His 7

1301: Environ Health Perspect. 2002 Nov;110(11):1141-6. Related Articles, Links Comment in: • •

Environ Health Perspect. 2002 Nov;110(11):A690. Environ Health Perspect. 2003 Jul;111(9):A451-2; author reply A452.

Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans. Lange JL, Schwartz DA, Doebbeling BN, Heller JM, Thorne PS. Department of Occupational and Environmental Health, College of Public Health, College of Medicine, University of Iowa, Iowa City, Iowa, USA. Military personnel deployed to the Persian Gulf War have reported a variety of symptoms attributed to their exposures. We examined relationships between symptoms of respiratory illness present 5 years after the war and both selfreported and modeled exposures to oil-fire smoke that occurred during deployment. Exposure and symptom information was obtained by structured telephone interview in a population-based sample of 1,560 veterans who served in the Gulf War. Modeled exposures were exhaustively developed using a geographic information system to integrate spatial and temporal records of smoke concentrations with troop movements ascertained from global positioning systems records. For the oil-fire period, there were 600,000 modeled data points with solar absorbance used to represent smoke concentrations to a 15-km resolution. Outcomes included respiratory symptoms (asthma, bronchitis) and control outcomes (major depression, injury). Approximately 94% of the study cohort were still in the gulf theater during the time of the oil-well fires, and 21% remained there more than 100 days during the fires. There was modest correlation between self-reported and modeled exposures (r = 0.48, p < 0.05). Odds ratios for asthma, bronchitis, and major depression increased with increasing self-reported exposure. In contrast, there was no association between the modeled exposure and any of the outcomes. These findings do not support speculation that exposures to oil-fire smoke caused respiratory symptoms among veterans. PMID: 12417486 [PubMed - indexed for MEDLINE] PMCID: PMC1241071

1302: Ann Nucl Med. 2002 Sep;16(6):383-5. Related Articles, Links

Japan's contribution to nuclear medical research. Rahman M, Sakamoto J, Fukui T. Department of Epidemiological and Clinical Research Information Management, Kyoto University Graduate School of Public Health, Japan. [email protected] We investigated the degree of Japan's contribution to the nuclear medical research in the last decade. Articles published in 1991-2000 in highly reputed nuclear medical journals were accessed through the MEDLINE database. The number of articles having affiliation with a Japanese institution was counted along with publication year. In addition, shares of top-ranking countries were determined along with their trends over time. Of the total number of articles (7,788), Japan's share of articles in selected nuclear medical journals was 11.4% (889 articles) and ranked 2nd in the world after the USA (2,645 articles). The recent increase in the share was statistically significant for Japan (p = 0.02, test for trend). Japan's share in nuclear medical research output is much higher than that in other biomedical fields. Publication Types: •

Comparative Study

PMID: 12416576 [PubMed - indexed for MEDLINE] 1303: Nippon Koshu Eisei Zasshi. 2002 Sep;49(9):967-82. Related Articles, Links

[A survey of infants requiring long-term neonatal intensive care in Tokyo: 1989-1998] [Article in Japanese] Yoneyama H, Ohkubo S. Maternal and Child Health Section, Public Health Promotion Division, Bureau of Public Health, Tokyo Metropolitan Government. In order to grasp the characteristics and outcomes with infants hospitalized longterm in NICUs, we reviewed all summary charts of 18 perinatal medical centers in

Tokyo for the period from January 1989 to December 1998. We sampled 3,000 infants who required neonatal intensive care over 90 consecutive days out of 46,309 registered cases during the decade. The duration of hospital stay, making a comparative analysis of the number of days for the 50 percentile, was as follows. As a whole the infants required 125 days until discharge. Infants with 29-30 weeks gestation and infants with birth weights 1,000-1,499 g required shorter stays (106 days in both cases). The "discharge with complications" group required 136 days, and the "discharge on remission" group 119 days. Within the 31-32 weeks gestation group, those with "discharge with complications" required 107 days. Within the 29-30 weeks gestation group, those with "discharge on remission" required 104 days. Infants with 1,000-1,499 g birth weights for the "discharge with complications" and "discharge on remission" groups required 116 and 104 days respectively. Focusing on birthplace, the group of "inside-born" (born at perinatal medical centers) infants required 124 days, and the "outsideborn" (born at non-perinatal medical centers) required 127 days. Respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) were often seen in patients under 29 weeks gestation and under 1,000 g birth weight. Hypoxic ischemic encephalopathy (HIE), convulsions, congenital malformations and chromosomal abnormalities were frequent in the groups over 31 weeks and over 1,500 g. Apnoea and transient tachypnoea of newborn (TTN) often occurred in these at 29-30 weeks and 1,000-1,499 g. Also, apnoea and TTN were often seen in the "discharge on remission" group. RDS, apnoea and TTN occurRed frequently in the "inside-born" infants with over 31 weeks of gestation and over 1,500 g birth weight. There were many cases of HIE and convulsions in the "outside-born" infants of these groups. We found infants who required long-term intensive care to comprise three main groups. The first group consisted of infants of 29-30 weeks gestation and 1,000-1,499 g birth weight and demonstrated mild or few complications. The second consisted of under 29 weeks and under 1,000 g and exhibited complications of chronic lung diseases caused by immaturity of respiratory organs. The third was the group of over 31 weeks and over 1,500 g who had complications due to central nervous system disease, congenital malformations and chromosomal abnormalities. Publication Types: •

English Abstract

PMID: 12402475 [PubMed - indexed for MEDLINE] 1304: Sangyo Eiseigaku Zasshi. 2002 Sep;44(5):188-99. Related Articles, Links

[A survey of utilization of and problems with the MSDS in chemical substances management at workplaces in Kanagawa Prefecture]

[Article in Japanese] Koshi K, Mouri T, Sugimori H, Numano T, Ashida T, Hiro H, Miyake H, Fukushima M, Ishiwata K. Kanagawa Occupational Health Promotion Center, Labour Welfare Cooperation, 2-2-1-1, Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8143, Japan. Kanagawa Occupational Health Promotion Center conducted a survey on how the MSDS is utilized at workplaces with more than 50 employees handling chemical substances, and what measures are taken to help employees to thoroughly understand information in the Material Safety Data Sheet (MSDS). Questionnaires were sent out to 265 enterprises in Kanagawa prefecture, putting questions to industrial physicians and industrial hygiene supervisors. The objective of the survey was to find out how MSDS is adopted in the system to manage occupational health, what improvements the survey respondents want in MSDS and what expectations the respondents have of our center. 193 enterprises (72.8%) returned answers to the questionnaire. The major findings are as follows. (1) In many companies, information on hazardous/toxic materials is "controlled by a division using such materials", and roughly half of the companies have compiled a common list shared throughout the company. (2) For the most part suppliers submit to the MSDS. Larger companies have a higher rate of posting up or filing the MSDS at their workplaces. Only 25.8% of the companies "rewrite the MSDS so that workers can understand it." (3) Companies that carry out a hazard/toxicity assessment before introducing a new chemical substance account for 72.1%, which is higher than we expected. It indicates that even though the companies don't manage the MSDS adequately, they are highly concerned about hazard control of chemical substances. (4) The rate of answering that "the current MSDS is not easy to understand" is higher among large-sized enterprises and lower among enterprises with fewer than 300 employees. (5) Asked what improvement needs to be made on the MSDS, the industrial physicians and industrial hygiene supervisors gave same answers such as "Workers find the terminology difficult to understand." and "Levels of toxicity can't be clearly identified." (6) The respondents expect our center to provide information for the MSDS. In conclusion, it is considered that in order to prepare understandable MSDSs to workers in enterprises, the role of our center to provide information and education on the MSDS to respondents was important. Publication Types: •

English Abstract

PMID: 12402464 [PubMed - indexed for MEDLINE] 1305: Sangyo Eiseigaku Zasshi. 2002 Sep;44(5):175-9.

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[Stress management for office workers] [Article in Japanese] Hayashi T. Hitachi Health Care Center, 3-16, Ose 4-chome, Hitachi-shi, Ibaraki, 317-0076, Japan. The environment which surrounds office workers has undergone a big transformation with the collapse of lifetime employment, the shift from the long employment principle to meritocracy, the results principle, the introduction of flexible work hours, outsourcing and dispatch work. Today's office worker stressor include 1. VDT work, 2. meritocracy, 3. management by objective, 4. excessive load on the middle and advanced age generations, 5. the collapse of the lifetime employment system and 6. non-employee changes. (1) VDT work management, (2) the use of Information technology, (3) Improvement of office environments, (4) Management of long overtime work and (5) Support of superiors and colleagues are thought as stress management. Publication Types: • •

English Abstract Review

PMID: 12402462 [PubMed - indexed for MEDLINE] 1306: Int J Environ Health Res. 2002 Jun;12(2):175-9. Related Articles, Links

Respiratory effects and arsenic contaminated well water in Bangladesh. Milton AH, Rahman M. Arsenic Cell, NGO Forum for Drinking Water Supply & Sanitation, Dhaka, Bangladesh. [email protected] Arsenic in drinking water causes a widespread concern in Bangladesh, where a major proportion of tube wells is contaminated. Arsenic ingestion causes skin lesions, which is considered as definite exposure. A prevalence comparison study of respiratory effects among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Exposed participants were recruited

through health awareness campaign programs. Unexposed participants were randomly selected, where tubewells were not contaminated with arsenic. A total of 169 individuals participated (44 exposed individuals exhibiting skin lesions; 125 unexposed individuals). The arsenic concentrations ranged from 136 to 1000 micro g l(-1). The information regarding respiratory system signs and symptoms were also collected and the analyses were confined to nonsmokers. The crude prevalence ratio for chronic bronchitis and chronic cough amounted to 2.1 (95% CI 0.7-6.1). The prevalence ratios for chronic bronchitis increased with increasing exposure, i.e., 1.0, 1.6, 2.7 and 2.6 using unexposed as the reference. The prevalence ratios for chronic cough were 1.0, 1.6, 2.7 and 2.6 for the exposure categories, using the same unexposed as the reference. The dose-response trend was the same (P < 0.1) for both conditions. These results add to evidence that long-term ingestion of arsenic exposure can cause respiratory effects. PMID: 12400554 [PubMed - indexed for MEDLINE] 1307: Biotechniques. 2002 Oct;33(4):822, 824-6, 828 passim. Related Articles, Links

SNPkit: an efficient approach to systematic evaluation of candidate single nucleotide polymorphisms in public databases. Hao K, Niu T, Sangokoya C, Li J, Xu X. Harvard School of Public Health, Boston, MA, USA. There is widespread interest in devising genotyping methods for SNPs that are robust, inexpensive, and simple to perform. Although several high-throughput SNP genotyping technologies have been developed, including the oligonucleotide ligation assay, real-time PCR, and mass spectrometry, the issues of simplicity and cost-effectiveness have not been adequately addressed. Here we describe the application of a novel computer software package, SNPkit, which designs SNP genotyping assays based on a classical approach for discriminating alleles, restriction enzyme digestion. SNPkit can be used in genotyping assays for almost any SNPs including those that do not alter "natural" restriction sites. Using this method, 164 SNPs have been evaluated in DNA samples from 48 immortalized cell lines of randomly selected Chinese subjects. Sixty-two (37.8%) of the SNPs appeared to be common (frequencies of the minor alleles are > or = 5%) and were subsequently applied to a larger population-based sample. Overall, by using SNPkit, we have been able to validate and genotype accurately a large fraction of publicly available SNPs without sophisticated instrumentation. Publication Types: • •

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

PMID: 12398191 [PubMed - indexed for MEDLINE] 1308: Int J Qual Health Care. 2002 Oct;14(5):383-91. Related Articles, Links

Assessing the factors influencing continuous quality improvement implementation: experience in Korean hospitals. Lee S, Choi KS, Kang HY, Cho W, Chae YM. OBJECTIVE: To assess the extent of continuous quality improvement (CQI) implementation in Korean hospitals and to identify its influencing factors. DESIGN: Cross-sectional study by mailed questionnaire survey. STUDY PARTICIPANTS: One hundred and seventeen staff members with responsibility for CQI at 67 hospitals with > or = 400 beds. MAIN OUTCOME MEASURES: The degree of CQI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors related to the degree of CQI implementation were the four components of the CQI pyramid, namely the cultural, technical, strategic, and structural attributes of individual hospitals. RESULTS: The average CQI implementation score across the seven dimensions by MBNQAC was 3.34 on a 5-point scale. The highest score was achieved in the dimension of 'customer satisfaction' (3.88), followed by 'information/analysis' (3.59), and 'quality management' (3.35). Regression analysis showed that hospitals which better fulfilled technical requirements, such as improving information systems (P< 0.05), using more scientific CQI tools, and adopting systematic problem-solving approaches (P<0.01), tended to achieve higher degrees of CQI implementation. Although statistically insignificant, positive trends were observed for group/developmental culture and the degree of employee empowerment, and the use of prospective strategy. CONCLUSION: It appears that the most important contributing factors to active CQI implementation in Korean hospitals were the use of scientific skills in decision-making and the adoption of a quality information system capable of producing precise and valid information. Publication Types: •

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

PMID: 12389804 [PubMed - indexed for MEDLINE] 1309: Clin Infect Dis. 2002 Nov 1;35(9):1047-52. Epub 2002 Oct 10. Related Articles, Links

Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop. Jelinek T, Mühlberger N, Harms G, Corachán M, Grobusch MP, Knobloch J, Bronner U, Laferl H, Kapaun A, Bisoffi Z, Clerinx J, Puente S, Fry G, Schulze M, Hellgren U, Gjørup I, Chalupa P, Hatz C, Matteelli A, Schmid M, Nielsen LN, da Cunha S, Atouguia J, Myrvang B, Fleischer K; European Network on Imported Infectious Disease Surveillance. Department of Infectious Diseases and Tropical Medicine, University of Munich, 80802 Munich, Germany. [email protected] Travelers have the potential both to acquire and to spread dengue virus infection. The incidence of dengue fever (DF) among European travelers certainly is underestimated, because few centers use standardized diagnostic procedures for febrile patients. In addition, DF is currently not reported in most European public health systems. Surveillance has commenced within the framework of a European Network on Imported Infectious Disease Surveillance (TropNetEurop) to gain information on the quantity and severity of cases of dengue imported into Europe. Descriptions of 294 patients with DF were analyzed for epidemiological information and clinical features. By far the most infections were imported from Asia, which suggests a high risk of DF for travelers to that region. Dengue hemorrhagic fever occurred in 7 patients (2.4%) all of whom recovered. Data reported by member sites of the TropNetEurop can contribute to understanding the epidemiology and clinical characteristics of imported DF. Publication Types: •

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

PMID: 12384837 [PubMed - indexed for MEDLINE] 1310: J Healthc Inf Manag. 2002 Fall;16(4):24-5. Related Articles, Links

IHE around the world. Vegoda P. MalvernGroup, Incorporated, Malvern, Pennsylvania, USA. PMID: 12365294 [PubMed - indexed for MEDLINE]

1311: Fam Pract. 2002 Oct;19(5):537-42. Related Articles, Links

The place of evidence-based medicine among primary health care physicians in Riyadh region, Saudi Arabia. Al-Ansary LA, Khoja TA. Department of Family and Community Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia. [email protected] BACKGROUND: Evidence-based medicine (EBM) is a style of practice in which doctors manage problems by reference to valid and relevant information. Unfortunately, research consistently has shown that clinical decisions rarely are based on the best available evidence. Since primary care is the essential foundation in effective health care systems, it follows that providing evidencebased primary care would reflect positively on the community's health. OBJECTIVES: Our aim was to explore the awareness and the attitude of primary health care physicians (PHCPs) towards evidence-based medicine (EBM) and determine their related educational needs. METHODS: A questionnaire study was carried out of all 650 PHCPs practising at the Ministry of Health Primary Health Care Centres in Riyadh region, Saudi Arabia. Main outcome measures were respondents' attitude towards EBM, ability to access and interpret evidence, perceived barriers to practising EBM and the best method of moving from opinion-based medicine to EBM. RESULTS: Respondents (n = 559) mainly welcomed EBM and agreed that its practice improves patient care. They had a low level of awareness of extracting journals, review publications and databases, and even if aware, many did not use them. The most commonly read journals by the PHCPs were The Practitioner and Medicine Digest. Only 16% had access to bibliographic databases and 10% to the worldwide web. The respondents showed a partial understanding of the technical terms used in EBM. The major perceived barriers to practising EBM were patient overload and lack of personal time. Respondents thought that the most appropriate way to move towards EBM was by learning the skills of EBM (43%), followed by using evidence-based guidelines developed by colleagues (37%). CONCLUSIONS: Efforts towards improving access to evidence-based guidelines and summaries are urgently needed. Teaching all the PHCPs literature searching and critical appraisal skills by feasible and friendly methods should be considered. Publication Types: •

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

PMID: 12356709 [PubMed - indexed for MEDLINE]

1312: Chang Gung Med J. 2002 Jul;25(7):458-63. Related Articles, Links

Factors delaying hospital arrival after acute stroke in southern Taiwan. Tan TY, Chang KC, Liou CW. First Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Niaosung, Taiwan, ROC. [email protected] BACKGROUND: Acute stroke management emphasizes prompt recognition of symptoms and early medical attention. The effectiveness of stroke treatment is highly dependent on amount of time lapsed between onset of symptoms and treatment. In this study, factors that delayed seeking medical attention after stroke in southern Taiwan were explored. METHODS: This was a prospective onecenter study in which information was collected from patients who arrived at the emergency department of the study hospital within 48 hours after stroke onset. All the data were categorized into arrival time less than 2 hours (T < 2 hours) and from 2 to 48 hours (T = 2-48 hours) after stroke onset. RESULTS: There were 789 stroke patients screened and 197 (25%) of them fulfilled the inclusion criteria. Among the 197 patients, 52 (26%) arrived at the study hospital within 2 hours of stroke (median, 75 minutes) and 145 (74%) arrived between 2-48 hours (median, 575 minutes). Among patients with T = 2-48 hours, 47 (24%) patients initially sought medical attention at other hospitals or clinics within 2 hours. The factors associated with T = 2-48 hours included interhospital transfer, location of stroke onset, first aid at outpatient clinic, and lack of awareness of emergent medical help for stroke. CONCLUSION: Significant prehospital delays for stroke patients exist in Taiwan. The implementation of well designed, effective public health programs, coordination of stroke centers within the community hospitals, and effective emergent medical service system are needed to minimize the time to evaluation and treatment of stroke. Because of the high population density and the high incidence of stroke in Taiwan, the programs mentioned above could have a major impact on improving the care of stroke patients. PMID: 12350032 [PubMed - indexed for MEDLINE] 1313: Glimpse. 2000 Mar;22(1):5-8. Related Articles, Links

Strengthening national health programmes. Applied research and technical assistance. [No authors listed]

PIP: Research findings of the Centre for Health and Population Research in Bangladesh have always been instrumental in strengthening national health programs in developing countries. In accordance with the fundamental mission of the Centre, the Health and Population Extension Division (HPED) has primarily conducted operations research and has disseminated the findings to program managers and policy-makers. In addition, it has provided technical assistance to the Government of Bangladesh (GoB) and nongovernmental organizations working in the health and population sector. This paper reports the contributions of the HPED and the Centre's Epidemic Control Preparedness Programme (ECPP) in improving national health programs in Bangladesh. Overall, it is noted that the HPED and the ECPP have conducted field-testing of interventions and provided technical assistance to GoB concerning the community clinics and the unified management information system. Moreover, the HPED, through its Operations Research Project has successfully disseminated lessons learnt from its applied research activities. Future plans of the HPED include continuing such activities and help translate the findings into policy actions, aiming at improving the effectiveness and efficiency of large-scale national programs. PMID: 12349775 [PubMed - indexed for MEDLINE] 1314: China Popul Today. 1999 Dec;16(6):4-5. Related Articles

Establish information feedback system: Heping, Tianjin. [No authors listed] PIP: In 1997, Heping District in China was designated as one of the five localities to pilot the Quality of Care program in family planning (FP). Over the last two years, the district has achieved encouraging results in forging an alternative path for implementing the family planning program in urban areas. District FP leaders have acknowledged the importance of meeting clients' needs in providing quality services, hence a service network was established to better meet the needs of the local residents. This network consists of a petition reception office, a district/subdistrict help center, a district FP publicity service center, a contraceptive distribution center and a subdistrict/neighborhood service center. It provides policy consulting, healthy childbirth and child rearing, education of the newlyweds and gynecological check-up, private counseling mailbox, sales and distribution of contraceptives, open publicity corners and provide publicity package, compilation and distribution of a handbook for FP work and implementing quality of care program. In addition to this service network, KAP surveys and training programs were also conducted. Lastly, the establishment of the information feedback system has facilitated the implementation of the Quality of Care program and avoided the wastage of resources.

PMID: 12349531 [PubMed - indexed for MEDLINE] 1315: China Popul Today. 1999 Oct;16(4-5):6-8. Related Articles

Integrate FP with community-based health service: Xuanwu, Beijing. Guo X. PIP: In response to the demands for high-quality health care service, the family planning (FP) and public health departments collaborated to provide such health services in Xuanwu, Beijing. As a pilot district for reforming the urban public health service system, Xuanwu established 28 community-based health service stations in 1997. These service stations focused on households in the neighborhood, providing information on prevention of diseases, treatment of common diseases, medical care, rehabilitation, health education and FP technical service. An average of 7-10 staff and workers were employed for every station, responsible for some 20,000 residents. The Public Health Bureau and Family Planning Committee of the district developed a set of program standards. The integrated community-based health service program has produced encouraging results. Community service stations are more capable of providing expedient, considerate, careful and quality services than hospitals. In addition, it has indirectly benefited the economy and society of the district. PMID: 12349378 [PubMed - indexed for MEDLINE] 1316: China Popul Today. 1999 Oct;16(4-5):19-21. Related Articles

MIS promotes contraception and reproductive health: Yandu, Jiangsu. Liu G. PIP: Yandu county, Jiangsu Province has made much progress in improving its family planning services through an effective management information system (MIS). Birth rate has decreased from 23.65/1000 in 1990 to 8/1000 in 1999. The MIS software was developed by the State Family Planning Commission and was applied in 1995 when the quality of care program was launched. The application of microcomputers in the family planning program makes it possible to integrate management with service provision at the county, township and village levels. Subsequently, it creates an information transmission system centering on townships and strengthens basic data management on a regular basis. In addition,

the MIS also delivers services, which include information dissemination on contraception, informed choice, regular follow-up visits, and prevention and treatment of complications and side effects of contraception. In the context of reproductive health, services include health care for the periods of puberty, premarital, marital, contraceptive and menopausal; genetic counseling, sex education and prenatal care; and gynecological check-ups, infertility treatment, and counseling on sexually transmitted disease prevention. PMID: 12349373 [PubMed - indexed for MEDLINE] 1317: China Popul Today. 1999 Apr;16(1-2):16-22. Related Articles

Reproductive health. [No authors listed] PIP: This article explores the reproductive health status of China. Since 1990, China has stepped up its efforts in promoting reproductive health and maternal and child health. Several studies demonstrated a remarkable progress made in this area. By 1997, maternal and infant mortality rates have declined, while the penetration rate for the immunization program and inpatient delivery rate increased. Despite these achievements, however, much remains to be done such as the lack of client-centered approaches to meet the increasingly diverse needs of the population for family planning services. A survey conducted in 1995 showed that the country's family planning program was focused primarily on demographic issues while little attention was given to reproductive health objectives. The situation improved when the State Planning Commission implemented its pilot program called the Quality of Care in Family Planning in China. The program yielded encouraging results including a reoriented philosophy towards reproductive health services, enhanced service facilities, informed choices for family planning methods, and the development of an operational information system. Another strategy adopted to address fertility and reproductive health issues was the implementation of adolescent reproductive health education as a required course for senior middle schools. Lastly, this article provided a brief overview of China's HIV/AIDS situation. PMID: 12349156 [PubMed - indexed for MEDLINE] 1318: Reprowatch. 1999 Mar 16-31;18(6):4. Related Articles, Links

DOH to integrate reproductive health in health care delivery. [No authors listed]

PIP: According to a Department of Health (DOH) official speaking at the recent Reproductive Health Advocacy Forum in Zamboanga City, the concept of reproductive health (RH) is now on the way to being fully integrated into the Philippines' primary health care system. The DOH is also developing integrated information, education, and communication material for an intensified advocacy campaign on RH among target groups in communities. The forum was held to enhance the knowledge and practice of RH among health, population and development program managers, field workers, and local government units. In this new RH framework, family planning becomes just one of many concerns of the RH package of services which includes maternal and child health, sexuality education, the prevention and treatment of abortion complications, prevention of violence against women, and the treatment of reproductive tract infections. Of concern, however, the Asian economic crisis has led the Philippine government to reduce funding, jeopardizing the public sector delivery of basic services, including reproductive health care. The crisis has also forced other governments in the region to reassess their priorities and redirect their available resources into projects which are practical and sustainable. PMID: 12349103 [PubMed - indexed for MEDLINE] 1319: TDR News. 1999 Feb;(58):10. Related Articles, Links

Schistosomiasis control in China: GIS training. [No authors listed] PIP: A training course on Geographic Information Systems (GIS) recently held at Jiangsu Institute of Parasitic Diseases (JIPD), Wuxi, Jiangsu Province was attended by 22 participants from schistosomiasis control programs and research institutes in schistosomiasis-endemic areas of China. Participants were introduced to the principles of GISs and learned how to create, edit, and digitize maps, set up databases with demographic or research data which could be linked to the maps; associate those databases with digitized maps; and then produce customized maps showing data or conduct spatial analyses. Case studies were used to give the participants some real public health applications. In addition to other activities during the 2-week course, the students produced maps of schistosomiasis incidence for their own provinces, related them to satellite images, and were guided through the creation of a GIS for Jiangsu Province based upon results collected during a UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR)-funded project. A network on the use of GISs for schistosomiasis control in China was established to link participants. PMID: 12322121 [PubMed - indexed for MEDLINE]

1320: JOICFP News. 1998 Feb;(284):4. Related Articles, Links

The adolescent girl in focus. Bangladesh. [No authors listed] PIP: The Integrated Family Development Project (IFDP) was launched in Bangladesh in 1993 as a community-based project providing quality reproductive health (RH) services through the primary health care system and reinforcing women's networking through volunteerism, education, skills training, and economic activities. Local women's status and level of health were raised through their direct involvement in all stages of the project. The IFDP is implemented in project areas of Panchdona and Dhalia unions by the Family Planning Association of Bangladesh (FPAB) together with JOICFP. Providing sustainable RH services which focus upon female adolescents is a key focus of the IFDP's second phase spanning 1996-99. The approximately 50 participants who attended the Workshop on Sustainable Reproductive Health Focusing on Adolescents in Cox's Bazar during December 2-4 discussed how to best reach the desired target population. Participants also focused upon developing strategies and policies to promote positive attitudes among young people toward family life education, to help adolescents delay marriage and parenthood until their late 20s, and to provide appropriate RH information and counseling for adolescents. PMID: 12321387 [PubMed - indexed for MEDLINE] 1321: Soc Sci Med. 2002 Nov;55(9):1579-87. Related Articles, Links

Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India. Chakraborty S, Frick K. World Bank, Washington DC, USA. [email protected] In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic.The

study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data.The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary. PMID: 12297244 [PubMed - indexed for MEDLINE] 1322: Arrows Change. 1999 Dec;5(3):3. Related Articles, Links

Learning from India's traditional birth attendants, the dais. [No authors listed] PIP: In India, Matrika (Motherhood and Traditional Resources, Information, Knowledge and Action) was established to learn from traditional birth attendants or dais, document their indigenous knowledge and assemble a database of therapies from alternative medical systems. The organization is committed to motivating health policy makers to include the participation of dais in all government reproductive health initiatives as knowledgeable resource people. Extensive research was conducted in the villages to gather gender and castesensitive information about the knowledge and practice of dais. The findings revealed that dais have indigenous knowledge of herbs, diet, and massage techniques to ease the pains of pregnancy and delivery. Such knowledge was found to be a combination of several factors: empirical observation, extensive experience, intuition and emphatic understanding. Matrika stresses that in India, culturally appropriate, affordable and gender-sensitive perspectives can only be implemented when health care providers and trainers have an appreciation of existing local health knowledge and practice. PMID: 12296266 [PubMed - indexed for MEDLINE] 1323: AIDS Wkly Plus. 1999 May 17:10-1.

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Links

India: HIV spreads despite World Bank project. [No authors listed] PIP: According to estimates of India's Parliamentary Standing Committee on Dreaded Diseases, 25% of all people infected with HIV worldwide live in India. This statistic was presented in Parliament even as another World Bank AIDS prevention project worth $250,000 was launched. This new project follows the bank's $84 million AIDS control project which ran from 1992 to 1997. India could face a major public health crisis with severe socioeconomic implications. UN agencies estimate that an HIV/AIDS epidemic could cost India $11 billion, or 5% of its total national income, by 2000 in health care and lost economic productivity. However, these latest UNAIDS calculations are based upon the assumption that only 4 million people in the country are currently infected with HIV. The World Bank funds to combat AIDS are provided to the National AIDS Control Organization (NACO) which invests it on information and communication activities, as well as the importation of expensive blood banking equipment which is mostly unused due to the country's lack of basic infrastructure like a steady power supply. India should instead follow the example of Thailand which successfully integrated HIV/AIDS management into its primary health care (PHC) system, for the types of HIV/AIDS control programs being promoted by donors cannot work in India in the absence of an effective PHC system. PMID: 12295211 [PubMed - indexed for MEDLINE] 1324: Reprod Contracept. 1999 Mar;10(1):49-57. Related Articles, Links

Cross-sectional study on their reproductive health status of 604 female floating residents in Beijing. Wang Y, An L, Zhang XB, Wang SX. PIP: The rapid increases in the numbers of female labor migrants ("floating residents") in cities such as Beijing have created challenges for China's reproductive health care system. An exploratory study conducted in Beijing in 1996 of 507 floating workers engaged in household management work (average age, 27.4 years) sought to gain information to facilitate the design of reproductive health services for this group. The women had resided in Beijing for an average of 3.7 years, generally with their families. 84% were married, at a mean age of 21.87 years; married women had an average of 1.43 live births, 42% of which had occurred in Beijing. 25% did not receive any prenatal care and 60% did not know whom to consult about maternal-child health care problems. Contraceptive prevalence was 81.1% among floating workers compared with 97% among a

comparison group of nonmigrant agricultural and textile workers. Most floating workers were unaware of any contraceptive methods other than the one they were using (generally the IUD or female sterilization). Finally, only 8.4% could cite symptoms of sexually transmitted diseases and 33.9% had not heard of AIDS. Laboratory examinations revealed a 29.3% prevalence of reproductive tract infections among female floating residents. bacterial vaginitis (11.6%) and Mycoplasma infection (6.7%) were most prevalent. These findings confirm that female floating residents remain in Beijing a long time and have a serious unmet need for targeted reproductive health care services. PMID: 12295179 [PubMed - indexed for MEDLINE] 1325: Int J Popul Geogr. 1999 Jan-Feb;5(1):19-29. Related Articles, Links

Factors affecting the performance of family planning workers: importance of geographical information systems in empirical analysis. Ali M, De Francisco A, Khan MM, Chakraborty J, Myaux J. PIP: Substantial variation in contraceptive prevalence rates (CPRs) and fertility rates (FRs) between community health workers (CHWs) has been documented since the inception of the Matlab family planning program in rural Bangladesh. The coefficients of variation of these indicators for Matlab CHWs were 7% and 26%, respectively, in 1995. To identify the reasons for these performance variations, geographical information system (GIS) approaches were applied to longitudinal and cross-sectional data on 80 CHWs for the period 1980-95. Each observation in the data-set included catchment area-specific characteristics, measures of CHW efficiency in service delivery, and CHW-specific characteristics for one specific year. A one-unit increase in the average age of target women in the catchment area increases the CPR by 9.2%. The CPR increases by 0.2% for each 1% increase in women's literacy and decreases by 0.1% for each 1% increase in the number of Muslim households in the catchment area. An increase of 1 sq. km in the size of the catchment area reduces the CPR by 3%. CHW performance increases with age up to 45 years and then decreases. Similarly, a 1-year increase in the average age of target women reduces the FR by 2%. A 10% increase in the size of the catchment area reduces program performance by increasing the FR by 1.4%. A single geographic barrier to movement increases the FR by 1%. This analysis indicates that CHW performance can be improved significantly by defining catchment areas through use of GIS techniques. Without knowledge of the spatial distribution of population and the physical barriers to movement, allocating a fixed number of clients per CHW may not be the most efficient approach. PMID: 12294868 [PubMed - indexed for MEDLINE]

1326: AVSC News. 1998 Summer;36(2):1, 6-7. Related Articles, Links

Voices of Mongolia. Antarsh L. PIP: Mongolia's rapid transformation in 1990 into a democratic, market economy republic, after 70 years of socialist rule, caused financial chaos from which the country is only recently recovering. Health care services deteriorated in the context of this economic crisis. The Mongolian Ministry of Health and Social Welfare and AVSC jointly sent teams of experts into four parts of the country in March 1998 to assess the quality and availability of reproductive health services. Three Mongolian doctors and the author visited Uvs aimag (province) as part of the assessment, where they interviewed potential reproductive health care clients and their providers about what they need and want from the health care system. Long distances and transportation problems reaching available health care providers, myths and traditional attitudes about contraceptives which limit their use, inadequate access to reproductive health services and information among men and women, the absence of anesthesia for use during abortions, inadequate STD prevention and control, and poor or lacking publicly provided reproductive health care for adolescents are among the major problems found to be currently plaguing the delivery of reproductive health care in Mongolia. The findings of this assessment will be used by the UN Population Fund to design and fund a program to improve services in Mongolia. That program will be implemented by the government and carried out by AVSC. PMID: 12294499 [PubMed - indexed for MEDLINE] 1327: Integration. 1998 Spring;(55):30-3. Related Articles

Into reproductive health. Nazareno MI, Eleserio G, Kenney AM, Collado E. PIP: Now that the government of the Philippines' Department of Health (DOH) has endorsed the notion of reproductive health (RH), the current UNFPA-funded program, Strengthening the Management and Field Implementation of the Family Planning/Reproductive Health Program, has taken initial steps to implement the RH agenda of the 1994 International Conference on Population and Development. The program is being implemented by the DOH, LGU, and NGO tracks of the Philippine Family Planning Program, although the NGO track has progressed faster than the other two tracks in operationalizing RH. In light of its success, the

NGO track will likely be used to develop and test models which may later be used in the other tracks. The authors present an overview of what has thus far been done to implement the reproductive health care agenda over the past 3 years under the NGO track. Reproductive tract infection (RTI) and HIV prevention, the detection and treatment of RTIs, syndromic case management, integrating RH into RTI/HIV services, preliminary results, human sexuality, maternal care, RH service statistics and management information systems, and lessons learned are discussed. PMID: 12294076 [PubMed - indexed for MEDLINE] 1328: Health Millions. 1997 Sep-Dec;23(5-6):5-6. Related Articles, Links

Food and nutrition security. [No authors listed] PIP: This article discusses the deficits in food security in India. It is recommended that India commit to nutrition security by direct actions. Programs should provide essential staples and a nutrient distribution system with affordable prices. India should adopt an Employment Guarantee Program. Creches should provide maternal-child health care, nutrition, literacy, and employment. Government must resolve the internal conflicts of interest between overlapping sectors. India should resolve the "dysfunction" between macroeconomic policies and anti-poverty strategies. Interventions should be people oriented, rely on social mobilization, and provide information and financial resources in a nonconflict context. Efforts will require the cooperation between the private sector, voluntary organizations, state agencies, and local self-governing decentralized agencies. There is a need to build capacity and viable institutions. Poverty agencies do not have access to the minimum required cereals for the poor. The Public Distribution System (PDS) does not guarantee a minimum quantity of foodstuffs per household regardless of income level. More high quality varieties of rice are produced due to higher prices in the marketplace. Most state governments do not provide staple cereals to the PDS at affordable prices. The government sets fair prices for sugar, but not cereal. The government sells more cereal in the open market than to PDS. PDS should target poor households; that is, the 29.9% who live below the poverty line. Lack of nutrition security is due to poverty that is enhanced by ignorance and the lack of health and nutrition education. PMID: 12293896 [PubMed - indexed for MEDLINE] 1329: Popul Headl. 1998 Mar-Apr;(263):3. Related Articles, Links

Kyrgyzstan sees fertility declining. [No authors listed] PIP: This article presents population statistics for Kyrgyzstan and describes some government actions to improve health and family planning. Kyrgyzstan has a population of 4.5 million. The crude birth rate declined sharply during 1990-96, to 24 births/1000 persons. The population growth rate is slightly under 2% annually. Population is expected to reach 6.2 million in 2005. 37.7% of the population is aged under 15 years. Average life expectancy is 68.3 years. Infant and maternal mortality is still high. Abortion is the primary means of birth control. In 1997, there were over 21,000 abortions performed at a rate of 19.4/1000 women of reproductive age. Women had 5-6 abortions/person during their reproductive years. Abortion is the main cause of maternal death. Contraceptive prevalence was only 30%. 70.2% of women used IUDs, and 15.2% used oral pills. The country recognizes the problem of such a high rate of abortion and is shifting family planning towards contraception. Program activity will also focus on adolescent reproductive health issues, such as adolescent abortion and sexually transmitted disease. The Ministry of Health has established the Kyz-Bala Program (Girl-Boy). This program aims to develop a healthy attitude toward reproductive and sexual health. The goal is to improve the information systems for providing updated reproductive health and sexual knowledge, for the use of methods of contraception, and for healthy life styles. PMID: 12293630 [PubMed - indexed for MEDLINE] 1330: Pharmacoeconomics. 2002;20 Suppl 2:9-15. Related Articles, Links

Information barriers to the implementation of economic evaluations in Japan. Nishimura S, Torrance GW, Ikegami N, Fukuhara S, Drummond M, Schubert F. Faculty of Economics, Kyoto University, Kyoto, Japan. [email protected] With increasing cost-containment pressures within healthcare systems worldwide, economic evaluations of medical technologies, particularly pharmaceuticals, are used to aid the allocation of expenditure and resources. Facing similar pressures, Japan will probably also introduce economic evaluation of health technology. However, the structure of the healthcare system in Japan does not lend itself naturally to the collection of the epidemiological and cost data required for economic evaluations in medicine. In addition, there are no formal

methodological guidelines in place for these analyses. To overcome these information barriers in Japan, progress may be aided by the adoption of approaches used in other countries for data collection and guideline development. Publication Types: •

Review

PMID: 12238944 [PubMed - indexed for MEDLINE] 1331: Prog Biophys Mol Biol. 2002 Jul-Aug;80(1-2):23-42. Related Articles, Links

Bioinformatics for the genomic sciences and towards systems biology. Japanese activities in the post-genome era. Yao T. RIKEN Genomic Sciences Center, 1-7-22, Suehiro, Tsurumi, Yokohama 2300045, Japan. [email protected] The knowledge gleaned from genome sequencing and post-genome analyses is having a very significant impact on a whole range of life sciences and their applications. 'Genome-wide analysis' is a good keyword to represent this tendency. Thanks to innovations in high-throughput measurement technologies and information technologies, genome-wide analysis is becoming available in a broad range of research fields from DNA sequences, gene and protein expressions, protein structures and interactions, to pathways or networks analysis. In fact, the number of research targets has increased by more than two orders in recent years and we should change drastically the attitude to research activities. The scope and speed of research activities are expanding and the field of bioinformatics is playing an important role. In parallel with the data-driven research approach that focuses on speedy handling and analyzing of the huge amount of data, a new approach is gradually gaining power. This is a 'modeldriven research' approach, that incorporates biological modeling in its research framework. Computational simulations of biological processes play a pivotal role. By modeling and simulating, this approach aims at predicting and even designing the dynamic behaviors of complex biological systems, which is expected to make rapid progress in life science researches and lead to meaningful applications to various fields such as health care, food supply and improvement of environment. Genomic sciences are now advancing as great frontiers of research and applications in the 21st century.This article starts with surveying the general progress of bioinformatics (Section 1), and describes Japanese activities in bioinformatics (Section 2). In Section 3, I will introduce recent developments in

Systems Biology which I think will become more important in the future. Copyright 2002 Elsevier Science Ltd. Publication Types: • •

Historical Article Review

PMID: 12231221 [PubMed - indexed for MEDLINE] 1332: Entre Nous Cph Den. 1999 Summer-Autumn;(43-44):12. Related Articles, Links

Spotlight on Georgia. [No authors listed] PIP: This article discusses the major areas of concern in Georgia regarding reproductive health. Unsafe practices of abortion have been trusted by Georgian women as a method of fertility regulation due to the shortage and unavailability of contraceptives. Pregnancy and delivery complications constitute 95% of maternal deaths due to insufficient hospital equipment, intensive care units, anesthesia services and personnel professionalism. In the advent of the UN Population Fund (UNFPA) in 1997, abortion rate had decreased from 41.1/1000 women in 1992 to 24/1000 in 1995. Also, UNFPA distributed contraceptives through clinics. Issues on the family planning, reproductive health, sexually transmitted infection, HIV/AIDS have been addressed or is presently being addressed to by the organization. The purpose of the organization is to develop a knowledge, attitudes, and practices (KAP) survey, develop and implement a national reproductive health program, assist the Ministry of Health in the implementation of management information system and extend access to reproductive health and family planning services. The project had been to proposed to extend until 1999 with prospective aims on the implementation of KAP, development of a national reproductive health program, further study of the management information system, and the pursuance of family planning and reproductive health services. PMID: 12222314 [PubMed - indexed for MEDLINE] 1333: Entre Nous Cph Den. 1997 Dec;(36-37):9-11. Related Articles, Links

Young people in Europe. Adolescent health -- sex education. [No authors listed]

PIP: Young people in Eastern Europe and the Newly Independent States have either witnessed, participated in, or been victims of abrupt changes which led to the collapse of the value systems by which they and their parents had learned to live. Their parents' position in society changed, with many struggling to support their families in conditions of widespread resource scarcity, including shortages of food, electricity, heating, and water supplies. Increased family tension has driven many parents to drink more alcohol, thereby increasing the risk of violence in the family. Almost everywhere in the region, young people expressed their desire to be better informed about reproductive health issues. A survey found that the overwhelming majority of more than 700 sampled youths had learned what they knew about reproductive health from friends, television, newspapers, and magazines. In Romania, lack of proper education and social discrimination mean that many people infected with STDs seek medical care only when their diseases have reached an advanced stage, while studies in Bulgaria show a declining mean age at first intercourse and a low level of condom use. In Turkey, an IEC (information, education, and communication) project was launched in 26 cities and towns to improve and extend family planning services. Elsewhere, the Orthodox Church in the Russian Federation has called abortion murder, young people can get good quality counseling in a range of institutions in Estonia, and abortion has become the main means of birth control in Ukraine. PMID: 12222290 [PubMed - indexed for MEDLINE] 1334: Health Reform Prior Serv. 1999 Summer-Fall:15-8. Related Articles

India: using stakeholder analysis to forecast success. Kumar Y, Chaudhury NR, Vasudev N. PIP: This article presents the use of stakeholder analysis to examine the efficacy of health reform programs in India. Stakeholder analysis assists planners in identifying groups affected by proposed activities, their reactions to prospective changes, and the roles they might play in supporting or opposing them. Such information is then used to develop strategies involving national and local officials and communities in reform. Stakeholder analysis was used by the US Agency for International Development (USAID) for the proposed Women's and Children's Health (WACH) project. It involved interviews among major stakeholders regarding their views on the effectiveness of the current health system, the new roles that health care organizations and individuals would have after changes in service delivery under WACH, and their institutional capacity to handle new roles. In addition to stakeholder analysis, three other tools are available to policy managers and health sector reform teams to help them manage and influence the process of health sector reform: 1) institutional mapping, which involves identification and analysis of an organization's structure; 2) political

mapping through graphic display of sources and degrees of political support and opposition; and 3) interest mapping, a combination of stakeholder analysis and political mapping. With the use of stakeholder analysis, USAID was provided with crucial information for the evaluation of community support and success capability of the WACH project. PMID: 12222164 [PubMed - indexed for MEDLINE] 1335: Environ Int. 2002 Sep;28(4):235-45. Related Articles, Links

Arsenic contamination of the environment: a new perspective from central-east India. Pandey PK, Yadav S, Nair S, Bhui A. Department of Engineering Chemistry, Bhilai Institute of Technology, MP, India. [email protected] This paper reports a regional contamination of the environment in central-east India that does not share geology or boundary with the Bengal Delta Plain. About 30,000 people residing in 30 villages and towns are directly exposed to arsenic and more than 200,000 people are "at risk." Complete geographical extent of this contamination is being established, and this newly reported contaminated area could be quite large. This paper further reports that the mechanisms involved in arsenic mobilisation are complex and the two theories of arsenic mobilisation, i.e., pyrite oxidation and oxyhydroxides reduction, do not fully explain the high levels of arsenic contamination. This paper also proposes the "oxidation-reduction theory" for arsenic mobilisation where the arsenic originates from the arsenopyrite oxidation and the arsenic thus mobilised forms the minerals and gets reduced underground in favourable Eh conditions. The stoppage of water withdrawal from the contaminated sources did not result in lowering of arsenic levels as expected according to the heavy groundwater extraction theory (pyrite oxidation theory). Cases of arsenicosis in the region are on the rise and the switchover to less contaminated water has not reversed the arsenicosis progression in the affected persons even after 2 years. Surface water of the rivers is also being contaminated because of the probable dislocation of contaminated groundwater due to the heavy rains in monsoon season, which indicates that the river water could be a major carrier of arsenic in dissolved or adsorbed forms that may be a cause of contamination of the delta plains. PMID: 12220110 [PubMed - indexed for MEDLINE] 1336: Environ Health Perspect. 2002 Sep;110(9):907-15. Related Articles, Links

Disease transmission models for public health decision making: toward an approach for designing intervention strategies for Schistosomiasis japonica. Spear RC, Hubbard A, Liang S, Seto E. Center for Occupational and Environmental Health, School of Public Health, University of California, Berkeley, California 94720, USA. [email protected] Mathematical models of disease transmission processes can serve as platforms for integration of diverse data, including site-specific information, for the purpose of designing strategies for minimizing transmission. A model describing the transmission of schistosomiasis is adapted to incorporate field data typically developed in disease control efforts in the mountainous regions of Sichuan Province in China, with the object of exploring the feasibility of model-based control strategies. The model is studied using computer simulation methods. Mechanistically based models of this sort typically have a large number of parameters that pose challenges in reducing parametric uncertainty to levels that will produce predictions sufficiently precise to discriminate among competing control options. We describe here an approach to parameter estimation that uses a recently developed statistical procedure called Bayesian melding to sequentially reduce parametric uncertainty as field data are accumulated over several seasons. Preliminary results of applying the approach to a historical data set in southwestern Sichuan are promising. Moreover, technologic advances using the global positioning system, remote sensing, and geographic information systems promise cost-effective improvements in the nature and quality of field data. This, in turn, suggests that the utility of the modeling approach will increase over time. Publication Types: • •

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

PMID: 12204826 [PubMed - indexed for MEDLINE] PMCID: PMC1240991

1337: Lepr Rev. 2002 Jun;73(2):177-85. Related Articles, Links

Processes and challenges: how the Sri Lankan health system

managed the integration of leprosy services. Kasturiaratchi ND, Settinayake S, Grewal P. Medical Education Unit, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. At the end of 1999, the Ministry of Health in Sri Lanka took the bold decision to integrate its Leprosy Services within the country's general health system. The integration was completed in February 2001 and is already starting to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventative health services needed to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities. Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. Prevalence has increased by 36% and the new case load by 41%. A few areas still need more attention, such as integrating MDT supplies within existing systems and improving the flow of information, but nonetheless the ownership of leprosy is shifting rapidly to local health services. PMID: 12192974 [PubMed - indexed for MEDLINE] 1338: Lepr Rev. 2002 Jun;73(2):147-59. Related Articles, Links

Lessons in integration--operations research in an Indian leprosy NGO. Porter JD, Ogden JA, Rao PV, Rao VP, Rajesh D, Buskade RA, Soutar D. Departments of Public Health and Policy and Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. [email protected] Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in

which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the public about these diseases and their treatment. This information has provided LEPRA with an understanding of how they might best fill gaps in the existing system and therefore assist in the process of integrating services in their own organization and through the primary health care structure. To achieve this aim, LEPRA will increasingly become involved in developing relationships and partnerships with government in the delivery of training and services and in infrastructure development. Publication Types: •

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

PMID: 12192971 [PubMed - indexed for MEDLINE] 1339: J Med Liban. 2001 May-Jun;49(3):123-5. Related Articles, Links

What does the World Health Report 2000 bring to Lebanon? Ammar W, Awar M. Ministry of Public Health, Beirut, Lebanon. [email protected] The World Health Report 2000 has been the subject of extensive debate. The authors highlight in the following, what they consider as major limitations that are either inherent to methods followed and the validity of data used, or related to the particular situation of Lebanon. This article tackles the first two of the set goals i.e. level of health and responsiveness as well as the overall system performance. The Report clearly states that extensive use has been made of estimates of

indicators, and that there were often conflicting sources of information on these indicators. In the case of Lebanon, data was not available for most of the values used. In fact, the last national population census was conducted in 1932, and vital registration is incomplete. Therefore, one would question the value of the estimates, based on which the calculations were made for Lebanon, such as Life tables, and Causes of Deaths. Finally, the authors conclude that despite the critics, embarking in this exercise is useful for Lebanon, particularly at this stage, for monitoring the reform process in the health sector. PMID: 12184454 [PubMed - indexed for MEDLINE] 1340: Demogr Res. 2000 Jun 27;2:[40] p.. Related Articles, Links

The Household Registration System: computer software for the rapid dissemination of demographic surveillance systems. Phillips JF, Macleod BB, Pence B. Although longitudinal experimental community health research is crucial to testing hypotheses about the demographic impact of health technologies, longitudinal demographic research field stations are rare, owing to the complexity and high cost of developing requisite computer software systems. This paper describes the Household Registration System (HRS), a software package that has been used for the rapid development of eleven surveillance systems in subSaharan Africa and Asia. Features of the HRS automate software generation for a family surveillance applications, obviating the need for new and complex computer software systems for each new longitudinal demographic study. PMID: 12178153 [PubMed - indexed for MEDLINE] 1341: Harefuah. 2002 May;141 Spec No:31-3, 122. Related Articles, Links

[Surveillance systems for early detection and mapping of the spread of morbidity caused by bioterrorism] [Article in Hebrew] Green MS, Kaufman Z. Sackler Faculty of Medicine, Tel Aviv University. The early clinical presentations of many infectious diseases, including those initiated by bioterrorism, tend to have non-specific features such as flu-like

symptoms, skin rashes, encephalitis and acute flaccid paralysis. Standard public health infectious disease surveillance systems depend on reports of specifically diagnosed diseases and thus may be relatively insensitive to the early identification of outbreaks. During the past few years, efforts have been made to improve the sensitivity of traditional systems, partly through implementation of new technologies such as electronic reporting and use of geographical information systems. In the United States, intensive efforts are being made to develop new surveillance systems for the early detection and mapping of the spread of diseases caused by bioterrorism. The development of such systems is based on the concept that surveillance for non-specific syndromes will enable earlier detection of infectious disease outbreaks compared with traditional systems. In addition, surveillance for non-specific syndromes could enable monitoring of the spread the outbreak, even before a definitive diagnosis has been made. In this paper, we describe several examples of prototype syndrome surveillance systems developed in the United States. These include the telephone hot-line system maintained by the New York City public health department, two internet based systems, LEADERS and RSVP, and an electronic reporting system, ESSENCE, operating in military facilities in the Washington DC area. Publication Types: •

English Abstract

PMID: 12170551 [PubMed - indexed for MEDLINE] 1342: Harefuah. 2002 May;141 Spec No:22-8, 123, 122. Related Articles, Links

[The Israeli medical response plan for an unusual biological event] [Article in Hebrew] Poles L. Kaplan Medical Center Lack of national preparedness for biological warfare or a bioterrorism event as well as for a natural outbreak of a dangerous agent may lead to grave consequences (large-scale morbidity and mortality) in the short and long term. Threat assessment and its consequences are the basis for the contingency for such an event, with the medical community playing the leading role. In this article we present the principles of the Israeli medical response plan for an unusual biological event--whether of natural origin or a deliberate attack. The primary goals of the preparedness program are reducing mortality and morbidity, preventing a disaster, decreasing the irrational public response and inducing the

resumption of the normal course of life. The program presented and its phases are universal, with the proper modifications needed to be implemented according to the specific etiology and the circumstances of the event. In order to successfully deal with the incident, national-level coordination of many non-medical organizations is required. An integration body in the Ministry of Health is a prerequisite for the early detection of the outbreak and for the rapid and proper identification of the etiologic agent. An effective triage system which screens the truly-exposed, the sick and their contacts among the many worried-well engorging the medical organizations, should be the spearhead for an integrated health system dealing with disease prevention and treatment. Public relations and recruitment of the media for transferring relevant information are a vital part of the response. In this rare and unfamiliar emergency situation the basic principle is to use existing response systems, implementing most of the routine procedures and functions, modified according to guidelines from central governmental bodies. Publication Types: •

English Abstract

PMID: 12170549 [PubMed - indexed for MEDLINE] 1343: Harefuah. 2002 May;141 Spec No:111-7, 118. Related Articles, Links

[Chemical and biological terrorism: psychological aspects, and guidelines for psychiatric preparedness] [Article in Hebrew] Bleich A, Kutz I. Lev-HaSharon, Psychiatric Hospital, Pardesyyia. Chemical or biological terror may cause mass casualties, but the major damage of such a threat is related mainly to psychological terror. Anxiety and panic that accompany chemical or biological threat, may affect mass populations, disrupt their lives, and enormously increase the demands from the medical systems. In the case of real attack, such an increased demands may be critical, especially to the functional ability of hospitals. The Israeli experience, during the Persian Gulf war, concerning preparations to chemical attacks at the national level, was unique in its nature. In addition, the Scud missiles attacks, accompanied with non-conventional threat, supplied valuable information on the populations behavior, and on the needed preparations for similar threats. In the case of chemical or biological threat or attack, the main task of the psychiatrist is to treat stress and anxiety casualties.

At the same time, he should be aware of the possibility that the psychological & behavioral symptoms may reflect organic brain damage due to the pathogenic agent, and that such a differential diagnosis may be life saving for the patient. Stress casualties will be referred from the ER, and treated by the mental health team, at a specifically designed "center for stress casualties". In addition, the psychiatrist will consult the medical teams, or sometimes directly intervene, with combined casualties, at other locations of the hospital. At the regional or community level, one should plane and exercise deployment and activation of multi-professional teams, including mental health, in existing installations designed for screening, treatment, and temporary containment of casualties. It is recommended that the head of the local authority, will be responsible for the preparations and activation of this formation. A planned and rational usage of the media may have a critical influence on the ability of the authorities to manage the crisis situation and on shaping the behavior of the population. In certain scenarios, the media may even serve as the main tool for calming and instructing the people being isolated at their homes. Publication Types: • •

English Abstract Review

PMID: 12170545 [PubMed - indexed for MEDLINE] 1344: Ren Fail. 2002 May;24(3):285-96. Related Articles, Links

Integration of APACHE II and III scoring systems in extremely high risk patients with acute renal failure treated by dialysis. Chen YC, Hsu HH, Chen CY, Fang JT, Huang CC. Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. OBJECTIVE: Acute physiology, age, chronic health evaluation II and III (APACHE II and III) scoring systems obtained on the day of the initiation of dialysis were compared the mortality rate among in critically ill patients with acute renal failure requiring dialysis. DESIGN: Retrospective study. SETTING: Intensive care units in a tertiary care university hospital in Taiwan. PATIENTS: 100 patients diagnosed with acute renal failure and requiring dialysis were admitted to intensive care units from January 1997 through December 1998. INTERVENTIONS: Information deemed necessary to compute the APACHE II and APACHE III score on the day of dialysis initiation was collected. MEASUREMENTS AND RESULTS: The overall hospital mortality rate was

71%. The relationship between APACHE II and APACHE III scores for patients was linear and correlated significantly in all subgroups. Goodness-of-fit was good for APACHE II and APACHE III models. Both reported good areas under receiver operating characteristic curve. Death in most patients was related to a higher APACHE II or APACHE III score during the 24 h immediately preceding the initiation of acute hemodialysis. Our results indicated a significant rise in mortality rates associated with higher APACHE II or III scores among all patients. Although less than 60%, the mortality rates markedly increased extent when APACHE II score of 24 or higher or APACHE III score above 90 had mortality rates exceeding 85%. CONCLUSION: Both predictive models demonstrated a similar degree of overall goodness-of-fit. Although APACHE II showed better calibration, APACHE III was better in terms of discrimination. The prediction accuracy of the APACHE II score for extremely high-risk patients is further enhanced by specific utility of APACHE III scoring as a second prediction model when the AII score is 24 or higher. Publication Types: • •

Clinical Trial Comparative Study

PMID: 12166695 [PubMed - indexed for MEDLINE] 1345: Bull World Health Organ. 2002;80(7):555-61. Epub 2002 Jul 30. Related Articles, Links

Inadequacies of death certification in Beirut: who is responsible? Sibai AM, Nuwayhid I, Beydoun M, Chaaya M. Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. [email protected] OBJECTIVE: To assess the completeness of data on death certificates over the past 25 years in Beirut, Lebanon, and to examine factors associated with the absence of certifiers' signatures and the non-reporting of the underlying cause of death. METHODS: A systematic 20% sample comprising 2607 death certificates covering the 1974, 1984, 1994, 1997 and 1998 registration periods was retrospectively reviewed for certification practices and missing data. FINDINGS: The information on the death certificates was almost complete in respect of all demographic characteristics of the deceased persons except for occupation and month of birth. Data relating to these variables were missing on approximately 95% and 78% of the certificates, respectively. Around half of the certificates did not carry a certifier's signature. Of those bearing such a signature, 21.6% lacked

documentation of the underlying cause of death. The certifier's signature was more likely to be absent on: certificates corresponding to the younger and older age groups than on those of persons aged 15-44 years; those of females than on those of males; those of persons who had been living remotely from the registration governorate than on those of other deceased persons; and those for which there had been delays in registration exceeding six months than on certificates for which registration had been quicker. For certificates that carried the certifier's signature there was no evidence that any of the demographic characteristics of the deceased person was associated with decreased likelihood of reporting an underlying cause of death. CONCLUSION: The responsibility for failure to report causes of death in Beirut lies with families who lack an incentive to call for a physician and with certifying physicians who do not carry out this duty. The deficiencies in death certification are rectifiable. However, any changes should be sensitive to the constraints of the organizational and legal infrastructure governing death registration practices and the medical educational systems in the country. Publication Types: •

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

PMID: 12163919 [PubMed - indexed for MEDLINE] 1346: J Nutr. 2002 Aug;132(8):2215-21. Related Articles, Links

The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. De Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. Helen Keller International, Indonesia and Asia Pacific, Jakarta, Indonesia. [email protected] Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low

Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West Java or East Java. Considering that maternal postpartum Hb reflects Hb during pregnancy, that anemia among mothers in this population is due mainly to iron deficiency, and that children born to anemic mothers are at higher risk of a low Hb, we hypothesize that low infant Hb in this population is due to iron deficiency. Intervention studies in iron deficient populations should test this hypothesis. Publication Types: • •

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

PMID: 12163665 [PubMed - indexed for MEDLINE] 1347: Leuk Res. 2002 Oct;26(10):903-8. Related Articles, Links

Trends in mortality from non-Hodgkin's lymphomas. Levi F, Lucchini F, Negri E, La Vecchia C. Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut Universitaire de Médecine, Sociale et Préventive, CHUV-Falaises 1, Lausanne, Switzerland. [email protected] Trends in death certification rates from non-Hodgkin's lymphomas (NHL) were analyzed on the basis of the World Health Organization database over the period 1969-1998. Until the late 1970s, mortality from NHL was similar in the European Union (EU), the USA and Japan, i.e. around 3/100,000 males and 2/100,000 females. Over the last two decades, NHL mortality in the EU rose to 4.4/100,000 males and 2.8/100,000 females. Upward trends were greater in the USA, whose rates approached 6/100,000 males and 4/100,000 females in the late 1990s, and were observed in Japan, too. Publication Types: • •

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

PMID: 12163051 [PubMed - indexed for MEDLINE] 1348: Methods Inf Med. 2002;41(3):220-3. Related Articles, Links

Standard protocol for exchange of health-checkup data based on SGML: the Health-checkup Data Markup Language (HDML). Sugimori H, Yoshida K, Hara S, Furumi K, Tofukuji I, Kubodera T, Yoda T, Kawai M. Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. [email protected] OBJECTIVES: To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities. RESULTS: A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described. RESULTS: The transfer of numerical lab data, summary findings and health status assessment was successful. CONCLUSIONS: HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data. Publication Types: •

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

PMID: 12162147 [PubMed - indexed for MEDLINE] 1349: Biomed Instrum Technol. 2002 Jul-Aug;36(4):274-6. Related Articles, Links

Global initiative strives to link health care information systems. Sensmeier J. PMID: 12162113 [PubMed - indexed for MEDLINE] 1350: Ann Acad Med Singapore. 2002 Jul;31(4):467-73. Related Articles, Links

Asthma disease management: a provider's perspective. Abisheganaden J. Department of Respiratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Asthma is a highly prevalent problem in Singapore, with an increasing societal and economic burden. However, asthma is also an eminently treatable condition, with evidence that integrated education-treatment efforts directed at important patient sub-groups can be cost-effective. What is important is a comprehensive and integrated asthma management programme, aimed at reducing the burden of asthma at all levels of the healthcare system, with the long-term goal of improving asthma care cost-effectively. This refers to asthma disease management. Asthma disease management should focus on identifying deficiencies in asthma management across the population diagnosed with the condition and establish a partnership between the patient, provider and the healthcare system to improve the overall quality of asthma care. The framework for implementing such a programme bridges key concepts and programmes that are already in place in the various institutions. These include patient and physician education, the use of clinical practice guidelines, clinical pathways, outcomes management, quality improvement processes, information technology, case management and existing asthma shared-care programmes and resources. In order to significantly reduce asthma morbidity, an integrated approach is required, involving individuals providing asthma care at various levels of care delivery. There is also a need to co-ordinate the efforts of such individuals and institutions involved so that there is good horizontal and vertical integration of care. The disease management approach described is intended to raise the overall standard of asthma care across a spectrum of patients with asthma. Publication Types: •

Review

PMID: 12161882 [PubMed - indexed for MEDLINE] 1351: Adolesc Educ Newsl. 1999 Dec;2(2):11. Related Articles

Democratic reform paves the way for new reproductive health strategy and advocacy. Mongolia. [No authors listed]

PIP: Ms. Munkhuu, senior adviser to the Reproductive Health Advocacy Project in Mongolia, reports the implementation as well as the impact of its National Adolescent Health Program. She relates the program's beginnings with the adoption of the National Program in Reproductive Health in 1997, which made adolescent reproductive health issues a public concern. Through the program, formal health education was incorporated in the secondary school curriculum. Other developments of the program were the training of trainers, publication of a quarterly newspaper called the Uerkhel--Love for adolescents, creation of educational radio and television programs on adolescent sexuality, and the establishment of a hot line service. In conclusion, Ms. Munkhuu emphasizes the need to make the program more effective and responsive by improving the country's information system and by increasing reproductive health awareness among policy-makers and the general public. Advocacy training should also be actively pursued. PMID: 12158247 [PubMed - indexed for MEDLINE] 1352: Adolesc Educ Newsl. 1998 Dec;1(2):10. Related Articles, Links

Nepal: positive trends in ARH. [No authors listed] PIP: This article records the Nepalese Government's adoption of a strategy, which is consistent with Nepal's second long-term health plan (1997-2017). The primary health care system would deliver an integrated reproductive health package, which gives emphasis on gender perspective, community participation, equitable access and intersectoral collaboration. In addition, some of the appropriate interventions being pursued are the formulation of national policies, provision of counseling and sex education and information, supplying contraceptives, and delivering youth-friendly reproductive health services. However, serious problems hindering efforts to implement effective adolescent reproductive health programs include limited access to food and health care; high infant and maternal mortality rate due to early and frequent pregnancies; low level of contraceptive use and increasing frequency of sexually transmitted diseases cases among adolescents; and low level of literacy, particularly among girls. PMID: 12158236 [PubMed - indexed for MEDLINE] 1353: Asia Pac J Public Health. 2001;13 Suppl:S1-61. Related Articles, Links

Information technology and flexible learning in public health. Proceedings of a conference and workshop organized by the Asia

Pacific Academic Consortium for Public Health and the Graduate School of Health Science and Management, Yonsei University. Seoul, Korea. April 18-20, 2001. [No authors listed] Publication Types: • •

Congresses Overall

PMID: 12141265 [PubMed - indexed for MEDLINE] 1354: Health Place. 2002 Sep;8(3):201-10. Related Articles, Links

Identifying environmental risk factors for endemic cholera: a raster GIS approach. Ali M, Emch M, Donnay JP, Yunus M, Sack RB. ICDDR,B: Centre for Health and Population Research, Bangladesh. [email protected] The bacteria that cause cholera are known to be normal inhabitants of surface water, however, the environmental risk factors for different biotypes of cholera are not well understood. This study identifies environmental risk factors for cholera in an endemic area of Bangladesh using a geographic information systems (GIS) approach. The study data were collected from a longitudinal health and demographic surveillance system and the data were integrated within a geographic information system database of the research area. Two study periods were chosen because they had different dominant biotypes of the disease. From 1992 to 1996 El Tor cholera was dominant and from 1983 to 1987 classical cholera was dominant. The study found the same three risk factors for the two biotypes of cholera including proximity to surface water, high population density, and poor educational level. The GIS database was used to measure the risk factors and spatial filtering techniques were employed. These robust spatial methods are offered as an example for future epidemiological research efforts that define environmental risk factors for infectious diseases. Publication Types: •

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

PMID: 12135643 [PubMed - indexed for MEDLINE] 1355: Am J Trop Med Hyg. 2002 Jan;66(1):40-8. Related Articles, Links

Control of aedes vectors of dengue in three provinces of Vietnam by use of Mesocyclops (Copepoda) and community-based methods validated by entomologic, clinical, and serological surveillance. Kay BH, Nam VS, Tien TV, Yen NT, Phong TV, Diep VT, Ninh TU, Bektas A, Aaskov JG. Queensland Institute of Medical Research and University of Queensland Tropical Health Program, Brisbane, Australia. We describe remarkable success in controlling dengue vectors, Aedes aegypti (L.) and Aedes albopictus (Skuse), in 6 communes with 11,675 households and 49,647 people in the northern provinces of Haiphong, Hung Yen, and Nam Dinh in Vietnam. The communes were selected for high-frequency use of large outdoor concrete tanks and wells. These were found to be the source of 49.6-98.4% of Ae. aegypti larvae, which were amenable to treatment with local Mesocyclops, mainly M. woutersi Van der Velde, M. aspericornis (Daday) and M. thermocyclopoides Harada. Knowledge, attitude, and practice surveys were performed to determine whether the communities viewed dengue and dengue hemorrhagic fever as a serious health threat; to determine their knowledge of the etiology, attitudes, and practices regarding control methods including Mesocyclops; and to determine their receptivity to various information methods. On the basis of the knowledge, attitude, and practice data, the community-based dengue control program comprised a system of local leaders, health volunteer teachers, and schoolchildren, supported by health professionals. Recycling of discards for economic gain was enhanced, where appropriate, and this, plus 37 clean-up campaigns, removed small containers unsuitable for Mesocyclops treatment. A previously successful eradication at Phan Boi village (Hung Yen province) was extended to 7 other villages forming Di Su commune (1,750 households) in the current study. Complete control was also achieved in Nghia Hiep (Hung Yen province) and in Xuan Phong (Nam Dinh province); control efficacy was > or = 99.7% in the other 3 communes (Lac Vien in Haiphong, Nghia Dong, and Xuan Kien in Nam Dinh). Although tanks and wells were the key container types of Ae. aegypti productivity, discarded materials were the source of 51% of the standing crop of Ae. albopictus. Aedes albopictus larvae were eliminated from the 3 Nam Dinh communes, and 86-98% control was achieved in the other 3 communes. Variable dengue attack rates made the clinical and serological comparison of control and untreated communes problematic, but these data indicate that clinical surveillance by itself is inadequate to monitor dengue transmission.

Publication Types: •

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

PMID: 12135266 [PubMed - indexed for MEDLINE] 1356: Chin Med J (Engl). 2002 Apr;115(4):607-11. Related Articles, Links

Evaluation of referrals for genetic investigation of short stature in Hong Kong. Lam WF, Hau WL, Lam TS. Clinical Genetic Service, Department of Health, Hong Kong Special Administrative Region, Kowloon, Hong Kong, China. [email protected] OBJECTIVE: To establish a profile of the causes of apparently unexplained SS in genetic referral center and evaluate the current referral system. METHODS: This was a retrospective database survey on patients who were referred our clinical genetic service from 1988 - 1998 primarily because of SS. We retrieved the study population from our computer database using "short stature"as a search handle and then studied the demographic, clinical and laboratory data from their medical records. RESULTS: Three hundred and fifty-three subjects were referred for genetic evaluation of SS in 1988 - 1998. The mean age of referred subjects was 11.5 years and the female to male ratio was 7.6. All referrals had undergone cytogenetic studies to exclude chromosomal abnormalities, 19% of girls with apparently unexplained short stature had Turner syndrome; at least 47.9% of the study population were normal variants and 25% of the referrals had inadequate information for classification. CONCLUSIONS: Genetic investigation is essential in the management of patients with SS, especially for girls suspected of having Turner syndrome, in which growth hormone treatment has shown to improve final height. We also highlight the inherited causes of short stature, which were often misdiagnosed as benign familial short stature, and discussed the drawbacks of the current referral system. PMID: 12133309 [PubMed - indexed for MEDLINE] 1357: Int J Health Plann Manage. 2002 Apr-Jun;17(2):165-83. Related Articles, Links

A development framework for promoting evidence-based policy action: drawing on experiences in Sri Lanka. Hornby P, Perera HS. Centre for Health Planning and Management, Keele University, Staffs, UK. [email protected] Most developing countries have embarked on one form or another of 'health sector reform' as a result of the global trend for health and health care reform that has emerged during the past decade. One consequence is that the issue of health sector performance is moving higher on the agenda of many developing countries, and particularly that of the corporate performance of health sector staff. Along with this movement has come increased attention to strengthening evidence-based management decision-making. To date, studies on measuring health sector performance, have had little impact on developing country health systems and have been limited to explorations primarily at an operational level. However, there is a growing recognition that there is a need to strengthen the policy function of ministries and their ability to monitor policy impact. Sri Lanka is one country that has identified the need to strengthen policy at national level. Many developing countries, like Sri Lanka, are familiar with input, process and output dimensions of operational performance. However, most are not ready to engage in routine performance assessment that can strengthen policy processes at national level. This paper explores (1) the implication and the use of indicators to support evidence based policy decision-making, and (2) the complexity of doing so in Ministries of Health that are undergoing some form of health sector reform. The paper emphasizes that new forms of organizational support are required for performance management at policy level. A conceptual framework for managing the collection and use of performance evidence is developed, including proposals for the introduction of outcome indicators into that process. The paper concludes with recommendations on initiatives required to develop appropriate organizational and technical capacity to engage with performance management at policy level and for further research towards creating ministries of health as 'learning organizations' that can change and adapt with informed decisions. PMID: 12126211 [PubMed - indexed for MEDLINE] 1358: Asia Pac J Public Health. 2001;13 Suppl:S19-22. Related Articles, Links

Evaluating health information sites on the Internet in Korea: a cross-sectional survey. Aeree S, Mee-Kyung S.

Graduate School of Health Sciences and Social Welfare, Sahmyook University, South Korea. [email protected] Through the internet the public in South Korea has access to a growing supply of information on health and disease. In South Korea an estimated 13.93 million people used the internet in 2000. The number has increased rapidly compared to 1.63 million in 1997. Health information is often said to be one of the most retrieved types of information on the internet. However, a concern has emerged for the quality of health information documents contained on the World Wide Web. Lack of evaluation and oversight, and ease of publication, have led to inaccurate and misleading health-related publications on the Internet. For those seeking easy ways to identify high-quality and reliable information, rating systems to evaluate the quality of health information on the internet should be provided and developed. Given this background, the purpose of this research was to evaluate health information web sites on the internet. In this study we aimed to survey websites providing health information. 440 websites were selected using four search engines, YahooKorea (http://www.yahoo.co.kr), LycosKorea (http://www.lycos.co.kr), Empas (http://www.empas.co.kr), and Naver (http://www.naver.com), to conduct searches in December 2000. General quality criteria were used for the evaluation. These included ownership, currency, authorship, source, feedback mechanism, links, and functionality. More than 50% of web sites did not provide the date of publication or update of information, author and author credentials, references to source, etc. Websites of universities and universities' hospitals were more likely to provide name and type of provider (p < .01), author's name (p < .001), and references to source (p < .01) than other service providers. There is a need for better evidence-based health information as well as a need to develop simple criteria that ordinary people can understand and use. In addition, gateway services that operate a selective process and provide links to other organizations that provide high-quality health information should be offered and developed. Publication Types: •

Evaluation Studies

PMID: 12109242 [PubMed - indexed for MEDLINE] 1359: Neoplasma. 2002;49(2):129-32. Related Articles, Links

The cost effectiveness of dual phase 201Tl thyroid scan in detecting thyroid cancer for evaluating thyroid nodules with equivocal fineneedle aspiration results: the preliminary Taiwanese experience.

Chen YS, Wang WH, Chan T, Sun SS, Kao A. Institute of Industrial Engineering and Enterprise Information of Tunghai University, Taichung, Taiwan. [email protected] The purposes of this study were to assess the helpfulness of dual phase 201Tl thyroid scan for differentiating malignant from benign thyroid lesions in cases of thyroid nodules with equivocal fine-needle aspiration (FNA) biopsy results. In addition, for thyroid nodules with equivocal FNA biopsy results, we try to make a decision analysis model compared the FNA biopsy alone strategy (strategy A) with decision strategy for the assistance of dual phase 201Tl thyroid scan (strategy B) before diagnostic thyroidectomy as thyroid cancer evaluation strategies for hypothetical cohorts of estimated 17,280-29,160 Taiwanese patients/per year with equivocal FNA biopsy results. Based on the findings of surgical histopathology, dual phase 201Tl thyroid scan sensitivity, specificity, and accuracy were 100%, 90%, and 96%, respectively, in cases of 27 thyroid nodules with equivocal FNA biopsy results. In cost effectiveness analysis, the strategy B showed a cost saving of 16,340,480-27,574,560 US dollars in unnecessary diagnostic thyroidectomy cost. The total cost of strategy B showed a cost saving of 13,932,232-23,520,564 US dollars than that of strategy A. The preliminary data indicate that dual phase 201Tl thyroid scan can save the cost of unnecessary diagnostic thyroidectomy in Taiwanese patients with equivocal FNA biopsy results. In addition, we may provide a noninvasive diagnostic method--dual phase 201Tl thyroid scan, as the first priority for Taiwanese patients with equivocal FNA biopsy before diagnostic thyroidectomy under the coverage of the national health insurance system in Taiwan. PMID: 12088107 [PubMed - indexed for MEDLINE] 1360: Nippon Koshu Eisei Zasshi. 2002 May;49(5):456-62. Related Articles, Links

[Construction and application of an information transfer system on prevalence of infectious disease for subscriber in a regional medical association] [Article in Japanese] Ohkuma K, Teramoto Y, Fukuta M, Takahashi H, Nakayama O, Wada F. Mie Prefectural Science and Technology Promotion Center, Public Health and Environment Research Division. PURPOSE: To assess the utility of an e-mail information exchange system, for subscription by members of a regional medical association, focusing on surveillance of infectious disease. METHODS: Questionnaires regarding addition

to the mailing list were first addressed to all 474 members of Yokkaichi regional medical association. After management for about three months, questionnaires focused on utility and application of the system were mailed out. RESULT: One hundred and seventy-three members (36.5%) responded in the questionnaire survey, then 73 of them (subsequently 75) actually subscribed. Forty-six subscribers (61.3%) responded to the second questionnaire, and 23 of them (56.5%) were in favor of 'weekly and monthly infectious disease reports transmitted from our research division', and 22 (47.8%) were in favor of 'e-mail exchanges of information'. CONCLUSION: These findings suggest that an electronic information transfer system is a useful medium for regional infectious disease efforts and contributions from primary care physicians. Publication Types: • •

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

PMID: 12087772 [PubMed - indexed for MEDLINE] 1361: Eur J Epidemiol. 2001;17(8):757-64. Related Articles, Links

Risk factor profile for atherosclerosis among young adults in Israel-results of a large-scale survey from the young adult periodic examinations in Israel (YAPEIS) database. Sharabi Y, Grotto I, Huerta M, Eldad A, Green MS. Israel Defence Forces, Medical Corps, Tel Aviv. [email protected] Assessing the prevalence of relevant risk factors among young adults is a critical step in the process of preventing atherosclerotic cardiovascular diseases (ASCVD) later in life. The Israel Defense Force Periodic Health Examination Center performs a routine check-up for subjects aged 25-45 years. Medical history, physical examination notes, laboratory results and ECG tracings are recorded, computerized and processed to form the Young Adults Periodic Examinations in Israel (YAPEIS) database. Data representing 31,640 subjects (27,769 males and 3871 females) examined between the years 1991-1999 were analyzed. The prevalence of documented risk factors for ASCVD were evaluated. The results of all parameters were graded categorically as low, moderate or high and the Framingham risk score was calculated. Fifty-one percent of the study participants were found to be overweight (body mass index > or = 25 kg/m2), 8.5% had high systolic blood pressure and 14.6% had high diastolic blood pressure. The prevalence of hypercholesterolemia and hyperglycemia was found

to be 44.7 and 9.7%, respectively. Thirty-two percent of the subjects smoked cigarettes, and 76.7% reported not performing any routine physical activity. Furthermore, 31.8% had a Framingham score indicating a greater than 5% risk for developing a coronary event within the next 10 years. As expected, the prevalence of these risk factors increased with age and were found to be less frequent among females. Thus we conclude that many young Israeli adults hold significant risk factors for future ASCVD. Many of these risk factors are modifiable, and risk behavior is often amenable to alteration. Awareness to the high prevalence of risk factors among young adults should spark vigorous health-promotion programs as well as screening, education, and interventional measures aimed at altering the expected outcome of future ASCVD. PMID: 12086094 [PubMed - indexed for MEDLINE] 1362: Nippon Rinsho. 2002 Jun;60(6):1070-6. Related Articles, Links

[PulseNet Japan--network system for the utilization of epidemiological information and the results of pulsed-field gel electrophoresis] [Article in Japanese] Terajima J, Izumiya H, Tamura K, Watanabe H. Department of Bacteriology, National Institute of Infectious Diseases. Since 1996, we have been analyzing DNA pattern of enterohemorrhagic Escherichia coli(EHEC) O157: H7 isolates in Japan by the use of pulsed-field gel electrophoresis. The method, capable of discriminating genotypical difference of the isolates, enabled us to find the contaminated food such as salmon roe which was the causative agent for the multiprefectual outbreaks in Japan. These outbreaks which we are referring as diffuse outbreaks seem to be increasing in number, because it reflects that some of widely distributed or mass-produced food products are being contaminated by pathogens such as EHEC. In order to find a diffuse outbreak promptly and prevent it becoming large, we are constructing a network, called PulseNet Japan, for sharing the results of pulsed-field gel electrophoresis and epidemiological information among municipal public health institutes and National Institute of Infectious Diseases. Publication Types: • •

English Abstract Review

PMID: 12078075 [PubMed - indexed for MEDLINE] 1363: Ann Acad Med Singapore. 2002 May;31(3):261-75. Related Articles, Links Comment in: •

Ann Acad Med Singapore. 2002 May;31(3):259-60.

Are maternal deaths on the ascent in Singapore? A review of maternal mortality as reflected by coronial casework from 1990 to 1999. Lau G. Centre for Forensic Medicine, Health Sciences Authority, 11 Outram Road, Singapore, 169078. [email protected] INTRODUCTION: In Singapore, published maternal mortality rates (MMR) over the last decade (1990 to 1999) have been so low (0.0 to 1.0 per 1000 live births and still births) as to imply that maternal deaths are rare to the point of being nonexistent in some years. This inference is counterintuitive, and earlier studies on maternal mortality, amniotic fluid embolism (AFE) and pulmonary thromboembolism (PTE) have also suggested otherwise. Accordingly, local trends in maternal mortality warrant further examination. MATERIALS AND METHODS: A descriptive and comparative study, comprising a clinicopathological review of maternal deaths, for which autopsies were conducted by the Centre for Forensic Medicine, during a 10-year period from 1990 to 1999. The annual necropsy-based, MMR (estimated MMR), as well as the prevalence of maternal deaths during this time, were estimated with the aid of the relevant, published demographic data on live births and still births. These were compared with the corresponding rates calculated (calculated MMR) from raw demographic data on maternal deaths classified as such in the published data. RESULTS: Coronial autopsies were conducted on a total of 51 cases of maternal death, of which 33, 17 and 1 were direct, indirect and fortuitous deaths, respectively. The annual, estimated MMR ranged from 0.4 to 1.8 per 10,000 live births and still births. The estimated MMR was twice as high as the calculated MMR and a statistically significant upward linear trend was demonstrated for the former (P = 0.046). AFE (16/51) and PTE (10/51) were the two most common causes of maternal death; their corresponding cause-specific, 10-year prevalence being 0.33 and 0.21 per 10,000 live births and still births, respectively. There was apparent clustering of the cases of PTE during the earlier part of the last decade (1990 to 1995), corresponding to a statistically significant, upward trend in its overall necropsy incidence during that time (P = 0.019). Cardiovascular and pulmonary

disorders constituted the bulk of indirect deaths (13/17), while antenatal suicides accounted for 3 of these deaths (0.06 per 10,000 live births and still births). CONCLUSIONS: This was an upward trend in MMR, as reflected in coronial casework, over the last decade. It would appear that the local, estimated (direct and indirect) maternal mortality prevalence compares favourably with the MMR reported in developed countries. The apparent rate of AFE was no less than 4 times higher than that reported in the United Kingdom, while the maternal mortality rate from PTE was at least as high. Allowing for the possibility that such deaths were under-reported, the actual annual MMR and 10-year prevalence could be appreciably higher than the estimates presented here. There may well be a case for the establishment of a comprehensive database of maternal deaths, that is updated continually and contemporaneously, in Singapore. Publication Types: •

Comparative Study

PMID: 12061284 [PubMed - indexed for MEDLINE] 1364: Nippon Eiseigaku Zasshi. 2002 May;57(2):527-34. Related Articles, Links

[General practitioner's recognition of service cooperation with community pharmacists related to home care in a suburban area] [Article in Japanese] Onda M, Kono K, Watanabe T, Watanabe M, Akashi M. Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan. [email protected] OBJECTIVES: To clarify the factors affecting a general practitioner's demands and the recognition of service cooperation with community pharmacists related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was administered to 215 general practitioners in a suburban area. Gender, age, specialty, length of practice, status of home visiting, requests for community pharmacists, awareness of a home visiting service by community pharmacists, status of issues about home visiting orders to community pharmacists and the criteria for deciding to issue an order, recognition of the necessity of a home visiting service by pharmacists, expectation value to the community of the pharmacists' participation in the home care service and requests, recognition of cooperation with other home care related professions, ease of cooperation with community pharmacists, disincentives for cooperation with community pharmacists, factors necessary to promote cooperation between

practitioners and community pharmacists, and factors necessary to promote the home care system were surveyed. Using the results, chi 2 test and principal component analysis were performed. RESULTS: It was found that the general practitioners' main demands were support and management of pharmaceutical therapy. Meanwhile, the practitioners' low cognition of pharmacists' home visiting seemed to be one disincentive to cooperation with pharmacists. Every practitioner who had issued visiting orders to pharmacists practiced home visiting and issued the visiting orders based on patients' condition at home. Practitioners who practiced home visiting were more active in promoting the home care system and had a better cognition and more extensive demands for pharmacists' home visiting compared to practitioners with no home visiting. Practitioners with good recognition of cooperation with community pharmacists had better cognition, realized the necessity of, and expected pharmacist's home visiting compared to practitioners with low awareness. However, practitioners' overall recognition of cooperation with pharmacists was relatively low. As disincentives, practitioners pointed out lack of acquaintance, the unclear function of pharmacists, and no opportunity for cooperation. So, enhancing practitioners' awareness of home care, clarifying the pharmacist's role, establishing a relationship of mutual trust through information feedback and/or exchange based on practice would be effective in promoting service cooperation with community pharmacists. Publication Types: •

English Abstract

PMID: 12061100 [PubMed - indexed for MEDLINE] 1365: Palliat Med. 2002 May;16(3):185-93. Related Articles, Links

Family satisfaction with inpatient palliative care in Japan. Morita T, Chihara S, Kashiwagi T; Quality Audit Committee of the Japanese Association of Hospice and Palliative Care Units. Seirei Hospice, Seirei Mikatabara Hospital, Hamamatsu, Shizuoka, Japan. [email protected] Whereas satisfaction is one of the most important outcomes in palliative care settings, there have been no systematic studies investigating the effects of familyand organization-related variables on family satisfaction with care. To clarify factors contributing to family satisfaction with inpatient palliative care services, a cross-sectional mailed survey was performed. A 60-item questionnaire was mailed to 1026 bereaved subjects who had lost family members at one of 37

palliative care units in Japan to evaluate their sociodemographic characteristics and satisfaction levels with care. An institution survey was performed to collect organization-related variables. Caregiver satisfaction was rated on the Satisfaction scale for Family members receiving Inpatient Palliative Care (Sat-Fam-IPC). A total of 640 responses were analysed (response rate = 62%). The responses to overall satisfaction were 'satisfied' in 41 % and 'very satisfied' in 47%. The mean total score of the Sat-Fam-IPC was 82.4 +/- 13.2 on the 0-100 scale. The mean subscale scores were: 85.8 +/- 14.5 (Nursing Care), 81.5 +/- 18.4 (Symptom Palliation), 85.0 +/- 13.8 (Facility), 83.3 +/- 16.6 (Information), 83.1 +/- 17.3 (Availability), 78.3 +/- 18.9 (Family Care), and 79.8 +/- 17.3 (Cost). Significant determinants of family satisfaction identified were: nursing system, the number of nurses at night and presence of attending medical social workers (Nursing Care), patient age and the number of physicians (Symptom Palliation), floor space per bed (Facility), duration of admission and presence of attending medical social workers (Availability), patient age, family age, gender and occupational status (Family Care), patient age and the extra charge for a private room (Cost). In conclusion, informal caregivers are generally satisfied with inpatient palliative care services provided by members of the Japanese Association of Hospice and Palliative Care Units. The levels of satisfaction are influenced by various familyand organization-related variables. PMID: 12046994 [PubMed - indexed for MEDLINE] 1366: Aust Health Rev. 2002;25(2):170-4. Related Articles, Links

Why is IT important? Cohen B. IBA Health, Singapore. Healthcare organisations are under pressure to offer improved patient care while at the same time attempting to reduce or, at best, manage costs. Technology has always played an important role in medicine, helping with devices and improving investigations and treatments. In many cases, this technology has helped to boost revenues at the same time. Information Technology (IT) has been applied traditionally within the administrative areas of the organisation. More recently, it is being used within the clinical area and is therefore confronting healthcare professionals with both opportunities and challenges in carrying out their tasks. This paper attempts to cut through the jargon and hype surrounding trends in Information Technology and focus on aspects with which the organisation should be concerned. PMID: 12046146 [PubMed - indexed for MEDLINE]

1367: Occup Med. 2002 Jul-Sep;17(3):427-35, iv. Related Articles, Links

Occupational health in Taiwan. Wang JD, Cheng TJ, Guo YL. Department of Internal Medicine, National Taiwan University, College of Public Health, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan. Challenges facing a developing country during transition to newly developed status include lack of: a hazard communication system, a prudent industrial zoning policy, and occupational safety and health (OSH) technology and personnel. The authors offer an approach to the future that encompasses implementation of a pollution prevention system, comprehensive coverage of occupational injuries and diseases, and integration of information technology with OSH protection. Publication Types: • •

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

PMID: 12028952 [PubMed - indexed for MEDLINE] 1368: Public Health Nutr. 2002 Feb;5(1A):183-9. Related Articles, Links

The nutrition and health transition in Thailand. Kosulwat V. Institute of Nutrition, Mahidol University, Phutthamonthon, Salaya, Nakhon Pathom, Thailand. [email protected] OBJECTIVE: To explore and describe the nutrition and health transition in Thailand in relation to social and economic changes, shifts in food consumption patterns and nutritional problems, as well as morbidity and mortality trends. DESIGN: This report reviews the nutrition and health situation and other related issues by compiling information from various reports and publications from several sources. Yearly statistics and reports from the National Statistical Office were used as well as data from the Food and Agriculture Organization (FAO) and national surveys on the nutrition and health situation of the Thai population.

RESULTS: Thailand has undergone social and economic transitions during the past three decades and is approaching the post-demographic transitional period. These are evidenced by an increase in life expectancy at birth of the population, and declines in the total fertility and infant mortality rates. The economic structure has also moved from agricultural to industrial. Industrial growth has surpassed that of the agricultural sector as indicated by a steady rise in the share of the industrial sector in the gross domestic product, which is greater than that of other sectors. At the same time, results from several nation-wide surveys indicate that the food consumption pattern of the population has changed considerably; Thai staples and side dishes are being replaced by diets containing a higher proportion of fats and animal meat. A shift in the proportion of expenditure on food prepared at home and that expended on purchased, ready-to-eat food, in both rural and urban settings, gives another reflection of the change in food consumption of the Thai population. The prevalence of overweight and obesity among children and adolescents has increased dramatically during the past 20 years and is more pronounced in children from private schools and urban communities than in those from public schools or rural areas. Among adults, results from two national surveys in 1991 and 1996 indicated that the problem of overweight and other risk factors for cardiovascular disease have increased significantly. In considering the overall causes of death among the Thai population, the leading causes are diet-related chronic degenerative diseases. Diseases of the circulatory system have become the number one cause of death in Thailand and cancer has ranked as the number three cause of death since the late 1980s. CONCLUSIONS: The rapid changes in food intake and lifestyle patterns in Thailand clearly demonstrate a significant impact on the shifting pattern of disease burden of the population. These changes should be monitored carefully and must be reversed through appropriate behaviour modification and the promotion of appropriate eating practices and physical activities. Publication Types: •

Review

PMID: 12027283 [PubMed - indexed for MEDLINE] 1369: J Med Syst. 2002 Jun;26(3):249-54. Related Articles, Links

A network system of medical and welfare information service for the patients, their families, hospitals, local governments, and commercial companies in a medical service area. Matsumura K, Antoku Y, Inoue R, Kobayashi M, Hanada E, Iwasaki Y, Kumagai Y, Iwamoto H, Tsuchihashi S, Iwaki M, Kira J, Nose Y.

Department of Medical Information Science, Kyushu University Hospital, Fukuoka, Japan. A service information system using the Internet, which connected the various people who are related to medical treatment and nursing welfare, was constructed. An intractable neurological disease patient who lives in the Onga district, Fukuoka, Japan, and the people who are related to the service were chosen as test users in an experimental model. The communicated service information was divided into open-use data (electronic bulletin board, welfare service, medical care service, and link to private company service home page) and closed-use data (the individual patient's hysterics). The open data server was installed in an Internet service provider The open data could be accessed not only by the patient, but also by the family, information center, companies, hospitals, and nursing commodity store related to patient's nursing and medical treatment. Closed data server was installed in an information center (public health center). Only patient and information center staff can access the closed data. Patients should search and collect the service information of various medical and welfare services by themselves. Therefore, services prepared for the patient are difficult to know, and they cannot be sufficiently utilized. With the use of this information system, all usable service information became accessible, and patients could easily use it. The electronic bulletin board system (BBS) was used by patients for knowing each other or each others' family, and was used as a device for exchange of wisdom. Also, the questions for the specialist, such as doctor, dentist, teacher, physical therapist, care manager, welfare office staff member, and public health nurse, and the answers were shown on the BBS. By arranging data file, a reference of various patients in question and answer, which appeared in this BBS, was made as "advisory hints" and was added to the open data. The advisory hints became the new service information for the patients and their family. This BBS discovered the possibility of becoming an important information source for companies, hospital and, administration to know the requirements of patients and their families and the kind of services to be served. Although suppliers provide medical and welfare services for the patient, there is a tendency that the service information is sent by the suppliers at their own convenience. The information system in which various people participated was constructed in order to collect information for the patient, taking a patient-oriented approach. The result of the model test showed that this information system using Internet technology is a good system for both the service supplier and its receiver. PMID: 12018611 [PubMed - indexed for MEDLINE] 1370: Comput Inform Nurs. 2002 May-Jun;20(3):101-7. Related Articles, Links

Nursing informatics in Korea. Park HA.

College of Nursing, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea. [email protected] The use of computers in the Korean healthcare system began in the late 1970s to expedite insurance reimbursements when the national health insurance system was introduced. Their application in nursing came much later because the insurance fee schedule does not include nursing services. This article explores the history and activities of nursing informatics in Korea in professional organization, education, research, clinical practice, and professional outreach. Suggestions are given on meeting the challenges of information technology for nursing in Korea. PMID: 12021608 [PubMed - indexed for MEDLINE] 1371: Acta Trop. 2002 May;82(2):157-68. Related Articles, Links

Epidemiology and control of mekongi schistosomiasis. Urbani C, Sinoun M, Socheat D, Pholsena K, Strandgaard H, Odermatt P, Hatz C. World Health Organization 63, Trang Hung Dao Street, P.O. Box 52, 10000, Hanoi, Vietnam. [email protected] Since the first case of Schistosoma mekongi infection was reported in 1957, control measures have been implemented in Laos and in Cambodia. Operational research provided the necessary information on parasite epidemiology and the associated morbidity in order to develop adequate control measures. S. mekongi transmission occurs in rocky banks of the river according to a seasonal cycle. Common daily activities of villagers living in the endemic areas constitute the risk factors for infection. The potential role of an animal reservoir is not fully understood. Severe disease is associated with advanced infection status. Signs and symptoms of portal hypertension dominate the clinical situation, and death is usually due to bleeding from ruptured esophageal varices. Schistosomiasis control in both Laos and Cambodia was based on universal treatment campaigns and resulted in a dramatic fall in the prevalence of the infection and in morbidity control. However, even if the disease and the infection have been satisfactorily controlled, transmission still occurs, and in very limited areas the prevalence reaches rates of more than 15%. Today, 60000 people are estimated to be still at risk of infection in Laos and about 80,000 in Cambodia. The new challenge in schistosomiasis control in endemic areas along the Mekong river is to consolidate the results, to establish a sensitive and reliable surveillance system, and finally to adapt control strategies to the low endemic situation. The impoverished nature of the region makes the possibility of sanitation unfeasible, and external support is

still needed to sustain activities in the near future and to enable the substantial reduction of risk behaviors. PMID: 12020888 [PubMed - indexed for MEDLINE] 1372: Drug Saf. 2002;25(5):323-44. Related Articles, Links

Panax ginseng: a systematic review of adverse effects and drug interactions. Coon JT, Ernst E. Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, United Kingdom. [email protected] Panax ginseng C. A. Meyer is a perennial herb native to Korea and China and has been used as an herbal remedy in eastern Asia for thousands of years. Modern therapeutic claims refer to vitality, immune function, cancer, cardiovascular diseases, improvement of cognitive and physical performance and sexual function. A recent systematic review of randomised controlled trials found that the efficacy of ginseng root extract could not be established beyond doubt for any of these indications. In order to obtain a balanced assessment of the therapeutic value of P. ginseng it is also necessary to consider the safety profile. In view of the extremely widespread use of P. ginseng it seems important to ask whether this herbal medicine involves health risks for the consumer. This review was conducted as a systematic attempt to document and evaluate all the available safety data on P. ginseng root extracts. Systematic searches were performed in five electronic databases and the reference lists of all papers located were checked for further relevant publications. All articles containing original data on adverse events and drug interactions with P. ginseng were included. Information was also requested from 12 manufacturers of ginseng preparations, the spontaneous reporting schemes of the WHO and national drug safety bodies. No language restrictions were imposed. Data from clinical trials suggest that the incidence of adverse events with ginseng monopreparations is similar to that with placebo. The most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. The possibility of more serious adverse events is indicated in isolated case reports and data from spontaneous reporting schemes; however, causality is often difficult to determine from the evidence provided. Combination products containing ginseng as one of several constituents have been associated with serious adverse events and even fatalities. Interpretation of these cases is difficult as ingredients other than P. ginseng may have caused the problems. Possible drug interactions have been reported between P. ginseng and warfarin, phenelzine and alcohol. Collectively, these data suggest that P. ginseng monopreparations are rarely associated with adverse events or drug interactions.

The ones that are documented are usually mild and transient. Combined preparations are more often associated with such events but causal attribution is usually not possible. Publication Types: • • •

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

PMID: 12020172 [PubMed - indexed for MEDLINE] 1373: Radiat Environ Biophys. 2002 Mar;41(1):75-80. Related Articles, Links

Fallout from nuclear tests: health effects in Kazakhstan. Grosche B, Land C, Bauer S, Pivina LM, Abylkassimova ZN, Gusev BI. Federal Office for Radiation Protection, Institute of Radiation Hygiene, Oberschleissheim, Germany. [email protected] Publication Types: •

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

PMID: 12014415 [PubMed - indexed for MEDLINE] 1374: Radiat Environ Biophys. 2002 Mar;41(1):69-73. Related Articles, Links Comment in: •

Radiat Environ Biophys. 2002 Mar;41(1):13-8.

Fallout from nuclear tests: health effects in the Altai region. Shoikhet YN, Kiselev VI, Algazin AI, Kolyado IB, Bauer S, Grosche B. Institute of Regional Medico-Ecological Problems, Barnaul, Russia. Publication Types:

•

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

PMID: 12014414 [PubMed - indexed for MEDLINE] 1375: Radiat Environ Biophys. 2002 Mar;41(1):61-7. Related Articles, Links Comment in: •

Radiat Environ Biophys. 2002 Mar;41(1):13-8.

Fallout from nuclear tests: dosimetry in Kazakhstan. Gordeev K, Vasilenko I, Lebedev A, Bouville A, Luckyanov N, Simon SL, Stepanov Y, Shinkarev S, Anspaugh L. State Research Center, Institute of Biophysics of the Ministry of Health, Moscow, Russian Federation. Publication Types: •

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

PMID: 12014413 [PubMed - indexed for MEDLINE] 1376: Radiat Environ Biophys. 2002 Mar;41(1):57-60. Related Articles, Links

Fallout from nuclear tests: dosimetry in the Altai region. Shoikhet Y, Loborev V, Sudakov V, Kiselev VI, Zelenov V, Azarov L. Research Institute of Regional Medical-Ecological Problems, Ministry of Health, Barnaul, Russian Federation. PMID: 12014412 [PubMed - indexed for MEDLINE] 1377: Mil Med. 2002 Apr;167(4):326-30. Related Articles, Links

International use of an academic nephrology World Wide Web site:

from medical information resource to business tool. Abbott KC, Oliver DK, Boal TR, Gadiyak G, Boocks C, Yuan CM, Welch PG, Poropatich RK. Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA. BACKGROUND: Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. METHODS: Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. RESULTS: From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. CONCLUSIONS: The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers. PMID: 11977886 [PubMed - indexed for MEDLINE] 1378: J Hum Ergol (Tokyo). 1999 Dec;28(1-2):59-65. Related Articles, Links

Human aspects of shift work in the developing countries--I: A case study in Bangladesh. Ahasan R, Khaleque A, Mohiuddin G. Work Science Laboratory, University of Oulu, FIN-90570 Oulu, Finland. There currently is little information available that allows objective prediction of

psychosocial risks and benefits associated with the shift work in the developing countries. To provide such information, this study assessed possible differential effects of fatigue associated with the shift workers' attitude, job satisfaction, psychosocial problems, and other difficulties. Data were collected from the subjective responses on various scales using questionnaire among sixty adult male subjects working on a weekly rotating three-shift system in a shoe factory in Bangladesh. The results indicated that shift work is associated with negative aspects of disturbing their family, conjugal and social lives, curtailed leisure activities, created difficulties in meeting their friends, caused irregularity of their mealtime, affected sleep and caused health problems. However, the effect is significant only for such feelings of social and family aspects, as well as sleepy and lively hood but no significant main effects of shift schedule are observed for any of the behavioural and organizational context. PMID: 11957325 [PubMed - indexed for MEDLINE] 1379: J Neurol. 2002 Jan;249(1):25-32. Related Articles, Links

Distinct pattern of age-specific incidence of Guillain-Barré syndrome in Harbin, China. Cheng Q, Wang DS, Jiang GX, Han H, Zhang Y, Wang WZ, Fredrikson S. Division of Neurology, Huddinge University Hospital, Sweden. [email protected] We describe the age-and sex-specific incidence of Guillain-Barré syndrome (GBS) in Harbin, China, based on the information from a prospective survey among a well-defined large population during one year. A network of physicians reported incident patients with a GBS diagnosis from a general population of 5.4 million inhabitants in Harbin, China, during the period from 1 October 1997 to 30 September 1998. Each reported patient was examined by senior neurologists and the GBS diagnosis was validated according to standard diagnostic criteria. All GBS patients were followed-up for six months after onset. Admission registers at all hospitals in Harbin were also checked afterwards for screening patients with a GBS diagnosis who might have been missed. During the study period, 79 patients with a GBS diagnosis were reported. After validation, the GBS diagnosis was confirmed in 70 patients. Another GBS patient was found through the screening of admission registers at hospitals. Among them, 36 GBS patients were residents in Harbin and the other 35 patients were from geographical areas out of Harbin. The GBS incidence, age-adjusted to the European standard population, was 0.66 (95% CI 0.46-0.91) per 100,000 person-years, with a male to female ratio of 1.4. The highest GBS incidence was found in the youngest age-group and the incidence among the elderly was remarkably lower than those reported from other populations in Western countries. Possible explanations for the distinct pattern of

age-specific incidence of GBS are discussed. Further studies are needed. Publication Types: •

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

PMID: 11954865 [PubMed - indexed for MEDLINE] 1380: AIDS. 2002 May 3;16(7):953-9. Related Articles, Links

National program for preventing mother-child HIV transmission in Thailand: successful implementation and lessons learned. Kanshana S, Simonds RJ. Department of Health, Ministry of Public Health, Tivanon Road, Nonthaburi 11000, Thailand. OBJECTIVE: To describe the development, components, and initial uptake of Thailand's national program for preventing mother-child HIV transmission. DESIGN: Historical review, interpretation of experience, national program monitoring. SETTING: Public health system, Thailand. PARTICIPANTS: Policymakers, clinicians, HIV-infected pregnant women. INTERVENTION: Voluntary counseling and HIV testing of pregnant women; short-course zidovudine for HIV-infected women and their infants and formula feeding for infants. MAIN OUTCOME MEASURES: Program components implemented and program uptake. RESULTS: Research, monitoring and evaluation of pilot projects, training, and policy-making provided the information, experience, infrastructure, and guidance to develop a program for preventing mother-child HIV transmission that was implemented in all Ministry of Public Health hospitals in Thailand in 2000. A national system was established to monitor program implementation. Monitoring reports were received from 669 hospitals in 65 provinces for the period October 2000 through July 2001. During this period, 93% of 318 721 women who gave birth were tested for HIV; 69% of 3958 HIVinfected women giving birth received zidovudine; and 86% and 80% of the 3865 children born to HIV-infected women received zidovudine and infant formula, respectively, through the program. CONCLUSIONS: A national program for preventing mother-child HIV transmission was successfully implemented in Thailand. Early monitoring indicates good program uptake. Lessons learned from implementing this program include the importance of paying attention to counseling, communication, and training in the program, and using pilot projects and focused monitoring and evaluation data to guide the program development, expansion, and improvement.

Publication Types: • •

Editorial Review

PMID: 11953461 [PubMed - indexed for MEDLINE] 1381: Int J Infect Dis. 2001;5(4):214-9. Related Articles, Links

Are the environmental niches of Vibrio cholerae O139 different from those of Vibrio cholerae O1 El Tor? Ali M, Emch M, Yunus M, Sack RB. Centre for Health and Population Research, Dhaka, Bangladesh. [email protected] BACKGROUND: Vibrio cholerae are known to be normal inhabitants of surface water. However, the environmental niches of the different strains of cholera are not well known, and therefore, populations at risk for cholera outbreaks cannot be clearly identified. METHODS: This study identifies environmental risk factors for cholera caused by V. cholerae O1 El Tor and O139 and environmental niches of the two strains present in Matlab, a cholera endemic area of Bangladesh. The study year was 1993, the year that the O139 strain first appeared in the study area. Patients who had either strain of cholera identified in a laboratory were included in the study. A geographic information system was used to map the household locations of the patients, to describe the human sanitary environment and population density, and to address potential anthropogenic and environmental risk factors of the disease. Spatial point pattern and exploratory spatial data analysis techniques were used to define the environmental niches of the two cholera strains. RESULTS: The study suggests the niches of O1 El Tor and O139 strains of V. cholerae appear to be similar, based on common environmental risk factors. CONCLUSIONS: The results of this study support a theory that O1 El Tor could possibly be replaced by the newer O139 strain in the future. Publication Types: •

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

PMID: 11953220 [PubMed - indexed for MEDLINE] 1382: Health Place. 2002 Jun;8(2):85-92.

Related Articles,

Links

Spatial filtering using a raster geographic information system: methods for scaling health and environmental data. Ali M, Emch M, Donnay JP. ICDDR,B, Mohakhali, Dhaka, Bangladesh. [email protected] Despite the use of geographic information systems (GIS) in academic research, it is still uncommon for public health officials to use such tools for addressing health and environmental issues. Complexities in methodological issues for addressing relationships between health and environment, investigating spatial variation of disease, and addressing spatial demand and supply of health care service, hinder the use of GIS in the health sector. This paper demonstrates simple spatial filtering methods for analyzing health and environmental data using a raster GIS. Computing spatial moving average rates reduces individual affects and creates a continuous surface of phenomena. Another spatial analytical method discussed is computation of exposure status surfaces including neighbors' influences weighted by distance decay. These methods describe how health and environmental data can be scaled in order to better address health problems. Spatial filtering methods are demonstrated using health and population surveillance data within a GIS that were collected for approximately 210,000 people in Matlab, Bangladesh. Publication Types: •

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

PMID: 11943581 [PubMed - indexed for MEDLINE] 1383: Int J Tuberc Lung Dis. 2002 Apr;6(4):307-12. Related Articles, Links

Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS). O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP. University of Leeds School of Medicine, UK. SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.

OBJECTIVES: To establish factors affecting compliance of patients with antituberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy. DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000. RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis. CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis. Publication Types: •

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

PMID: 11936739 [PubMed - indexed for MEDLINE] 1384: Clin Microbiol Rev. 2002 Apr;15(2):223-46. Related Articles, Links

Dracunculiasis (Guinea worm disease) and the eradication initiative. Cairncross S, Muller R, Zagaria N. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom. [email protected] Dracunculiasis, also known as guinea worm disease, is caused by the large female of the nematode Dracunculus medinensis, which emerges painfully and slowly from the skin, usually on the lower limbs. The disease can infect animals, and sustainable animal cycles occur in North America and Central Asia but do not act as reservoirs of human infection. The disease is endemic across the Sahel belt of Africa from Mauritania to Ethiopia, having been eliminated from Asia and some African countries. It has a significant socioeconomic impact because of the

temporary disability that it causes. Dracunculiasis is exclusively caught from drinking water, usually from ponds. A campaign to eradicate the disease was launched in the 1980s and has made significant progress. The strategy of the campaign is discussed, including water supply, health education, case management, and vector control. Current issues including the integration of the campaign into primary health care and the mapping of cases by using geographic information systems are also considered. Finally, some lessons for other disease control and eradication programs are outlined. Publication Types: •

Review

PMID: 11932231 [PubMed - indexed for MEDLINE] PMCID: PMC118073

1385: Patient Educ Couns. 2002 Apr;46(4):277-85. Related Articles, Links

The interaction between physician and patient communication behaviors in Japanese cancer consultations and the influence of personal and consultation characteristics. Ishikawa H, Takayama T, Yamazaki Y, Seki Y, Katsumata N, Aoki Y. Department of Health Sociology, School of Health Sciences and Nursing, The University of Tokyo, Tokyo, Japan. [email protected] The communications of physician and patient vary with the characteristics of patient and consultation, as well as the communications of the counterpart. The purpose of this study is to explore the interaction between physician and patient communications in Japanese cancer consultation in view of the influence of patient and consultation characteristics. One hundred and forty cancer outpatients and 12 physicians were included in this study. The Roter Interaction Analysis System (RIAS) was used to analyze the physician-patient interaction. Patient information giving was positively related to physician facilitation, while patient question asking and emotional expression were associated with the warm and empathetic attitude of the physician. On the other hand, the encouraging statements of the physician were greater in shorter consultations, which implies physicians might have interrupted patients with encouragement before thoroughly listening to the patients concern. Further investigation is needed to confirm the causal relationships of these interactions.

Publication Types: •

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

PMID: 11932127 [PubMed - indexed for MEDLINE] 1386: Psychiatr Serv. 2002 Apr;53(4):476-8. Related Articles, Links

A computerized patient information system in a psychiatric hospital. Modai I, Ritsner M, Silver H, Kurs R. Institute of Psychiatric Studies of Sha'ar Menashe Mental Health Center, Mobile, Israel. [email protected] The authors describe a computerized patient information system at a psychiatric hospital in Israel. The system is a fully implemented work instrument that promotes clinical safety and cost containment. It allows interactive online consultations, clinical cross-checking, the production of computerized reports and schedules, fast response to laboratory results, and safer drug administration, all of which help improve the quality of care. Cost savings have been achieved in areas such as pharmacy and food distribution. The initial investment in the system was $400,000, which is expected to be recouped after 11.4 years. PMID: 11919364 [PubMed - indexed for MEDLINE] 1387: Am J Public Health. 2002 Apr;92(4):615-23. Related Articles, Links

A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Gee GC. Training Program in Identity, Self, Role, and Mental Health, Department of Sociology, Indiana University, Ballantine Hall 744, 1020 E Kirkwood Avenue, Bloomington, IN 47405-7103, USA. [email protected] OBJECTIVES: This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with

poor health status among members of an ethnic group. METHODS: Adult respondents (n = 1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures. RESULTS: Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value. CONCLUSIONS: The data support the hypothesis that discrimination at multiple levels influences the health of minority group members. Publication Types: •

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

PMID: 11919062 [PubMed - indexed for MEDLINE] PMCID: PMC1447127

1388: J Nurses Staff Dev. 2000 Sep-Oct;16(5):222-6. Related Articles, Links

Preparing for an international consultation. Brunt BA. Summa Health System, Akron, Ohio, USA. This article outlines the experiences of a staff development educator in preparing for an international staff development consultation. Sections on preparing for travel and for the actual consultation visit provide suggestions in each of these areas. The consultation is described in terms of work done before, during, and after the visit. This information will be helpful to staff development educators considering an international consultation. PMID: 11913019 [PubMed - indexed for MEDLINE] 1389: Epilepsia. 2002 Mar;43(3):311-6. Related Articles, Links

Comment in: •

Epilepsia. 2003 Feb;44(2):268-9; author reply 269-70.

Public awareness, attitude, and understanding of epilepsy in Hong Kong Special Administrative Region, China. Fong CY, Hung A. University Department of Medicine, Queen Mary Hospital, Hong Kong. [email protected] PURPOSE: Because of the nature of the epileptic seizure, the social stigma attached to epilepsy is a major handicap to persons with epilepsy compared with the disability associated with seizures or the side effects from medications. Measuring the awareness, attitude, and understanding of epilepsy is the first step in alleviating discrimination. METHODS: We conducted a face-to-face questionnaire interview survey in five different locations (HKSAR) that represented the population structure, administrative function, and occupations of inhabitants. Subjects with epilepsy or with relatives who had epilepsy were excluded. RESULTS: We interviewed 1,128 subjects; 58.2% had heard about epilepsy before. Of these, 55% had witnessed one or more epileptic seizure, and 18.9% knew one or more persons with epilepsy; 52.7% would put an object into a patient's mouth during an epileptic seizure to prevent injury of the tongue (32.2% learned this from a local television program), and 94.1% agreed that persons with epilepsy could be married. However, only 72.5% considered pregnancy to be appropriate; 11.2% would not let their children play with others with epilepsy; 32.2% would not allow their children to marry persons with epilepsy. Employers (22.5%) would terminate the employment contract after an epileptic seizure in an employee with unreported epilepsy. CONCLUSIONS: This study documented the public attitude toward epilepsy in HKSAR; although it was more negative than that in Western societies, it was more positive than that of the Chinese in China or Taiwan. We suggest that more effort be made to improve public awareness of, attitude toward, and understanding of epilepsy through school education and epilepsy-related organizations in HKSAR. PMID: 11906517 [PubMed - indexed for MEDLINE] 1390: Mil Med. 2002 Mar;167(3):205-10. Related Articles, Links

Ambulatory medical visits among anthrax-vaccinated and unvaccinated personnel after return from southwest Asia.

Rehme PA, Williams R, Grabenstein J. Air National Guard, Office of the Air Surgeon, 3500 Fetchet Avenue, Andrews Air Force Base, MD 20762, USA. The Department of Defense launched a mandatory anthrax immunization program for military personnel in December 1997. This program has been criticized for many reasons, including concern over side effects. This study was designed to give a quick answer to the question of whether vaccinated persons who deployed to southwest Asia were more likely to seek medical care upon their return than their unvaccinated counterparts. The results demonstrated that there was no greater risk for vaccinated persons to have a diagnosis recorded in the Ambulatory Data System (0.96 RR) than unvaccinated persons. In addition, there was no significant increased risk for a recorded diagnosis in any 1 of the 17 International Classification of Diseases, Ninth Revision, categories or for 16 specific adverse health conditions. PMID: 11901567 [PubMed - indexed for MEDLINE] 1391: Am J Hum Biol. 2002 Mar-Apr;14(2):264-74. Related Articles, Links

Lay perceptions of genetic risks attributable to inbreeding in Pakistan. Hussain R. Senior Lecturer in Health Management, School of Health, University of New England, Australia. [email protected] Pakistan along with many other West and South Asian countries has a very high prevalence of consanguineous, especially close cousin, marriages. Although there is substantial empirical information on offspring morbidity and mortality attributable to parental consanguinity, population-based information on how communities in general, and women in particular, perceive the health risks associated with consanguineous unions is limited. This paper considers community perceptions of health effects associated with consanguineous marriages using qualitative data from 15 focus group discussions and 294 indepth interviews. The study was conducted in four low-income, multi-ethnic, and multi-religious communities in Karachi, the principal commercial center of Pakistan. The results show a general lack of awareness of the possible adverse health effects of consanguineous marriage. In cases where a link between consanguinity and ill health was acknowledged, it often centered on the familial origins of non-communicable disorders such as diabetes and hypertension or

infectious diseases such as tuberculosis. Belief in fate and the "evil eye" was widespread across all ethnic and religious groups. Many respondents did not agree with medical explanations of a genetic mode of disease inheritance, even in cases where there was an affected child in the family. The absence of a uniform manifestation of disease among all children of a couple who were identified as carriers of a specific mutation added to the confusion among participants. The study highlights the need for further quantification of risks associated with consanguinity and a need for provision of appropriate information to primary-care clinicians and also to communities. The likely impact of increasing morbidity attributable to inbreeding on the health care system in resource poor settings is also discussed. Publication Types: •

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

PMID: 11891938 [PubMed - indexed for MEDLINE] 1392: Am J Emerg Med. 2002 Mar;20(2):118-21. Related Articles, Links

The feasibility of full computerization in the ED. Hu SC, Yen DH, Kao WF. Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital, Buddhist Tzu-Chi University, Hualien, Taiwan. [email protected] For understanding the feasibility of full computerization of an emergency department (ED), we investigated the completion rate performed by doctors, nurses, or registration clerks since the implementation of full computerization in our ED. We evaluated the changing style of chart-recording, from hand-writing pattern to full computer recording, by recording the execution rate of different information keyed by doctors, nurses, or registration clerks according to their work in ED. We recorded and analyzed different monthly reports of the execution rate in the 18-month period of study. Statistical analysis was performed using Wilcoxon rank-sum test or Kruskal-Wallis one-way ANOVA. The average monthly census was 4570.1 +/- 580.7 (95% confidence interval [CI] for mean: 4281.3, 4858.9). The average execution rate for mode of arrival and triage classification were 97.1 +/- 4.1% (95% CI for mean: 95.1%, 99.1%) and 97.2 +/4.1% (95% CI for mean: 95.2%, 99.2%), respectively. In comparison with the execution rate for disposition status between the period of the first 10 months (keying data by nurses) and the late 8 months (keying data by clerks), it showed 72.0 +/- 33.2% v 96.7 +/- 2.0%; 66.7 +/- 35.0% v 95.8 +/- 1.9%; 57.5 +/- 32.0% v

88.2 +/- 8.2% in nontrauma, trauma and pediatric section, respectively, with statistic significance (P <.01). To compare the rate of execution performed by physicians, we divided the study period into 3 phases (phase 1: first 6 months, phase 2: 7-12 months, phase 3: 13-18 months of the study period). The results were statistically significant (P =.004) in phase 3 (83.4 +/- 5.3%) with higher execution rate than phase 1 (69.7 +/- 7.7%) and phase 2 (75.2 +/- 4.9%) in trauma physician. In the pediatric section, it was also significantly higher in phase 3 than phase 2 (88.2 +/- 7.7% v 70.7 +/- 5.9%, P =.012). We concluded that it is efficient to key in data by registration clerks instead of nurses, and it takes time to persuade and educate most physicians to cooperate in using the computer while seeing patients. Copyright 2002, Elsevier Science (USA). All rights reserved.) PMID: 11880878 [PubMed - indexed for MEDLINE] 1393: J Public Health Med. 2001 Dec;23(4):278-85. Related Articles, Links

Development and validation of a computerized South Asian Names and Group Recognition Algorithm (SANGRA) for use in British health-related studies. Nanchahal K, Mangtani P, Alston M, dos Santos Silva I. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine. [email protected] BACKGROUND: Studies on ethnic variations in health have played an important role in aetiological and health services research. Most routine datasets, however, do not include information on ethnicity. South Asians, one of the largest minority ethnic groups in Britain, have distinctive names that also allow differentiation of the main sub-groups with their important differences in health-related exposures and disease risks. METHODS: A computerized name recognition algorithm (SANGRA) was developed incorporating directories of South Asian first names and surnames together with their religious and linguistic origin. SANGRA was validated using health-related data with self-ascribed information on ethnicity. RESULTS: SANGRA was successful in recognizing South Asian origin in reference datasets, with sensitivity of 89-96 per cent, specificity of 94-98 per cent, positive predictive value (PPV) of 80-89 per cent and negative predictive value (NPV) of 98-99 per cent. Religious origin was correctly assigned in the majority of cases: sensitivity, specificity and PPV were 94 per cent, 91 per cent and 90 per cent for Hindus; 90 per cent, 99 per cent and 98 per cent for Muslims; and 76 per cent, 99 per cent and 94 per cent for Sikhs. SANGRA correctly identified 76 per cent Gujerati and 70 per cent Punjabi names, although only 62 per cent of Gujerati names were sufficiently distinct to be allocated to the Gujerati-only category and only 53 per cent Punjabi names were allocated to the Punjabi-only

category. However, specificity and PPV were high for both languages (respectively 97 per cent and 93 per cent for Gujerati, and 99 per cent and 97 per cent for Punjabi). CONCLUSIONS: SANGRA provides a practical and valid method of ascertaining South Asian origin by name and, to a lesser degree of accuracy, of differentiating between the main religious and linguistic subgroups living in Britain. This algorithm will be useful in health-related studies where information on self-ascribed ethnicity is not available or is of a limited nature. Publication Types: • •

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

PMID: 11873889 [PubMed - indexed for MEDLINE] 1394: World Hosp Health Serv. 2001;37(3):19-23, 40-3. Related Articles, Links

Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals. Cheah J, Heng BH. Department of Community, Occupational and Family Medicine, National University of Singapore. The public health care delivery system in Singapore faces the challenges of a rapidly ageing population, an increasing chronic disease burden, increasing healthcare cost, rising expectations and demand for better health services, and shortage of resources. It is also fragmented, resulting in duplication and lack of coordination between institutions. A disease management approach has been adopted by the National Healthcare Group (NHG) as a critical strategy to provide holistic, cost-effective, seamless and well-coordinated care across the continuum. The framework in the development of the disease management plan included identifying the diseases and defining the target population, organizing a multidisciplinary team lead by a clinician champion, defining the core components, treatment protocols and evaluation methods, defining the goals, and measuring and managing the outcomes. As disease management and case management for chronic diseases are new approaches adopted in the healthcare delivery system, there is a lack of understanding by healthcare professionals. The leadership and participation of hospital physicians was sought in the planning, design and outcomes monitoring to ensure their 'buy-in' and the successful implementation and effectiveness of the program. The episodic diagnosis related group (DRG)based framework of funding and subvention for healthcare, and the shortage of step-care care facilities, have been recognized by the Ministry of Health as an

impediments to the implementation, and these are currently being addressed. PMID: 11858007 [PubMed - indexed for MEDLINE] 1395: Child Care Health Dev. 2002 Jan;28(1):87-93. Related Articles, Links

Disability in children from different ethnic populations. Morton R, Sharma V, Nicholson J, Broderick M, Poyser J. Ronnie Mackeith Child Development Centre, Derbyshire Childrens' Hospital, Derby, UK. We report on the prevalence of severe neurodisability in children in the Southern Derbyshire Health Authority from different ethnic groups. Information was obtained from the health records of children at the Child Development Centre (CDC), and analysed according to ethnic group. There were 53 in the Pakistani group, 20 in the Indian group and 764 in a mixed group, of which 95% were of European origin. It was estimated that all children with severe disability in the area of the Health Authority had notes at the CDC, except for 10% of the mixed group living on the periphery. The numbers of children with different disabling conditions were recorded, together with a measure of the level of individual disability; the 'Disability Scores'. We also noted if the condition was genetic or chromosomal in origin. Pakistani children showed a higher prevalence than the other groups of severe learning disorder, severe and profound hearing loss and severe visual problems. They also had a slightly increased prevalence of autism and cerebral palsy. Conversely, they showed a lower prevalence of language disorder. Disability scores for Pakistani children attending the CDC were higher than for other groups. Genetic disease causing disability was 10 times more common in the Pakistani children than other ethnic groups. Disability is more common in Pakistani children probably as a result of the cultural practice of consanguineous marriages. This community needs special help for disabled children, and their families, for general support and appropriate genetic counselling. Publication Types: •

Comparative Study

PMID: 11856191 [PubMed - indexed for MEDLINE] 1396: Harefuah. 2002 Jan;141(1):89-92, 123. Related Articles, Links

[Sports injuries among children] [Article in Hebrew] Dankner R, Barel V. Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. In addition to the very positive effect of physical activity on health, sport is liable to cause injury and disability. In Israel, physical activity has become part of leisure time activity over the years. This combination has led to a consequential rise in the risk of injury. Most sport injuries are mild and do not require hospital treatment, but they may be severe and sometimes lead to hospitalization, permanent disability and even death. In 1995-6, there were 356 sports related injuries among children 5-17 years old, which were registered in the Israeli National Trauma Registry (INTR). These represented 8.8% of all injuries registered in the INTR for children of that age in 1995-6. In order to promote the prevention of sports related injuries, the magnitude of the problem must first be identified and the incidence and severity of the sports injuries described. In Israel there is no systematic surveillance of sports injuries, nor knowledge of the specific patterns of injury in Israel. In order to reduce the incidence and severity of sports injuries in Israel, there is a necessity to improve the level of information regarding such injuries through the establishment of a national sports injury surveillance system. Publication Types: • •

English Abstract Review

PMID: 11851118 [PubMed - indexed for MEDLINE] 1397: Trop Med Int Health. 2002 Feb;7(2):140-8. Related Articles, Links

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal. Furber AS, Newell JN, Lubben MM. Nuffield Institute for Health, University of Leeds, UK.

OBJECTIVE: To systematically review information on HIV epidemiology and on sexual behaviour in Nepal with a view to identifying gaps in current knowledge. METHODS: Systematic review covering electronic databases, web-based information, personal contact with experts and hand searching of key journals. RESULTS: HIV-1 seroprevalence has been rising rapidly in association with high-risk behaviours, with current levels of 40% amongst the nation's injecting drug users and approaching 20% amongst Kathmandu's female commercial sex workers (FCSWs). HIV seroprevalence remains low in the general population (0.29% of 15-49 year olds). There are significant methodological limitations in many of the seroprevalence studies identified, and these estimates need to be treated with caution. There are extensive migration patterns both within the country and internationally which provide the potential for considerable sexual networking. However, studies of sexual behaviour have focused on FCSWs and the extent of sexual networks within the general population is largely unknown. CONCLUSIONS: Whilst some of the ingredients are present for an explosive HIV epidemic in Nepal, crucial knowledge on sexual behaviour in the general population is missing. Research on sexual networking is urgently required to guide HIV control in Nepal. There is also a need for further good-quality epidemiological studies of HIV seroprevalence. Publication Types: •

Review

PMID: 11841704 [PubMed - indexed for MEDLINE] 1398: Soc Work Health Care. 2001;33(3-4):129-51. Related Articles, Links

Comparing social work's role in renal dialysis in Israel and the United States: the practice-based research potential of available clinical information. Auslander G, Dobrof J, Epstein I. Hebrew University, School of Social Work, Mt Scopus, Jerusalem, Israel. [email protected] This paper demonstrates the use of clinical data-mining in a study of social work interventions with dialysis patients in two countries, the US and Israel. We aimed to examine the role of social workers in improving kidney patient outcomes and to determine the potential of readily available patient information for studying this process. The findings showed considerable differences between the patient samples in both countries, as far as the socio-demographic background was considered. In spite of this, there were numerous similarities in the type of

psycho-social problems and reactions, as well as the social workers' interventions. Differences which arose in various patient states and outcomes were examined in light of variations in the health care systems and socio-cultural contexts of renal dialysis in both sites. Publication Types: • •

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

PMID: 11837358 [PubMed - indexed for MEDLINE] 1399: Pharmacoepidemiol Drug Saf. 2001 Oct-Nov;10(6):487-92. Related Articles, Links

Construction of the Korea Elderly Pharmacoepidemiologic Cohort: drug utilization review of cephalosporins in geriatric inpatients. Park BJ, Cho YK, Kim SA. Department of Preventive Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-799, Korea. [email protected] We performed a cohort-based pharmacoepidemiologic study in order to evaluate the pattern of cephalosporin prescriptions in elderly inpatients in Korea. The Korea Elderly Pharmacoepidemiologic Cohort was composed of a geriatric population of beneficiaries of the Korea Medical Insurance Corporation residing in Busan in 1993. The cohort consisted of 23,649 members, comprising 15,221 women (64.4%) and 8428 men (35.6%). The study population for drug utilization review consisted of those cohort members who were admitted into hospitals during the period January 1993 through December 1994. The number of hospitalized patients was 4262, comprising 2631 women (61.7%) and 1681 men (38.3%). The trend of cephalosporin prescriptions over the 2-year period showed that the use of second and third generation cephalosporins increased relative to the use of first generation. The use of cephalosporins combined with other antibiotics was found to occur in 22.8% aminoglycosides (76.7%) and quinolones (17.1%) being the most common antibiotics combined with cephalosporins. Our result demonstrates an increase in the prescription of second and third generation cephalosporins in Korea, which has implications not only for the elderly population but also for the total population because of the impact on health care costs and the potential for the emergence of antimicrobial resistance. Publication Types:

•

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

PMID: 11828829 [PubMed - indexed for MEDLINE] 1400: Cancer Causes Control. 2001 Dec;12(10):909-16. Related Articles, Links

Arsenic in drinking water and skin cancers: cell-type specificity (Taiwan, ROC). Guo HR, Yu HS, Hu H, Monson RR. Graduate Institute of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. [email protected] OBJECTIVE: The association between arsenic ingestion and cancer has been documented for more than a century. Previous studies showed that the carcinogenic effects of arsenic on the urinary system are cell-type specific. To evaluate whether this is also true for skin cancers, we conducted an ecological study in 243 townships in Taiwan. METHODS: The arsenic exposure was assessed on the basis of measurement reports from a previous survey, and cases of skin cancer were identified using the information gathered by the National Cancer Registry Program. We analyzed the data by regression models using multiple variables to describe the exposure status, and an urbanization index was also included in the models to adjust for the effects of urbanization. RESULTS: A total of 2369 patients with skin cancer, comprising 1415 men and 954 women, were registered between 1 January 1980 and 31 December 1989. Among the three major cell types of skin cancer, squamous cell carcinoma and basal cell carcinoma appear to be associated with ingestion of arsenic. Such an association was not observed for malignant melanoma. CONCLUSIONS: The results suggested that the carcinogenicity of arsenic on skin is cell-type specific, which is compatible with the findings in previous studies on urinary cancers. Publication Types: • • • •

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

PMID: 11808710 [PubMed - indexed for MEDLINE]

1401: Nippon Rinsho. 2001 Nov;59 Suppl 7:566-73. Related Articles, Links

[Non-Hodgkin lymphoma] [Article in Japanese] Sawada U. First Department of Internal Medicine, Nihon University School of Medicine. Publication Types: •

Review

PMID: 11808168 [PubMed - indexed for MEDLINE] 1402: Nippon Rinsho. 2001 Nov;59 Suppl 7:182-8. Related Articles, Links

[Parasitic infections] [Article in Japanese] Fujita K. Section of Environmental Parasitology, Department of International Health Development, Graduate School, Tokyo Medical and Dental University. Publication Types: •

Review

PMID: 11808119 [PubMed - indexed for MEDLINE] 1403: Ann N Y Acad Sci. 2001 Apr;928:281-6. Related Articles, Links

Anti-aging and health-promoting constituents derived from traditional oriental herbal remedies: information retrieval using the TradiMed 2000 DB.

Chang IM. Graduate Studies in Natural Products Science, Natural Products Research Institute, Seoul National University, Seoul, Korea. [email protected] Asia, Korea, China, and Japan have legally adopted the traditional Oriental (Chinese) medical system along with the Western system. A number of traditional herbal drugs including the polypharmacy type of prescriptions (a combination of multiple herbs) are available and are widely dispensed. Herbal therapy used in traditional Oriental medicine appears to be quite different from its counterpart Western drug therapy. The polypharmacy type of herbal therapy generally exhibits holistic effectiveness by exerting activities to multitarget organs (organ systems) according to the principles of traditional Oriental medicine. The Traditional Oriental Medicine Database (TradiMed 2000 DB) is a unique database of traditional Oriental herbal therapy containing a variety of information such as formulae, chemical information on ingredients, botanical information on herbal materials, and a dictionary of disease classification (TOM and Western classification). A formula, namely, the Sip-Jeon-Dae-Bo-Tang consisting of 10 different herbs, was selected by retrieving information from the TradiMed 2000 DB. Then its tonic effects for elderly people were shown as an example. PMID: 11795519 [PubMed - indexed for MEDLINE] 1404: Isr Med Assoc J. 2001 Dec;3(12):947-51. Related Articles, Links

The use of medical quality indices as a performance-enhancement tool for community clinics. Elhayany A. Clalit Health Services, Rishon Lezion, Israel. [email protected] One of the most important issues for a country, its population and doctors is the effective use of its health system. The extensive variation in doctors' performance leads to a tremendous waste of resources. To combat this, and at the same time ensure that medical quality plays a role when making decisions on interventions, it is essential to equip doctors and clinic directors with information on the quality of the medical care they are providing. In order to assist clinic directors in maintaining medical quality, Clalit Health Services has developed comparative medical indices enabling doctors to compare their performance to that of their colleagues, as well as to the standard and their performance over time. The development of an index to evaluate the quality of medical treatment offered in clinics provides doctors and the health system with an essential tool to lessen the existing variation among doctors and to enhance and evaluate performance.

Publication Types: •

Review

PMID: 11794921 [PubMed - indexed for MEDLINE] 1405: Jpn J Cancer Res. 2002 Jan;93(1):6-14. Related Articles, Links

Smoking and risk of premature death among middle-aged Japanese: ten-year follow-up of the Japan Public Health Center-based prospective study on cancer and cardiovascular diseases (JPHC Study) cohort I. Hara M, Sobue T, Sasaki S, Tsugane S. Epidemiology and Biostatistics Division, National Cancer Center Research Institute East, Kashiwa, Chiba 277-8577, Japan. [email protected] To update the evidence on the association between smoking and mortality, we analyzed data from a population-based prospective study in Japan. In total, 19950 men and 21534 women aged 40 - 59 who reported their smoking history and had no serious disease at baseline survey were followed. During 1990 - 1999, 1014 men and 500 women died. Smokers were associated with an unhealthy lifestyle. Relative risks (RRs) for selected cause of death due to smoking were slightly attenuated by adjusting for possible confounding factors. Age- and area-adjusted RRs of male current smokers compared with never smokers were 1.66 (95% confidence intervals (CI): 1.40, 1.95) for all causes, 1.69 (1.31, 2.18) for all cancers, 1.67 (1.20, 2.34) for all circulatory system disease, and 1.63 (1.24, 2.15) for other causes, while those of females were 2.03 (1.52, 2.73), 2.06 (1.35, 3.15), 2.99 (1.75, 5.11), 1.31 (0.69, 2.51), respectively. After adjusting for multivariate variables, the corresponding RRs of male smokers were 1.55 (1.29, 1.86), 1.61 (1.20, 2.15), 1.41 (0.97, 2.03), and 1.61 (1.17, 2.19), against 1.89 (1.36, 2.62), 1.83 (1.14, 2.95), 2.72 (1.45, 5.07), and 1.39 (0.71, 2.73) for females. Twenty-two percent of death from all causes, 25% of all cancer, and 17% of all circulatory system disease deaths, could be attributed to cigarette smoking in males, and 5%, 4%, and 11% in females, respectively. Cumulative dose as indicated by packyears was clearly associated with cancer death. These findings provided information as to the quantitative risk for premature death due to smoking among middle-aged Japanese men and women, and showed that the elevated risk was not explained by the unhealthy lifestyle of smokers. Publication Types:

• •

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

PMID: 11802802 [PubMed - indexed for MEDLINE] 1406: East Mediterr Health J. 2000 Jul;6(4):822-5. Related Articles, Links

Primary health care networks in the Islamic Republic of Iran. Shadpour K. Ministry of Health and Medical Education, Teheran, Islamic Republic of Iran. The progress towards achieving health for all in the Islamic Republic of Iran is reported in this paper with particular reference to primary health care networks. The establishment of the networks is outlined and the vital elements within the system described, such as the community health workers (behvarz) and the health information system. Areas of achievement are reviewed. PMID: 11794090 [PubMed - indexed for MEDLINE] 1407: J UOEH. 2001 Dec 1;23(4):389-401. Related Articles, Links

[Survey on opinions among employers regarding special health examinations in small-scale enterprises] [Article in Japanese] Tsutsui T, Horie S, Kaji H. Department of Health Policy and Management, Institute of Industrial Ecological Science, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan. In order to clarify the employers' opinions regarding special health examinations and follow-up measures, we conducted a survey targeting small-scale enterprises that had less than fifty employees and no obligation to assign an occupational physician. We received 354 answers, a response rate of 49.5%. More than 60% of the employers felt that the special health examination was useful for preventing occupational diseases and for the health promotion of employees, and 83.9% of employers felt that the special health examinations were effective. On the other hand, about 30% of the employers felt that it was difficult to allocate a time and

pay financial costs for special health examinations. The limited number of employees and financial restriction might prohibit them from carrying out and performing appropriate follow-up measures after the special health examination. Only 21.2% of enterprises had an occupational physician, 44.7% of employers had no information regarding the local occupational health service center, 51.4% of employers did not request an opinion related to employee's health problems after health examination. We concluded that it is important to build a social system to give employers information on where and how they may find sufficient medical resources for the effective application of the special health examination in small-scale enterprises. Publication Types: •

English Abstract

PMID: 11789141 [PubMed - indexed for MEDLINE] 1408: Journal (Inst Health Rec Inf Manag). 2001 Mar;42(1):22-4. Related Articles, Links

Oman towards electronic medical records. Mogli GD. Ministry of Health, Sultanate of Oman. PMID: 11778289 [PubMed - indexed for MEDLINE] 1409: Health Commun. 2001;13(4):387-408. Related Articles, Links

Media, audience, and policy perspectives in health broadcasting. Sharada PV, Venkataramana C, Nirupama KR. Reproductive and Child Health Project, Commissionerate of Family Welfare, Government of Andhra Pradesh, Hyderabad, India. Effective coordination between service delivery systems and communication networks is essential for the success of development programs. This becomes particularly crucial when the number of agencies involved is large and they are not working under 1 authority. Information needs of the community are another major concern. This article attempts to assess the extent of convergence between electronic media, government policy, and the targeted audience on the coverage

of health topics. The Indian state of Andhra Pradesh was chosen as the field. The study adopts a mix of both quantitative and qualitative techniques. The findings reveal limited convergence, indicating the need for more effective reflection of the policy guidelines into media programs. PMID: 11771803 [PubMed - indexed for MEDLINE] 1410: MMWR CDC Surveill Summ. 2001 Dec 7;50(5):1-20. Related Articles, Links

Malaria surveillance--United States, 1998. Holtz TH, Kachur SP, MacArthur JR, Roberts JM, Barber AM, Steketee RW, Parise ME. Division of Parasitic Diseases, National Center for Infectious Diseases, USA. PROBLEM/CONDITION: Human malaria is caused by one or more of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). The protozoa 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 endemic transmission. Cases occasionally occur that are acquired 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. REPORTING PERIOD: Cases with an onset of symptoms during 1998. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and state health departments by health-care providers and laboratory staff members. Case investigations are conducted by local and state health departments, and reports are sent to CDC through the National Malaria Surveillance System (NMSS). This report uses NMSS data. RESULTS: CDC received reports of 1,227 cases of malaria with onsets of symptoms in 1998, among persons in the United States and its territories. This number represents a decrease of 20.5% from the 1,544 cases reported during 1997. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 42.8%, 37.8%, 3.5%, and 2.1% of cases, respectively. More than one species was present in seven patients (0.6% of total). The infecting species was not determined in 162 (13.2%) cases. Compared with reported cases in 1997, reported malaria cases acquired in Africa increased by 1.3% (n = 706); those acquired in Asia decreased by 52.1% (n = 239); and those acquired in the Americas decreased by 6.5% (n = 229). Of 636 U.S. civilians who acquired malaria abroad, 126 (19.8%) reportedly had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Five persons became infected in the United States. One case was congenitally acquired; one was acquired by blood transfusion; and three were

isolated cases that could not be epidemiologically linked to another case. Four deaths were attributed to malaria. INTERPRETATION: The 20.5% decrease in malaria cases during 1998 compared with 1997 resulted primarily from decreases in P. vivax cases acquired in Asia among non-U.S. civilians. This decrease could have resulted from local changes in disease transmission, decreased immigration from the region, decreased travel to the region, incomplete reporting from state and local health departments, or increased use of effective antimalarial chemoprophylaxis. In a majority of reported cases, U.S. civilians who acquired infection abroad had not taken an appropriate chemoprophylaxis regimen for the country where they acquired malaria. PUBLIC HEALTH ACTIONS TAKEN: Additional information was obtained from state and local health departments and clinics concerning the four fatal cases and the five infections acquired in the United States. Persons traveling to a malarious area should take a recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and subsequently develops fever or influenza-like symptoms should seek medical care immediately; the investigation should include a blood smear for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Current recommendations concerning prevention and treatment of malaria can be obtained from CDC. Publication Types: •

Case Reports

PMID: 11770906 [PubMed - indexed for MEDLINE] 1411: Indian J Pediatr. 2001 Nov;68(11):1047-50. Related Articles, Links

National Family Health Survey and children. Dwivedi SN, Sundaram KR. Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. [email protected] This article aims to describe the National Family Health Survey (NFHS) being carried out in India with its first round during 1992-93 (NFHS-I) and second round during 1998-99 (NFHS-II), with special reference to information available in relation to children. The survey was on lines of the existing systems of Demographic Surveys (DHS) in various developed as well as developing countries. Another important objective of the survey was to provide quality data to the researchers to carry out analytical work on various aspects. Further, the survey has paved the way to carry out comparative studies not only between states in India but also between countries. An attempt has also been made here to

present salient features of comparative results under NFHS-I and NFHS-II. PMID: 11770240 [PubMed - indexed for MEDLINE] 1412: Kekkaku. 2001 Nov;76(11):707-13. Related Articles, Links

[Medical treatment support to tuberculous patients--from the standpoint of community support] [Article in Japanese] [No authors listed] A symposium with "Medical Treatment Support to Tuberculous Patients--From the standpoint of community support" as its theme was held at the 76th Annual Meeting of the Japanese Society for Tuberculosis (April 20, 2001). "Once, It is infected with tuberculosis, one have to complete medication with a sensitive antituberculosis drug by observing the prescribed dose and duration for successful treatment". For this to be promoted community, it is necessary that (1) to manage patient's medication by medical facilities, (2) to support patient's medication by health center and (3) to support patient's living by welfare offices. Not that each facilities takes such responsibilities alone, but various community must fulfill them continuously in liaison with one another. On what measures should be taken to that end, reports based on practical examples from Nagoya City, Yokohama City and Kanagawa Prefecture have been compiled as follows. 1. It was in-office liaison by conference that supported the DOTS activities of health nurses. 2. It is cooperating, without health, medical treatment, and welfare going out, as follows. (1) A system for hospitals and clinics to carry out DOTS treatment consistently has been kept in good condition. (2) For a patient to take a drug in front of a nurse has become common, causing the patients to be motivated. (3) Assignment of MSW and nurses in charge of DOTS sent from hospitals has make it possible to offer or exchange information smoothly among those concerned. (4) A system for many persons concerned to support patients timely has been kept in good condition. This resulted in an increase in the cure rate of tuberculosis in the areas which have day laborers' lodgings. 3. By DOTS for in-patients, the number of self-discharges has decreased by 1/3, and the treatment completion rate was 94%. 4. In promotion of DOTS for the patients who have health problems other than tuberculosis, the role MSW plays is great. 5. As conditions for supporting DOTS promotion, it is necessary to create a system by which to stabilize the living of the patient himself, guarantee earnings to support it and dissolve the living problem faced by the patient. 6. Introduction of the "early guidance system for the patients in whom the treatment of tuberculosis" was discontinued has strengthened the liaison between health offices and medical facilities, has led to early detection in persons yet to receive medical treatment and resumption of medical treatment, making it possible to deal with problem cases effectively on a priority basis. It has

been confirmed that liaison between health, medical service and welfare for community support of the treatment of tuberculous patients who live in that community resulted in improvement of clinical results of tuberculous patients. In this connection, Dr. Shirai advised "For a tuberculous patient to form a habit of taking a drug wherever he lives needs to be recognized as a major subject". He presented the forcible yell. "Any local government office has the homeless. I want you to make efforts so that DOTS be given to all the tuberculous persons. If there is any problem, I am ready to give advice." Publication Types: •

English Abstract

PMID: 11766362 [PubMed - indexed for MEDLINE] 1413: Ind Health. 2001 Oct;39(4):341-5. Related Articles, Links

Relationships between chemical structures and mutagenicity: a preliminary survey for a database of mutagenicity test results of new work place chemicals. Sawatari K, Nakanishi Y, Matsushima T. National Institute of Industrial Health, Kawasaki, Japan. A database of mutagenicity test results of new chemicals has been developed. Based on the amendment of the Industrial Safety and Health Law (ISHL) in 1979, manufacturers and importers in Japan are required to register any new work place chemicals with bacterial mutagenicity test results. At present more than ten thousand substances have been examined. We have surveyed correlations between 44 substructures and mutagenicity in 2,857 ISHL data as well as in 1,207 National Toxicology Program data as a preliminary analysis. The percentages of the mutagenic compounds were calculated. High percentages were found for electrophilic reagents such as epoxides (63%), aromatic nitro compounds (49%) and primary alkyl monohalides (46%). 71% of peroxides was found to be mutagenic. The results suggest that several types of reactions such as nucleophilic substitution reaction, nitrenium cation reaction and radical reaction are included in the process of the mutagenic alterations of DNA. PMID: 11758998 [PubMed - indexed for MEDLINE] 1414: Midwifery. 2001 Dec;17(4):314-22. Related Articles, Links

Exploring factors influencing Chinese women's decision to have elective caesarean surgery. Lee LY, Holroyd E, Ng CY. The Open University of Hong Kong, 30 Good Shepherd Street, Ho Man Tin, Kowloon, Hong Kong. [email protected] OBJECTIVES: to identify the factors that influence Hong Kong Chinese women's decision to have an elective caesarean section. To explore Chinese women's perceptions of their autonomous involvement in childbirth decision-making. DESIGN: a qualitative exploratory design. SETTING: a postnatal ward of a private hospital in Hong Kong. PARTICIPANTS: a purposive sample of six postnatal women who had undergone an elective caesarean section. Findings: four thematic categories were identified including: avoiding fetal and maternal risks, exercising autonomy to make an independent choice, Chinese belief systems, and rejoicing and regretting. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we propose the provision of a 'named' midwife and continuity of care. Improving the availability of information on caesarean sections, accommodating a Chinese belief system in the planning of midwifery services at the international level and establishing post caesarean section peer support groups are recommended. Copyright 2001 Harcourt Publishers Ltd. PMID: 11749064 [PubMed - indexed for MEDLINE] 1415: Obes Res. 2001 Dec;9(12):741-5. Related Articles, Links Comment in: •

Obes Res. 2001 Dec;9(12):806-9.

Association of BMI with the beta3-adrenergic receptor gene polymorphism in Japanese: meta-analysis. Kurokawa N, Nakai K, Kameo S, Liu ZM, Satoh H. Department of Environmental Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan. [email protected] OBJECTIVE: To assess the effect of the Trp64Arg polymorphism in the beta3adrenergic receptor gene (ADRB3) on body mass index (BMI) in the Japanese

population. RESEARCH METHODS AND PROCEDURES: We selected studies that evaluated the association between BMI and ADRB3 polymorphism among Japanese, using MEDLINE and PubMed. After data collection, an extension of ANOVA was performed to assess the differences according to the genotype. RESULTS: In a total of 35 subgroups including 2316 subjects with the Trp64Arg variant and 4266 subjects without this variant, the weighted mean difference in BMI was 0.26 kg/m(2) (95% confidence interval: 0.18 to 0.42; p < 0.01), indicating that variant carriers exhibited higher BMI than did normal homozygous subjects. DISCUSSION: Although it is known that the allele frequency of the ADRB3 polymorphism differs among races, this study focuses on the Japanese population, which has a high allele frequency of ADRB3 polymorphism. We assumed that statistical errors would be prevented due to the sufficient number of subjects. In conclusion, the results support the hypothesis that ADRB3 gene polymorphism is associated with BMI. Publication Types: • •

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

PMID: 11743057 [PubMed - indexed for MEDLINE] 1416: Health Policy Plan. 2001 Dec;16(4):412-20. Related Articles, Links

Determining the full costs of medical education in Thai Binh, Vietnam: a generalizable model. Bicknell WJ, Beggs AC, Tham PV. Department of International Health, Boston University School of Public Health, Boston, MA 02118, USA. We summarize a model for determining the full cost of educating a medical student at Thai Binh Medical School in Vietnam. This is the first full-cost analysis of medical education in a low-income country in over 20 years. We emphasize policy implications and the importance of looking at the educational costs and service roles of the major health professions. In Vietnam fully subsidized medical education has given way to a system combining student-paid tuition and fees with decreased government subsidies. Full cost information facilitates resource management, setting tuition charges at a school and adjusting budget allocations between medical schools, teaching hospitals, and health centres. When linked to quality indicators, trends within and useful comparisons between schools are possible. Cost comparisons between different types of providers can assist policy-

makers in judging the appropriateness of expenditures per graduate for nursing and allied health education versus physician education. If privatization of medical education is considered, cost analysis allows policy-makers to know the full costs of educating physicians including the subsidies required in clinical settings. Our approach is intuitively simple and provides useful, understandable new information to managers and policy-makers. The full cost per medical graduate in 1997 was 111 462 989 Vietnamese Dong (US$9527). The relative expenditure per Vietnamese physician educated was 2.8 times the expenditure in the United States when adjusted for GNP per capita. Preliminary findings suggest that, within Vietnam, the cost to educate a physician is 14 times the cost of educating a nurse. Given the direct costs of physician education, the lifetime earnings of physicians and the costs that physicians generate for the use of health services and supplies, it is remarkable that so little attention is paid to the costs of educating physicians. Studies of this type can provide the quantitative basis for vital human resource and health services policy considerations. Publication Types: • •

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

PMID: 11739366 [PubMed - indexed for MEDLINE] 1417: J Adv Nurs. 2001 Dec;36(5):676-84. Related Articles, Links

The effects of postpartum stress and social support on postpartum women's health status. Hung CH, Chung HH. College of Nursing, Kaohsiung Medical University, Taiwan. [email protected] BACKGROUND: Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period. AIM: The purpose of this study was to determine postpartum women's health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic. METHOD: A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty-six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health

Questionnaire were used to obtain information about the women's postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA, and multiple logistic regression. RESULTS: Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity. CONCLUSIONS: Because the postpartum women's self-reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury's conclusion regarding the significance of social support during the Chinese women's postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women's health status. Future studies should compare the level of postpartum stress, social support, and women's health status in both Western and Eastern cultures. Publication Types: •

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

PMID: 11737500 [PubMed - indexed for MEDLINE] 1418: Med J Malaysia. 2001 Sep;56(3):350-8. Related Articles, Links

Quality of life--how do Malaysian asthmatics fare? Sararaks S, Rugayah B, Azman AB, Karuthan C, Low LL. Health Systems Research Division, Institute of Public Health, 50590 Kuala Lumpur. Asthma can place considerable restrictions on the physical, emotional and social aspects of the lives of patients. The assessment of quality of life aims to provide a means of measuring the impact of this disease on patients' lives, from the patients' perspective. A cross sectional multi-centre study was conducted in six government hospitals throughout the country. Self-administered SF-36 was used, and clinical information obtained through interviews and examination. 1612 asthmatics responded. Females constituted 63% of the respondents; mean age was 40.9 years; Malays were the majority ethnic group, while 70.8% had secondary level education and 53.7% were employed. Half had suffered from asthma for at least 13 years, while 46.8% and 23.6% have moderate and severe disease

respectively. Quality of life was affected by severity of disease. Asthmatics, had a significantly poorer quality of life than the general US population. Severe asthma disease was associated with a compromised quality of life, similar to that of COPD. Publication Types: •

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

PMID: 11732082 [PubMed - indexed for MEDLINE] 1419: IHRIM. 2000 Jan;41(1):19. Related Articles, Links

Health Management Strengthening Project. West Bank and the Gaza strip. Nicholson L. PMID: 11727420 [PubMed - indexed for MEDLINE] 1420: Ann Acad Med Singapore. 2001 Jul;30(4 Suppl):13-6. Related Articles, Links

Funding and future diagnosis related group development. Vertrees JC. PURPOSE: Diagnosis Related Groups (DRGs) are widely used for a variety of purposes including quality improvement, hospital output measurement and funding. DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its casemix) to the costs incurred by the hospital. This is done by classifying patients into mutually exclusive groups based on the patient's principal diagnosis and other information. The original Health Care Financing Administration DRGs (HCFA DRGs) have been in use since 1982. This document provides an overview of future directions for the newer DRG systems and it provides a framework for understanding the use of DRGs for funding. FUTURE DIRECTIONS: Newer DRG systems incorporate explicit adjustment for severity of illness, include separate measures for the likelihood of mortality, and are more independent of the underlying coding systems (e.g., ICD-10 for diagnoses, ICD-9-CM for procedures). THE FRAMEWORK: The framework for a casemix-based budgeting system consists of five basic aspects. They are: 1) Categories--which kind of DRG will be the basis for the casemix system; 2) Relative Weights--relative weights reflect the

expected cost of a case in one DRG relative to the expected cost of the average patient; 3) Base Rates/Pricing--the base rate converts the relative values to prices or budgets; 4) Adjustments--adjustments account for exogenous factors; 5) Transition Policy--this provides time so hospital administrators can learn to respond to the incentives contained in the DRG system. PMID: 11721272 [PubMed - indexed for MEDLINE] 1421: J Med Internet Res. 2001 Jan-Mar;3(1):E12. Related Articles, Links

Internet medical usage in Japan: current situation and issues. Tatsumi H, Mitani H, Haruki Y, Ogushi Y. Department of Anatomy, Sapporo Medical University, Sapporo, 060-8556, Japan. [email protected] Internet use by physicians and patients has become very popular in Japan. Fifty percent of physicians use the Internet to search for medical and other information. Over the past year, 22% of patients used the Internet to obtain medical information. Because there are no restrictions within Japan on using Web sites to advertise medical treatment, information can be freely sent out, and over the past two or three years this practice has increased dramatically. Internet medical information provides information about illnesses and medications, and it helps improve the quality of life of patients and families. Yet, depending on the content of the information provided and the way this information is used, there is a potential negative side as well. On principle, users are responsible for the way information is used, but there is a need for information providers to consider users safety and to make the information effective for use. Because there is no absolute standard for evaluating the value of medical information, it is necessary to establish a system that opens a dialogue with society and that continuously accumulates high-quality information through the collection of various evaluations, rather than rely on an established authority. For industries and organizations related to commercial pursuits, in particular, it is most effective to establish their own codes for ethical conduct, rather than rely on governmental regulations. At the same time, it is important to have a confirmation function to evaluate how goals set by the outside are being implemented. Aiming at establishing a framework for the Internet medical usage, the Japan Internet Medical Association (JIMA) was founded in 1998 by medical professionals, lawyers, researchers, consumer representatives, patients and their families. We propose a system that would combine feedback from users, who would take on the role of evaluators of the implementation of an ethical code, with a displayed mark that verifies the identity of the Web site. Objective evaluation of information is needed to ensure that users have the power to make choices.

Medical experts or patient and family groups would assist in this task. The development of medical care will be promoted through patients and physicians working together in the accumulation of shared resources for good medical care information. Publication Types: •

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

PMID: 11720954 [PubMed - indexed for MEDLINE] PMCID: PMC1761890

1422: J Interprof Care. 2001 Aug;15(3):215-21. Related Articles, Links

Changing systems in health and social care for older people in Japan: observations and implications for interprofessional working. Tompsett H. Faculty of Health and Social Care Sciences, St George's Hospital Medical School/Kingston University, Kenry House, Kingston Hill, KT2 7LB, UK. [email protected] The impact of a rapidly ageing population on the development of insurance policies and health and social care services of older people is a major concern in Japan. The discussion in this paper draws on information gained from recent visits to leaders of these services in Japan. The paper briefly reviews the policy and demographic background to recent legislative changes in the long-term care insurance system, models of care management and assessment and outstanding challenges for health and social care professionals. Some key issues have emerged with implications for interprofessional working, such as the lack of integrated care systems, contradictions within the scope and responsibilities of care management, and the absence of quality and ethical frameworks to safeguard the interests of the service user and carer. Publication Types: • •

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

PMID: 11705230 [PubMed - indexed for MEDLINE]

1423: J Med Invest. 2001 Aug;48(3-4):198-209. Related Articles, Links

The development of a pollen information system for the improvement of QOL. Moriguchi H, Matsumoto M, Nishimoto Y, Kuwada K. Division of Medical Informatics, University Hospital, University of Tokushima School of Medicine, Kuramoto-cho, Tokushima 770-8503, Japan. The Kochi Prefecture Japanese Cedar and Cypress Pollen Information System (PNet Kochi) was established in 1991 on the initiative of the Pharmaceuticals and Sanitation Division to improve the quality of life of people in Kochi Prefecture, particularly patients with pollinosis. Kochi Prefecture has the highest forests percentage (84%) in Japan. In addition, 40% of the population of the prefecture is concentrated in Kochi City. The average pollen count at 10 observation points an one year was about 20,000/cm2 during the observation period, but it exceeded 110,000/cm2 in 1995, when it was also high nationwide. Kochi Prefecture organized a system to promote people's understanding of pollinosis in connection with environmental problems, and to enlighten people on appropriate preventive measures. The system has been improved in the rapid and efficient transmission of information over the years with technological advances. The introduction of an automatic monitoring system not dependent on human labor and the support of the users proved to be indispensable for the maintenance of the system. PMID: 11694960 [PubMed - indexed for MEDLINE] 1424: Trop Med Int Health. 2001 Oct;6(10):799-810. Related Articles, Links

Evaluation of a comprehensive home-based midwifery programme in South Kalimantan, Indonesia. Ronsmans C, Endang A, Gunawan S, Zazri A, McDermott J, Koblinsky M, Marshall T. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. [email protected] We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an

information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through inservice training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life-saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care. Publication Types: • • •

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

PMID: 11679128 [PubMed - indexed for MEDLINE] 1425: Am J Hum Genet. 1999 Feb;64(2):335-8. Related Articles, Links

Eugenics and the misuse of genetic information to restrict reproductive freedom: ASHG statement. American Society of Human Genetics. Board of Directors. Publication Types: •

Guideline

PMID: 11645144 [PubMed - indexed for MEDLINE] PMCID: PMC1377741

1426: Dentomaxillofac Radiol. 2001 Nov;30(6):336-41.

Related Articles,

Links

Management of oral and maxillofacial radiology clinics in Taiwan's dental schools. Chen SK, Chien HH, Lin L. School of Dentistry, College of Medicine, National Taiwan University, Taipei, Chinese Taipei. [email protected] OBJECTIVES: To investigate management of Taiwanese dental school Oral and Maxillofacial Radiology (OMFR) clinics and to suggest alternative management strategies. METHODS:A management questionnaire was designed for the faculty responsible for teaching the Oral and Maxillofacial Radiology curriculum. RESULTS: Data from all seven Taiwanese schools indicated inadequate supervision of the prescription of radiological examinations in the absence of guidelines. Most schools are understaffed and not properly equipped. There is a significant shortage of trained dentists in the field of OMFR. In some schools no dentist is involved in the management of OMFR clinics. Some aspects of quality assurance procedures should be enhanced. An average of 21.4% of films were reported lost, with the highest rate at 40%, demonstrating serious problems in image archiving. Clinician satisfaction with clinic management averaged 74.3%, with a minimum of 50%. CONCLUSION: A set of standards is recommended by the Taiwanese OMFR Association after reviewing the survey findings. Prescription for OMFR examination should be supervised by licensed clinicians, and there is a need for guidelines. Trained and dedicated personnel should be assigned for the management of OMFR clinics. More quality assurance procedures should be performed. A computer-based image archiving system is desirable. PMID: 11641733 [PubMed - indexed for MEDLINE] 1427: Stud Health Technol Inform. 2001;84(Pt 1):849-53. Related Articles, Links

EMR-based TeleGeriatric system. Pallawala PM, Lun KC. School of Computing, National University of Singapore, Singapore, 119260, Singapore. [email protected] INTRODUCTION: As medical services improve due to new technologies and breakthroughs, it has lead to an increasingly aging population. There has been much discussion and debate on how to solve various aspects such as

psychological, socio-economic and medical problems related to aging. Our effort is to implement a feasible telegeriatric medical service with the use of the state of the art technology to deliver medical services efficiently to remote sites where elderly homes are based. The TeleGeriatric system will lead to rapid decisionmaking in the presence of acute or subacute emergencies. This triage will also lead to a reduction of unnecessary admission. It will enable the doctors who visit these elderly homes once a week basis to improve their geriatric management skills by communication with geriatric specialist. Nursing skills in the geriatric care will also benefit from this system. Integrated electronic medical record (EMR) system will be indispensable in the face of emergency admissions to hospitals. Evolution of EMR database would lead to future research in telegeriatrics and will help to identify the areas where telegeriatrics can be optimally used. METHODOLOGY: This system is based on current web browsing technology and broadband communication. The TeleGeriatric web based server is developed using Java Technology. The TeleGeriatric database server was developed using Microsoft SQL server. Both are based at the Medical Informatics Programme, National University of Singapore. Two elderly homes situated in the periphery of Singapore and a leading government hospital in geriatric care have been chosen for the project. These 3 institutions and National University of Singapore are connected via ADSL protocol. ADSL connection supports high bandwidth, which is necessary for high quality videoconferencing. Each time a patient needs a teleconsultation a nurse or a doctor in the remote site sends the patient's record to the TeleGeriatric server. The TeleGeriatric server forwards the request to the Alexandra Hospital for consultation. Geriatrics specialists at the Alexandra Hospital carry out teleward rounds twice weekly and on demand basis. SUMMARY OF RESULTS: Following the implementation of the system, a trial run has been done. Total results have demonstrated a high degree of coordination and cooperation between remote site and the Alexandra Hospital. Also the patient compliance is very high and they prefer teleconsultation. CONCLUSION: Initial results show that the TeleGeriatric system has definite advantages in managing geriatric patients at a remote site. As the system evolves, further research will show the areas where telegeriatrics can be used optimally. Publication Types: •

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

PMID: 11604856 [PubMed - indexed for MEDLINE] 1428: Stud Health Technol Inform. 2001;84(Pt 1):724-6. Related Articles, Links

Community health information and its management system: a new form for the next century.

Din BF, Wu LP, Zhang Y. Department of Information, Nanjing Chest Hospital, Nanjing Jiangsu, 210029, China. [email protected] The development of community health service brings a new branch of Medical Informatics, Community health care informatics and a new management system, Community Health Care Information System in the beginning of nest century. The paper first advance and explore this new concept. It states the focus of Community health care informatics as the promotion of health for the whole community. It not only gives treatment to individual patients through ways of disease management and information network, but also improves health condition of the whole community by "diagnosis of community health" and "prescription for community health". The paper also introduces the community health information system and its formation, technology, function and practical use, pointing out the crucial point of its research work to be precisely discovering the "information origin" and "three-in-one" working group. PMID: 11604831 [PubMed - indexed for MEDLINE] 1429: Comput Biol Med. 2001 Nov;31(6):513-23. Related Articles, Links

A model approach to sharing electronic medical records between and within the state hospitals in Turkey. Güler I, Müldür S. Electronics & Computer Education Department, Faculty of Technical Education, Gazi University, 06500 Teknikokullar, Ankara, Turkey. [email protected] It has always been a research interest to solve hospital management problems with systematic approach by using modern management tools. Almost all the Hospital Information System (HIS) software packages in Turkey keep track of local transactions in administrative activities and material flow. In state hospitals in Turkey, very little medical information is processed and most of the records are still kept manually and archived on papers.In this paper, a cost-effective, flexible and easy-to-use Hospital Information System model is proposed in order to give better diagnostic and treatment services. It is also demonstrated that this model makes it possible to exchange information between and within the hospitals over Transmission Control Protocol/Internet Protocol (TCP/IP) network. User needs are taken into consideration during model development and the benefits of model implementation to the hospital administration are stated. According to the model proposed in this paper, only a single health care record number (HCRN) is

required for a patient to access all her/his medical records stored in different locations, from any state hospital in Turkey. PMID: 11604155 [PubMed - indexed for MEDLINE] 1430: Patient Educ Couns. 2001 Oct;45(1):59-68. Related Articles, Links

Client communication behaviors with health care providers in Indonesia. Kim YM, Kols A, Bonnin C, Richardson P, Roter D. Center for Communication Programs, Johns Hopkins University, Suite 310, 111 Market Place, Baltimore, MD 21202-4024, USA. [email protected] Patient participation in health care consultations can improve the quality of decision making and increase patients' commitment to the treatment plan. This study examines client participation, operationally defined as client active communication, during family planning consultations in Indonesia. Data were collected on 1203 consultations in the provinces of East Java and Lampung. Sessions were audiotaped and the conversation coded using an adaptation of the roter interaction analysis system (RIAS). Culturally acceptable ways for Indonesian clients to participate in consultations include asking questions, requesting clarification, stating opinions, and expressing concerns. Factors significantly associated with client active communication were, in order of importance, providers' information giving, providers' facilitative communication, providers' expressions of negative emotion, client educational level, and province. The latter suggests the influence of culture on client participation. The results suggest that a combination of provider training and client education on key communication skills could increase client participation in health care consultations. Publication Types: • •

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

PMID: 11602369 [PubMed - indexed for MEDLINE] 1431: Biomed Environ Sci. 2001 Jun;14(1-2):98-103. Related Articles, Links

Fortification challenges and needs.

Florentino RF. Philippine Association of Nutrition. Experience in many parts of the developing world has shown that food fortification offers a cost-effective and sustainable solution to the problem of micronutrient malnutrition. Building on the advances in science and technology and backed by studies on the economic benefits of fortification programs, governments and industry are beginning to respond positively to the call of nutrition advocates to adopt fortification as a long-term strategy. On the other hand, formidable challenges still remain in many countries in Asia, constraining the widespread adoption of this strategy. The science and technology community needs to provide adequate scientific and technological information as basis for planning and decision making. The government faces the challenge of providing the enabling environment for all stakeholders to cooperate in the fortification effort. Industry faces the challenge of adapting its production system to the requirements of fortification in order that they can contribute to social objectives while pursuing their economic objectives. The international and bilateral aid agencies need to seek tried and innovative ways to support the multiple players of food fortification, as these players in turn face the challenges that confront them. PMID: 11594487 [PubMed - indexed for MEDLINE] 1432: Biomed Environ Sci. 2001 Jun;14(1-2):66-74. Related Articles, Links

Perspectives on nutrition needs for the new millennium for South Asian regions. Krishnaswamy K. National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, AP, India. South Asia is the most populated region of the world with several nutritional challenges. Though per capita food energy supply, child survival and life expectancy have improved, and even today large segments of the population are below the poverty line with high infant and maternal mortality rates. It is important to recognize the crucial role of nutrition throughout the life cycle-from conception to old age. It is very necessary now to move from food security to nutrition security and improve the quality of foods both in macro- and micronutrients in order to break the transgenerational effects of malnutrition. The key solutions to the problems should address the issue of social development, population stabilization, environmental degradation and inadequate health and nutritional services. Strategies for empowering women and actuating community

participation as sustainable programmes for human development, measures to reduce underweight and stunting in children and prevention of micronutrient malnutrition across the population are required. Enhancing food and nutrition security through innovative diversified agriculture and dietary practices, prevention and control of infection, promotion of food safety and fortification of staples with appropriate attention on emerging chronic disorders are essential. Population control measures to stabilize the fertility rates, biotechnological approaches for genetically modified foods, nutrition surveillance based on assessment, analysis and action to address the logistic, technical and compliance issues with emphasis on promotion of breast feeding and complementary foods with adequate attention on the reproductive needs of adolescent girls, pregnant mothers and lactating women would eliminate low birth weight, stunting, and chronic energy deficiency in vulnerable groups. Focused studies on bioavailability of micronutrients and its enhancement, innovative horticulture interventions, fortifications, social marketing strategies would promote the intake of micronutrient and phytonutrient rich foods. In-depth epidemiological research, an insight into foetal origins of adult disease and nutrition-genes interaction and life style alterations will avert the emerging epidemic of chronic diet related disorders. An investment in preventing foetal malnutrition improves nutrition of women in reproductive age, infant and child nutrition and prevents the onset of chronic disease in adult life. Human resource development, IEC measures, technology transfer, operational and logistic research, building of databases, integrated, intersectoral, multidisciplinary plans and sound management information system and surveillance with net working and experience sharing in the region will help to overcome the common challenges and lay the foundation for a better scenario in these regions in the near future. PMID: 11594482 [PubMed - indexed for MEDLINE] 1433: Psychiatr Clin North Am. 2001 Sep;24(3):421-31. Related Articles, Links

From diversity to unity. The classification of mental disorders in 21st-century China. Lee S. Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong, China. Psychiatric disease constructs represent social constructs and genuine states of distress that have biopsychosocial sources. As such, they have social uses peculiar to the social groups in which they are created and legitimized. This is as true in the United States as in the rest of the world. The DSM schema, for instance, is so organized that every possible mental condition is listed as a disease to legitimate remuneration to practitioners from private medical insurance and government

programs. This particular social use may be irrelevant to other societies where health care is financed differently. The CCMD-3 system represents an attempt at global unification and preservation of features that are salient for local application. Compared with its previous editions, noticeable changes have been made to render it in tune with international usage. This remarkable speed of adaptation speaks to the global flows of information technology and China's openness under rapid economic reform. It also demonstrates that the middle-aged cohort of more pragmatic Chinese psychiatric leaders who headed the CCMD-3 task force are now less vulnerable to the domination of the most senior generation of Chinese psychiatrists. Having been trained in the Russian system of psychiatry and gone through the various periods of national shame that traumatized China, they used to be very cautious about adopting foreign technology in general. This is why much less harmonization with the ICD-10 occurred with the CCMD-2-R, when the responsible task force was, for better or worse, dominated by these senior psychiatrists. Nonetheless, as Stengel and Sartorius remarked, an international classification must not aim to oust or replace regional classifications that serve valuable functions in the local contexts. No single classificatory system, Kirmayer submits, will suffice for all purposes--the correct diagnostic scheme is the one that accomplishes its explicit pragmatic aim by addressing the relevant level of description. The particular additions (e.g., travelling psychosis, culturerelated mental disorders), deletions (e.g., depressive neurosis, pathologic gambling, avoidant and borderline personality disorders), retentions (e.g., unipolar mania, neurosis, hysteria, homosexuality), and epistemologic variations (e.g., somatoform disorder, neurasthenia) of diagnostic categories reflect exactly this simultaneous need to globalize and to take account of the changing reality of illness in contemporary China. Stengel advised that "no psychiatric classification can help being partly etiological and partly symptomatological, because these are the criteria by which psychiatrists distinguish mental disorders from each other." To an extent, the CCMD-3 is a critique of certain nosologic assumptions of Western psychiatry, such as the feasibility of a neo-Kraepelinian taxonomy grounded exclusively in symptomatology across all diagnostic categories, and the validity of syndromic architectures based on a firm adherence to the mind-body dichotomy. From this angle of vision, local systems of classification such as the CCMD-3 may offer an opportunity for needed reflections by North American psychiatrists who have simply taken the DSM-IV schema for granted. Sartorius reckoned that a classification is a way of seeing the world at a point in time. A deep study of the CCMD-3 is thus an avenue for achieving an understanding of the contemporary Chinese mind and the social realities in China. The remarkable diversity of China at present, namely, a Communist Party dominated state socialist political structure but the most rapidly growing capitalist economy in the world, guarantees that Chinese people's social and moral experience of illness will continue to change. The study of such culture-specific categories as travelling psychosis, neurasthenia, qigong-induced mental disorder, and dysfunctional homosexuality sheds light on the larger sociomoral processes and destabilizing changes in subjectivity that are occurring in this most populous country in the world.

Publication Types: •

Comparative Study

PMID: 11593854 [PubMed - indexed for MEDLINE] 1434: Saudi Med J. 2001 Sep;22(9):743-8. Related Articles, Links

Global directions for reforming health systems and expanding insurance. What is suitable for the Arab Gulf countries? Banoob SN. College of Public Health, University of South Florida, Tampa, Florida 336123805, United States of America. Most countries are exploring and implementing reforms of their health care systems. The Arab countries in the Gulf are no exception after establishing modern governmental health care systems accessible to all and free of charge. Current problems of the Arab systems include financial, managerial and quality issues. The private sector in these countries has no defined national role and is gowing abruptly and unplanned. The paper presents the major global health reform directions, analyzing the current activities in the Arab Gulf countries and proposing certain practical relevant approaches for health reform, and expansion of insurance in these activites. Publication Types: •

Review

PMID: 11590445 [PubMed - indexed for MEDLINE] 1435: Science. 2001 Oct 5;294(5540):82-5. Related Articles, Links

So many choices, so little money. Pennisi E. Publication Types:

•

News

PMID: 11588245 [PubMed - indexed for MEDLINE] 1436: J Adv Nurs. 2001 Oct;36(2):270-3. Related Articles, Links

Chinese values, health and nursing. Chen YC. Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, Taiwan, Republic of China. [email protected] PURPOSE: To describe the roots of Chinese values, beliefs and the concept of health, and to illustrate how these ways have influenced the development of health care and nursing among Chinese in the Republic of China (ROC) and the People's Republic of China (PRC). Scope. Based on the literature and direct observation in the PRC and ROC, this is an introduction to Chinese philosophies, religion, basic beliefs, and values with a special meaning for health and nursing. Chinese philosophies and religion include Confucian principles, Taoism, theory of "Yin" and "Yang", and Buddhism. Beliefs and values include the way of education, practice of acupuncture, herbal treatments and diet therapy. How people value traditional Chinese medicine in combination with western science, and the future direction of nursing and nursing inquiry are also briefly addressed. CONCLUSION: Chinese philosophies and religions strongly influence the Chinese way of living and thinking about health and health care. Nurses must combine information about culture with clinical assessment of the patient to provide cultural sensitive care. A better way may be to combine both western and Chinese values into the Chinese health care system by negotiating between the traditional values while at the same time, respecting an individual's choice. The foundation of China's philosophical and aesthetic tradition, in combination with western science is important to the future advancement of nursing research that will be beneficial to the Republics, Asia, and the world. Publication Types: •

Review

PMID: 11580802 [PubMed - indexed for MEDLINE] 1437: Nippon Koshu Eisei Zasshi. 2001 Aug;48(8):613-9.

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[An attempt to estimate geographical accessibility to day service facilities among the elderly with a geographical information system] [Article in Japanese] Kitajima T, Kitazawa T, Ing CK, Noyama O. Department of Health Administraton School of Health Sciences, Kyorin University. OBJECTIVE: The objective of this study was to assess inequality in geographical accessibility to day service among the elderly in a municipality using a geographical information system (GIS). We also examined problems in measuring geographical accessibility and ways to validate results. METHODS: The target was Hachioji City. The following two data sets were constructed: a data set for day service facilities for all of Hachioji City and a data set for the people aged 65 and over, living within 1 km meshes in Hachioji City. These were integrated and displayed on a digital map with GIS software. Geographical accessibility was estimated by measuring the shortest road distance from the center point of each mesh to day service facilities. RESULTS: There were 47 day service facilities serving Hachioji City in October, 2000 and 139 meshes that had elderly residents. Their center points were all located within Hachioji City, which was estimated to have 73,760 elderly in 2000. The mean distance from the center point of each mesh to the nearest day service facility was 1.99 km (SD = 1.75, max = 9.21, min = 0.03). The proportions of the elderly who had 5 or more facilities within 3 km and 5 km from their residence were estimated to be 57.3% and 96.4%, respectively. CONCLUSIONS: The results of this study suggest that there is variation in geographical accessibility to day service facilities among the elderly living in a relatively large municipality. It is now necessary to examine whether the difference in geographical accessibility to day service affects the service utilization. Publication Types: • •

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

PMID: 11579485 [PubMed - indexed for MEDLINE] 1438: Ann Pharmacother. 2001 Sep;35(9):1122-9. Related Articles, Links

Infrastructure of pharmaceutical research and development in Japan. Ono S, Kodama Y, Nagao T. National Institute of Health Sciences, Ministry of Health and Welfare, Tokyo, Japan. [email protected] OBJECTIVE: To examine the roles of different types of hospitals in implementation of multicenter Phase II/III trials in Japan, specifically focusing on two dichotomies: public versus private, and academic versus nonacademic. Possible explanation was sought as to why a hospital of one category was more likely to participate in specific types of trials in the Japanese medical environment. METHODS: A database containing attributes of published clinical trials (n = 217) was established from four journals featuring reports of clinical trial results. The preferences of public and academic hospitals for specific types of trials were estimated by applying a linear regression model. The trial compositions of these institutions were also estimated, taking the actual prevalence of trials in 1995 into consideration. RESULTS: Public sector hospitals, which were established for particular policy purposes in the national healthcare system, were more likely to accept trials in some fields (e.g., cardiovascular diseases, anesthesiology, antineoplastics, pediatrics) and of some kinds (e.g., Phase II rather than Phase III trials, trials supervised by the principal investigator in the public sector). Academic hospitals also showed preferences for some types of trials (e.g., cardiovascular diseases, dermatology; Phase II rather than Phase III trials). The analysis focusing on public hospitals suggested that policy purposes were achieved at least in some fields such as antineoplastics and anesthesiology. CONCLUSIONS: Japanese clinical trials were unevenly distributed between public and private sectors, and also between academic and nonacademic sectors. These data provide fundamental information about the clinical research environment for future pharmaceutical research and development strategies and policies. Publication Types: •

Review

PMID: 11573865 [PubMed - indexed for MEDLINE] 1439: Int Dent J. 2001 Aug;51(4):313-24. Related Articles, Links

International profiles of dental hygiene 1987 to 1998: a 19-nation

comparative study. Johnson PM. PMJ Consultants, Toronto, ON, Canada. [email protected] AIM: Development of an international longitudinal database to examine patterns, trends and changes in dental hygiene. METHOD: Three surveys of national dental hygienists' associations, mainly members of the International Federation of Dental Hygienists. Data were collected by mail in 1987, 1992 and 1998, using a 40-item questionnaire. Sample size increased over time; results presented are based on responses for 13, 15 and 19 countries respectively. Preliminary tabulations were circulated to respondents for validation. RESULTS: Overall, characteristics of the profession were remarkably similar; most noteworthy was the scope of dental hygiene clinical practice. Regarding historical development, education and professional organisation, the profession was more similar than dissimilar. Greater variation was evident in terms of numbers, distribution, workforce behaviour, predominant work setting and remuneration. While apparent change over the relatively short period 1987 to 1998 was viewed with caution, several observations were of particular interest: marked increases in the supply of dental hygienists, scope of practice and range of practice settings, accompanied by a decline in mandated level of work supervision. A slight but gradual increase in independent dental hygiene practice also was noted. CONCLUSION: By 1998 the profiles reflected the vast majority of the world's population of dental hygienists. While rate of change varied across the countries examined, the nature of the change tended to be consistent, resulting in a continuing homogeneity in the profession worldwide. Changes and emerging trends should continue to be monitored in terms of improved access to quality oral health services and technical efficiency in the provision of those services. Publication Types: • •

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

PMID: 11570548 [PubMed - indexed for MEDLINE] 1440: J UOEH. 2001 Sep 1;23(3):285-95. Related Articles, Links

[An analysis of medical expenses of outpatient service for the elderly at one health insurance society in Fukuoka prefecture--focused on medical service and concentration of medical expenses]

[Article in Japanese] Homan M, Matsuda S. Department of Preventive Medicine and Community of Health, School of Medicine, University of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan. To determine the best way to reduce medical expenses of the elderly, we analyzed the aged outpatients' receipts covered by the Health and Medical Service Law for the Aged at one health insurance society in Fukuoka prefecture. We used 312 medical receipts during July, 1997. The proportion of frequency of each medical service was 89.7% for medications, 45.8% for laboratory tests and 26.3% for procedures. The proportion of expenses of each medical service was 38.3% for medications, 20.0% for examinations and 12.1% for laboratory tests. Medication is considered as one of the main causes of increasing medical expenses. As a result of multiple regression analysis, the number of consulting days, urinary and genital disorder, the number of diseases, home care, laboratory tests and prescriptions for outside pharmacies were detected as statistically significant factors associated with medical expenses. There was a concentration of medical expenses, i.e. about 10% of higher rank receipts consumed around 40% of total outpatients' expenses and included 6 of 10 home medical care receipts. One of the causes of expensive outpatients' medical expenses was medication. The separation of dispensary and prescription of drugs does not contribute to the reduction of medical expenses. In the higher rank of the expenses group, compared with the lower rank of the expenses group, the consultation days were longer, the number of diseases was greater and the proportions of expenses for procedures and home care were larger. Medical expenditures for patients receiving home medical care were higher than those of others, but home care should be compared with admissions. Because the insurance societies are now facing financial difficulties in Japan, analyzing the data of medical receipts is very important. During our analysis, we had to make an enormous effort to combine two data sources, because the receipts were made separately by clinics and pharmacies. It is strongly suggested that a computerized information system with a standardized format for clinics and pharmacies be developed. Publication Types: •

English Abstract

PMID: 11570052 [PubMed - indexed for MEDLINE] 1441: J Oral Rehabil. 2001 Aug;28(8):717-20. Related Articles, Links

Oral health care status of homebound elderly in Japan. Morishita M, Takaesu Y, Miyatake K, Shinsho F, Fujioka M. Department of Preventive Dentistry, Hiroshima University School of Dentistry, Hiroshima, Japan. [email protected] We examined the present conditions of oral health care in order to contribute towards an effective system to provide oral health care for homebound elderly in Japan. A questionnaire was mailed to homebound elderly subjects (n=908) and returned by mail. A 73.6% response was achieved. The questionnaire was designed to elicit information with respect to the general condition of the subjects and independence of oral health care. About 70% of the subjects were chair- or bed-bound. Among all subjects, 37.6% required partial or full assistance on toothbrushing, 55.6% on cleaning dentures and 46.7% on eating. The degree of oral health care tended to be poor for chair- or bed-bound elderly compared with independent or house-bound elderly. Homebound elderly with lower Activities of Daily Living Scale (ADL) required more support for oral health care compared with elderly with higher ADL. Publication Types: • •

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

PMID: 11556951 [PubMed - indexed for MEDLINE] 1442: Methods Inf Med. 2001;40(4):307-14. Related Articles, Links

Building a controlled health vocabulary in Japanese. Liu Y, Satomura Y. Division of Medical Informatics, Chiba University Hospital, Japan. [email protected] OBJECTIVES: This study is aimed at developing a controlled clinical vocabulary for use in electronic patient record (EPR) systems. METHODS: In this paper, we propose a model for building the vocabulary. The model is composed of a Canonical Term Dictionary, an Atom Dictionary, a Composite Atom Dictionary, and an Index. Parsing and composing functions are included in this model. Canonical terms were extracted from reference terminologies. Atoms were

extracted from the Canonical Term Dictionary and reduced to a set from which the Composite Atom Dictionary can be built. The index was built to link these two dictionaries. For testing the model, we compiled a sample vocabulary and applied the model to a SNOMED translation system (English to Japanese) and a term similarity estimation system. RESULTS: The sample vocabulary consisted of 15,600 atomic terms and 4,450 composite terms. 33,441 SNOMED terms were translated by the SNOMED translation system. The system gave adequate Japanese candidates in 56.3% of cases. The similarity estimation system found an average of 5.4 candidates when the equality ratio was over 50%. CONCLUSIONS: The trial applications produced good results. The model seems promising for building a standard clinical vocabulary system. This system can be applied in certain other Asian countries, such as China and Korea. PMID: 11552343 [PubMed - indexed for MEDLINE] 1443: Med Parazitol (Mosk). 2001 Jan-Mar;(1):37-9. Related Articles, Links

[Current malaria situation in Turkmenistan] [Article in Russian] Amangel'diev KA. Malaria is one of the main health problems facing most developing countries having a hot climate. It is a problem in Turkmenistan. The country is situated in Central Asia, north of the Kopetdag mountains, between the Caspian Sea to the west and the Amu-Darya river to the east. Turkmenistan stretches for a distance of 1,100 km from west to east and 650 km from north to south. It borders Kazakhstan in the north, Uzbekistan in the east and north-east, Iran in the south, and Afghanistan in the south-east. Seven malaria vector species are found in Turkmenistan, the main ones being Anopheles superpictus, An. pulcherrimus, and An. martinius. The potentially endemic area consists of the floodplains of the Tejen and Murgab rivers, with a long chain of reservoirs built along them. In 1980 most cases of imported malaria were recorded in military personnel who had returned from service in Afghanistan. In the past years, only tertian (Plasmodium vivax) malaria has been recorded and there have been no death from malaria over that period. In the Serkhetabad (Gushgi) district there are currently 5 active foci of malaria infection, with a population of 22,000 people. In 1999, forty nine cases of P. vivax malaria were recorded in Turkmenistan. Of them, 36 cases, including 4 children under 14 years were diagnosed for the first time while 13 were relapses. There were 88 fewer cases than those in the previous year (by a factor of 2.8). There were 17 more cases of imported malaria than those in 1998 (by a factor of 1.7), most of which occurred in the foci of malaria infection (Serkhetabad, Tagtabazar, and Kerki districts), in the city of Ashkhabat and in Lebap, Dashkhovuz and Akhal Regions. The emergence of indigenous malaria in the

border areas was due to the importation of the disease at intervals by infected mosquitoes flying in from neighbouring countries (e.g. Afghanistan), the lack of drugs to treat the first cases and the lack of alternative insecticides. Most patients suffer from tertian malaria, which is the most dangerous from the epidemiological point of view since the main vectors in Turkmenistan, are highly susceptible to P. vivax infection. The particular dangerous phenomenon is the higher incidence of imported tertian malaria in rural areas where sick people and those who carry the parasite come into close contact with highly susceptible vectors. Thus, the risk that new malaria outbreaks will occur and the disease will become reestablished in the country is very high. It is also influenced by major changes in water use in the country, which have aggravated the mosquito situation. In the area around the Karakum canal and river basins, 17 large reservoirs have been constructed, with very extensive filtration ponds around them, which have become breeding ground's for malaria mosquitoes. There are 1219 water areas without any economic significance in the country, covering a total area of 1054 ha, which require regular treatment with insecticides. With assistance from the WHO European Regional Office, Dr. Guido Sabatinelli in particular, Turkmenistan has developed a plan for preventive malaria control measures for 1999-2001, which has been approved in a decree issued by the Ministry of Health and Medical Industry. The material support received has made it possible to provide largescale prophylaxis for people who suffered from malaria in 1997-1999, seasonal treatment for people living near the active foci of the disease and interseasonal prophylaxis for people visiting these areas. Seasonal treatment with Dellaguil was made in 4,590 people living in the active foci of malaria infection, and 2,281 fixed-term military personnel belonging to the units stationed in the active foci of malaria infection. In all foci of infection, every person with malaria or carrying the parasite underwent epidemiological investigation and all cases were entered in health clinic records. In 1999, four seminars were held to train 75 specialists from all administrative areas in ways of improving senior staff's skills in the laboratory diagnosis of malaria. The laboratory equipment which the country has received makes it possible to train high-level specialists and to equip its main malaria diagnosis centers with microscopes and reagents. The received insecticides and sprayers enable mosquitoes to be eliminated in an area of 960,000 sq. km (240 foci of infection): for this, our sincere thanks and gratitude are due to Dr. Guido Sabatinelli. Specialists teams have been created in each region by a decree of the Ministry of Health and Medical Industry to conduct mosquito elimination activities, with personal responsibility for their progress. Three-day vector control seminars have been held for disinfectors in all regions. We should stress that 5 extra posts have been created in the parasitology department of the Central Laboratory of Hygiene and Epidemiology, State Epidemiological Surveillance Service in order to strengthen preventive malaria control activities in Turkmenistan (organizational and methodological support for health facilities, staff training, etc.). To prevent the emergence of new breeding grounds for malaria vectors, the state system of health surveillance over the hygiene and technical status of water facilities and the rules governing their work have been reinforced. Local executive authorities do every effort to eliminate small,

economically unprofitable water areas by draining, filling in or cleaning them. All existing and potential mosquito breeding grounds within a three-kilometer radius of any community were identified. These water areas were certified and their previous certifications analyzed, taking into account any changes and additional information which has become available about the area. Seasonal variations in the number of larvae and imagoes were monitored in the specimen areas of water and daytime resting sites. The existing vector species were identified and a list of the main species in all areas was prepared. Water areas were treated in accordance with epidemiological instructions. These activities yielded positive results: only 10 cases of locally transmitted malaria were recorded throughout the country in 1999. To interrupt the endemic process of malaria in Turkmenistan, the following plan for 1999-2001 has been adopted. To improve the equipment and material base of a sanitary and epidemiological surveillance service and malaria diagnosis laboratories (vehicles, sprayers, microscopes, chemical reagents, etc.). To continue effort to recruit staff to fill vacancies for parasitologists, entomologists, and parasitology laboratory physicians in the sanitary and epidemiological surveillance service at regional, subregional, and district level. In April 2000, two six-day seminars were held for epidemiologists, parasitologists, and entomologists, organized jointly with WHO representatives at the Central Laboratory for Hygiene and Epidemiology. Two seminars on the laboratory diagnosis of malaria for laboratory physicians were also intended to be held in April 2000. To continue to treat malaria patients and parasite carriers throughout the year to prevent relapses. To continue activities to eliminate mosquitoes, to monitor seasonal variations in the number of vector larvae and imagoes in the specimen areas of water and daytime resting sites mosquito habitats, to identify the existing vector species, and to prepare a list of main species in all areas. To strengthen preventive health monitoring. To provide effective support of health care service by the state border guard service of Turkmenistan by supplying drugs for curative and preventive treatment of its staff. To provide the quantities of insecticides required for mosquito elimination and support staff training. To improve malaria control activities by reporting all cases of malaria promptly, conducting a high-quality epidemiological investigation of every case and a prompt laboratory diagnosis, and providing the parasitology departments of sanitary and epidemiological surveillance service at all levels with all-terrain vehicles, microscopes, and effective communication systems which they require. We are very happy to be cooperating with WHO and grateful for the help it has provided. Publication Types: •

English Abstract

PMID: 11548312 [PubMed - indexed for MEDLINE] 1444: Med Parazitol (Mosk). 2001 Jan-Mar;(1):24-33.

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[Current malaria situation in the Republic of Kazakhstan] [Article in Russian] Bismil'din FB, Shapieva ZhZh, Anpilova EN. The Republic of Kazakhstan is situated in the northern hemisphere on the boundary of two continents--Europe and Asia--at a longitude of 45 degrees E--87 degrees E and a latitude of 40 degrees N--55 degrees N. The total area of the republic is 2,724,900 square kilometers. Kazakhstan shares a border with the Russian Federation to the north-west, north and east: the border between the two countries is almost 6500 km long. To the south, Kazakhstan shares a border with the Central Asian states of Turkmenistan (380 km), Uzbekistan (2300 km) and Kyrgystan (980 km). To the south-east, it shares a border with China (1460 km): to the west is the Caspian Sea (600 km). Thus, the total length of Kazakhstan's external borders is 12,000 km. Because of the geographical, natural and climatic features prevailing throughout most of the Republic, there is a potential danger that local transmission of malaria may begin again if the disease is imported from abroad. The areas most at risk are the Panfilov and Uigur raions of Almaty oblast, which share a border with malaria-endemic regions of China, and the Saryagash and Makhtaral' raions of South Kazakhstan oblast along the border with Uzbekistan. The Government of the Republic of Kazakhstan places particular emphasis on malaria prevention and control, taking into account the historical data about the prevalence of malaria from the late 1920s to the early 1940s, amounting to hundreds of thousands of cases every year. Government Decree No. 840 entitled "Urgent Measures to Protect the Population from Blood-Sucking Insects and Ticks Dangerous to Humans", which lays down measures for the control of malarial mosquitoes in the areas most susceptible to malaria resurgence, was adopted in 1996. The Ministry of Health of the Republic of Kazakhstan issued instructions in 1998 and 1999 which were designed to motivate all health facilities in the field of malaria prevention and control. At present, as part of the directives developed by the Republican Health Epidemiology Posts, work is being done on the planning of malaria control measures in Kazakhstan for the period 2001-2003. In 1994 a programme of epidemiological malaria surveillance was introduced, which has enabled us to improve our monitoring of the epidemiological situation of malaria. The number of cases of imported malaria has declined: in 1997, there were 102 cases, in 199887 and in 1999-52. There have been occasional local cases in some years, and in 1998 there were four local cases in the south and north-west of the country: two cases in Almaty oblast, one case in Zhambyl oblast and one in West Kazakhstan oblast (see Fig. 1). Most malaria infections are imported from Tajikistan and Azerbaijan, with occasional cases from Pakistan, India, Turkey and Afghanistan. Analysis of the occupational status of patients shows that around 45% are military personnel who have served on the Tajik-Afghan border. The others are refugees,

merchants, unemployed people or students. The overall aetiological structure of malaria cases is dominated by P. vivax malaria. For example, in 1999, there were 48 cases of P. vivax malaria (90.5% of the total), one case of tropical malaria (1.9%), two cases of quartan malaria (3.8%) and two cases of P. vivax + P. malariae (3.8%). In order to prevent indigenous malaria occurring within the country, a system of malaria screening has been set up; screening is carried out every year on groups who have visited neighbouring or more distant malariaendemic countries and for patients with a persistent fever who are suspected of suffering from malaria. The area of water throughout the country within communities or within a 3-5 km radius of them which is susceptible to colonization by the Anopheles mosquito amounts to over 5000 hectares, according to the certification system in force. In addition, approximately 70,000 hectares in three oblasts used for rice cultivation also provide a habitat for Anopheles. The main malaria vector, An. messeae, is found throughout the country: in a few areas An. hyrcanus and An. claviger are found and, in the south, An. pulcherrimus. Data from recent years show the presence of An. superpictus, An. plumbeus and An. algeriensis. In 1999, from data collected during systematic observations of the phenology and seasonal variations in the number of Anopheles at 114 observation posts, the average seasonal numerical indicators for the mosquito imago reached a maximum of between 21 and 46.5 adult mosquitoes per cattle shed, up to 2.7-3.3 adult mosquitoes per residential building and 30-67.3 larvae per square metre of surface water. According to the results of large scale trapping programmes (486 communities were screened in 1999), the maximum value of the numerical indicator was 16.8-74.1 adult mosquitoes per cattle shed and 4.1-3.8 adult mosquitoes per residential building. In 1999, compared with 1998, the number of malarial mosquitoes detected throughout the country declined encouragingly, or stayed at the same level, which is one of the factors responsible for the country's favourable epidemiological situation with regard to malaria. According to data going back many years, there has been a significant increase in the number of mosquitoes at some observation posts in Almaty, East Kazakhstan and Kyzlorda oblasts. There is a tendency everywhere for the numbers of imagos detected in residential buildings to increase, which presents a definite epidemiological risk that indigenous malaria will re-emerge if the disease is imported into Kazakhstan from countries which suffer from it. If we consider the species of mosquito present in the country and the temperature factor (the number of days in the year when the average daily temperature is over 16 degrees C), the country can be divided, on the basis of incomplete 1999 data, into zones at very high risk of re-emergence of malaria (Almaty, Zhambyl and South Kazakhstan oblasts), high risk (Karaganda oblasts and Almaty city), medium risk (Aktyubinsk and Akmolinsk oblasts), and low risk (Kostanay oblast). The malaria risk of the other oblasts has been calculated using data from earlier years (map attached) [Translator's Note: map missing]. Preventive malaria control measures in Kazakhstan are divided into three categories to suit three different groups of communities. One hundred and seventy-nine communities have been allocated to the first group, at high risk of malaria resurgence; 1377 communities to the second group, at medium risk; and the remainder to the third group, at little or no

risk of malaria resurgence. The following factors were used to categorize communities according to the risk that malaria might become reestablished if the disease should be imported from elsewhere: species of malarial mosquito present; changes in mosquito numbers and in the area of water susceptible to population by Anopheles; temperature conditions and, consequently, the length of the malaria transmission season and the season of effective susceptibility of the mosquito to infection; population migration; quality of laboratory testing for the diagnosis of malaria. Measures aimed at the destruction of mosquitoes are intended to reduce the numbers of Anopheles in the communities most at risk of malaria resurgence, i.e. those in group 1 above and the actual foci of malaria infection. Because of the economic crisis and financial difficulties, fewer areas have been treated in recent years. In 1999, 1387 hectares of water and 450,000 square metres of buildings were treated (see Fig. 2). Measures to control biting flies in health establishments, recreation areas, etc. Certainly also help to protect people from malarial mosquitoes. In 1999, 12,501 hectares of water and land were treated from the ground or the air (see Fig. 3). In the present situation, the main reasons for the difficulties affecting the malaria control and prevention campaign are as follows. Staff numbers in the Republic's parasitology service have been unjustifiably reduced. For example, the number of entomologists and entomology assistants employed is 58% and 48%, respectively, of the number laid down in Ministry of Health directives. At the health epidemiology posts, the number of disinfectors has been reduced to a minimum, and practically all engineer/water engineer posts have been abolished. The country does not possess the necessary education base for initial training or continuing education of staff for the parasitology service. The lack of basic scientific information about the problems of malaria control and prevention and parasitology in general. There is no research to test or introduce the most effective, safe and low-cost malaria control products and insecticides. The methodological literature required to use certain modern insecticides is not available. Entomologists are not provided with specialist insect control equipment. Entomological surveys are left incomplete because of shortages of transport and fuel at the health epidemiology posts. Because of the economic crisis and the high cost of the radical water engineering measures necessary to combat malaria, these measures cannot be implemented on the scale required. The equipment and materials stocks of the parasitology laboratories are highly inadequate: there is a lack of modern laboratory equipment, as well as a lack of opportunities for high-level professional training for staff. The exchange of information between the CIS countries is unsatisfactory, and there is no common information space: nor is there any systematic data available from other foreign countries. In the period 2000-2003, Kazakhstan plans to carry out malaria control activities (mosquito destruction) over an area of 2000 hectares of water and 1.5 million square metres of buildings. Publication Types: •

English Abstract

PMID: 11548308 [PubMed - indexed for MEDLINE] 1445: Acta Astronaut. 1998 Jan-Apr;42(1-8):69-87. Related Articles, Links

Overview of the Neurolab Spacelab mission. Homick JL, Delaney P, Rodda K.Collaborators (1) Homick JL. NASA Johnson Space Center, Houston, Texas 77058, USA. Neurolab is a NASA Spacelab mission with multinational cooperative participation that is dedicated to research on the nervous system. The nervous systems of all animal species have evolved in a one-g environment and are functionally influenced by the presence of gravity. The absence of gravity presents a unique opportunity to gain new insights into basic neurologic functions as well as an enhanced understanding of physiological and behavioral responses mediated by the nervous system. The primary goal of Neurolab is to expand our understanding of how the nervous system develops, functions in, and adapts to microgravity space flight. Twenty-six peer reviewed investigations using human and nonhuman test subjects were assigned to one of eight science discipline teams. Individual and integrated experiments within these teams have been designed to collect a wide range of physiological and behavior data in flight as well as pre- and postflight. Information from these investigations will be applicable to enhancing the well being and performance of future long duration space travelers, will contribute to our understanding of normal and pathological functioning of the nervous system, and may be applied by the medical community to enhance the health of humans on Earth. PMID: 11541633 [PubMed - indexed for MEDLINE] 1446: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2000;(118):85-9. Related Articles, Links

[Archives of environmental health digital maps and their delivery by the Internet] [Article in Japanese] Kaminuma T, Kabuyama N, Hayakawa M, Futatsuki Y. [email protected]

Geographic Information System is becoming a very important tool for environmental health research. We have produced various digital maps for different scales for different purposes. The burst of E. Coli O-157, distribution of hazadarous chemicals in East Asia, and coastal resin pellets are some examples. It now becomes a problem how to archive these digital maps and how to retrieve these maps according to user's request. We have developed a computer system that can store various types of digital maps and can retrieve them from WWW client machines. The key concept of this archive system is to classify every digital maps according to their region of interest. Publication Types: •

English Abstract

PMID: 11534133 [PubMed - indexed for MEDLINE] 1447: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2000;(118):107-16. Related Articles, Links

[The status of NIHS Information and Computing Infrastructure (NICI)] [Article in Japanese] Nakata K, Nakano T, Takai T, Komine K, Kaminuma T. [email protected] From 1999 to 2000, NIHS Information and Computing Infrastructure (NICI) were newly renovated. The purposes of the renovation are (1) the improvement of the communication for business works in NIHS, (2) supporting for the research, (3) supporting for the administration work. The Internet connection speed was upgraded from 256 Kbps to 1.5 Mbps. The high quality network sever machines and database server machines were installed. The large-scale software systems were renewed their versions. Four experimental stations for medical plants at Hokkaido, Izu, Wakayama and Tanegashima connected to NIHS at Tokyo or Osaka branch by ISDN. We describe the providing information on NIHS home page, and how to utilize NICI for our research and official works. Publication Types: •

English Abstract

PMID: 11534109 [PubMed - indexed for MEDLINE] 1448: Sangyo Eiseigaku Zasshi. 2001 Jul;43(4):76-87. Related Articles, Links

[Present condition of health information control and attitudes of occupational health professionals in collecting and utilizing health information in workplaces] [Article in Japanese] Nakamura K, Niino N. Department of Hygiene and Preventive Medicine, Showa University School of Medicine. Since the Labor Safety and Health Law of Japan provides that the employer is responsible for taking custody of personal information obtained in periodic health examinations, we are anxious about infringement of privacy. This study was conducted to investigate the present condition of health information control in each workplace and attitudes of occupational health professionals in collecting and utilizing personal health information by means of self-administered mail questionnaires. The numbers of respondents were a total of 549 (physicians: 237, public health nurses: 175, nurses 122, others & unknown: 15). The major results were as follows. 1. Percentage of workplaces in which only health professionals can know personal health data from periodic health examinations was 24% altogether, but it was 39% in large workplaces where full-time occupational physicians were working. 2. More than half of the respondents were of the opinion that the results of routine health activities could be presented in academic conferences unconditionally or under comprehensive approval of the representative of each workplace. 3. About a half of the respondents believed that it was necessary to consider the intention of each examinee in utilizing blood specimen collected at health examinations for research purposes, even though personal identification had been erased. 4. There were many differences among types of occupation or age groups in the attitude to changing the procedure for health examination. And it was the majority opinion that personal health data provided to the employer should be the minimum in order to protect individual benefits. 5. The proportion of physicians who felt it necessity to ask about the occupational history at the employment health examination was significantly higher than that of public health nurses. 6. When a disease was discovered, there were great differences among types of disease in the attitude to give the name or condition of the disease to the employer without the consent of the patient or his family. In view of these results, we feel that occupational health professionals are in a dilemma in introducing modern ideas which lay stress on privacy into the Japanese occupational health care system which is still operating on the basis of

traditional paternalism. Publication Types: • •

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

PMID: 11534105 [PubMed - indexed for MEDLINE] 1449: Qual Health Care. 2001 Sep;10(3):166-72. Related Articles, Links

Development of guidelines to facilitate improved support of South Asian carers by primary health care teams. Katbamna S, Baker R, Ahmad W, Bhakta P, Parker G. Nuffield Community Care Studies Unit, Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP, UK. [email protected] BACKGROUND: Evidence based guidelines are regarded as an appropriate basis for providing effective health care, but few guidelines incorporate the views of users such as carers. AIM:To develop guidelines to assist primary health care teams (PHCTs) in their work with carers within South Asian communities. METHODS: The guidelines were drawn up by a development group consisting of members of teams in areas with South Asian communities (Leicester and Bradford). The teams were invited to make their recommendations based on a systematic review of literature on minority ethnic carers and the findings of a study of the needs and experiences of local South Asian carers. A grading system was devised to enable the teams and a group of expert peer reviewers to assess the quality of evidence in support of each recommendation. RESULTS: The teams agreed seven recommendations, graded according to available evidence and strength of opinion. External peer review supported the PHCTs' interpretation of evidence and their recommendations. The recommendations included consideration of communication and information for carers, coordination of care within teams, and recognition by team members of the roles of carers and their cultural and religious beliefs. CONCLUSION: There are particular steps that PHCTs can take to improve their support of South Asian carers. It is possible to develop guidelines that take users' views into account and incorporate evidence from qualitative studies. Publication Types: •

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

PMID: 11533424 [PubMed - indexed for MEDLINE] PMCID: PMC1743443

1450: Health Policy Plan. 2001 Sep;16(3):322-5. Related Articles, Links

Newspaper reports as a source for injury data in developing countries. Ghaffar A, Hyder AA, Bishai D. Health Services Academy, Ministry of Health, Government of Pakistan, Islamabad, Pakistan. Injuries are an important public health problem and a leading cause of death among adults and children. In most of the developing world, with rapid changes in lifestyle, rural development, urbanization, an increase in number of vehicles, introduction of mechanized farming and pesticides in agriculture, the effect of injuries on mortality and morbidity is expected to increase. Injuries have been infrequently studied in developing countries; their importance is incompletely understood and they are seriously neglected in health research and policy. The reasons for this situation may be many, but one important reason is the unavailability of data in countries to assess the magnitude of the problem. Hospital and police records are the primary data source for injuries in the majority of the developing world. Newspaper reports may be an alternative source for injury data. This hypothesis was tested in the Rawalpindi Division of Pakistan by collecting data from newspaper reports for both intentional and unintentional injuries for 6 months (January-June 1999). This was compared with police data for the same time period. The results revealed that newspapers report more injuryrelated events and for some categories, such as suicides, the reporting was far greater by newspapers than the police. We conclude that the current system of police data collection needs to be strengthened. Newspapers may serve as a comparative source of information to evaluate the coverage of police data. Publication Types: •

Comparative Study

PMID: 11527873 [PubMed - indexed for MEDLINE]

1451: Nippon Koshu Eisei Zasshi. 2001 Jul;48(7):551-9. Related Articles, Links

[An individual based analysis of medical expenses of outpatient services for the elderly at one health insurance society in Fukuoka Prefecture. Focus on multiple or redundant consultations] [Article in Japanese] Homan M, Matsuda S. Department of Preventive Medicine and Community of Health, University of Occupational and Environmental Health, Japan. PURPOSE: To ascertain way to reduce medical expenses of the elderly, we analyzed old outpatients' receipts covered by the Health and Medical Services Law for the Aged at one health insurance society in Fukuoka prefecture. In addition, an attempt was made to find better ways to share medical information and construct a system of receipt analysis. SUBJECTS AND METHODS: We used 312 receipts for 179 old outpatients in July in 1997. The number of prescriptions was internalized into the number of outpatients' receipt. We classified the patients as "multiple" who consulted several clinics a month and as "redundant" who consulted several clinics for the same diseases. RESULTS AND CONCLUSION: 1) The expenses of outpatients accounted for about 1/3 of the total. Average values for patients were 78.3 years old of age, 7.7 diseases, 1.5 pharmacies, 1.7 clinics, 7 consulting days, and the medical expenses of 40,482 yen per month. 2) The rate of multiple including redundant consultations was 49.7% and that for those that were redundant was 9.5%. Redundant consultations increased as the number of consultation clinics increased. 3) Factors considered to increase medical expenses were the number of diseases, the consulting days, and the number of consultation/prescription organizations. Multiple and redundant consultations amounting to half of the whole fulfilled all of these criteria. 4) The average medical expense for non-multiple and non-redundant patients was 28,314 yen, as compared with 52,786 yen for multiple and redundant and 64,306 yen for redundant cases. If there were no multiple consultations, thirty percent of the expenses could be avoided and if there were no redundant consultations, the reduction might be 6%, although more detailed clinical records are necessary for firm conclusions. To reduce excess expenditure, instructions for patients having home doctors and passing through introductions are important. 5) Regarding the expense of medical services, medication was accounted for 39.2% as the greatest outlay. Cautions for suitable use of drugs are required for multiple and redundant patients, because they tend to visit many pharmacies. Considering the rate rise of separation of pharmacy and clinic, fixing of field division of work and the sharing of medical information are inadequate. For example, introduction of an IC card system might be very useful to facilitate the development of community-based medical information system. 6) It is strongly suggested that a computerized

information system with a standardized format should be developed on the initiative of a national organization such as the National Federation of Health Insurance Societies. Publication Types: •

English Abstract

PMID: 11524830 [PubMed - indexed for MEDLINE] 1452: J Am Med Inform Assoc. 2001 Sep-Oct;8(5):515-7. Related Articles, Links

Medical informatics and health care in Oman. Dhar A. Publication Types: •

Letter

PMID: 11522773 [PubMed - indexed for MEDLINE] PMCID: PMC131050

1453: J Health Popul Nutr. 2001 Jun;19(2):100-10. Related Articles, Links

Implementation of a medical geographic information system: concepts and uses. Ali M, Emch M, Ashley C, Streatfield PK. ICDDR, B: Centre for Health and Population Research, Mohakhali, Dhaka 1212, Bangladesh. [email protected] This paper introduces a medical geographic information system which has been implemented to enhance public-health research by facilitating the modelling of spatial processes of disease, environment, and healthcare systems in a rural area of Bangladesh. In 1966, a surveillance system was implemented to record all vital demographic events in the study area. Selected information on reproductive and

child health, socioeconomic conditions, and health and family-planning interventions is being collected for the surveillance database. This paper discusses the conceptual design of integrating the surveillance database with the medical geographic information system and its use in conducting multidisciplinary health research. The paper is intended to help those who wish to implement a healthbased geographic information system to understand the links between people and their environments and to better meet the health needs of target communities. Publication Types: •

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

PMID: 11503345 [PubMed - indexed for MEDLINE] 1454: Gerontology. 2001 Sep-Oct;47(5):254-62. Related Articles, Links

Association of comorbidity with depressive symptoms in community-dwelling older persons. Lee Y, Choi K, Lee YK. Department of Preventive Medicine, Ajou University School of Medicine, Suwon, South Korea. [email protected] BACKGROUND: Depression in later life poses a serious threat to mental health and well-being of older persons burdened with medical illnesses. Comorbid medical conditions independently, as well as through interactions, may influence the degree of depressive symptoms manifested by the elderly. Insight into the role medical comorbidity plays in the manifestation of depression may help to better address both physical and mental health care needs of the depressed elderly. OBJECTIVE: To examine independent and synergistic effects of comorbid medical conditions in the presentation of depressive symptoms among older adults living in the community. METHODS: Data from a national survey of community-dwelling older persons aged 60 years and over (n = 2,058) in Korea were used. The levels of depression were assessed using an eleven-item Center for Epidemiological Studies Depression Scale. Comorbidity was defined as the number of chronic medical conditions and the combination of disease pairs. Sociodemographic characteristics, self-rated health, physical functioning, history of hospital admission in the past year, frequency of contact with friends or neighbors, and emotional support were used as covariates. RESULTS: Overall, persons with a medical condition compared to those without tended to show a higher depressive symptom score. Comorbidity, in terms of the number of medical conditions, tended to show a significant linear association with

depression, controlling for confounders. More important, independent effects of medical conditions as well as a tendency to synergy among specific medical conditions were found, with notable gender differences. CONCLUSION: Given the significant but complex association of comorbid medical conditions with depressive symptoms in aged persons, clinicians should exercise care to address their physical and mental health needs within a common therapeutic context. Copyright 2001 S. Karger AG, Basel Publication Types: • •

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

PMID: 11490144 [PubMed - indexed for MEDLINE] 1455: J Adv Nurs. 2001 Aug;35(3):393-401. Related Articles, Links

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong. Holroyd E, Twinn S, Shiu A. Department of Nursing, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong. [email protected] AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.

Publication Types: •

Evaluation Studies

PMID: 11489024 [PubMed - indexed for MEDLINE] 1456: Southeast Asian J Trop Med Public Health. 2000;31 Suppl 2:5-21. Related Articles, Links

Promotion of the health of rural women towards safe motherhood-an intervention project in northeast Thailand. Saowakontha S, Pongpaew P, Vudhivai N, Tungtrongchitr R, Sanchaisuriya P, Mahaweerawat U, Laohasiriwong W, Intarakhao C, Leelapanmetha P, Chaisiri K, Vatanasapt V, Merkle A, Schelp FP. Faculty of Medicine, Khon Kaen University, Thailand. An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not

possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam. Publication Types: •

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

PMID: 11488446 [PubMed - indexed for MEDLINE] 1457: Sci Am. 2001 Aug;285(2):66-71. Related Articles, Links

Taming the killing fields of Laos. Lovering D. Publication Types: •

Review

PMID: 11478004 [PubMed - indexed for MEDLINE] 1458: Bull World Health Organ. 2001;79(7):648-56. Related Articles, Links

Three case definitions of malaria and their effect on diagnosis, treatment and surveillance in Cox's Bazar district, Bangladesh. Montanari RM, Bangali AM, Talukder KR, Baqui A, Maheswary NP, Gosh A, Rahman M, Mahmood AH. WHO Dhaka, Bangladesh. In countries where malaria is endemic, routine blood slide examinations remain the major source of data for the public health surveillance system. This approach has become inadequate, however, as the public health emphasis has changed from surveillance of laboratory-confirmed malaria infections to the early detection and treatment of the disease. As a result, it has been advocated that the information collected about malaria be changed radically and should include the monitoring of

morbidity and mortality, clinical practice and quality of care. To improve the early diagnosis and prompt treatment (EDPT) of malaria patients, three malaria case definitions (MCDs) were developed, with treatment and reporting guidelines, and used in all static health facilities of Cox's Bazar district, Bangladesh (population 1.5 million). The three MCDs were: uncomplicated malaria (UM); treatment failure malaria (TFM); and severe malaria (SM). The number of malaria deaths was also reported. This paper reviews the rationale and need for MCDs in malaria control programmes and presents an analysis of the integrated surveillance information collected during the three-year period, 1995-97. The combined analysis of slide-based and clinical data and their related indicators shows that blood slide analysis is no longer used to document fever episodes but to support EDPT, with priority given to SM and TFM patients. Data indicate a decrease in the overall positive predictive value of the three MCDs as malaria prevalence decreases. Hence the data quantify the extent to which the mainly clinical diagnosis of UM leads to over-diagnosis and over-treatment in changing epidemiological conditions. Also the new surveillance data show: a halving in the case fatality rate among SM cases (from 6% to 3.1%) attributable to improved quality of care, and a stable proportion of TFM cases (around 7%) against a defined population denominator. Changes implemented in the EDPT of malaria patients and in the surveillance system were based on existing staff capacity and routine reporting structures. Publication Types: •

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

PMID: 11477968 [PubMed - indexed for MEDLINE] 1459: Int J Med Inform. 2001 Jul;62(2-3):113-9. Related Articles, Links

Medical informatics--the state of the art in the Hospital Authority. Cheung NT, Fung KW, Wong KC, Cheung A, Cheung J, Ho W, Cheung C, Shung E, Fung V, Fung H. Hospital Planning and Development Division, Hospital Authority, Hong Kong, China. [email protected] Since its inception in 1990, the Hospital Authority (HA) has strongly supported the development and implementation of information systems both to improve the delivery of care and to make better information available to managers. This paper summarizes the progress to date and discusses current and future developments. Following the first two phases of the HA information technology strategy the

basic infrastructural elements were laid in place. These included the foundation administrative and financial systems and databases; establishment of a wide area network linking all hospitals and clinics together; laboratory, radiology and pharmacy systems with access to results in the ward. A major push into clinical systems began in 1994 with the clinical management system (CMS), which established a clinical workstation for use in both ward and ambulatory settings. The CMS is now running at all major hospitals, and provides single logon access to almost all the electronically collected clinical data in the HA. The next phase of development is focussed on further support for clinical activities in the CMS. Key elements include the longitudinal electronic patient record (ePR), clinical order entry, generic support for clinical reports, broadening the scope to include allied health and the rehabilitative phase, clinical decision support, an improved clinical documentation framework, sharing of clinical information with other health care providers and a comprehensive data repository for analysis and reporting purposes. PMID: 11470614 [PubMed - indexed for MEDLINE] 1460: Int J Med Inform. 2001 Jul;62(2-3):103-11. Related Articles, Links

Data mining approach to policy analysis in a health insurance domain. Chae YM, Ho SH, Cho KW, Lee DH, Ji SH. Graduate School of Health Policy and Administration, Yonsei University, CPO Box 8044, Seoul, 120-749, South Korea. [email protected] This study examined the characteristics of the knowledge discovery and data mining algorithms to demonstrate how they can be used to predict health outcomes and provide policy information for hypertension management using the Korea Medical Insurance Corporation database. Specifically, this study validated the predictive power of data mining algorithms by comparing the performance of logistic regression and two decision tree algorithms, CHIAD (Chi-squared Automatic Interaction Detection) and C5.0 (a variant of C4.5) using the test set of 4588 beneficiaries and the training set of 13,689 beneficiaries. Contrary to the previous study, the CHIAD algorithm performed better than the logistic regression in predicting hypertension, and C5.0 had the lowest predictive power. In addition, the CHIAD algorithm and the association rule also provided the segment-specific information for the risk factors and target group that may be used in a policy analysis for hypertension management. PMID: 11470613 [PubMed - indexed for MEDLINE]

1461: Reprod Health Matters. 2001 May;9(17):118-27. Related Articles, Links

Sexual behaviour and contraceptive use among unmarried, young women migrant workers in five cities in China. Zheng Z, Zhou Y, Zheng L, Yang Y, Zhao D, Lou C, Zhao S. Institute of Population Research, Peking University, 3-4, Building 22, Muxidi, Beijing 100038, China. [email protected] This paper reports the results of exploratory research on reproductive and sexual health knowledge and sexual behaviour of young, unmarried women who migrate to cities from rural areas for work, and their access to and needs in relation to family planning in Beijing, Guangzhou, Shanghai, Guiyang and Taiyuan, in China. Focus group discussions were conducted with 146 young women aged 1625 and 58 in-depth interviews with key informants. Some of the young female migrant workers were sexually active and living with their boyfriends, most of whom expected to marry each other. Most of the women lacked basic information about reproduction and contraception, and did not know where or how to obtain contraception. There were social, psychological and economic barriers to accessing services. Only a small proportion of those who were unmarried were using contraception, so induced abortion was often the outcome of unprotected premarital sex. Pleasing male partners also played an important role in unprotected sex. The training, attitudes and approach of the entire family planning service system in relation to unmarried and young people in China, including this migrant population, needs to be reorientated so as to provide them with appropriate and adequate services. Publication Types: •

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

PMID: 11468827 [PubMed - indexed for MEDLINE] 1462: Bull Med Libr Assoc. 2001 Jul;89(3):287-93. Related Articles, Links

Health sciences libraries in Kuwait: a study of their resources, facilities, and services. Al-Ansari HA, Al-Enezi S.

Kuwait University, Khalidia. The purpose of this study was to examine the current status of health sciences libraries in Kuwait in terms of their staff, collections, facilities, use of information technology, information services, and cooperation. Seventeen libraries participated in the study. Results show that the majority of health sciences libraries were established during the 1980s. Their collections are relatively small. The majority of their staff is nonprofessional. The majority of libraries provide only basic information services. Cooperation among libraries is limited. Survey results also indicate that a significant number of health sciences libraries are not automated. Some recommendations for the improvement of existing resources, facilities, and services are made. PMID: 11465688 [PubMed - indexed for MEDLINE] PMCID: PMC34562

1463: AIDS Care. 2001 Aug;13(4):441-56. Related Articles, Links

Promoting the positive: responses to stigma and discrimination in Southeast Asia. Busza JR. Programme Officer, Population Council, Bangkok, Thailand. [email protected] Pervasive stigma has surrounded HIV/AIDS since the beginning of the pandemic. In Southeast Asia, as elsewhere, it has been accompanied by discrimination, affecting transmission patterns and access to care and support. Beginning with definitions of stigma and discrimination as they relate to HIV/AIDS, this paper outlines the contexts of discrimination experienced in the region and reviews local community-based interventions that have worked to reduce negative attitudes. The evidence presented comes primarily from unpublished literature and anecdotal evidence gained through interviews with project staff throughout the region. Although the activities represent initiatives in a number of countries and contexts of discrimination, they nonetheless share certain components which are highlighted. What these characteristics have in common is an emphasis on process, indicating that reducing community-level discrimination can be integrated into any approach to HIV/AIDS. PMID: 11454265 [PubMed - indexed for MEDLINE] 1464: Fukuoka Igaku Zasshi. 2001 May;92(5):134-8.

Related Articles,

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[Detection of underlying causes of death among the deceased of Yusho patients by linkage to the national vital statistics data] [Article in Japanese] Kaneko S, Yoshimura T, Ikeda M, Nishisaka K. Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan. As of January 31, 1996, 292 deaths among registered patients of Yusho were identified by three follow-up studies conducted in 1986, 1990, and 1996. In this study, we attempted to identify underlying causes of death by linkage of the registered data to the National Vital Statistics Data provided by the Management and Coordination Agency of Japan, which included 15 million deaths between 1978 and 1996. The two datasets were linked by matching for six variables; birth year/month/day, death year/month, and sex, along with a variable of death day or death place, or both. The matched cases were 203 among 235 deaths between 1978 and 1996 (matching rate was 86%). Among the 203 deaths, 58 underlying causes of death were newly identified, 146 causes of death were already grasped by the follow-up studies, and 31 deaths did not have matching pair in the National Vital Statistics data. Among the 146 deaths, 110 causes of death were concordant with each other, however, 35 causes of death were completely discord. The reason of the discordance and the unmatched deaths might be due to difference in information of the matching variables in the two datasets. In order to conduct an efficient follow-up study of Yusho patients, identification of underlying causes of death by linkage to the National Vital Statistics Date is evitable. For that, we need to substitute basic information in the Yusho database to those compatible to the National civil registration system. Publication Types: • •

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

PMID: 11452510 [PubMed - indexed for MEDLINE] 1465: Indian J Public Health. 2000 Oct-Dec;44(4):124-8. Related Articles, Links

Diet nutrition and health profile of elderly population of urban Baroda.

Mehta P, Shringarpure B. Department of Foods and Nutrition, Faculty of Home Science, M. S. University, Baroda, Vadodara-390 002. Geriatric population forms a significant proportion of our total population. Hence, various problems affecting the overall health of the elderly need special consideration. In this context, studies were undertaken to assess the sociodemographic factors, diet and health profile of 320 elderly men and women of all the three income groups of Urban Baroda. Data on socio-demographic factors was collected using an open ended questionnaire. Nutritional status was assessed using anthropometric measurements of height, weight, mid upper arm circumference (MUAC) and body mass index (BMI). Information on dietary profile was collected by 24 hour dietary recall method. Fasting practices were also studied. Socio-demographic data of geriatric men of high, middle and low income groups revealed that majority of the subjects were married. A greater percentage of high income group (HIG) men had nuclear family whereas majority of low income groups (LIG) elderly men resided in a joint family. Socio-demographic profile of elderly women of all the 3 income groups revealed that most of the subjects were Hindus. The percentage of widowhood, illiteracy and joint family system were higher in LIG as compared to the elderly women in middle and high income groups (MIG and HIG). Nutrient intake data of elderly men of all the income groups revealed lower consumption of energy, protein, iron and beta-carotene as compared to the RDA whereas fats and vitamin C intakes were higher as compared to the RDA (p < 0.05). The mean nutrient intake, by the LIG elderly women, in terms of energy, protein, iron, calcium, beta-carotene and vitamin C were significantly (p < 0.05) lower than the RDA as well as when compared to the elderly women of MIG and HIG. Mean anthropometric measurements of weight and BMI were higher in elderly HIG and MIG men as compared to the elderly men from LIG. Significant difference was found in all the anthropometric measurements of elderly women of LIG as compared to HIG and MIG. Morbidity profile showed a striking rise in problems of oral cavity, cardio vascular disease, neurological problems and problems of gastro intestinal tract with advancing age in both elderly men and women. The study reveals striking differences in diet, health and disease profile with advancing age. PMID: 11439876 [PubMed - indexed for MEDLINE] 1466: Acta Psychiatr Scand. 2001 Jul;104(1):4-11. Related Articles, Links

A review of the epidemiological transition in dementia--crossnational comparisons of the indices related to Alzheimer's disease and vascular dementia.

Suh GH, Shah A. Department of Psychiatry, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul, Korea. OBJECTIVE: To examine temporal changes in the prevalence of dementia and associated factors. METHOD: All publications on the epidemiology of dementia were identified using a medline search for the years 1966-1999. RESULTS: Alzheimer's disease (AD) has become nearly twice as prevalent as vascular dementia (VaD) in Korea, Japan, and China since transition in early 1990s. Prior to this, in the 1980s, VaD was more prevalent than AD in these countries. In Nigeria, the prevalence of dementia was low. Indian studies were contradictory, with both AD and VaD being more prevalent in different studies. American and European studies consistently reported AD to be more prevalent than VaD. CONCLUSION: A theoretical model of transition from low incidence-high mortality society to high incidence-high mortality society to low incidence-low mortality society may explain these findings. Rigorous testing in prospective, longitudinal and population-based cross-national studies using culture-fair diagnostic instruments is required. Publication Types: •

Review

PMID: 11437743 [PubMed - indexed for MEDLINE] 1467: Bull World Health Organ. 2001;79(6):561-8. Related Articles, Links Erratum in: •

Bull World Health Organ 2001;79(12):1177.

Maternal mortality at the end of a decade: signs of progress? AbouZahr C, Wardlaw T. World Health Organization, 1211 Geneva 27, Switzerland. Maternal mortality is an important measure of women's health and indicative of the performance of health care systems. Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality. However, monitoring progress towards the goal has proved to

be problematic because maternal mortality is difficult to measure, especially in developing countries with weak health information and vital registration systems. This has led to interest in using alternative indicators for monitoring progress. This article examines recent trends in two indicators associated with maternal mortality: the percentage of births assisted by a skilled health care worker and rates of caesarean delivery. Globally, modest improvements in coverage of skilled care at delivery have occurred, with an average annual increase of 1.7% over the period 1989-99. Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over 2%. In sub-Saharan Africa, on the other hand, coverage has stagnated. In general, caesarean delivery rates were stable over the 1990s. Countries where rates of caesarean deliveries were the lowest-and where the needs were greatest--showed the least change. This analysis leads us to conclude that whereas there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East, the situation in sub-Saharan Africa remains disquieting. Publication Types: •

Comparative Study

PMID: 11436479 [PubMed - indexed for MEDLINE] 1468: Eur J Cancer. 2001 Jul;37(11):1402-8. Related Articles, Links

Population-based survival from colorectal cancer in Mumbai, (Bombay) India. Yeole BB, Sunny L, Swaminathan R, Sankaranarayanan R, Parkin DM. Bombay Cancer Registry, Indian Cancer Society, 74 Jerbai Wadia Road, Parel, (Bombay), 400 012, Mumbai, India. Survival estimates of patients registered by population-based cancer registries reflect the average prognosis from a given cancer as they are based on unselected patients with a wide range of natural histories and treatment patterns. In this paper, we report the survival experience of colorectal cancer patients in Mumbai (Bombay), India. Follow-up information on 1642 colorectal cancer patients registered by the Bombay Population-based Cancer Registry for the period 19871991 was obtained by matching with death certificates from the Bombay vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. Cumulative observed and relative survival proportions were calculated by Hakulinen's method. For comparison of results with other populations, age-standardised relative survival (ASRS) was calculated by directly

standardising age-specific relative survival to the specific age distributions of the world standard cancer patient population in 1985. The log-rank test was used to identify the potential prognostic variables which were introduced step-wise into a Cox regression model to identify the independent predictors of survival. The 5year relative survival was 36.6% for colon and 42.2% for rectal cancer. Age, site of cancer and clinical stage of disease emerged as independent predictors of survival. Age-specific 5-year relative survival declined with advancing age. Survival at 5 years was 61.2% for localised colon cancer; 31.9% for regional and 9.0% for distant metastatic disease. These were 65.7, 25.6 and 4.3%, respectively for rectal cancers. Comparison of the results with other populations revealed significant variations, which seem to be related to differences in detection and treatment. The prognosis from colorectal cancer in Mumbai and developing countries, may be further improved through early detection linked with treatment. Publication Types: • •

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

PMID: 11435072 [PubMed - indexed for MEDLINE] 1469: Disasters. 2001 Jun;25(2):172-80. Related Articles, Links

The accuracy of mortality reporting in displaced persons camps during the post-emergency phase. Spiegel PB, Sheik M, Woodruff BA, Burnham G. Johns Hopkins University, USA. [email protected] For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divided by the number of investigatoridentified deaths, of 83 per cent. For the majority of camps which under-reported deaths, mortality reporting ratios were significantly higher for women than men, and for camps with central mortality registers rather than those without. In the few camps which over-reported deaths, these occurred primarily among children younger than five years of age, probably due to the inclusion of abortions and stillbirths. Despite the overall under-reporting of deaths by humanitarian organisations, the existing health information systems appear to estimate mortality

rates adequately in these post-emergency camps. However, organisations should improve the precision and completeness with which they report the characteristics of deaths in order to provide valuable data to target their programmes at the most vulnerable people. Publication Types: •

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

PMID: 11434236 [PubMed - indexed for MEDLINE] 1470: J Med Genet. 2001 Jul;38(7):425-9. Related Articles, Links

Cultural aspects of cancer genetics: setting a research agenda. Meiser B, Eisenbruch M, Barlow-Stewart K, Tucker K, Steel Z, Goldstein D. Department of Psychological Medicine, Block 4, Level 5, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia. [email protected] BACKGROUND: Anecdotal evidence suggests that people from non-AngloCeltic backgrounds are under-represented at familial cancer clinics in the UK, the USA, and Australia. This article discusses cultural beliefs as a potential key barrier to access, reviews previous empirical research on cultural aspects of cancer genetics, draws implications from findings, and sets a research agenda on the inter-relationships between culture, cancer genetics, and kinship. METHODS: The CD-ROM databases MEDLINE, PsychLIT, CINAHL, and Sociological Abstracts were searched from 1980 onwards. RESULTS: Cultural aspects of cancer genetics is the focus of an emerging body of publications. Almost all studies assessed African-American women with a family history of breast cancer and few studies included more diverse samples, such as Americans of Ashkenazi Jewish background or Hawaiian- and Japanese-Americans. Our analysis of published reports suggests several directions for future research. First, an increased focus on various Asian societies appears warranted. Research outside North America could explore the extent to which findings can be replicated in other multicultural settings. In addition, control group designs are likely to benefit from systematically assessing culture based beliefs and cultural identity in the "majority culture" group used for comparative purposes. CONCLUSION: More data on which to base the provision of culturally appropriate familial cancer clinic services to ethnically diverse societies are needed. Empirical data will assist with culturally appropriate categorisation of people from other cultures into risk groups based on their family histories and provide the basis for the development of culturally appropriate patient education strategies and materials.

Publication Types: •

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

PMID: 11432959 [PubMed - indexed for MEDLINE] PMCID: PMC1757175

1471: Accid Anal Prev. 2001 Jul;33(4):563-5. Related Articles, Links

Safety and ergonomics evaluation of hybrid systems in Hong Kong. Chan AH, Courtney AJ. Department of Manufacturing Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong. [email protected] This study is aimed at understanding common safety and ergonomics problems with robot installation in Hong Kong. Information was collected through direct observations and personal interviews with robot users from advanced hybrid manufacturing systems. The application areas of robots and types of safety devices employed were investigated. The ages, types of jobs, daily working hours and working conditions of personnel were examined. Fire precaution measures, types and varieties of training programs for users were analyzed. The results showed that although investments were made for installation of robots for improving production activity, limited attention was paid to the health, safety, and ergonomics aspects in the hybrid systems. There were also cases reported where no formal guidelines for robot manipulation and operation were provided. It seems that management and users paid attention to robot function and capability more than robot safety during robotization process. Conclusions were made by the authors that efforts should immediately be made to adopt recommendations on the safety devices and facilities and training requirements for improving users' health and safety before fatal accidents occur. PMID: 11426686 [PubMed - indexed for MEDLINE] 1472: Saudi Med J. 2001 Jun;22(6):477-80. Related Articles, Links

Going beyond the curriculum to promote medical education and practice in Saudi Arabia.

Shawky S, Soliman NK. Department of Community Medicine and Primary Health Care, Faculty of Medicine and Allied Health Sciences, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia. [email protected] The foundation of health starts as early as undergraduate medical education. Medical education in the Kingdom has always been successful in promoting the medical profession and population health. The current issue in the Kingdom is quality assurance in all organizations including the health field. Thus emerges the value of evaluating the efficiency and effectiveness of the current system in meeting health needs and expectations. The aim of this paper was to analyze the current situation in order to design a frame for the direction of promotion of medical education and practice that best meets health needs and expectations. In fact, medical practice is a multidisciplinary process that is showing continuously changing theories. It has a broad scope of serving the whole community and improving the quality of life of all population categories. The huge quantity of information, needed to be retained by medical professionals, necessitates the move away from traditional methods of education to more practical and comprehensive programs of study. Most of the recent reform in medical education, in the Kingdom, has focused on curriculum and disregarded the education process. The requisite for the education process is a complete model of community-based health care, education and research. This study proposes a design aiming to enhance medical education and promote the medical profession, through developing the quality of medical professionals, that will foster growth of their activity and productivity, moving them into the community where clinical practice and experience are more relevant to the true health situation. Publication Types: •

Review

PMID: 11426235 [PubMed - indexed for MEDLINE] 1473: Saudi Med J. 2000 Aug;21(8):751-4. Related Articles, Links

Assessment of reporting and recording system of communicable diseases in Jeddah Region. Bakarman MA, Al-Raddadi RM. Joint Program for Postgraduate Family and Community Medicine, PO Box 8252, Jeddah 21482, Kingdom of Saudi Arabia.

OBJECTIVE: To determine the rate of reporting communicable diseases in Jeddah region, and to compare the recording system between the governmental and private sector. METHODS: This is a review of records study, in which the reports of communicable diseases from all hospitals and health centers (with or without cases) were studied, during the period of study; 1st to 25th international weeks 1999, and the reporting rate was calculated. A simple random sample was collected from these international weeks to evaluate the quality of recorded information. RESULTS: The reporting rate was 74%. Private hospitals have the highest rate in reporting (87%) and polyclinics have the least (67%). The recording rate was above 90% for administrative data. Personal data was complete except for patient name (76.5%), address (20%), and occupation (73%). The most prominent defect in the disease data was found to be in recording the mode of infection (13%), followed by previous vaccination (29%), date of symptoms (89%), and date of diagnosis (98%). Mode of infection was recorded in (40.5%) of cases by primary health care centers, but in polyclinics in only 1% of cases. Previous vaccination was recorded better by governmental sectors; (29%) by governmental hospital and (49%) by primary health care centers while in the private sectors the rate was (21%) by polyclinic and (25%) by private hospital. Date of symptoms was recorded in 90% of cases in all sectors except in governmental hospitals where it was only (50%). Date of diagnosis was recorded in more than (95%) in all sectors. The results show a statistical significant difference between different health sectors in recording data where government hospitals were least in recording doctor's name and in putting an official stamp in the form (p< 0.001); primary health care centers were the best in recording patient name and occupation (p< 0.001); polyclinics were least in recording mode of infection and previous vaccination (p< 0.001); for recording date of symptoms private hospitals were the best (p< 0.001). CONCLUSION: The reporting rate in Jeddah region was 74%, but its usefulness was diminished because of the incomplete, absent or incorrect personal and disease data. Publication Types: • •

Comparative Study Evaluation Studies

PMID: 11423888 [PubMed - indexed for MEDLINE] 1474: Osteoporos Int. 2001;12(4):311-8. Related Articles, Links

Hip fracture incidence rates in Singapore 1991-1998. Koh LK, Saw SM, Lee JJ, Leong KH, Lee J; National Working Committee

on Osteoporosis. Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore 169608. [email protected] In this population-based study, we determined the incidence rates of hip fracture among Singapore residents aged 50 years and above. Information was obtained from a centralized database system which captured admissions with the primary diagnosis of a closed hip fracture (ICD-9 codes 820, 820.0, 820.2 and 820.8, n = 12,927) from all health care establishments in the country from 1991 to 1998 inclusive. After removing duplicates, hospital transfers, readmissions and nonacute care admissions, the total number of hip fractures was 9406. Based on the national population census 1990 (n = 464,100) and yearly population estimates, the age-adjusted hip fracture rates for 1991-1998 (per 100,000) were 152 in men and 402 in women. This was 1.5 and over 5 times higher than corresponding rates in the 1960s. From 1991 to 1998, these hip fracture rates tended to increase by 0.7% annually in men and by 1.2% annually in women. Among the three major racial groups, in men, the Chinese had significantly higher age-adjusted hip fracture rates (per 100,000): 168 (95% confidence interval (CI) 158-178) compared with 128 (95% CI 105-152) for Indians and 71 (95% CI 54-88) for Malays. A similar pattern occurred in women: 410 (95% CI 395-425), for Chinese compared with 361 (95% CI 290-432) for Indians and 264 (95% CI 225-303) for Malays. Since the 1960s, the main increases in hip fracture rates have been seen in the Chinese and Malays, with the rates in Indians appearing to decrease. Hip fracture incidence rates in Singapore have risen rapidly over the past 30-40 years, particularly in women, and are now among the highest in Asia. Significant racial differences in hip fracture rates occur within the same community. Time trends in hip fracture rates differed between races. PMID: 11420781 [PubMed - indexed for MEDLINE] 1475: Crisis. 2000;21(4):156-8. Related Articles, Links

Intervention without interference: a column of Befrienders International. Keir N. PMID: 11419524 [PubMed - indexed for MEDLINE] 1476: Mil Med. 2001 Jun;166(6):475-9. Related Articles, Links

Quality of deployment surveillance data in southwest Asia.

Morrow RC, Schafer KO, Williams RL. Navy Environmental Health Center, Norfolk, VA 23513, USA. The Global Expeditionary Medical System (GEMS), formerly known as Desert Care II, provides clinical data on every medical encounter that occurs at U.S. Air Force medical treatment facilities in theater. After 22 months of surveillance from March 1997 to January 1999, 59,026 records were generated from 27,305 active duty members. A random sample of 273 individuals were reviewed for four key fields: chief complaint, diagnosis, International Classification of Diseases, 9th Revision, code, and disease and nonbattle injury category. The vast majority (> 99%) of records were consistently classified and reported. An unrelated subset of all cases categorized as "Medical/Other" seen at Prince Sultan Air Base (5,640 records) also were analyzed. Reassignment was made in 19% of cases into other categories, suggesting that further refinement of disease and nonbattle injury reporting is needed for effective deployment medical surveillance. Overall, this electronic data-gathering system has high internal validity, consistency, and reliability for service members in the deployed U.S. Air Force setting. PMID: 11413722 [PubMed - indexed for MEDLINE] 1477: Public Health Rev. 2000;28(1-4):23-6. Related Articles, Links

The first Israeli national health and nutrition survey (MABAT) as a policy maker. Kaluski DN, Goldsmith R, Arie OM, Mayer C, Green M. PMID: 11411274 [PubMed - indexed for MEDLINE] 1478: Radiother Oncol. 2001 Jul;60(1):81-9. Related Articles, Links

Quantitative status of resources for radiation therapy in Asia and Pacific region. Tatsuzaki H, Levin CV. Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency (IAEA), P.O. Box 200, A-1400, Vienna, Austria. PURPOSE: Resources for radiation therapy in Asian and Pacific countries were analyzed to obtain a better understanding of the status of radiation oncological

practice in the region. METHODS AND MATERIALS: The data were obtained mainly through surveys on the availability of major equipment and personnel which were conducted through an International Atomic Energy Agency regional project. The study included 17 countries in South Asia, South East Asia, East Asia and Australasia. Data were related to national populations and economic and a general health care indices. RESULTS: Large differences in equipment and personnel among countries were demonstrated. The availability of both teletherapy and brachytherapy was related to the economic status of the countries. The shortage of teletherapy machines was evident in more countries than that of brachytherapy. Many departments were found to treat patients without simulators or treatment planning systems. The number of radiation oncologists standardized by cancer incidence of a country did not correlate well with economic status. CONCLUSIONS: There were significant deficiencies in the availability of all components of radiation therapy in the analyzed countries. The deficiencies were linked predominantly to the economic status of the country. Cognisance should be taken of the specific shortfalls in each country to ensure that expansion or any assistance offered appropriately match its needs and can be fully utilized. The information on the resources currently available for radiation oncological practice in the region presented in this paper provides a valuable basis for planning of development aid programs on radiation therapy. PMID: 11410308 [PubMed - indexed for MEDLINE] 1479: Public Health. 2001 Jan;115(1):2-3. Related Articles, Links

The long march to primary health care in China: from collectivism to market economics. Browne D. Medical Adviser Health Promotion, Southampton Community NHS Trust, Southampton, UK. PMID: 11402345 [PubMed - indexed for MEDLINE] 1480: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 2:43-4. Related Articles, Links

International cooperation in neonatal screening: technical training course for newborn and infant screening. Fukushi M, Hanai J, Yamaguchi A, Mikami A, Honma K, Nomura Y, Arai O, Tagami Y, Oda H, Fujita K.

Sapporo City Institute of Public Health, Sapporo, Japan. We report the outline and results of our experience with a group training course of neonatal screening for health care professionals in developing countries. Sapporo City Institute of Public Health (SCIPH) has been offered a training course on neonatal screening once a year since 1991 under the Technical Training Program of the Japan International Cooperation Agency (JICA). The aims of this training course are to enhance the participants' technical knowledge and skills, and also to deepen their understanding of the principle of neonatal screening as well as the relevant diseases. Lectures and laboratory practice on phenylketonuria (PKU), congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH) and neuroblastoma are included in the 3-month program. After the completion of the training, participants are expected to play a major role in establishing and expanding neonatal screening system in each of their countries. We have received a total of 67 participants from 25 countries until March 1998: 58 pediatricians; 2 gynecologists; 6 biochemists; 1 administrative officer. After they returned to their countries, 11 engaged in neonatal screening and started PKU and CH screening in their institute, city or province in Argentina, Brazil, Mexico, Peru and Thailand. We believe that these results fulfilled our objectives. Also, for follow-up, SCIPH has been giving information and consultation to the participants on requests. This international cooperation network could also benefit our present network of the International Society Screening in the future. PMID: 11400777 [PubMed - indexed for MEDLINE] 1481: Environ Sci Pollut Res Int. 2001;8(2):127-37. Related Articles, Links

Using sustainable development indicators as a supplementary measure for the integrated management of environmental information system in Taiwan. Chang IC, Yu YH. Graduate Institute of Environmental Engineering, National Taiwan University, Room 311, 71 Chou-San Road, Taipei 106, Taiwan. [email protected] Environmental Information System (EIS) transfers environmental data and information to audiences in any field of knowledge or activity interested in environmental problems. Currently, numerous conventional EISs or Environmental Databases (EDs) are available in Taiwan. However, they fail to adequately address the strong correlations among the environmental, social and economic components. Notably, Sustainable Development Indicators (SDIs) combine environmental, social and economic dimensions, as well as illustrate the links among systems. Subsequently, developing a set of SDIs will provide an excellent opportunity to systematically consolidate the information scattered

among many archives, as well as promoting an integrated EIS. This work presents an experimental model referred to as the 'Sustainable Development Information System of the Island Taiwan' (SDISIT). This system was developed to assist the integrated management of either EIS or ED. The Factor Analysis Method (FAM) is one tool that may prove useful in easing the developing process. Furthermore, by examining the correlations between the indicators, this method can apply existing SDIs to identify the structure of interrelationships among indicators. Publication Types: •

Review

PMID: 11400638 [PubMed - indexed for MEDLINE] 1482: J Environ Manage. 2001 May;62(1):93-100. Related Articles, Links

Application of the Australian river bioassessment system (AUSRIVAS) in the Brantas River, East Java, Indonesia. Hart BT, Davies PE, Humphrey CL, Norris RN, Sudaryanti S, Trihadiningrum Y. Cooperative Research Centre for Freshwater Ecology and Water Studies Centre, Monash University, Wellington Road, Clayton 3800, Australia. Assessment of river 'health' using biological methods, particularly those based on macro-invertebrates, is now commonplace in most developed countries. However, this is not the case in most developing countries, where physical and chemical methods are used to assess water quality, with very little use of biological assessment methods. This paper reports on a project that aimed to assess the possible introduction of biological assessment of river condition using the Australian River Assessment System (AUSRIVAS) into Indonesia. The paper addresses three components of the project: (1) science--does the bioassessment method work in this tropical region? (2) resources--are they adequate and if not what additional resources are needed? (3) politics--what needs to be done to convince the agencies (both central and provincial) to take up such a new philosophy and approach? A pilot study was run in the upper Brantas River, East Java. A total of 66 reference sites and 15 test sites were sampled and the macroinvertebrates collected were identified to family level. A rigorous quality-control protocol was introduced to ensure the data were reliable and reproducible. The macro-invertebrate data were used to develop a predictive model of the AUSRIVAS type for the upper Brantas River, and the model was then used to assess the 'health' of sites that were presumed to be damaged in this section of the

river. A number of difficulties were experienced during the study, including: locating reference sites sufficiently unmodified by humans; lack of skills to identify animals collected; and a paucity of facilities required for aquatic macroinvertebrate identification (e.g. identification keys and good quality binocular microscopes). For resources, the major constraint to the introduction of a bioassessment capability in Indonesia is the lack of personnel trained in the bioassessment techniques. An 'on-the-job' training approach was adopted, largely because of the specialist nature of this work. Six Indonesians were trained and will now become the 'trainers' of further Indonesian scientists (we have called this process 'training-the-trainers'). For politics, it was hoped that the AUSRIVAS method would be suitable for introduction into the Indonesian national Clean River Program. A strategy was developed and implemented to ensure the method and its outputs were accepted technically by the Indonesian scientific community, and also by the resource managers and relevant government officials. Experience shows that if the latter do not see how the bioassessment information will be used for management purposes they will not accept the method even if it is scientifically sound. Publication Types: •

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

PMID: 11400467 [PubMed - indexed for MEDLINE] 1483: J Allied Health. 2001 Summer;30(2):68-74. Related Articles, Links

Determinants of job satisfaction among selected care providers in Kuwait. Shah MA, Chowdhury RI, al-Enezi N, Shah NM. Department of Health Information Administration, Faculty of Allied Health Sciences and Nursing, Kuwait University, Kuwait. [email protected] The study reports job satisfaction among a sample of 370 physicians, nurses, pharmacists, and medical laboratory technologists in the Ministry of Health hospitals in Kuwait. Job satisfaction was measured using Dunnette's scale. The respondents in all four categories were satisfied with all aspects of their jobs except salary. The medical laboratory technologists were, however, dissatisfied with professional advancement as well. The physicians were found to be most satisfied, closely followed by nurses and pharmacists, while medical laboratory technologists were least satisfied. Multivariate analysis was used to assess the net effects of background and work environment characteristics on overall job

satisfaction. Introduction to job, in-service training, and monthly income had significant positive effects on overall job satisfaction. These findings may have serious implications for health care delivery systems that recruit expatriate care providers. Publication Types: •

Multicenter Study

PMID: 11398232 [PubMed - indexed for MEDLINE] 1484: J Health Popul Nutr. 2001 Mar;19(1):6-11. Related Articles, Links Comment in: •

J Health Popul Nutr. 2001 Mar;19(1):4-5.

Health ethics in Pakistan: a literature review of its present state. Hyder AA, Nadeem S. Department of International Health, Johns Hopkins University, 615 North Wolfe Street, Suite E-8132, Baltimore, MD 21205, USA. [email protected] National literature on ethics provides an insight into the nature and development of a dialogue on health issues within a population. This study investigated the health ethics discourse in Pakistan. The purpose was to critically reflect on the nature and level of such discussions with the aim of stimulating an interest in the ethical implications of health and medicine in developing countries. The study evaluated the literature on biomedical and health ethics published in Pakistan during 1988-1999. Overall, there is a dearth of published discourse on healthcare ethics in Pakistan. Values that are considered to stem from religious teachings predominate in discussions relating to medical ethics. A lack of effective policy and legislation concerning the ethical practice of medicine is reported to have negative effects on the profession. Research ethics has not been captured in the published papers in Pakistan. Consideration of ethical issues in health is at an early stage in the country and may reflect the situation in a large part of the developing world. Publication Types: •

Review

PMID: 11394185 [PubMed - indexed for MEDLINE] 1485: Comput Methods Programs Biomed. 2001 Jul;66(1):5-15. Related Articles, Links

Status of PACS and technology assessment in Japan. Inamura K, Konishi J, Nishitani H, Kousaka S, Matsumura Y, Takeda H, Kondoh H. Faculty of Medicine, School of Allied Health Sciences, Osaka University, Yamadaoka 1-7, Suita-city, 565-0871, Osaka, Japan. The situation of PACS installations in Japan from 1987 to 1999 has been investigated. By 1999, 751 PACS units have been installed. Of these, 613 are small-size PACS with less than four image display terminals, 96 are medium-size with 5-14 terminals and 42 are large-size with 15 up to 300 terminals. The 42 hospitals with large sized PACS have been retrospectively investigated from 1984 for PACS experiments and from 1989 for PACS operation. Most of these 42 hospitals have increased the number of PACS terminals by installing additional PACS units instead of reinforcing the existing single PACS. Some (23%) PACS installations have obviously not been successful because of low image transfer speed and inadequate image quality. The use of DICOMM interfaces has increased the number of modalities connected to PACS and influenced the spread of PACS installations in Japan. The status of HIS and RIS coupling to PACS and the use of PACS in primary diagnosis or in image referral are discussed. Assessment of PACS is now in a very early stage. Baseline studies of HIS/RIS/PACS effectiveness have been carried out to assess quantitatively the PACS merit. Radiologists' answers to the questionnaire on PACS usage do not fully support the finding that the number of PACS installations is growing in Japan. PMID: 11378216 [PubMed - indexed for MEDLINE] 1486: Acta Trop. 2001 Apr 27;79(1):7-12. Related Articles, Links

A global network for the control of snail-borne disease using satellite surveillance and geographic information systems. Malone JB, Bergquist NR, Huh OK, Bavia ME, Bernardi M, El Bahy MM, Fuentes MV, Kristensen TK, McCarroll JC, Yilma JM, Zhou XN.

Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA. [email protected] At a team residency sponsored by the Rockefeller Foundation in Bellagio, Italy, 10-14 April 2000 an organizational plan was conceived to create a global network of collaborating health workers and earth scientists dedicated to the development of computer-based models that can be used for improved control programs for schistosomiasis and other snail-borne diseases of medical and veterinary importance. The models will be assembled using GIS methods, global climate model data, sensor data from earth observing satellites, disease prevalence data, the distribution and abundance of snail hosts, and digital maps of key environmental factors that affect development and propagation of snail-borne disease agents. A work plan was developed for research collaboration and data sharing, recruitment of new contributing researchers, and means of access of other medical scientists and national control program managers to GIS models that may be used for more effective control of snail-borne disease. Agreement was reached on the use of compatible GIS formats, software, methods and data resources, including the definition of a 'minimum medical database' to enable seamless incorporation of results from each regional GIS project into a global model. The collaboration plan calls for linking a 'central resource group' at the World Health Organization, the Food and Agriculture Organization, Louisiana State University and the Danish Bilharziasis Laboratory with regional GIS networks to be initiated in Eastern Africa, Southern Africa, West Africa, Latin America and Southern Asia. An Internet site, www.gnosisGIS.org, (GIS Network On Snail-borne Infections with special reference to Schistosomiasis), has been initiated to allow interaction of team members as a 'virtual research group'. When completed, the site will point users to a toolbox of common resources resident on computers at member organizations, provide assistance on routine use of GIS health maps in selected national disease control programs and provide a forum for development of GIS models to predict the health impacts of water development projects and climate variation. Publication Types: •

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

PMID: 11378137 [PubMed - indexed for MEDLINE] 1487: East Mediterr Health J. 2000 Jan;6(1):25-33. Related Articles, Links

Alternative medicine and the medical profession: views of medical students and general practitioners. Hasan MY, Das M, Behjat S.

Department of Pharmacology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. A survey was undertaken to explore the attitudes and practices of general practitioners and medical students in the United Arab Emirates with regards to forms of therapy not generally accepted by conventional medicine, including herbal medicine, acupuncture, homeopathy, spiritual therapy and osteopathy/chiropractic. The study found that alternative medicine is in common use to complement conventional medicine by a section of educated people within the health care system. Our observations lead us to appreciate its role in community health care and indicate a need to design culturally appropriate medical curricula which incorporate information about alternative medicine. PMID: 11370337 [PubMed - indexed for MEDLINE] 1488: Prehosp Disaster Med. 2001 Jan-Mar;16(1):18-21. Related Articles, Links

Proceedings for the 5th Asia-Pacific Conference on Disaster Medicine: creating an agenda for action. De Grace M, Ericson D, Folz H, Greene W, Ho K, Pearce L. Vancouver Hospital and Health Sciences Centre, USA. Disaster medicine has come to the forefront and has become the focus of interest not only in the medical community, but also in the eyes of the public. The 5th APCDM was convened in Vancouver, Canada, 27-30 September 2000. It brought together over 300 delegates from 32 countries to share their experiences and thoughts regarding disaster events and how to effectively manage them. The conference was devoted to the task of establishing priorities and creating an Agenda for Action. From the discussions, key actions required were defined: COMMUNICATIONS: (1) Identify existing regional telehealth groups and gather lessons to be learned from them; (2) Form a telehealth advisory group to work with regional groups to compile telehealth initiatives, identify international protocols in telehealth already in existence, and solicit feedback before setting international standards; and (3) Increase corporate partnerships in the fields of telehealth and telecommunications, and invite corporations to send delegates to future APCDM meetings. This should be an initiative of the APCDM, the World Association of Disaster and Emergency Medicine (WADEM), or the European Society of Emergency Medicine. EDUCATION AND RESEARCH: (1) Formalize education in disaster medicine and management. The World Health Organization and WADEM should take a leadership role; (2) WADEM is requested to hold a conference with a focus on qualitative research; (3) WHO is requested to continue the provision of international research teams, but to

advocate for the development of national disaster research infrastructure; (4) Make research findings and reports available on web sites of such organizations as WHO and PAHO; (5) Develop the translation of research for community utilization. The WHO and PAHO are organizations that are requested to consider this action; and (6) WADEM/APCDM are requested to focus future conferences on applied research. INFORMATION AND DATA: (1) Create an "Information and Data Clearinghouse on Disaster Management" to collect, collate, and disseminate information; (2) Collect data using standardized tools, such as CAR or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness and establish mechanisms for addressing the obstacles to preparedness; and (4) WADEM is requested to develop a web site providing a resource list of interdisciplinary institutions and response activities, organized by country, topic, and research interests. Links to other pertinent web sites should be provided. INTERDISCIPLINARY DEVELOPMENT: (1) Focus on the interdisciplinary nature of disaster response through more conferences encompassing grassroots efforts and through WADEM publications; (2) Develop and apply a standardized template of Needs Assessment for use by multidisciplinary teams. Team Needs Assessment is essential to determine the following: (a) Local response and international assistance required; (b) Appropriate command system; and (c) Psychosocial impact and support necessary. PSYCHOSOCIAL ASPECTS: (1) Incorporate relief for caregivers into action plans. This should include prime family members who also are caregivers; and (2) Implement measures that give survivors control over the recovery process. RESPONSE MANAGEMENT: (1) Define relationships and roles between governments, military and security personnel, non-governmental organizations (NGOs), and civic groups. Use an international legal framework and liability to reinforce accountability of disaster responders; (2) Establish a more sophisticated use of the media during disasters; (3) Establish standards in key areas. WADEM is requested to write "White Papers" on standards for the following areas: (a) management, (b) health/public health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4) Establish task forces to anticipate and resolve issues around evolving and emerging disasters (e.g., chemical and biological terrorism, landmines, emerging infectious diseases). WADEM was again identified as the vehicle for promoting this action. The responsibility of the next meeting of the Asia-Pacific Conference on Disaster Medicine will be to measure progress made in these areas by assessing how well these collective decisions have been implemented. Publication Types: •

Congresses

PMID: 11367932 [PubMed - indexed for MEDLINE] 1489: J Int Assoc Physicians AIDS Care. 1997 Oct;3(10):24-8. Related Articles, Links

HIV and AIDS in Germany. Mauss S, Dressler S. Deutsche AIDS-Hilfe, Berlin, Germany. AIDS: While Germany is still classified as a pattern I country under the World Health Organization (WHO) standards, meaning most new HIV infections occur in populations at risk, trends within this broad classification are slowly changing. Both the proportion and the absolute number of women reported as newly infected have increased, and account for 20 percent of all new infections. The annual number of new infections among gay men has stabilized at close to 1,000, or 55 percent of all new infections. Immigrants and refugees from endemic areas in Asia and Africa now comprise 17 percent of all newly reported infections. In addition, the country's policy of making new drugs available to Germans immediately after they are approved anywhere else in the world has created a healthcare system in which patients have access to a broad array of exciting new treatments, but little professional advice on treatment strategies or safety precautions. Thus, medical professionals must work to remain abreast of new developments in treatment. Meanwhile, organizations that have been set up to help people live with HIV face increased economic difficulties as new treatments lower morbidity rates. Publication Types: •

Newspaper Article

PMID: 11364743 [PubMed - indexed for MEDLINE] 1490: Saudi Med J. 2000 Dec;21(12):1168-72. Related Articles, Links

Study of hemoglobinopathies in Oman through a national register. Rajab AG, Patton MA, Modell B. Genetic Blood Disorders Unit, DGHA, Ministry of Health, PO Box 880, Muscat 113, Sultanate of Oman. [email protected] OBJECTIVES: A national register of symptomatic hemoglobinopathies has been developed in Oman to facilitate the development of the National Program for the control of genetic blood disorders. METHODS: The information was initially collected retrospectively through hospital records and was refined prospectively with data collected through a survey of pediatricians. The percentages of

heterozygotes in different population groups and geographical locations, birth prevalence, age distribution of cases and factors determining frequencies of Hemoglobinopathies in different regions of the country were studied from the register. RESULTS: The register has identified 1757 cases of homozygous Sickle Cell Anemia and 243 cases of beta-thalassemia major in a population of 1.5 million in 1995. Register based national figures of heterozygote carriers approximate 10% for Sickle Cell Anemia and 4% for beta-thalassemia major. CONCLUSION: Defining regional and tribal variations can assist efficient targeting of health resources. This approach provides a simple model for other countries or regions to follow providing there is a health care system that facilitates registration. PMID: 11360093 [PubMed - indexed for MEDLINE] 1491: Health Policy Plan. 2001 Jun;16(2):193-8. Related Articles, Links

The effectiveness of patient referral in Pakistan. Siddiqi S, Kielmann A, Khan M, Ali N, Ghaffar A, Sheikh U, Mumtaz Z. Health Services Academy, Islamabad, Pakistan. In Pakistan, despite an elaborate network of over 5000 basic health units and rural health centres, supported by higher-level facilities, primary health care activities have not brought about expected improvements in health status, especially of rural population groups. A poorly functioning referral system may be partly to blame. System analysis of patient referral was conducted in a district of Punjab province (Attock) for the purpose of identifying major shortcomings, if any, in this domain. Respondents from 225 households were interviewed. Of the households experiencing serious illnesses less than half were taken to a nearest first-level care facility (FLCF). Major reasons included dissatisfaction with quality of care offered, non-availability of physician, and patients being too ill to be taken to the FLCF. The FLCF utilization rate was less than 0.6 patient visits/person/year. The mean number of patients referred per FLCF during the previous 3 months was 6.5 +/- 5.0. Only 15% of patients were referred on the prescribed referral form. None of the higher-level facilities provided feedback to FLCFS: Records of higher-level facilities revealed lack of information on either patient referrals or feedback. There were no surgical or emergency obstetric services available at any of the first-level referral facilities. Seventy-five percent of the patients attending the first-level referral facilities and 44% of the patients attending higher-level facilities had a problem of a primary nature that could well have been managed at the FLCF. As a result of the study findings, eight principal criteria were identified that need to be satisfied before a referral system may be considered functional.

Publication Types: •

Evaluation Studies

PMID: 11358921 [PubMed - indexed for MEDLINE] 1492: Health Policy Plan. 2001 Jun;16(2):180-6. Related Articles, Links

Using costing as a district planning and management tool in Balochistan, Pakistan. Green A, Ali B, Naeem A, Vassall A. Nuffield Institute for Health, University of Leeds, UK. This paper reports on two studies in the province of Balochistan, Pakistan, analyzing the costs of primary care facilities and district and divisional hospitals. There are no known previous cost studies within Balochistan and the information gained is a critical element in developing a more rational allocation of resources within the health sector. The results demonstrate both the high level of underfunding of primary care within the health sector and the current inefficiency of allocation towards primary care and, within budgets, between different line items. Medicines in particular are significantly under-funded at the expense of staffing costs. The results are of use in developing more bottom-up budgeting systems within a more rational resource allocation system that is being developed as an element of the more decentralized health system towards which the province is working. Publication Types: •

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

PMID: 11358919 [PubMed - indexed for MEDLINE] 1493: Am J Trop Med Hyg. 2000 Jul-Aug;63(1-2):5-11. Related Articles, Links

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Harris E, Videa E, Pérez L, Sandoval E, Téllez Y, Pérez ML, Cuadra R, Rocha J, Idiaquez W, Alonso RE, Delgado MA, Campo LA, Acevedo F, Gonzalez A, Amador JJ, Balmaseda A. Division of Infectious Diseases, School of Public Health, University of California, Berkeley 94720-7360, USA. [email protected] From July to December 1998, a hospital- and health center-based surveillance system for dengue was established at selected sites in Nicaragua to better define the epidemiology of this disease. Demographic and clinical information as well as clinical laboratory results were obtained, and virus isolation, reverse transcriptasepolymerase chain reaction, and serologic assays were performed. World Health Organization criteria were used to classify disease severity; however, a number of patients presented with signs of shock in the absence of thrombocytopenia or hemoconcentration. Therefore, a new category was designated as "dengue with signs associated with shock" (DSAS). Of 1,027 patients enrolled in the study, 614 (60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%) as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary infection was not significantly correlated with DHF/DSS, in contrast to previous studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a minority due to DEN-2; both serotypes contributed to severe disease. As evidenced by the analysis of this epidemic, the epidemiology of dengue can differ according to geographic region and viral serotype. Publication Types: •

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

PMID: 11357995 [PubMed - indexed for MEDLINE] 1494: Schizophr Bull. 2001;27(2):181-5. Related Articles, Links

Impact of the term schizophrenia on the culture of ideograph: the Japanese experience. Kim Y, Berrios GE. Division of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ichikawa, Japan. [email protected]

The ideographic Chinese writing system (in use in Asian countries that account for about a quarter of the world's population) directly expresses the meaning of schizophrenia as "the disease of disorganized mind." The term directly challenges a deeply ingrained concept of personal autonomy, and this is stigmatizing. Japanese psychiatrists are thus reluctant to tell their patients that they are suffering from schizophrenia, and, as a result, no more than 20 percent of sufferers actually do know about their diagnosis. Because taking medication is based on informed consent and the exercise of the patient's autonomy, such lack of information has important negative effects. It is unlikely that this problem can be resolved by education or information alone, and it may well be the case that in cultures using ideographs, the illness will need to be renamed. This article suggests some alternatives. Publication Types: •

Comparative Study

PMID: 11354585 [PubMed - indexed for MEDLINE] 1495: Isr Med Assoc J. 2001 Jan;3(1):17-20. Related Articles, Links

A four year survey of neonatal narcotic withdrawal: evaluation and treatment. Lifshitz M, Gavrilov V, Galil A, Landau D. Toxicology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. [email protected] BACKGROUND: Narcotic abuse has steadily become more prevalent in Israel and may result in an increasing number of children exposed prenatally to narcotics, with a consequent increase in the number of infants born with neonatal abstinence syndrome. OBJECTIVE: To report our experience with infants born to narcotic-addicted women between the years 1995 and 1998 at the Soroka University Medical Center. METHODS: The medical records of 24 newborns and their drug-addicted mothers admitted to our Medical Center for parturition were analyzed retrospectively. A diagnosis of NAS was established on the basis of the clinical presentation and anamnesis. The Finnegan Neonatal Abstinence Scoring System was used to assess drug withdrawal. Urine toxicological analysis for narcotics was done only for the year 1998. RESULTS: Of the 24 newborn infants exposed prenatally to narcotics 23 (96%) developed NAS, and 78% (18 of the 23) had a Finnegan score of 8 or more. These 18 infants were treated

pharmacologically (tincture of opium and/or phenobarbital) until the score was reduced to less than 8, after which they received supportive treatment. In one child who became lethargic after the first dose of tincture of opium, the medication was stopped and supportive treatment alone was given. Four of the five neonates with scores of 7 and less were given supportive treatment. One of five infants who had a low Finnegan score at birth nevertheless received pharmacological therapy to prevent further deterioration of his physical state since he was born with severe dyspnea. Ten of the 24 children (42%) were followed for lengths of time ranging from 6 to 22 months after discharge, all of whom showed normal development. CONCLUSIONS: About three-quarters of newborns exhibiting withdrawal syndrome required pharmacological therapy. Previous information on maternal drug abuse is a crucial criterion for early detection and treatment. PMID: 11344794 [PubMed - indexed for MEDLINE] 1496: Isr Med Assoc J. 2000 Nov;2(11):811-5. Related Articles, Links

Medical research in Israel and the Israel biomedical database. Berns DS, Rager-Zisman B. Chief Scientist's Office, Ministry of Health, Jerusalem, Israel. The data collected for the second edition of the Directory of Medical Research in Israel and the Israel Biomedical Database have yielded very relevant information concerning the distribution of investigators, publication activities and funding sources. The aggregate data confirm the findings of the first edition published in 1996 [2]. Those facts endorse the highly concentrated and extensive nature of medical research in the Jerusalem area, which is conducted at the Hebrew University and its affiliated hospitals. In contrast, Tel Aviv University, whose basic research staff is about two-thirds the size of the Hebrew University staff, has a more diffuse relationship with its clinical staff who are located at more than half a dozen hospitals. Ben-Gurion University in Beer Sheva and the Technion in Haifa are smaller in size, but have closer geographic contact between their clinical and basic research staff. Nonetheless, all the medical schools and affiliated hospitals have good publication and funding records. It is important to note that while some aspects of the performance at basic research institutions seem to be somewhat better than at hospitals, the records are actually quite similar despite the greater burden of clinical services at the hospitals as compared to teaching responsibilities in the basic sciences. The survey also indicates the substantial number of young investigators in the latest survey who did not appear in the first survey. While this is certainly encouraging, it is also disturbing that the funding sources are apparently decreasing at a time when young investigators are

attempting to become established and the increasing burden of health care costs precludes financial assistance from hospital sources. The intensity and undoubtedly the quality of medical research in Israel remains at a level consistent with many of the more advanced western countries. This conclusion is somewhat mitigated by the fact that there is a decrease in available funding and a measurable decrease in scholarly activity at a time when a new, younger generation of investigators is just beginning to become productive. In closing, we wish to stress that the collection of data for the Biomedical Database is a continuing project and we encourage all medical researches who may not have contributed relevant information to write to the Office of the Chief Scientist or contact the office by email. PMID: 11344748 [PubMed - indexed for MEDLINE] 1497: Asia Pac J Public Health. 2000;12 Suppl:S67-70. Related Articles, Links

Healthy City Kwachon 21 Project: a community health promotion programme in Korea. Kim HJ. Graduate School of Health Science and Management, Yonsei University Medical Center, 134 Shinchon-Dong, Soedaemoon-Gu, Seoul 120-752, Korea. Disease patterns of Koreans changed from infectious disease to non-infectious disease in the 1970's. Even though there has been a need for a health promotion programme, it was hard to find the programme in the community before 1985 in Korea. In 1985, the Public Health Promotion Law was enacted and the Korean government started to encourage local government to plan and conduct community health promotion programs. Healthy City Kwachon 21 (HCK21) is a health promotion programme for all residents in Kwachon, a city which has about 70,000 population and is located adjacent to Seoul, Korea. HCK21 launched in 1998 with three guiding principles: 1) programs should be accessible to all citizens; 2) Programmes should stimulate strong community participation and 3) Programmes should change environment and society. The long term goal of HCK21 is to increase the healthy life span of citizens in Kwachon. HCK21 is a collaborative project between Kwachon and the Institute for Health Promotion of the Graduate School of Health Science and Management, Yonsei University. It has seven components: 1) Publication of Monthly Health Newsletter; 2) Smoking Cessation and Tobacco Prevention Program; 3) Community Nutrition Program; 4) Maternal and Women's Health Programme; 5) Programme for Development of District Health Management Information System; 6) Hypertension Prevention and Control Programme and 7) Physical Activity Programme. HCK21 is now being implemented in the third year program since the program conducted in 1998 and 1999 was successful with received support from the citizens. It is recommended

that HCK21 be a model for an integrated community-based health promotion programme in developing countries. PMID: 11338743 [PubMed - indexed for MEDLINE] 1498: Nippon Ishinkin Gakkai Zasshi. 2001;42(2):75-80. Related Articles, Links

US-Japan workshops in medical mycology: past, present and future. Dixon DM. Bacteriology and Mycology Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 23298, USA. The Extramural Mycology Program of the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) has organized and implemented a five workshop series in medical mycology during a critical period in the evolution of contemporary medical mycology (1992 to 2000; http://www.niaid.nih.gov.ezproxy.lib.ucalgary.ca/research/dmid.htm). The goals of the workshop series were to: initiate interactions; build collaborations; identify research needs; turn needs into opportunities; stimulate molecular research in medical mycology; and summarize recommendations emerging from the workshop proceedings. A recurring recommendation in the series was to foster communications within and beyond the field of medical mycology. US-Japan interactions were noted as one specific example of potential information exchange for mutual benefit. The first formal action directed at this recommendation was the workshop Emergence and Recognition of Fungal Diseases convened under the auspices of the US-Japan Cooperative Medical Science Program (USJCMSP; http://www.niaid. nih.gov/dmid/us%5Fjapan/default.htm) in Bethesda, Maryland USA on 30 June 1999 (D.M. Dixon & T. Matsumoto, co-chairs). A major goal of the workshop was to present contemporary medical mycology to the Joint Committee of the USJCMSP through representative research presentations in order to make the Committee aware of current status in the field, and the potential for scientific interactions. The second formal action is the workshop, under the auspices of the Japanese Society for Medical Mycology Medical Perspectives of Fungal Genome Studies scheduled for 28 November 2000 in Tokyo, Japan (T. Matsumoto & D.M. Dixon, co-chairs). The NIAID Mycology Workshop series recommended interactions between the following groups: academic and pharmaceutical; medical and molecular (model systems); medical and plant pathogens; basic and clinical; mycologists and immunologists. The first two USJapan workshops can be viewed as consistent with these recommendations, and serve as a Western/Eastern gateway for exchange. The focus of the second USJapan workshop on genome projects for the medically important fungi provides an excellent model for international communications. Given the tsunami of

information that is flowing from genomics and bioinformatics, it is clear that global interactions will be essential in managing and interpreting the data. Publication Types: •

Review

PMID: 11331467 [PubMed - indexed for MEDLINE] 1499: Soc Sci Med. 2001 Feb;52(3):393-404. Related Articles, Links

Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic. Stenson B, Syhakhang L, Eriksson B, Tomson G. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. [email protected] The private sector is a dominant actor in the provision of pharmaceuticals, particularly in developing countries. Private provision of drugs has been associated with risks regarding availability, affordability, rational use and drug quality. Ensuring an effective regulatory framework is therefore a major challenge for governments, yet the capacity of regulatory authorities is often outstripped by private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a poor, landlocked country in South East Asia, the private provision of drugs has increased dramatically since the liberalisation of the economy in the late 1980s. This paper aims to describe the quality of the private pharmacy services in the Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument which serves to make the concept of Good Pharmacy Practice (GPP) operational was developed and applied to a sample of pharmacies. Service quality, as measured by three facility-specific indicators, showed a tendency to be lower in the most distant districts. Poor dispensing practices were manifest by a lack of information about drugs sold in 59% of cases, drugs not being labelled in 47% and different drugs being mixed in the same package in 26% of cases. The prices of four sample drugs were slightly higher in the remote districts. A 10-fold price difference for the same drug was recorded in one district. After reporting the findings, the paper discusses the possible influence of district and pharmacy variables on the quality of services, and goes on to discuss the price differences. It is concluded that further government interventions are needed in order to improve the quality of services and to focus regulatory action on a limited number of aspects, to ensure that drugs can be traced before trying to establish a comprehensive regulatory system.

Publication Types: •

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

PMID: 11330774 [PubMed - indexed for MEDLINE] 1500: Cancer Nurs. 2001 Apr;24(2):156-61. Related Articles, Links •

Development of a breast self-examination program for the Internet: health information for Korean women. Kim HS, Kim E, Kim JW. Yonsei University, College of Nursing, Seoul, Korea. Internet-based health information will enable us to interact with many people despite distance and time constraints. Informational media by computer is expected to become an important factor that affects health behavior. This study was done to develop an accessible multimedia program about breast selfexamination on the Internet. This study was designed by using the two steps of need assessment and program development. For the need assessment step, a survey was carried out. The sample consisted of the 82 women of Yonsei University selected by convenient random sampling. At the program development step, screen design took into account perspectives of computer engineering. A storyboard for every screen was made via screen design and then ported to computer using the Netscape Navigator program. A breast self-examination program was developed using Netscape 4.0 on the Windows 98 platform. The multimedia program, including text, graphics, animation, and sound, was constructed with HTML language using Memo Sheet in Netscape Navigator. The contents of health information posted on the Internet included general information about breast cancer, the importance of breast self-examination, self-risk appraisal of breast cancer, the diverse methods about breast self-examination, the monthly check list graph, and social network for consultation. It is possible to interact with clients through the Question and Answer function on screen. This Internet-based health information program provides enough information, which can be accessed using search systems on the Internet. PMID: 11318264