong Sheng Tai Xue Bao. 2003 Dec;14(12):2108-12. Related Articles, Links

[Structure and ecological benefits of urban forest in Shenyang buildup area] [Article in Chinese] Hu Z, He X, Chen W, Li Y, Li H. Institute of Applied Ecology, Chinese Academy of Scinces, Shenyang 110016, China. [email protected]

Investigations were made in the sampling plots covering 243 km2 of the Shenyang urban area, and the results were used as the input for the Urban Forest Management Information System (UFMIS), which was developed based on the model of CITY green. With this system, and using tree species, tree density, tree height grade distribution, tree DBH (diameter at beast height) grade distribution, and tree health condition as parameters, the land use and forest structure in Shenyang City were analyzed. It was found that there were 1,914,500 trees in Shenyang, belonging to 136 species. The 25 dominant species accounted for 84.78% of the total number of trees, and the forest coverage was 9.765%. Trees with DBH < 0.25 m and > 0.5 m accounted for 82.8% of the total, and the young, middle-aged and old trees occupied 27%, 58% and 15% of the total, respectively. The healthy status of 84% of the trees was above middle level. Therefore, the forest in Shenyang urban is at a stable stage. According to the statistical results from UFMIS, the ecological value of forest in Shenyang urban is as high as 26,526,955. 1 USD in terms of economy. Publication Types: • •

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

PMID: 15031897 [PubMed - indexed for MEDLINE] 1065: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):201-17. Related Articles, Links Erratum in: •

J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):table of contents.

How are biomarkers related to physical and mental well-being? Seplaki CL, Goldman N, Weinstein M, Lin YH. Office of Population Research, Princeton University, New Jersey 08544, USA. [email protected] We investigate how biological markers of individual responses to stressful experiences are associated with profiles of physical and mental functioning in a national sample of middle-aged and elderly Taiwanese. Data come from a population-based sample of middle-aged and elderly Taiwanese in 2000. The data combine rich biological measures with self-reported information on physical and mental health. Grade of membership methods are used to summarize functional

status, and multinomial logit models provide information on the association between biological measures and function. The analysis identifies significant associations between biomarkers of stressful experience and profiles of physical and mental functioning. The estimates reveal the potential importance for health of both low and high values of biological parameters. The findings point to directions for future research regarding development of aggregate measures of cumulative dysregulation across multiple physiological systems. Publication Types: •

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

PMID: 15031304 [PubMed - indexed for MEDLINE] 1066: Soc Sci Med. 2004 May;58(10):2045-67. Related Articles, Links

Changing geographic access to and locational efficiency of health services in two Indian districts between 1981 and 1996. Kumar N. Population Studies and Training Center, Brown University, Providence RI 02912, USA. [email protected] In developing countries, including India, the role of the private sector in the provision of basic healthcare services is gradually expanding, since the public sector provides limited services and covers only limited areas. Using locationallocation models (LAM), this paper (1) examines the changing geographic access to and locational efficiency of basic public healthcare vis-à-vis private healthcare services in two districts located in northwestern part of India, and (2) interrogates the factors that govern their geographic accessibility and locational-efficiency. Although this research confirms regional inequalities in geographic accessibility and locational efficiency of both public and private healthcare services in the selected districts, the locational efficiency of private health services is significantly lower than that of public health services. This paper further demonstrates the use of LAM for new site identification (keeping the existing healthcare sites intact) that will, in the future, improve locational efficiency of these services. This paper not only recommends improved geographic access to both public and private health services and their enhanced complementary role, but also stresses the need to evaluate geographic access from the service-users' perspective and the use of more realistic data on demand and supply in future research. The findings of this paper can be extended to areas with similar geographic settings, and socio-economic and demographic conditions.

Publication Types: •

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

PMID: 15020019 [PubMed - indexed for MEDLINE] 1067: Respirology. 2003 Nov;8 Suppl:S46-8. Related Articles, Links

SARS: public health measures in Hong Kong. Tsang T, Lam TH. Department of Health, Hong Kong Government, Hong Kong, SAR, China. [email protected] As there are no validated and rapid diagnostic tests nor specific treatment for severe acute respiratory syndrome (SARS) at the initial stage of the outbreak, public health measures are vital for the control of the disease. These included an enhanced disease surveillance system, expanded laboratory diagnostic capacity, heightened infection control in hospitals and residential institutions for the elderly, intensive contact tracing coupled with medical surveillance at designated medical centres, quarantine of close contacts by way of home confinement, formation of multidisciplinary investigation and response teams, and public education and communication. The above measures were implemented in many countries during the outbreak. To prevent spread in the region and beyond, port health measures targeted at both entry and exit health screenings were also carried out together with regional and international liaison. PMID: 15018134 [PubMed - indexed for MEDLINE] 1068: Sci Total Environ. 2004 Mar 29;320(2-3):89-107. Related Articles, Links

Assessing the benefit and cost for a voluntary indoor air quality certification scheme in Hong Kong. Tse MS, Chau CK, Lee WL. The Department of Building Services Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Sar, Hong Kong.

A voluntary indoor air quality certification scheme has been proposed in Hong Kong for assessing and evaluating the indoor air quality level in a variety of public places like offices, restaurants and pubs. The scheme intends to promote the public well being, however, its technical and financial practicality has led to serious discussions among the government officials, practitioners and premises owners. Accordingly, this study intends to develop a protocol for examining its financial viability by linking the appropriate dose-response and economic data with the results from indoor micro-environment models. The financial viability of the scheme is evaluated by examining the cost and benefit associated with compliance on the different prescribed indoor particulate (PM10) levels. According to our analysis, the indoor action level of 180 microg/m3 as 8-h mean (with the objective of protecting the health of general public) does not require office owners to improve beyond the base setting. Nevertheless, owners should consider altering the base settings in their air conditioning systems so as to secure more benefit on every dollar they spent. On the contrary, the 20 microg/m3 level as 8-h mean (with the objective of providing comfort) is not considered to be financially viable for office owners as they will incur financial loss on compliance. Subsequent sensitivity analysis indicates that the total net benefit derived have a great dependency on the value-of-life estimates used. If conservative health estimates are adopted, the optimum level determined to be beneficial to both owners and the society will be 55 microg/m3, which can be obtained by operating the air conditioning system with a ventilation rate of 10 l/s, primary filters of 80-85% efficiency and secondary filters efficiency of 60-65% arrestance. This information should be extremely valuable for government officials and policy makers in assessing the financial viability of the voluntary indoor assessment scheme. Publication Types: •

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

PMID: 15016500 [PubMed - indexed for MEDLINE] 1069: Annu Rev Public Health. 2004;25:327-39. Related Articles, Links

The current state of public health in China. Lee L. Chinese Center for Disease Control and Prevention, Beijing 100050, China. [email protected] In the past 50 years, China has made great achievements in controlling infectious

diseases and improving the public's health and hygiene. However, in the twentyfirst century, owing to the negative effects brought on by aging of the population and the burdens of diseases, urbanization, industrialization, and globalization, Chinese public health officials are encountering greater difficulties than ever. Old operating models of public health cannot meet present requirements. The main problems are poor capacity to respond to public health emergencies, severe inequality of health care services, and lagging development of public health information systems. Public health in China can gradually meet the requirements of social development and the increasing public demand for health care services only when the public health is directed by informatization, globalization, technification, and humanization. PMID: 15015923 [PubMed - indexed for MEDLINE] 1070: J R Army Med Corps. 2003 Dec;149(4):277-83. Related Articles, Links Comment in: • • • •

J R Army Med Corps. 2004 Jun;150(2):153. J R Army Med Corps. 2004 Mar;150(1):66. J R Army Med Corps. 2004 Mar;150(1):66; author reply 66. J R Army Med Corps. 2004 Sep;150(3):225.

Impact of deployment of personnel with chronic conditions to forward areas. Hodgetts TJ, Greasley LA. University of Birmingham. [email protected] AIM: To identify reasons for inappropriate deployment of soldiers with chronic conditions to an operational environment. SETTING: Two British Army field hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop concentration prior to war-fighting (Operation Telic). POPULATION: All British military personnel on land during the concentration phase, rising to an estimated 28,000 troops. METHODS: Real-time electronic record maintained of all cases presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed. RESULTS: 50 sequential cases were analysed. 34% were downgraded prior to deployment. Of those who were P2 FE, 85% were judged to have required protection from deployment by down-grading. 20% of all cases had a history of chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of all cases were deployed while waiting for secondary care investigation or review that should have ensured protection from deployment. No patient had an existing "FT" (forward temperate) or "LT" (lines of communication temperate) grading:

but in four cases it was predictable that the patient's underlying condition would be adversely affected by deployment to a desert environment. In 5 cases it was identified that the inappropriate deployment could be attributed to clinical management within the civilian sector, with a consequent failure to institute the necessary downgrading process. CONCLUSIONS: Review of the medical grading process is needed to protect those soldiers who are awaiting outpatient opinion or definitive diagnosis from investigation, and to provide an employability grading that matches a soldier's fitness for operational role. PMID: 15015800 [PubMed - indexed for MEDLINE] 1071: Pediatr Infect Dis J. 2004 Mar;23(3):221-6. Related Articles, Links

Use of a computerized database to study the effectiveness of an attenuated varicella vaccine. Passwell JH, Hemo B, Levi Y, Ramon R, Friedman N, Lerner-Geva L. Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel. [email protected] BACKGROUND: The varicella vaccine Varilrix (GlaxoSmithKline) was introduced in Israel in June 2000 as an optional vaccination for children. METHODS: We used the database of a single health maintenance organization that serves 25% of the population in Israel to assess the effectiveness of the vaccine retrospectively. Incidence and complications of varicella were derived from the database from January 1, 1998 until December 31, 2002. RESULTS: Since licensure >30000 individuals younger than 10 years in this health maintenance organization have been immunized with the vaccine. Annual incidence of disease per 1000 in the study population was 86.6 in 1998, 74.6 in 1999, 74.0 in 2000, 37.1 in 2001 and 44.6 in 2002. This declining trend in incidence of disease was statistically significant. Complications of varicella occurred in approximately 1% of patients throughout the 5-year study period, but there was a parallel decline in the number of patients with complications corresponding to the decline in disease incidence. Vaccine effectiveness for prevention of clinical disease in this population was 92% (95% confidence interval, 91.0 to 92.7). There were varying rates of utilization within communities of varied socioeconomic class, so that in the higher socioeconomic class there was an increased utilization and a corresponding decrease of attack rate; whereas in communities where there were lower utilization rates, corresponding increased numbers of varicella cases were seen. CONCLUSION: This database enables long term follow-up of the effectiveness of this vaccine in a large population. PMID: 15014296 [PubMed - indexed for MEDLINE]

1072: J Telemed Telecare. 2004;10(1):25-8. Related Articles, Links

Reliability of Web-based teledermatology consultations. Oztas MO, Calikoglu E, Baz K, Birol A, Onder M, Calikoglu T, Kitapci MT. Department of Dermatology, Gazi University, Turkey. [email protected] We studied the reliability of teledermatology diagnoses made using a Web-based system. Clinical photographs and information relating to 125 patients were placed on a Web server. Three dermatologists made the most likely diagnosis via a Web interface. The reference diagnosis was made in a face-to-face consultation with a fourth dermatologist; where appropriate it was confirmed histologically. The teledermatologists were correct in 57% of cases when viewing the images alone. Their diagnostic accuracy improved to 70% when additional clinical information was available. The rate of agreement between the teledermatologists ranged from 44% to 70% (kappa= 0.22-0.32). Seventy-seven per cent of the patients were correctly diagnosed by at least two dermatologists when clinical information was provided. A Web-based system appears to be reliable for teledermatology. A single well trained teledermatologist may give better results than a group of less well trained clinicians. PMID: 15006212 [PubMed - indexed for MEDLINE] 1073: Rev Sci Tech. 2003 Dec;22(3):977-87. Related Articles, Links

Animal disease surveillance: prospects for development in Pakistan. Akhtar S, White F. Division of Epidemiology and Biostatistics, Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi 74800, Pakistan. Surveillance is a continuous and systematic process of collection, consolidation, analysis, interpretation and dissemination of relevant information on the occurrence of health problems. Data from surveillance can be used to calculate the incidence and prevalence of events, to categorise disease distribution by relevant characteristics, to guide investigations into the occurrence of epidemic and endemic disease, and to contribute essential information for the design and evaluation of effective disease prevention and control programmes. Disease surveillance systems should also respond to the information needs of government

agencies, agribusiness, academia, producers and consumers. However, in most developing countries, including Pakistan, animal disease surveillance systems are not well developed, and do not produce a desirable quality of information on disease status and trends. In this paper, the authors describe various facets of a generic surveillance system and propose a structure for a surveillance system at district level. Such systems have been designed and implemented for public health surveillance in a number of countries, and may be developed to meet the needs of veterinary public health. Publication Types: •

Review

PMID: 15005554 [PubMed - indexed for MEDLINE] 1074: Lancet Infect Dis. 2004 Mar;4(3):171-7. Related Articles, Links Erratum in: •

Lancet Infect Dis. 2004 Aug;4(8):533.

Role of a sentinel surveillance system in the context of global surveillance of infectious diseases. Arita I, Nakane M, Kojima K, Yoshihara N, Nakano T, El-Gohary A. Agency for Cooperation in International Health, Kumamoto City, Japan. [email protected] In some nation states, sustained integrated global epidemiological surveillance has been weakened as a result of political unrest, disinterest, and a poorly developed infrastructure due to rapidly increasing global inequality. The emergence of severe acute respiratory syndrome has shown vividly the importance of sensitive worldwide surveillance. The Agency for Cooperation in International Health, a Japanese non-governmental organisation, has developed on a voluntary basis a sentinel surveillance system for selected target infectious diseases, covering South America, Africa, and Asia. The system has uncovered unreported infectious diseases of international importance including cholera, plague, and influenza; current trends of acute flaccid paralysis surveillance in polio eradication; and prevalence of HIV, syphilis, hepatitis B, and hepatitis C in individual areas covered by the sentinels. Despite a limited geographical coverage, the system seems to supplement disease information being obtained by global surveillance.

Further development of this sentinel surveillance system would be desirable to contribute to current global surveillance efforts, for which, needless to say, national surveillance and alert system takes principal responsibility. Publication Types: •

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

PMID: 14998504 [PubMed - indexed for MEDLINE] 1075: Radiol Technol. 2004 Jan-Feb;75(3):242. Related Articles, Links

Kuwaiti radiographers and PACS. al-Shawaf H, Sayed MG. Department of Health Information Administration, College of Allied Health, Kuwait University, Kuwait. PMID: 14983594 [PubMed - indexed for MEDLINE] 1076: Mar Pollut Bull. 2004 Mar;48(5-6):449-57. Related Articles, Links

Marine litter prediction by artificial intelligence. Balas CE, Ergin A, Williams AT, Koc L. Department of Civil Engineering, Faculty of Engineering and Architecture, Gazi University, Celal Bayar Bulvari, 06570 Maltepe, Ankara, Turkey. [email protected] Artificial intelligence techniques of neural network and fuzzy systems were applied as alternative methods to determine beach litter grading, based on litter surveys of the Antalya coastline (the Turkish Riviera). Litter measurements were categorized and assessed by artificial intelligence techniques, which lead to a new litter categorization system. The constructed neural network satisfactorily predicted the grading of the Antalya beaches and litter categories based on the number of litter items in the general litter category. It has been concluded that, neural networks could be used for high-speed predictions of litter items and beach grading, when the characteristics of the main litter category was determined by field studies. This can save on field effort when fast and reliable estimations of litter categories are required for management or research studies of beaches--

especially those concerned with health and safety, and it has economic implications. The main advantages in using fuzzy systems are that they consider linguistic adjectival definitions, e.g. many/few, etc. As a result, additional information inherent in linguistic comments/refinements and judgments made during field studies can be incorporated in grading systems. PMID: 14980461 [PubMed - indexed for MEDLINE] 1077: J Contemp Dent Pract. 2004 Feb 15;5(1):31-41. Related Articles, Links

Medical health and medication use in elderly dental patients. Jainkittivong A, Aneksuk V, Langlais RP. Department of Oral Medicine in the Faculty of Dentistry at Chulalongkorn University, Bangkok, Thailand. [email protected] The objectives of this study were to obtain information on the medical conditions and medications used among elderly Thai dental patients and to investigate the relationship between the findings in relation to age and sex. The information regarding medical conditions and medication use was obtained from interviews of 510 dental patients aged 60 years and older. The incidence of medical conditions was 82.5%; women had a significantly higher incidence of medical conditions (86.5%) than men (76.5%). The incidence of medical conditions did not differ among the three age groups. Overall, cardiovascular disease was the leading problem (33.7%) with hypertension being the major component (26.1%). The prevalent problems were bone/joint disorders (32.4%), allergies (18.2%), diabetes mellitus (14.5%), and eye and ear problems (14.3%). In our sample, 65.5% reported taking medications, with an average of 1.5 drug groups per person. The average number of medications taken increased as age increased. Women took medications more frequently than men (70% vs. 58.5%). The four most prevalent drugs were cardiovascular agents (32%), endocrinologic drugs (14.5%), nutritional therapeutics (12.9%), and drugs acting on the musculoskeletal system (11.4%). The present study supports the findings of previous reports in that the presence of medical conditions is high in the elderly and the incidence of medication use increases with advancing age. PMID: 14973558 [PubMed - indexed for MEDLINE] 1078: Int Arch Occup Environ Health. 2004 Apr;77(3):153-8. Epub 2004 Feb 13. Related Articles, Links

Yucheng: health effects of prenatal exposure to polychlorinated

biphenyls and dibenzofurans. Guo YL, Lambert GH, Hsu CC, Hsu MM. Department of Occupational and Environmental Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan. [email protected] Yucheng ("oil-disease") victims were Taiwanese people exposed to polychlorinated biphenyls (PCBs) and their heat-degradation products, mainly polychlorinated dibenzofurans (PCDFs), from the ingestion of contaminated rice oil in 1978-1979. Serial studies in Yucheng offspring born between 1978 and 1992 are summarized. Children of the exposed women were born with retarded growth, with dysmorphic physical findings, and, during development, with delayed cognitive development, increased otitis media, and more behavioral problems than unexposed children. Recently, examination of the reproductive system has suggested that prenatal exposure exerts late effects on semen parameters in young men after puberty. Results of the investigation in Yucheng children will provide important information about the human health effects and toxicology of PCB/PCDF exposure. Prenatal exposure to these environmental chemicals causes the fetus to be sensitive to the toxic effects of persistent organic pollutants. Publication Types: • •

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

PMID: 14963712 [PubMed - indexed for MEDLINE] 1079: Masui. 2003 Dec;52 Suppl:S110-4. Related Articles, Links

[Significance of introduction of information technology in hospitals] [Article in Japanese] Inoue M. Publication Types: •

Lectures

PMID: 14870570 [PubMed - indexed for MEDLINE]

1080: Turk J Pediatr. 2003 Oct-Dec;45(4):283-9. Related Articles, Links

Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000. Atasay B, Günlemez A, Unal S, Arsan S. Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey. Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26.3%) of the infants, respectively. Overall survival rate was 83.5% (111/133); most of the deceased cases were under 750 g (12/22). It was prospectively shown that 111 (100%) of the surviving infants could be regularly followed in a newborn follow-up clinic to provide health maintenance, developmental assessment and support. Compared with reports from other developing countries, VLBW infants at our center had higher survival rates. Compared to developed countries, survival rate was lower, especially for extremely very low birth weight infants. There is interaction between birth weight and survival rate. Among selected neonatal outcomes, chronic lung disease, threshold retinopathy, severe intraventricular hemorrhage (IVH > or = grade III)

and nosocomial infection rates at this center were comparable with some reports from developed nations. PMID: 14768790 [PubMed - indexed for MEDLINE] 1081: Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Dec;24(12):1096-9. Related Articles, Links

[Epidemiological features of severe acute respiratory syndrome in Beijing] [Article in Chinese] Liang WN, Mi J; Information Branch, Joint Leadership Group of SARS Prevention and Control in Beijing. Beijing Health Bureau, Beijing 100053, China. OBJECTIVE: To describe the epidemiologic features of severe acute respiratory syndrome (SARS) in Beijing. METHOD: Database of the 2 521 probable cases of SARS in Beijing Center for Disease Prevention and Control was used. RESULTS: The course of SARS epidemic in Beijing could be divided into five phases: import and spreading-from 1 to 31 in March, rising-from April 1 to April 15, peak-from April 16 to May 4, declining-from 5 to 18 in May, terminating-from 19 to 28 in May. The proportions of portable cases of SARS in each phase were 2.7%, 13.6%, 71.0%, 11.6% and 1.1%, respectively. Totally, 2 521 portable cases were diagnosed and verified according to the diagnostic criteria of SARS issued by the Ministry of Health. Among them, 192 died from SARS. The incidence and mortality rates of SARS were 18.57 per 100,000 and 1.41 per 100,000 with the fatality of 7.6%. The ratio of male to female with SARS was 1:0.97. The highest incidence rate of SARS was in the group of 20 - 29 years (30.85 per 100,000), and the lowest was in the group of 0 - 14 years (2.54 per 100,000). People aged 20 49 accounted for 72.3% of all SARS cases. The incidence rates in urban, suburb and far-suburb were 32.25/100,000, 20.57/100,000 and 8.90/100,000, respectively, decreasing according to the population density. Health care providers (17.3%), staff (12.9%), retirees (11.4%), workers (9.7%) and household unemployees (8.8%) appeared to be at the five top risk populations being infected. The fatality increased significantly with age. CONCLUSION: Beijing was the most severe epidemic region of SARS in the world, but the fatality was the lowest. Publication Types: •

English Abstract

PMID: 14761623 [PubMed - indexed for MEDLINE] 1082: Ann Trop Med Parasitol. 2003 Dec;97(8):793-802. Related Articles, Links

The burden of malaria in Ahmedabad city, India: a retrospective analysis of reported cases and deaths. Yadav RS, Bhatt RM, Kohli VK, Sharma VP. Malaria Research Centre (ICMR), Field Station, Civil Hospital, Nadiad -- 387001, India. [email protected] Owing to the paucity of accurate information on the burden of malaria in urban India, a retrospective, epidemiological study was carried out in Ahmedabad city, which has a population of about 3 million. Surveillance data for the years 19651998 showed a gradual resurgence of malaria between 1967 to 1976, followed by waves of low and high incidences. Plasmodium vivax always predominated but the proportion of cases attributed to P. falciparum increased markedly from 1983. When the surveillance data and health records of the major public and private health facilities in the city were analysed, for the period between 1991 and 1998, P. vivax was found to account for 69% of all malaria cases and P. falciparum for the other 31%. The incidence of infection with each Plasmodium species showed seasonal variation, with that of P. vivax increasing from January to September but then declining as the incidence of P. falciparum increased. The age-specific differences seen in incidence were not statistically significant (P=0.7). The annual numbers of malaria-attributable deaths were strongly correlated with the incidence of P. falciparum (r=0.88). The malaria incidence detected (37431 cases, representing a mean annual incidence of 12.2 cases/1000) was nine times greater than that officially reported (4119 cases, or 1.3 cases/1000 each year). Similarly, the annual malaria-attributable mortality detected (22 deaths/million) was far higher than that officially notified (0.3 death/million). The results of the retrospective analysis not only provide a more accurate, baseline estimate of the burden of malaria in an urban area of India but also clearly indicate the need for a much more efficient health-information system, for recording and managing malaria in such a setting. Publication Types: •

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

PMID: 14754491 [PubMed - indexed for MEDLINE]

1083: Immunol Allergy Clin North Am. 2003 Nov;23(4):665-97. Related Articles, Links Erratum in: •

Immunol Allergy Clin North Am. 2004 May;24(2):335.

Allergic reactions to Japanese encephalitis vaccine. Plesner AM. Department of Medical Officers of Health, Copenhagen County, Islands Brygge 67 DK-2300 Copenhagen S, Denmark. [email protected] The JEV widely is used in Asian countries each year and is an important vaccine for travelers to the East from other parts of the world. JE virus is a zoonotic disease with natural reservoirs and cannot be eliminated. Although a declining incidence of JE has been observed in Asia because of reduced transmission by agricultural approaches and vaccination, the most important control measure now, and in the future, is vaccination of humans against JE. The inactivated vaccine, produced from infected mouse-brain-derived tissue, is the only commercially available vaccine. There are several concerns with the use of this vaccine. It is expensive, requires two or three doses to achieve protective efficacy, and, in practice, requires further booster doses to maintain immunity. The apparent increase in allergic reactions in the first part of the 1990s has set focus on the safety of the JEV. A cheap, live attenuated SA 14-14-2 vaccine is used almost exclusively in China and parts of Korea, but there have been no trials of SA 1414-2 vaccine outside JE endemic countries. The vaccine seems to be highly efficient, and few adverse events have been observed; however, PHK cells are used for the production of this vaccine, and these cells are not approved by the WHO. A satisfactory cell substrate is needed. A committee under the WHO has proposed that for the live JEV, there should be validity of the assays for retrovirus when applied to PHK cell substrate and validity of the mouse assays for neurovirulence. Further information should be reviewed on the long-term followup of recipients of the vaccine. Several new types of vaccines have reached the phase of clinical trials; however, studies remain to be completed. Until a new vaccine is available, the priority of surveillance of adverse events and the continuous reporting of such events to the users of the vaccines must be of importance. This fact is highlighted by the possibility of the varying frequency of adverse events with different batches over the years. The WHO offers information and recommendations for vaccines in the EPI and issues a series of updated papers on other vaccines that are of international public health importance (eg, JEV). The development of alternative efficient, safe, and appropriately priced JEVs is recommended, as is intensified surveillance of adverse events. Prospective vaccine studies of safety may be limited because of sample size and

because rare adverse events may not be detected. Several new initiatives have been taken to improve surveillance of adverse events to vaccines within the past 10 years. In Japan, there is an increasing awareness of the importance of efforts taken to improve vaccine safety, and surveillance of adverse events and possibilities of compensation for vaccine-related injuries are in place. In Vietnam, a database to detect adverse events after vaccination has been established; the project involves active visits to data collectors at the vaccination sites. Comparative studies of adverse events, such as one recent study from Japan and the United States, are important for the evaluation of the reporting systems. The reporting rate for JEV adverse events from Japan was approximately one order of magnitude lower than that in the United States. Japan had strict predefined reporting criteria and time limits for observations. If time limits for the observation are too strict (eg, defining a possible neurologic reaction to occur within 1 week after vaccination), later reactions will not be included (eg, if ADEM is elicited by a vaccine, the symptoms cannot be expected to occur until weeks after the vaccination). The passive surveillance systems have limitations with an underreporting of adverse events, depending on clinical seriousness, temporal proximity to vaccination, awareness of healthcare workers, and tradition of reporting particular events. In developed countries, surveillance of adverse events is formalized, although not necessarily optimal. An increase in reporting would be expected when the reporting of adverse events is mandatory. Reports have been sent to VAERS, the Vaccine Safety Datalink Project, and the European Union Pharmacovigilance System. A Brighton collaboration has been implemented to enhance comparability of vaccine safety data. Public health authorities in specific countries, such as the CDC in the United States and the National Advisory Committee in Canada, regularly have published information on the JE situation in Asia and the preventive measures to be taken, including information on the vaccines and adverse reactions. The conventional recommendation is that travelers should be vaccinated if they will spend more than 1 month in a JE endemic area or in areas with epidemic transmission with even shorter periods. Although the risk for JE for short-term travelers is considered small (1 case per 1 million travelers per year), sporadic cases, including deaths, have been reported among tourists traveling to endemic areas. Risk for travelers in rural districts in the season of risk is considerably higher (range, 1 case per 5000 travelers to 1 case per 20,000 travelers per week). Doctors who advise travelers should be updated on the latest JE occurrences in Asia. Updates on the JE situation can be found on bulletins at http://www.promedmail.org or are available from the WHO or CDC. The allergic reactions primarily described after vaccination with the inactivated mouse-brainderived JEV have been observed in several countries during the 1900s. Allergic reactions, including the mucocutaneous and neurologic reactions reported after JE vaccination, may vary in frequency, and these reactions should be evaluated meticulously yearly. This step enables recommendations, including information on possible side effects, to be given in an optimal way. Publication Types:

•

Review

PMID: 14753386 [PubMed - indexed for MEDLINE] 1084: Lepr Rev. 2003 Dec;74(4):337-48. Related Articles, Links

Impairments and Hansen's disease control in Rondônia state, Amazon region of Brazil. De Oliveira CR, De Alencar Mde J, De Sena Neto SA, Lehman LF, Schreuder PA. Hansen's Disease Control Program, State Secretary of Health, Rondônia, Brazil. This retrospective study of impairments in a decentralized and integrated, routine Hansen's disease (HD) programme was done on a cohort of all new patients detected in Rondônia state from 1996 to 1999. It shows that the dynamics of impairments during treatment in Rondônia are similar to what has been published in other recent studies from Africa and Asia. Data about impairments at detection and at release from treatment (cure), the prescription of steroids, and epidemiological information are provided. Of the original 5350 new patients, 4230 patients (80%) completed multidrug therapy (MDT) and had complete data about their impairment status. At the start of treatment, 9% of the paucibacillary (PB) and 26% of the multibacillary (MB) patients had WHO grade 1 impairment. Three percent of the PB and 11% of the MB patients had visible deformities (WHO grade 2 impairment). Of the patients without impairments (grade 0) at the start of treatment, 5% of the PB and 20% of the MB patients developed impairments during treatment. Of the PB patients with a WHO impairment grade 1 at start of treatment, 34% improved and 6% got worse. Of the MB patients 34% improved and 12% became worse. In a separate study of patients from the 1997 intake, 17% of the PB and 58% of the MB patients were treated at least once with a course of steroids or thalidomide during MDT treatment. It is noted in the literature that the percentage of persons with recent nerve function impairment (NFI), nerve pain or tenderness and/or reaction reactions differs between projects. This may reflect real differences or may be caused by differences in routine monitoring and/or criteria and methods of treatment. The use of the WHO maximum score, particularly for the patients with grade 2, is not as sensitive to change as utilizing the summary of Eye, Hand and Foot (EHF) scores. If overall impairment figures are given, the proportions of MB patients may define the differences between projects, therefore it is important to analysis and present the results of PB and MB patients separately. The most simple (outcome) indicator to estimate the effectiveness of patient management would be the proportions of patients with impairment grade 0 at start of treatment who develop either grade 1 or 2 impairments during treatment. An additional (outcome) indicator could be the

proportion of patients with impairment grade 1 at start of treatment who develop grade 2 impairments during treatment. Currently, no operational targets or acceptable level of performance for patient management have been set. This would be important to enable programme managers to determine if adequate patient education, treatment and follow up have been provided after the disease detection to prevent and/or minimize problems associated with the disease. The available evidence strongly suggests that reactions and impairments related to HD will continue to occur in large numbers, requiring the development of adequate infrastructures and sustainable services to detect and to manage problems associated with HD during and after MDT treatment. Publication Types: •

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

PMID: 14750579 [PubMed - indexed for MEDLINE] 1085: Med J Malaysia. 2003 Aug;58(3):365-74. Related Articles, Links

Morbidity and process of care in urban Malaysian general practice: the impact of payment system. Teng CL, Aljunid SM, Cheah M, Leong KC, Kwa SK. International Medical University, Jalan Rasah, 70300 Seremban, Negeri Sembilan. BACKGROUND: The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. OBJECTIVES: We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. RESULTS: During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies

of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. CONCLUSION: This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities. Publication Types: •

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

PMID: 14750376 [PubMed - indexed for MEDLINE] 1086: J Clin Pharm Ther. 2004 Feb;29(1):59-63. Related Articles, Links

Longer than recommended empiric antibiotic treatment of urinary tract infection in women: an avoidable waste of money. Kahan NR, Chinitz DP, Kahan E. Leumit Health Fund, Tel Aviv, Israel. CONTEXT: Current Israeli guidelines for the empiric treatment of uncomplicated urinary tract infection (UTI) in women recommend nitrofurantoin for 5 days. Some physicians nevertheless opt for ofloxacin, which should be prescribed for 3 days according to universally accepted guidelines. OBJECTIVE: To evaluate the economic consequences of longer than recommended durations of antibiotic therapy in the empiric treatment of uncomplicated UTI in women. DESIGN, SETTING AND PATIENTS: Data were derived from the electronic records of one of the four health maintenance organizations in Israel. The sample included all women aged 18-75 years who were diagnosed with acute cystitis or UTI from January 2001 to June 2002 and were empirically treated with antibiotics. Of the 7738 patients identified, 1138 received nitrofurantoin and 1054 ofloxacin. The excess expenditure accrued due to longer than recommended therapy with these drugs was evaluated. RESULTS: The rate of adherence was 22.23% for nitrofurantoin (95% CI=19.81%, 24.65%), and 4.08% for ofloxacin (95% CI=2.88%, 5.28%). The average excess expenditure per case was 5.78 USD (US Dollar) with ofloxacin and 3.43 USD with nitrofurantoin, resulting in an annual

loss to the health maintenance organizations of approximately 19,000 USD. When extrapolated to the national population of 6.5 million, the loss due to inappropriate treatment of adult women is 190,000 USD. CONCLUSIONS: The lack of adherence to national and international guidelines with regard to the recommended duration of antibiotic treatment of UTI in women resulted in a significant and avoidable waste of health system resources. This study suggests that drug utilization analyses that concentrate solely on the choice of drug may be overlooking important information. PMID: 14748899 [PubMed - indexed for MEDLINE] 1087: Indian J Med Res. 2003 Jun;117:260-9. Related Articles, Links

Hand anthropometry of Indian women. Nag A, Nag PK, Desai H. National Institute of Occupational Health (ICMR), Ahmedabad, India. [email protected] BACKGROUND & OBJECTIVES: Data on the physical dimension of the hand of Indian women are scanty. This information is necessary to ascertain humanmachine compatibility in the design of manual systems for the bare and gloved hand, such as design and sizing of hand tools, controls, knobs and other applications in different kinds of precision and power grips. The present study was undertaken to generate hand anthropometric data of 95 women, working in informal industries (beedi, agarbatti and garment making). METHODS: Fifty one hand measurements of the right hand (lengths, breadths, circumferences, depths, spreads and clearances of hand and fingers) were taken, using anthropometric sliding and spreading calipers, measuring tape and handgrip strength dynamometer. The data were statistically analyzed to determine the normality of data and the percentile values of different hand dimensions, and simple and multiple regression analysis were done to determine better predictors of hand length and grip strength. RESULTS: The hand breadths, circumferences and depths were approximately normally distributed, with some deviation in case of the finger lengths. Hand length was significantly correlated with the fist, wrist and finger circumferences. The fist and wrist circumferences, in combination, were better predictors of hand length. The hand lengths, breadths and depths, including finger joints of the Indian women studied were smaller than those of American, British and West Indian women. The hand circumferences of the Indian women were also smaller than the American women. Grip strengths of Indian women (20.36 +/- 3.24 kg) were less than those of American, British and West Indian women. Grip strength was found to be statistically significant with hand dimensions, such as hand height perpendicular to wrist crease (digit 5), proximal interphalangeal joint breadth (digit 3) and hand spread across wedge 1.

INTERPRETATION & CONCLUSION: The women who are forced to frequently use cutters, strippers and other tools, which are not optimally designed to their hand dimensions and strength range, might have higher prevalence of clinical symptoms and disorders of the hand. In view of the human hand-tool interface requirements, the present data on Indian women would be useful for ergo-design applications of hand tools and devices. PMID: 14748472 [PubMed - indexed for MEDLINE] 1088: J Digit Imaging. 2003 Dec;16(4):331-6. Epub 2004 Jan 30. Related Articles, Links

Medical Image Resource Center--making electronic teaching files from PACS. Lim CC, Yang GL, Nowinski WL, Hui F. Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433. [email protected] A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research. Publication Types: •

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

PMID: 14747933 [PubMed - indexed for MEDLINE] 1089: Acta Trop. 2004 Feb;89(3):299-308. Related Articles, Links

The effectiveness of impregnated bed net in malaria control in Laos. Kobayashi J, Phompida S, Toma T, Looareensuwan S, Toma H, Miyagi I. Bureau of International Cooperation, International Medical Center of Japan (IMCJ), Japan. [email protected] Impregnated bed net (IBN) were used in 366 villages in the central and southern three provinces of Lao PDR from 1999 to 2000. It was confirmed that 81.0% of 40000 bed nets, which were donated by Japanese Grant Aid, were delivered within 2 years. The strengthening of information network systems in anti-malaria and strong relationship between community and local authorities ensured the success of operation in a short period. The number of patients and the slide positive rate of malaria decreased markedly in public health facilities in three provinces after the use of IBN. An entomological survey was conducted in Boualapha district, where malaria is endemic, to investigate the IBN efficacy on malaria vector. The density and parous rate of Anopeles dirus, which is the main malaria vector in the area, were markedly decreased in the village where IBN was used. This mosquito's behavior, which was baiting mainly humans during the time when the inhabitants sleep in the IBN, was considered to be advantageous in preventing malaria infection using by IBN. The area of distribution of A. dirus is similar to the high endemic area of malaria in Lao PDR. Thus, it is expected that the expansion of the IBN program in the southern provinces will lead to successful malaria control in subsequent years. Publication Types: •

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

PMID: 14744556 [PubMed - indexed for MEDLINE] 1090: Educ Health (Abingdon). 2003 Jul;16(2):129-32. Related Articles, Links

Making community-based education programs sustainable? Joseph A, Abraham S. Publication Types: •

Editorial

PMID: 14741896 [PubMed - indexed for MEDLINE] 1091: Am J Trop Med Hyg. 2003 Dec;69(6):634-40. Related Articles, Links

Use of a geographic information system for defining spatial risk for dengue transmission in Bangladesh: role for Aedes albopictus in an urban outbreak. Ali M, Wagatsuma Y, Emch M, Breiman RF. Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh. [email protected] We used conventional and spatial analytical tools to characterize patterns of transmission during a community-wide outbreak of dengue fever and dengue hemorrhagic fever in Dhaka, Bangladesh in 2000. A comprehensive householdlevel mosquito vector survey and interview was conducted to obtain data on mosquito species and breeding as well as illness consistent with dengue. Clusters of dengue illnesses and high-density vector populations were observed in a distinct sector of the city. Dengue clusters are less identifiable in areas further away from major hospitals, suggesting that proximity to hospitals determines whether cases of dengue are diagnosed. Focusing on those areas relatively close to hospitals, we found a spatial association between dengue clusters and vector populations. Households reporting a recent dengue illness were more likely to have Aedes albopictus larvae present in the home when compared with households not reporting cases. Households reporting a recent dengue illness were also more likely to have a neighbor with Ae. albopictus present in the home. In contrast, the presence of Aedes aegypti within the premises as well as the homes of neighbors (within 50 meters) was not associated with dengue illness. Given that the breeding habitats for Ae. albopictus are somewhat distinct from those of Ae. aegypti, the findings of this study have implications for control of dengue transmission in this urban setting where much of the focus has been on indoor mosquito breeding and transmission. Public health officials may find the diseaseenvironment map useful for planning targeted interventions because it displays areas where transmission is most intense. Publication Types: • •

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

PMID: 14740881 [PubMed - indexed for MEDLINE]

1092: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2003;(121):1-11. Related Articles, Links

[Safety information project on drug, food and chemicals. Division of Safety Information on Drug, Food and Chemicals. National Institute of Health Sciences] [Article in Japanese] Morikawa K, Yamamoto M, Nakano T, Kasuga F, Yamamoto M. [email protected] Recent issues on BSE(Bovine Spongiform Encephalopathy) and health hazards caused by adverse reactions of medical drugs, have strongly emphasized the necessity for safety measures to secure public health. These issues have been attributed to the delay to obtain overseas information on safety and regulation, and the lack of an adequate system for acquirement and assessment of such information. In order to develop a system where domestic and international safety information is collected, analyzed, assessed and presented both scientifically and systematically, the Division of Chem-Bio Informatics of the National Institute of Health Sciences was reorganized to the Division of Safety Information on Drug, Food and Chemicals in April, 2003. Collection and evaluation of safety information on medical drugs, food and chemical substances is now centralized at the Division, which consists of 5 sections, the first, second and third sections being newly established. The first section assesses information on medical drugs, the second section deals with food microorganisms, and the third section focuses on chemicals in food. The fourth and fifth sections retain their previous functions, namely, chemical safety information research and information network infrastructure support within the institute, respectively. The purpose of this paper is to describe how we will manage safety information on drug, food and chemicals, focusing on the role of the three new sections. Publication Types: • •

English Abstract Review

PMID: 14740398 [PubMed - indexed for MEDLINE] 1093: AMIA Annu Symp Proc. 2003:882. Related Articles, Links

Clinicians' perceptions and the relevant computer-based information needs towards the practice of evidence based medicine. Jiang G, Ogasawara K, Endoh A, Sakurai T. Department of Medical Informatics, Hokkaido University Graduate School of Medicine, Sapporo, Japan. We conducted a survey among 100 clinicians in a university hospital to determine the clinician's attitudes and the relevant computer-based information needs towards the practice of evidence-based medicine in outpatient setting. PMID: 14728387 [PubMed - indexed for MEDLINE] PMCID: PMC1480090

1094: AMIA Annu Symp Proc. 2003:244-54. Related Articles, Links

Will decision support in medications order entry save money? A return on investment analysis of the case of the Hong Kong hospital authority. Fung KW, Vogel LH. Department of Biomedical Informatics, Columbia University, USA. The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drugallergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 - 8.4%. Based on this estimate, a total net saving of $44,000 - $586,000 is expected over five years. The breakeven period is estimated to be between two to four years. PMID: 14728171 [PubMed - indexed for MEDLINE] PMCID: PMC1480307

1095: Intensive Care Med. 2004 Feb;30(2):248-53. Epub 2004 Jan 15. Related Articles, Links

Prediction of mortality in an Indian intensive care unit. Comparison between APACHE II and artificial neural networks. Nimgaonkar A, Karnad DR, Sudarshan S, Ohno-Machado L, Kohane I. Children's Hospital Informatics Program, Ender's Building, 5th Floor, 320 Longwood Avenue, Boston, Massachusetts, USA. [email protected] OBJECTIVE: To compare hospital outcome prediction using an artificial neural network model, built on an Indian data set, with the APACHE II (Acute Physiology and Chronic Health Evaluation II) logistic regression model. DESIGN: Analysis of a database containing prospectively collected data. SETTING: Medical-neurological ICU of a university hospital in Mumbai, India. SUBJECTS: Two thousand sixty-two consecutive admissions between 1996 and 1998. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The 22 variables used to obtain day-1 APACHE II score and risk of death were recorded. Data from 1,962 patients were used to train the neural network using a backpropagation algorithm. Data from the remaining 1,000 patients were used for testing this model and comparing it with APACHE II. There were 337 deaths in these 1,000 patients; APACHE II predicted 246 deaths while the neural network predicted 336 deaths. Calibration, assessed by the Hosmer-Lemeshow statistic, was better with the neural network (H=22.4) than with APACHE II (H=123.5) and so was discrimination (area under receiver operating characteristic curve =0.87 versus 0.77, p=0.002). Analysis of information gain due to each of the 22 variables revealed that the neural network could predict outcome using only 15 variables. A new model using these 15 variables predicted 335 deaths, had calibration (H=27.7) and discrimination (area under receiver operating characteristic curve =0.88) which was comparable to the 22-variable model (p=0.87) and superior to the APACHE II equation (p<0.001). CONCLUSION: Artificial neural networks, trained on Indian patient data, used fewer variables and yet outperformed the APACHE II system in predicting hospital outcome. Publication Types: •

Comparative Study

PMID: 14727015 [PubMed - indexed for MEDLINE] 1096: Disasters. 2003 Dec;27(4):288-304. Related Articles, Links

Integration of different data bodies for humanitarian decision support: an example from mine action. Benini AA, Conley CE, Shdeed R, Spurway K, Yarmoshuk M. National Demining Office, Lebanon. [email protected] Geographic information systems (GIS) are increasingly used for integrating data from different sources and substantive areas, including in humanitarian action. The challenges of integration are particularly well illustrated by humanitarian mine action. The informational requirements of mine action are expensive, with socio-economic impact surveys costing over US$1.5 million per country, and are feeding a continuous debate on the merits of considering more factors or 'keeping it simple'. National census offices could, in theory, contribute relevant data, but in practice surveys have rarely overcome institutional obstacles to external data acquisition. A positive exception occurred in Lebanon, where the landmine impact survey had access to agricultural census data. The challenges, costs and benefits of this data integration exercise are analysed in a detailed case study. The benefits are considerable, but so are the costs, particularly the hidden ones. The Lebanon experience prompts some wider reflections. In the humanitarian community, data integration has been fostered not only by the diffusion of GIS technology, but also by institutional changes such as the creation of UN-led Humanitarian Information Centres. There is a question whether the analytic capacity is in step with aggressive data acquisition. Humanitarian action may yet have to build the kind of strong analytic tradition that public health and poverty alleviation have accomplished. PMID: 14725088 [PubMed - indexed for MEDLINE] 1097: Aust N Z J Public Health. 2003 Dec;27(6):642-4. Related Articles, Links

Analysing health care systems performance: the story behind the statistics. Healy J. European Observatory on Health Care Systems. [email protected] This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Observatory on Health Care Systems to inform health sector policy: an Asia-Pacific Observatory. The countries in this diverse region, ranging from highly developed to very poor countries, are

undergoing dramatic and diverse health sector changes, often on the basis of little evidence and with little information on successes and failures in neighbouring countries. The international community also is interested in knowing more about the many distinctive models of Asia-Pacific health care. While statistical comparisons are important, health policymakers and researchers need to understand the story behind the statistics in order to interpret the numbers and to formulate policies and strategies. Health system profiles therefore are useful instruments that describe how a complex health sector works, offer a comparative framework for cross-national comparisons, identify trends in health system design, and with standardised measures and regular updates measure progress against benchmarks. These reports and expanded analyses have influenced both national and Europe-wide debates on health policy. In the Asia-Pacific region, health systems research has built up a critical mass of studies and people with strong links across countries. The next ambitious steps are to identify sponsors able to support an enterprise that transcends national boundaries and to begin a project of comparative studies of national health systems. PMID: 14723414 [PubMed - indexed for MEDLINE] 1098: Asian J Surg. 2004 Jan;27(1):58-64. Related Articles, Links

Peer review audit of trauma deaths in a developing country. Jat AA, Khan MR, Zafar H, Raja AJ, Hoda Q, Rehmani R, Lakdawala RH, Bashir S. Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan. OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable. RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were nonpreventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was

significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country. PMID: 14719518 [PubMed - indexed for MEDLINE] 1099: Isr Med Assoc J. 2003 Oct;5(10):706-8. Related Articles, Links

Influenza vaccination: reduction in hospitalizations and death rates among members of "Maccabi Healthcare Services" during the 20002001 influenza season. Shapiro Y, Shemer J, Heymann A, Shalev V, Maharshak N, Chodik G, Green MS, Kokia E. BACKGROUND: Upper respiratory tract illnesses have been associated with an increased risk of morbidity and mortality. OBJECTIVE: To assess the influence of vaccination against influenza on the risk of hospitalization in internal medicine and geriatric wards, and the risk of death from all causes during the 2000-2001 influenza season. METHODS: A historical cohort study was conducted using computerized general practitioner records on patients aged 65 years and above, members of "Maccabi Healthcare Services"--the second largest health maintenance organization in Israel with 1.6 million members. The patients were divided into high and low risk groups corresponding to coexisting conditions, and were studied. Administrative and clinical data were used to evaluate outcomes. RESULTS: Of the 84,613 subjects in the cohort 42.8% were immunized. At baseline, vaccinated subjects were sicker and had higher rates of coexisting conditions than unvaccinated subjects. Vaccination against influenza was associated with a 30% reduction in hospitalization rates and 70% in mortality rates in the high risk group. The NNT (number needed to treat) measured to prevent one hospitalization was 53.2 (28.2 in the high risk group and 100.4 in the low risk group). When referring to length of hospitalization, one vaccine was needed to prevent 1 day of hospitalization among the high risk group. Analyses according to age and the presence or absence of major medical conditions at baseline revealed similar findings across all subgroups. CONCLUSIONS: In the elderly, vaccination against influenza is associated with a reduction in both the total risk of hospitalization and in the risk of death from all causes during the influenza season. These findings compel the rationale to increase compliance with recommendations for annual influenza vaccination among the elderly. PMID: 14719464 [PubMed - indexed for MEDLINE]

1100: An Pediatr (Barc). 2004 Jan;60(1):35-41. Related Articles, Links

[Foreign minors in the protection system of the Autonomous Community of Aragón (Spain)] [Article in Spanish] Oliván Gonzalvo G. Servicios de Pediatría y Adolescencia. Instituto Aragonés de Servicios Sociales. Departamento de Salud, Consumo y Servicios Sociales. Gobierno de Aragón. Zaragoza. España. [email protected] OBJECTIVES: To determine the prevalence of foreign minors in protection centers, their demographic characteristics, and reasons for entry, as well as the relation with geographic area, family, social and health risk factors, and highpriority health needs. PATIENTS AND METHODS: We performed a retrospective cross-sectional study over an 11-year period (1992-2002). The health and socio-familial reports of 1,619 minors who were admitted to protection centers were reviewed and those from a foreign country were included. Compilation of information, definition of concepts, and health assessments were performed according to standard protocols. RESULTS: Two hundred forty-one foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years (adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study period. The prevalence was 4.6 times higher than that expected. Origin: Africa 68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east 9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and relation with geographic area were as follows: 1. Being an abandoned illegal immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2. Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7 %, no difference by geographic area); 3. Temporary incapacity for their care 18.7 % (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa 18.1 %, Europe 17.5 %); 4. Other causes 7 %. Risk factors: at least one (78.4 %) and more than one (33.6 %); housing problems and especially living in a single parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %); main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %), growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %). CONCLUSIONS: Being a minor immigrant in a foreign country with problems of documentation, housing or family regrouping and especially if there are language, cultural or racial (ethnic minorities) barriers is a major risk factor for living in a situation of vulnerability, risk or neglect/abandonment that requires social protection measures. Continuous follow-up by the social services of the adoptive

community is required for the prevention and early detection of children in need of protection. Publication Types: •

English Abstract

PMID: 14718130 [PubMed - indexed for MEDLINE]