His 8

1501: Int J Med Inform. 2001 May;61(2-3):175-87. Related Articles, Links

Implementation and evaluation of a multifunctional telemedicine system in NTUH. Lin CC, Chen HS, Chen CY, Hou SM. Department of Medical Informatics, Collage of Medicine, National Taiwan University, Taipei, Taiwan. In this article, we proposed a multifunctional telemedicine system supporting both telediagnosis and teleconsultation services. We attempted not only to insure that the implementation of this system satisfied most requirements, but also to evaluate the impact of the system. With regard to system architecture, we designed a unified multimedia database to store all types of data and used two kinds of network (ATM and ISDN) for different possible applications. As for data transmission, the REFRESH and PREFETCH mechanisms were implemented to enhance data transfer efficiency. A total of 1107 consultations employing the telemedicine system were performed during the past 3 years. This technology was used most frequently for radiology consultation (32.7%, n = 362) and ultrasonic examination (19.5%, n = 216). An evaluation of the impact on diagnosis (507 valid cases) indicated that the diagnosis in 80 cases (15.78%) were altered on the basis of second opinions from a medical center; and the number of patients transferred to the medical center was reduced from 24 (4.7%) to eight cases. Most of the rural-site physicians (97%) thought that they did benefit from specialists' experience and knowledge via the telemedicine system. Based on 431 valid questionnaires, the number of the patients with confidence in the telemedicine system at their local healthcare center increased from 72.6% to 87.5%. Overall, more than 90% of patients and physicians believed that the system was valuable and provided satisfactory services. Publication Types: • •

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

PMID: 11311672 [PubMed - indexed for MEDLINE] 1502: Int J Med Inform. 2001 May;61(2-3):117-29. Related Articles, Links

Review of telemedicine projects in Taiwan. Chen HS, Guo FR, Chen CY, Chen JH, Kuo TS. Department of Medical Informatics, Section 1, 1 Jen-Ai Road, 100, Taipei, Taiwan. [email protected] Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household. Publication Types: •

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

PMID: 11311666 [PubMed - indexed for MEDLINE] 1503: Int J Med Inform. 2001 May;61(2-3):113-6. Related Articles, Links

The Ministry of Public Health telemedicine network of Thailand.

Kasitipradith N. Ministry of Public Health, 11000, Nonthaburi, Thailand. [email protected] The concept of telemedicine is rather new in Thailand and initially, the introduction of telemedicine into the country was hampered by technological limitations. The problem was further aggravated by the inadequacy of telecommunications infrastructures in the rural areas. However, recent rapid advances in info-communications technology, together with the launch of Thailand's first communication satellite, THAICOM I in December 1993, have made it possible for health care to be delivered to remote areas of the country via telemedicine. This paper documents the experience of implementing Thailand's nationwide Telemedicine Network by the Ministry of Public Health (MOPH), beginning with a pilot project in 1994 to the current system, launched in January 1998, that links the Information Technology Office of the MOPH and 19 hospitals with health facilities all over the country via satellite and computer networks. PMID: 11311665 [PubMed - indexed for MEDLINE] 1504: Cancer Epidemiol Biomarkers Prev. 2001 Mar;10(3):237-42. Related Articles, Links

Epidemiological study of urinary 6beta-hydroxycortisol to cortisol ratios and breast cancer risk. Zheng W, Jin F, Dunning LA, Shu XO, Dai Q, Wen WQ, Gao YT, Holtzman JL. Vanderbilt Center for Health Services Research and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee 37232-8300, USA. The ratio of urinary 6beta-hydroxycortisol:cortisol is a measure of the activity of cytochrome p450 3A4 (CYP3A4). CYP3A4 catalyzes the formation of the genotoxic estrogen, 16alpha-hydroxyestrone. It is also involved in the activation of many other mammary carcinogens, such as the polycyclic aromatic hydrocarbons and heterocyclic amines. We evaluated the association between urinary cortisol ratios and breast cancer risk in a subgroup of women who participated in a population-based case-control study in Shanghai. Overnight urine samples from 246 case-control pairs were assayed for 6beta-hydroxycortisol (6beta-OHC) to cortisol. The urine samples from all of the breast cancer patients were collected before any chemotherapy or radiotherapy. In-person interviews were conducted to obtain comprehensive information on dietary habits, reproductive history, and other lifestyle factors. The median levels of 6betaOHC:cortisol ratios were 2.61 in cases and 2.16 in controls, a 20.8% difference (P

< 0.001). The case-control difference was larger in women over 45 years of age (31.3% difference; P < 0.001) than younger women (6.0%; P = 0.45). After adjusting for confounding variables, the risks of breast cancer were increased from 1.0 (reference) to 1.6 [95% confidence interval (CI), 0.9-3.1], 2.2 (95% CI, 1.1-4.2), and 3.7 (95% CI, 1.9-7.4; P for trend, <0.001) with increasing levels of 6beta-OHC:cortisol ratios. The positive association was more pronounced among older women (>45 years) than among younger women (< or = 45 years). The adjusted odds ratios associated with the highest cortisol ratio were 6.0 (95%CI, 2.2-16.1) among older women and 2.2 (95%CI, 0.8-6.1) among younger women. The association of the 6beta-OHC:cortisol ratio was stronger among older women who had a high body mass index, late age at menopause, and early age at menarche (factors related to high endogenous estrogen exposure) than those who did not have these factors. These findings are consistent with the role of CYP3A4 in estrogen and carcinogen metabolism and suggest that high CYP3A4 activity may be a risk factor for breast cancer risk. Publication Types: • •

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

PMID: 11303593 [PubMed - indexed for MEDLINE] 1505: JAMA. 2001 Mar 28;285(12):1632-40. Related Articles, Links

Medical malpractice and legal resolution systems in Japan. Nakajima K, Keyes C, Kuroyanagi T, Tatara K. Department of Social and Environmental Health F2, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita-shi, Osaka 565-0871, Japan. [email protected] Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars).

Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-ofcourt review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians. PMID: 11268273 [PubMed - indexed for MEDLINE] 1506: J Oral Rehabil. 2001 Jan;28(1):78-87. Related Articles, Links

On-line computerized diagnosis of pain-related disability and psychological status of TMD patients: a pilot study. Yap AU, Tan KB, Hoe JK, Yap RH, Jaffar J. Department of Restorative Dentistry, Faculty of Dentistry, National University of Singapore, Republic of Singapore. [email protected] Temporomandibular disorders (TMD) is a collective term embracing a number of clinical problems, which involve the masticatory musculature, the temporomandibular joint or both. Virtually all theories dealing with the aetiology and treatment of TMD have recognized the importance of psychological factors. This paper reports the development of a computerized on-line program (NUS TMD v1.1) for the diagnosis of pain-related disability and psychological status of TMD patients based on Axis II of the research diagnostic criteria (RDC)/TMD (Dworkin, S.F. & LeResche, L. 1992. Journal of Craniomandibular Disorders: Facial Oral Pain, 6, 301), which was developed to redress the lack of diagnostic criteria in TMD research. Methods adopted by RDC/TMD for use in assessing Axis II status include a seven-item questionnaire for grading chronic pain severity, the Symptom Checklist 90 Revised (SCL-90-R) and a jaw disability checklist. A pilot study, based on 37 new TMD patient records, was conducted to study the pain-related disability and psychological status of TMD patients using this newly developed program. The mean age of the predominantly Chinese

population (86.5%) was 32.19 years (range 20-72 years) with a sex distribution of 24 females and 13 males. Most patients (78%) had low disability, with 12 patients having low intensity and 17 patients having high intensity pain. Approximately 73% of the sample population were moderately or severely depressed. Patients that were moderately and severely depressed had significantly higher scores for limitation related to mandibular functioning than normal patients. The three most frequent jaw disabilities were: eating hard foods (84%), yawning (78%) and chewing (65%). PMID: 11298913 [PubMed - indexed for MEDLINE] 1507: J Indian Med Assoc. 2000 Sep;98(9):559-60, 562-6, 571. Related Articles, Links

Integrated child development services scheme (ICDS) in India: its activities, present status and future strategy to reduce malnutrition. Kapil U, Pradhan R. Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi. Integrated Child Development Services Scheme (ICDS) provides an integrated approach for converging all the basic services for improved child care, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. Its objectives are: To improve nutritional and health status of children of 0-6 years; to reduce the incidence of mortality, morbidity, malnutrition and school dropout; to achieve effective co-ordination amongst various departments to promote child development; to lay foundation of proper psychological,physical and social development of the child; to enahance mother's capability to look after normal health and nutritional needs of the child. ICDS services are provided through a village based centre ie, the Anganwadicentre for the services of: Supplementary nutrition, immunisation, health check-up, referral services, treatment of minor illnesses, nutrition and health education to women, preschool education to children and supports for water supply, sanitation, etc. Several government departments and their services are co-ordinated at village, block, district, state and central levels. The Anganwadiworker is the most peripheral functionary which implements the programme services at the village/community level. In projects where able leadership has been provided, ICDS has been reported to be better. Though there are some shortcomings in ICDS, till future thrust of the programme is necessary for aiming of the upliftment of underprivileged section of the population. Operative research in various areas is suggested which can help in improving the efficiency of ICDS.

Publication Types: •

Review

PMID: 11291790 [PubMed - indexed for MEDLINE] 1508: Soc Sci Med. 2001 May;52(9):1313-27. Related Articles, Links

Older people and AIDS: quantitative evidence of the impact in Thailand. Knodel J, VanLandingham M, Saengtienchai C, Im-em W. Population Studies Center and Department of Sociology, Institute for Social Research, University of Michigan, Ann Arbor 48106-1248, USA. [email protected] Discussions of the AIDS epidemic rarely consider the impact on older people except as infected persons. Virtually no systematic quantitative assessments exist of the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in either the West or the developing world. We assess the extent of such types of involvement in Thailand, a country where substantial proportions of elderly parents depend on adult children for support and where co-residence with an adult child is common. Interviews with local key informants in the public health system in rural and urban communities provided quantitative information on a total of 963 adult cases who either had died of AIDS or were currently symptomatic. The results indicate that a substantial proportion of persons with AIDS move back to their communities of origin at some stage of the illness. Two-thirds of the adults who died of an AIDS-related disease either lived with or adjacent to a parent by the terminal stage of illness and a parent, usually the mother, acted as a main caregiver for about half. For 70%, either a parent or other older generation relative provided at least some care. The vast majority of the parents were aged 50 or more and many were aged 60 or older. This extent of older generation involvement appears to be far greater than in Western countries such as the US. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situations in Thailand and the West. The fact that older people in Thailand, and probably many other developing countries, are extensively impacted by the AIDS epidemic through their involvement with their infected adult children has important implications for public health programs that address caretaker education and social and economic support.

Publication Types: • •

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

PMID: 11286358 [PubMed - indexed for MEDLINE] 1509: Biosci Biotechnol Biochem. 2001 Jan;65(1):1-13. Related Articles, Links

A mainstay of functional food science in Japan--history, present status, and future outlook. Arai S, Osawa T, Ohigashi H, Yoshikawa M, Kaminogawa S, Watanabe M, Ogawa T, Okubo K, Watanabe S, Nishino H, Shinohara K, Esashi T, Hirahara T. Department of Nutritional Science, Tokyo University of Agriculture, Japan. The development of food science in the near future probably depends on the advance in functional food science, the concept of which was proposed first in Japan nearly 15 years ago. The new science has been internationally distributed and accepted as conceptually being beyond nutrition. In Japan, however, it traced a unique path of progress in the form of a product-driven rather than conceptdriven science. Actually, a number of substances and products with potential for disease risk reduction rather than simply for health maintenance have been investigated for their body-modulating functions. Some of them have been applied in practice to the industrialization of functional foods in terms of "foods for specified health uses" legally defined by new legislation. A variety of sophisticated methods have been introduced as well, including the so-called "XYZ" evaluation system, database construction for assessment of the function, and even the DNA microarray technique. The Ministry of Agriculture, Forestry, and Fisheries (MAFF) and the Ministry of Health and Welfare (MHW) also commenced their scientific as well as political activity, with its spread to industries which almost simultaneously began to vigorously investigate functional food products for enlargement of the food market. With all of this as a background, the Japan Liaison of the International Union of Food Science and Technology (IUFoST) hold a function food science symposium on behalf of related scientific bodies including the Japan Section of the International Life Science Institute (ILSI). This paper is an overview compiled from 12 presentations made in the symposium, with the aim of internationally publicizing the activity of functional food science in Japan.

Publication Types: •

Review

PMID: 11272811 [PubMed - indexed for MEDLINE] 1510: Health Promot Int. 2001 Mar;16(1):87-94. Related Articles, Links

Health literacy in health systems: perspectives on patient selfmanagement in Israel. Levin-Zamir D, Peterburg Y. Department of Health Education and Promotion, Clalit Health Services, 101 Arlozorov Street, Tel Aviv 62098, Israel. Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and inservice training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-

management capabilities and advocate for improved health services, can be very beneficial. PMID: 11257858 [PubMed - indexed for MEDLINE] 1511: J Air Waste Manag Assoc. 2001 Feb;51(2):264-72. Related Articles, Links

Remedial strategies for municipal solid waste management in China. Wang H, Nie Y. Department of Environmental Science and Engineering, Tsinghua University, Beijing, China. [email protected] The purpose of this investigation is to evaluate the current status and to identify the problems of municipal solid waste (MSW) management in China to determine appropriate remedial strategies. This is the second of two papers proposed on this topic. Major problems or difficulties identified in MSW management in China include MSW land, air, and water pollution, commingled collection, poor administration, shortage of funds, lack of facilities, and problems of training and public awareness. In order to solve these problems and to improve MSW management in China, remedial strategies in three areas are recommended: institutional reform, technology development, and legislation and administrative improvement. The primary principle involved in institutional reform is unifying legislative responsibilities into one body and developing a market mechanism for handling MSW. Composting, landfills, and incineration should be equally developed in accordance with China's needs. The feasibility of developing technology to handle MSW in China is discussed. Also recommended is the establishment of sound regulatory systems, including a service fee system, a source separation system, and a training program. China is presently undergoing economic and institutional reform at the national and local levels. Results of this study will provide useful information on MSW management in China. PMID: 11256501 [PubMed - indexed for MEDLINE] 1512: J Adv Nurs. 2001 Feb;33(4):467-74. Related Articles, Links

Nursing competencies: personal characteristics contributing to effective nursing performance. Zhang Z, Luk W, Arthur D, Wong T.

Guanghua School of Management, Peking University, Beijing, China. [email protected] AIMS OF THE STUDY: Core competencies are important in enabling an individual to adapt to new environments and perform superior professional practice. This study was to identify the underlying competencies which contributed to effective nursing performance. BACKGROUND: Most of the previous competencies are either derived from researchers' conceptual analysis or based on practitioners' direct report. Competencies derived from these methods either are subject to bias or are unable to identify the essential elements for effective nursing care. METHOD: Following the McBer method, 50 experienced nurses in China were asked to report 82 valid critical incidents in their jobs. Two individuals coded the scripts and decided the presence of each competency according to a pre-established coding system. RESULTS: Ten competencies including interpersonal understanding, commitment, information gathering, etc. were identified. Each competency was illustrated by behavioural indicators. CONCLUSIONS: Skills, traits, motives and attitudes all contribute to effective nursing performance. The findings assist in the delineation and development of nursing competencies and thus provide realistic working behaviours for nursing education and management. Publication Types: •

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

PMID: 11251734 [PubMed - indexed for MEDLINE] 1513: Bull World Health Organ. 2001;79(2):142-9. Related Articles, Links

Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh. Routh S, el Arifeen S, Jahan SA, Begum A, Thwin AA, Baqui AH. Operations Research Project, Health and Population Extension Division, ICDDR,B-Centre for Health and Population Research, Mohakhali, Dhaka 1212, Bangladesh. The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour-intensive and costly. More cost-

effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinicbased service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services. Publication Types: •

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

PMID: 11242821 [PubMed - indexed for MEDLINE] 1514: Int J Radiat Biol. 2001 Feb;77(2):254. Related Articles, Links

International cooperation post-Chernobyl. Scientific Project Panel of the International Cooperation to Establish Post Chernobyl Thyroid Tissue, Nucleic Acid and Databanks. Thomas GA, Williams ED. Publication Types: •

Letter

PMID: 11236933 [PubMed - indexed for MEDLINE] 1515: Ann Trop Med Parasitol. 2001 Jan;95(1):41-6. Related Articles, Links

Resistance of Plasmodium falciparum malaria to chloroquine is widespread in eastern Afghanistan.

Rab MA, Freeman TW, Durrani N, de Poerck D, Rowland MW. HealthNet International, 11-A Circular Lane, University Town, P.O. Box 889, Peshawar, Pakistan. [email protected] After two decades of war and conflict in Afghanistan, the public-health system is in disarray and malaria has re-emerged as a major disease, with Plasmodium falciparum malaria becoming increasingly common. The limited healthcare services that are available are mainly delivered by non-governmental organizations in collaboration with the Ministry of Health. Although chloroquine (CQ) remains the official first-line treatment against P. falciparum malaria, there is little information on the severity or distribution of resistance to this drug in Afghanistan. In-vivo surveys, co-ordinated by the Malaria Reference Centre in Jalalabad, were therefore performed to determine the frequency and grades of CQ resistance in the three eastern provinces of Kunar, Nangarhar and Laghman. Of the 142 cases enrolled in the study, only 47 (33%) were sensitive. Most of the cases (55%) showed RI resistance but RII/RIII resistance was not uncommon (11%). The prevalence of resistance appeared similar in children and adults, in males and females, and in each of the three provinces investigated. Gametocyte carriage post-treatment was elevated in the resistant cases. As in neighbouring Pakistan, the resurgence of P. falciparum in Afghanistan is probably associated with the transmission and spread of chloroquine-resistant strains. The first-line therapy used against P. falciparum malaria must be changed in order to reverse this trend. Publication Types: •

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

PMID: 11235552 [PubMed - indexed for MEDLINE] 1516: J Trauma. 2001 Jan;50(1):20-3. Related Articles, Links

Do accidents happen accidentally? A study of trauma registry and periodical examination database. Avi A, Yehonatan S, Alon S, Alexandra H, Arieh E. Israel Defense Force-Medical Corps. BACKGROUND: Health profile of trauma victims might affect accident involvement. Information linking medical data to accident epidemiology is lacking. This study aims to identify health factors that increase risk of accident

involvement. METHODS: The Israeli Defense Forces maintains two databases: records of periodical health examination of military personnel and a trauma registry including emergency department referrals of personnel resulting from injury. We identified 5,578 subjects who were examined in the Periodical Health Examination Center and were victims of trauma. We analyzed relation between injuries and various health parameters. RESULTS: Results shows cigarette smoking is more frequent among the population involved in trauma (40% in motor vehicle crash, 37% in fall injury, and 31% in blunt contusion compared with 28% in Periodical Health Examination Center population not involved in trauma, p < 0.05). Odds ratio of smokers involvement in motor vehicle crash is 1.82 (95% confidence interval, 1.25-2.67, p < 0.005). Younger age is relatively more frequent among trauma victims. CONCLUSION: We conclude that cigarette smokers and younger subjects might be at greater risk of being involved in accidental injuries. PMID: 11231664 [PubMed - indexed for MEDLINE] 1517: Health Policy. 2001 Apr;56(1):1-20. Related Articles, Links

Reforming the Israeli health system: findings of a 3-year evaluation. Gross R, Rosen B, Shirom A. JDC-Brookdale Institute, P.O.B. 13087, 91130, Jerusalem, Israel. [email protected] Israel, like many other European countries, has recently reformed its health care system. The regulated market created by the National Health Insurance (NHI) law embodies many of the principles of managed competition. The purpose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of the reform and the extent to which it has achieved its main goals. The evaluation was conducted using multiple quantitative and qualitative research tools: interviews with key informants; analysis of documents and sick fund financial statements; analysis of trends in sick fund membership; and population surveys conducted in 1995 and 1997 to assess the impact of the reform on outcome measures related to level of services to the public. Data from the evaluation show that the NHI law achieved a considerable number of its goals: to provide insurance coverage for the entire population, to ensure freedom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of the weaker populations. From the financial perspective, concerns that NHI would lead to a rise in the national health expenditure were not realized as of 1997. In

the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. However, the Israeli experience shows that regulating competition does not necessarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health system including level of resources allocated to health, organizational structure of the hospital system, manpower planning and the extent of government involvement in system. Additional policy changes may be needed to resolve these issues. Up-to-date information is essential in helping policymakers track the process of reform implementation and results, and identify problems which need to be addressed in the future. Publication Types: •

Evaluation Studies

PMID: 11230905 [PubMed - indexed for MEDLINE] 1518: Nippon Rinsho. 2001 Feb;59(2):381-90. Related Articles, Links

[The Cochrane Collaboration: the present and the future] [Article in Japanese] Nakayama T, Tsutani K. Department of Medical System Informatics, School of Public Health, Kyoto University. The Cochrane Collaboration has developed in response to the call for systematic, up-to-date reviews of all relevant randomized controlled trials (RCTs) of health care. Both evidence-based medicine (EBM) and the Cochrane Collaboration have been gaining attention of healthcare professionals in Japan recently. Ways for Japanese people to contribute to the Cochrane Collaboration are as follows: participating in a collaborative review group as a reviewer; increasing registry number of Japanese RCT articles; and Japanese translation of their outputs and its dissemination. Establishment of Japan Cochrane Center will integrate and promote the related activities. Furthermore, the positive recognitions for the Cochrane Collaboration and EBM among Japanese people can improve environments for conducting clinical trials and epidemiological studies in Japan. Publication Types: •

English Abstract

•

Review

PMID: 11218416 [PubMed - indexed for MEDLINE] 1519: Rinsho Byori. 2000 Oct;48(10):931-4. Related Articles, Links

[Results of a questionnaire survey about "standardization" of connection methods in Laboratory Automation System or Laboratory Information System by the National University Hospital Clinical Laboratory Divisions] [Article in Japanese] Kambe M. Department of Clinical Laboratory Medicine, Hiroshima University, Faculty of Medicine, Hiroshima 734-8551. "Standardization" is very important in the field of clinical laboratory medicine. Enzyme reference materials(ERM) and standard plasma proteins(CRM470) have already been developed. Reference methods for some clinical chemical tests have also been developed. We are studying "standardization" of electric communication methods between computers and automatic analyzers in Laboratory Automation System(LAS) or Laboratory Information System(LIS). We present the results of a questionnaire survey of 73 LAS or LIS making Companies in this paper. Although "standardization" of electric communications or local area network in LAS or LIS has been done in only 22 companies(34.9%), we are planning more functional standard electric communication methods such as Health Level 7(HL7) or American Society for Testing and Materials(ASTM). Publication Types: •

English Abstract

PMID: 11215106 [PubMed - indexed for MEDLINE] 1520: Rinsho Byori. 2000 Oct;48(10):910-4. Related Articles, Links

[Development of perinatal management system using optical card and regional health information network]

[Article in Japanese] Hara K. Department of Perinato-Gynecology, Kagawa Medical University, Kagawa 7610793. In Kagawa Prefecture, a perinatal management system using the optical medical card and the information network has been introduced since October 1998. Four hospitals(Kagawa Medical University, Sakaide Municipal Hospital, Uchinomi Town Hospital and Tsuda Prefectural Hospital) are connected with each other through the health information network(Kagawa Health and Welfare Information Network) organized by Kagawa Prefecture. (http://www.hw.kagawaswc.or.jp/net/) Patients' clinical data are described on the optical card based on the "standard format of the Japan Association of Obstetricians and Gynecologists(JAOG). (http://www.jaog.or.jp/JAPANESE/MEMBERS/JOUHOU/H10/index.htm). Clinical information including the fetal heart rate(FHR) and sonography (JPG) can be easily transmitted through this network(on line). Without the network, patient data can also be transmitted using the optical card(off line). There are still many technical and social problems to be solved in the future, research into the use of medical information network should be continued. Publication Types: • • •

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

PMID: 11215102 [PubMed - indexed for MEDLINE] 1521: Rinsho Byori. 2000 Oct;48(10):906-9. Related Articles, Links

[Past, present and future of optical cards for medical use] [Article in Japanese] Shiina S. Tokyo Medical and Dental University, Hachioji 192-0066. In the hospital, the chart is an important medical information record. However, it is not easy to refer to chart records. Although a computer is useful in referring to the chart, the most critical defect is the lack of exchangeability between hospitals.

An optical card is a new medium for medical use. It has a large capacity for electronic storage, low price and high security. Therefore, the author considers this card a second medical chart. As another card, there is the IC card, which has some limitations in medical use. Although both systems are being examined experimentally, there is no actual practice in the medical field. The reason for this lack of wide use, it is thought that these systems are not yet supported by national health insurance. Publication Types: • •

English Abstract Review

PMID: 11215101 [PubMed - indexed for MEDLINE] 1522: J Am Diet Assoc. 2001 Jan;101(1):47-52. Related Articles, Links

Comparison of visual estimates of children's portion sizes under both shared-plate and individual-plate conditions. Shankar AV, Gittelsohn J, Stallings R, West KP Jr, Gnywali T, Dhungel C, Dahal B. Division of Community Health and Health Systems, E8009, Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD 21205, USA. OBJECTIVE: This paper compares the accuracy of visual estimations of children's food intake in settings where several children eat together off 1 plate vs individual-plate eating scenarios. DESIGN: Eight trained observers were tested in their ability to estimate food portions consumed by children enacting common eating scenarios. Foods were categorized by food group and according to their presentation by individual-plate and shared-plate. Observed food weight estimates were compared to actual weights. SUBJECTS/SETTING: The 8 observers visually estimated 69 food portions of children eating alone and 26 portions where children were eating from a shared plate. This study was carried out in Sarlahi District, a rural, central lowland region of Nepal. STATISTICAL ANALYSES: Pearson's correlation coefficients were calculated to examine associations between estimated and actual weights. A fixed effects model was constructed to compare observers. RESULTS: Analyses revealed that observer estimates of food weights under field conditions were well correlated with actual weights for individual-plate (r = 0.89) and for shared-plate (r = 0.84) scenarios. Observers estimated food weights when children ate together on a shared plate less

accurately than they did in settings where children ate alone. With the exception of 1 observer, observers did not differ significantly in their ability to estimate food weights. Accuracy of estimations was influenced by food weight with greater error associated with food quantities of less than 70 g. CONCLUSIONS: Visual estimation is a relatively accurate, valid method of assessing child food intake under rural field conditions, and the only method to obtain accurate information on dietary intake in regions where shared-plate eating is frequent. Publication Types: • • • • •

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

PMID: 11209584 [PubMed - indexed for MEDLINE] 1523: Lepr Rev. 2000 Dec;71(4):472-85. Related Articles, Links Comment in: •

Lepr Rev. 2003 Jun;74(2):175-6.

Making sense of rehabilitation projects: classification by objectives. Cornielje H, Nicholls PG, Velema J. Hogeschool Leiden, Department of Public Health, Leiden, The Netherlands. Rehabilitation of disabled persons can take many different forms according to the socio-cultural and political context in which it is undertaken. Some approaches have emphasized the restoration of the physical function of the client, while others have looked beyond to psychological and social well-being. Some have built on the expertise of professionals while others have emphasized the caring capacity available in the family and the community and sought to reinforce it. Besides providing a wide range of possible services to disabled persons, rehabilitation seeks to change the attitudes that prevail in society as a whole and promote the integration of disabled people into society with equal rights and opportunities. This paper reviews a range of models and approaches which have been put forward in the international debate on rehabilitation. Furthermore, four dimensions are described which can be used to characterize and define classes of rehabilitation projects based on the objectives that are defined for them. Thus

types of rehabilitation projects can be distinguished. Management, evaluation and technical support for rehabilitation projects need to take these essential characteristics into account. Publication Types: •

Review

PMID: 11201902 [PubMed - indexed for MEDLINE] 1524: Int Dent J. 2000 Dec;50(6):371-7. Related Articles, Links

Workforce requirements for a primary oral health care system. van Palenstein Helderman W, Mikx F, Truin GJ, Hoang TH, Pham HL. WHO Collaborating Centre, Dentistry 117, Postbus 9101, 6500 HB Nijmegen, The Netherlands. [email protected] AIM: To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. METHODS: Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. FINDINGS: Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. CONCLUSION: A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam. PMID: 11197196 [PubMed - indexed for MEDLINE] 1525: Ann N Y Acad Sci. 2000;916:139-46.

Related Articles,

Links

The role of the World Reference Laboratories for Foot-and-Mouth Disease and for Rinderpest. Kitching RP. Institute for Animal Health, Surrey, United Kingdom. The World Reference Laboratories for Foot-and-Mouth Disease and for Rinderpest provide a worldwide diagnostic and surveillance service for these disease for FAO and OIE. Both laboratories are housed within the high security facility of the Institute for Animal Health, Pirbright, UK. Foot-and-mouth disease (FMD) and rinderpest (RP) are OIE List A diseases and historically have caused huge losses to agricultural economies around the world, prompting the establishment of veterinary colleges in Europe and environmentally controversial control programs in Africa. FMD and RP have now been geographically restricted, but the large legal and illegal world trade in live animals and animal products constantly threatens to allow them to spread back into disease-free areas. The Reference Laboratories provide a center of excellence for the development of improved diagnostic techniques and a repository of isolates collected over many years. These libraries provide material for investigations of the molecular epidemiology and evolution of the viruses and a data base against which new isolates can be compared. Thus it is possible to individually characterize new outbreak strains, identify their likely origin and provide the most up-to-date support for their control. PMID: 11193614 [PubMed - indexed for MEDLINE] 1526: J Pak Med Assoc. 2000 Dec;50(12):405-9. Related Articles, Links

Health care utilization during terminal child illness in squatter settlements of Karachi. Hasan IJ, Khanum A. Department of Community Health Sciences, Aga Khan University, Karachi. OBJECTIVE: Information on health seeking behavior and health care utilization has important policy implications in health systems development. The paper presents some of the issues related to health care utilization and health seeking behavior in case of terminal child illness in seven squatter settlements of Karachi. METHODS: From seven squatter settlements of Karachi, with a population of 100,000 approximately, we collected information, using pretested structured

questionnaire, from the mothers on health care utilization during the final illness of under five children dying during 1995-1996. These deaths were identified from an earlier baseline health and demographic survey in these areas. RESULTS: Interviews were completed for 259 infant and child deaths of which 57% were boys. Of all deaths 72% were taken to a health care provider, of which 82% went as soon as the child got ill. Private sector is the most preferred first choice i.e., 83%. Of all those who had been to a health care provider, 65% were referred to some other place and 72% of them took more than 12 hours altogether to reach the referred facility. Children in older age categories (OR 4.4 95% CI 2.22-8.67 and OR 5.0, 95% CI 2.09-12.31), boys (OR 2.6, 95% CI 1.46-4.77) and those with appropriate or incomplete immunization (OR 4.1, 95% CI 2.13-7.94) were significantly associated with the health care utilization as compared to their counterparts. CONCLUSION: Living in urban areas does not ensure accessibility to effective health care. In poor urban communities, referral to other facility delay the initiation of effective treatment in case of child illness leading to death which could be prevented otherwise. Private sector constitutes an important segment of our health care system, which requires strengthening and back up support. Furthermore, the study finding is suggestive of gender discrimination in health seeking behavior. Publication Types: •

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

PMID: 11191439 [PubMed - indexed for MEDLINE] 1527: Gan To Kagaku Ryoho. 2000 Dec;27 Suppl 3:683-6. Related Articles, Links

[Role of national insurance pharmacies in community complete home care networks--home TPN and home care supported by local national insurance pharmacies] [Article in Japanese] Tomita I, Ishii S, Yonezawa M, Ito T, Hirai A, Mizuno K. Sanbu-gun City Pharmacists Association, Chiba Prefecture. The reforms in the medical system and introduction of home care insurance have brought great changes to national health insurance pharmacies. In April 1998, Dr. Hirai became new director of the Chiba Togane Hospital. The development of a community complete medical system was included in a restructuring of the hospital, and various reforms were begun. A system covering all aspects of the medical/pharmaceutical field was started in August 1998. For its part, the Sanbu-

gun Pharmacists Association began accepting prescriptions outside the hospital, and regular meetings for the exchange of knowledge were held with members of the physicians and pharmacists associations. After building a relationship of trust in this way, a community complete home treatment system was begun in July 1999 with Togane Hospital functioning as its backup support hospital. To date, home TPN terminal care has been provided in cases of terminal cancer, incurable neurological diseases, and for the very aged and patients with cerebrovascular impairments. Any general pharmacy in the region can participate in the program to fill prescriptions for TPN, provided that the pharmacist him or herself so wishes, establishes a clean bench at the pharmacy, and undergoes training at Togane Hospital on the preparation of i.v. medicines in order to function responsibly in this capacity. These pharmacies are called satellite pharmacies, and at present there are four of them located with a good balance within the region. These satellite pharmacies prepare liquid medications for TPN, including narcotics, and oral medicines following the prescriptions written by the physician from the hospital who is serving as the primary home treatment physician. The pharmacy also delivers the medicines to the home of the patient. The pharmacist checks the status of remaining TPN liquids and oral medicines and informs the primary home physician and support hospital by e-mail or fax, so that everyone shares the same information. The success or failure of home TPN from a general pharmacy depends on the formation of a digital network in order to share information using the Internet and a back-up system for unconditional support by the support hospital in times of patient emergency. In our region, these conditions have been fulfilled. Publication Types: •

English Abstract

PMID: 11190321 [PubMed - indexed for MEDLINE] 1528: Stud Health Technol Inform. 2000;77:663-7. Related Articles, Links

A personalised Healthcare Information Delivery System: pushing customised healthcare information over the WWW. Abidi SS, Goh A. Health Informatics Research Group, School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia. Easier and focused access to healthcare information can empower individuals to make 'informed' choices and judgements about personal health maintenance. To achieve 'optimum' patient empowerment, we need to re-evaluate and potentially

re-design the processes of healthcare information delivery. Our suggestion is that healthcare information should be personalised according to each individual's healthcare needs and it should be pro-actively delivered, i.e. pushed towards the individual. We present an intelligent Personalised Healthcare Information Delivery Systems that aims to enhance patient empowerment by pro-actively pushing customised, based on one's Electronic Medical Record, health maintenance information via the WWW. PMID: 11187636 [PubMed - indexed for MEDLINE] 1529: Jpn Hosp. 1999 Jul;(18):59-66. Related Articles

Development of the local medical service network system. Integration of medical service with the network system between university hospital and other medical institutions. Sadamoto K, Shiozawa M, Imaizumi S, Miura M, Shiibashi S, Kouhata H, Shibata I. Dept. of Local Medical Service Network, Toho University Hospital, Tokyo, Japan. Although every medical institution always make efforts to provide best services for the patients, it tends to be insufficient to send the patient's information and share them with other medical institutions. It is partly because in the Japanese medical care system there is no obligation to inform patients' medical information to other medical institutions. To provide effective and cost-effective medical service, we made a local network system between university hospital and other medical institutions. The system contributes to clarify the role of medical institutions and the continuity of medical service. For the next step, we must construct the home-care information service network towards the total service for the patients. PMID: 11184924 [PubMed - indexed for MEDLINE] 1530: Jpn Hosp. 1999 Jul;(18):31-45. Related Articles, Links

The present state of managed care and the feasibility of its application to Japan. From the standpoint as a provider, an insurer, and consumer. Kameda T.

Kameda Group/Kameda Medical Center. PMID: 11184921 [PubMed - indexed for MEDLINE] 1531: Thorax. 2001 Mar;56(3):173-9. Related Articles, Links Erratum in: •

Thorax 2001 Jun;56(6):504.

Comment in: •

Thorax. 2001 Nov;56(11):897.

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998. Rose AM, Watson JM, Graham C, Nunn AJ, Drobniewski F, Ormerod LP, Darbyshire JH, Leese J; Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group. PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK. [email protected] BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed

since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients coinfected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey. Publication Types: •

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

PMID: 11182007 [PubMed - indexed for MEDLINE] PMCID: PMC1758771

1532: Int J Med Inform. 2000 Nov;60(2):119-25. Related Articles, Links

Health data use and protection policy; based on differences by cultural and social environment. Ishikawa K. Medical Informatics and Systems Management Department, Hiroshima Unirersity Hospital, Kasumi, Japan. [email protected] On April 22, 1999, the Japanese Ministry of Health and Welfare proposed

electronic preservation of all clinical records. Simultaneously, deliberations on legislation on data disclosure and privacy protection were held. To promote these movements, electronic use of Personal Health Data (PHD) is indispensable, and the system development is on its way to meet rising demands. Indigenous Japanese did not have a word to describe the concept of privacy. It was only in the 1960s when we became aware of that. In this article, the protection policy for data use will be discussed from a Japanese perspective compared with those in other nations, giving an example of the hospital management system under construction at the Hiroshima University Hospital. PMID: 11154962 [PubMed - indexed for MEDLINE] 1533: Med Law. 2000;19(3):421-31. Related Articles, Links

The narrative approach in teaching medical ethics: the Turkish experience. Oguz NY. Ankara University Faculty of Medicine, Department of Deontology, Ankara, Turkey. The Deontology and Medical History Departments in Turkey teach Medical Ethics Education. These departments were first established by medical historians and for the time being the staff is primarily interested in deontology. The Department of Deontology in the Faculty of Medicine at Ankara University is the first department in Turkey to teach medical ethics. In 1974, issues including medical ethics were included in the current curriculum for the Medical Deontology and Medical History Course, but without changing the title of the course. Since then, different scholars have used different teaching methods. In this paper, a very new teaching strategy and technique used by the author will be discussed. In Turkey, the main resources being used as teaching materials in medical ethics are books and periodicals of mainly Western European and North American origin. Cultural, religious, and traditional characteristics of Turkey differ a great deal, so these texts need to be modified. This modification is hard to accomplish, because discourse on authentic values and value systems is inadequate. Also, this way of thinking about values is alien to most medical students. A narrative approach in teaching medical ethics aims to introduce local values that affect medical practice to first year medical students of the Faculty of Medicine at Ankara University, by searching for those values in literary texts and case histories. Besides introducing local values, some of our main goals are to encourage students to develop a sensitivity towards ethical issues and to teach them the methodology of ethical thinking. This is still a pilot study that covers only four hours of a thirty-hour program (two-hour sessions, twice in one semester), but some conclusions can be drawn. In this presentation, some

information about the content and the structure of the course will be given, and the positive and negative results about the narrative approach will be discussed, arising from our limited local experience. PMID: 11143879 [PubMed - indexed for MEDLINE] 1534: Bull World Health Organ. 2000;78(11):1324-9. Related Articles, Links

Use of existing data for public health planning: a study of the prevalence of hepatitis B surface antigen and core antibody in Al Ain Medical District, United Arab Emirates. al-Owais A, al-Suwaidi K, Amiri N, Carter AO, Hossain MM, Sheek-Hussein MM. Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates. INTRODUCTION: Hepatitis B is of major public health importance. Accurate information on its occurrence, with particular reference to the prevalence of immunity and chronic infection (marked by the presence of hepatitis B core antibody and surface antigen, respectively, in serum), is essential for planning public health programmes for the control of the disease. The generation of marker prevalence data through serological surveys is costly and time-consuming. The present study in Al Ain Medical District, United Arab Emirates, investigated the possibility of obtaining sufficiently accurate marker prevalence estimates from existing data to plan public health programmes. METHODS: Two antenatal screening databases, one student serological survey database, one immunization programme database and one pre-marriage screening database containing information on marker prevalence were identified. Epidemiological data were abstracted from these databases and analysed. RESULTS: The data showed that the prevalence of hepatitis B surface antigen and the prevalence of core antibody in young citizens in 1998 were approximately 2% and 14% respectively, that any immunization campaign aimed at citizens of the United Arab Emirates should target teenagers as they had the highest risk of acquiring the disease, and that preimmunization screening of young adults would be wasteful. However, the data did not yield information on the prevalence of hepatitis B surface antigen and core antibody in other population subgroups of public health significance. DISCUSSION: While data generated by the study are sufficient to support a hepatitis B immunization programme targeted at teenaged citizens, more accurate data, generated by a well-designed serological survey, would be essential for optimal public health planning. PMID: 11143192 [PubMed - indexed for MEDLINE]

1535: Healthc Inform. 1999 Oct;16(10):33-6. Related Articles, Links

India: health informatics begins to grow. Nadarajah I. PMID: 11143127 [PubMed - indexed for MEDLINE] 1536: Health Policy. 2001 Jan;55(1):1-18. Related Articles, Links

Developing financial autonomy in public hospitals in India: Rajasthan's model. Sharma S, Hotchkiss DR. Carolina Consulting Corporation and The Futures Group International, 1050 17th Street, N.W. Suite 1000, Washington, DC 20036, USA. [email protected] In India's state-administered health care system, many government decisionmakers are exploring the introduction or expansion of hospital autonomy as a means of improving the efficiency and financial sustainability of the overall public health care system. One initiative that has recently received a considerable amount of attention is the introduction of Medicare Relief Societies (MRS) in the state of Rajasthan. The societies are autonomous organizations that are formed with the objective of complementing and supplementing existing service provision in public hospitals. The state has provided incentives for the formation of MRS by relaxing state-imposed restrictions on the collection and use of revenue by hospitals, thereby encouraging the use of alternative financing mechanisms such as user-fee schemes and in-hospital pharmacies. The purpose of this article is to describe and critically evaluate Rajasthan's experience with MRS. Emphasis is placed on whether and how the introduction of these societies have influenced two key aspects of hospital autonomy - operations and management, and financing. Data for the study come from a survey of representatives from each of the 69 hospitals in Rajasthan that contain 100 or more beds. Information was collected on whether a society was operating within the hospital, the management of the society, the range of activities carried out, and the revenue and expenditures of each activity. The results are used to identify key strengths and weakness of the MRS initiative in Rajasthan, and how future hospital autonomy efforts can be strengthened. Publication Types: •

Comparative Study

•

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

PMID: 11137185 [PubMed - indexed for MEDLINE] 1537: Ann Acad Med Singapore. 2000 Sep;29(5):621-7. Related Articles, Links

Post-release drug treatment risks: strategies to minimise harm to patients. Oh VM. Division of Clinical Pharmacology and Therapeutics, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. [email protected] This paper examines the perceptions and causes of drug treatment-related error, and suggests some risk reducing strategies. Interest in medical error surged recently, culminating with an estimate by the US Institute of Medicine in 1999 of 44,000 to 98,000 annual care-related deaths. Public media pressure elicited responses from health care providers, purchasers, internists and health professionals' organisations. A search was made using PubMed, focusing on papers from 1980 to date giving data on trends and causes of in-hospital drugrelated error. Papers with estimates of prevalence rates of drug-induced injury in large denominator populations were selected. One hundred and seven papers on drug-related error were identified; 36 clearly defined denominators and compared rates in different groups. Occurrence rates of drug-induced harm were similar (2.2% to 6.7%) in the US and British hospital surveys. The Harvard Medical Practice Study first reliably measured the frequency of care-related patient harm. More reliable and accurate information is needed on the base-line rates of drugrelated injury. Whereas there are few precise estimates of drug-induced injury, the evidence suggests that between half and two-thirds of hospital-related harmful events are preventable. Most experts agree that hospitals need to change radically their approach to professional error from one of blaming individuals to overhauling the systems for monitoring, detecting and preventing drug-related error. Hospital managers should implement voluntary, non-punitive, and confidential systems for reporting error, and apply methods of safety enhancement which succeed in high-risk industries. A realistic and achievable target could be halving of current risk. Incentives can be given to event monitoring and pharmacotherapy quality assurance, to encourage timely and accurate reporting. On-line doctors' entry of drug orders and computerised adverse event monitoring also promote error reduction. PMID: 11126698 [PubMed - indexed for MEDLINE]

1538: Transplant Proc. 2000 Nov;32(7):1470-2. Related Articles, Links

Strategies and obstacles in an organ donation program in developing countries: Saudi Arabian experience. Shaheen FA, Souqiyyeh MZ, Abdullah A. Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia. PMID: 11119793 [PubMed - indexed for MEDLINE] 1539: Public Health. 2000 Nov;114(6):488-94. Related Articles, Links

Recommendations for water supply in arsenic mitigation: a case study from Bangladesh. Hoque BA, Mahmood AA, Quadiruzzaman M, Khan F, Ahmed SA, Shafique SA, Rahman M, Morshed G, Chowdhury T, Rahman MM, Khan FH, Shahjahan M, Begum M, Hoque MM. International Centre for Diarrhoeal Disease Research, Bangladesh. [email protected] Arsenic problems have been observed in several countries around the world. The challenges of arsenic mitigation are more difficult for developing and poor countries due to resource and other limitations. Bangladesh is experiencing the worst arsenic problem in the world, as about 30 million people are possibly drinking arsenic contaminated water. Lack of knowledge has hampered the mitigation initiatives. This paper presents experience gained during an action research on water supply in arsenic mitigation in rural Singair, Bangladesh. The mitigation has been implemented there through integrated research and development of appropriate water supply options and its use through community participation. Political leaders and women played key roles in the success of the mitigation. More than one option for safe water has been developed and/or identified. The main recommendations include: integration of screening of tubewells and supply of safe water, research on technological and social aspects, community, women and local government participation, education and training of all stakeholders, immediate and appropriate use of the available knowledge, links between intermediate/immediate and long term investment, effective coordination and immediate attention by health, nutrition, agriculture, education, and other programs to this arsenic issue. PMID: 11114764 [PubMed - indexed for MEDLINE]

1540: Telemed J E Health. 2000 Fall;6(3):315-25. Related Articles, Links

Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions. Angood PB, Satava R, Doarn C, Merrell R; E3 Group. Yale University School of Medicine, New Haven, Connecticut, USA. [email protected] The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings--Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel--including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments--which for some may even be their home environment during/after a medical illness. PMID: 11110635 [PubMed - indexed for MEDLINE] 1541: Ugeskr Laeger. 2000 Nov 13;162(46):6220-2. Related Articles, Links

[Type 2 diabetes among immigrants] [Article in Danish] Vibe-Petersen J, Perrild HJ. Klinik I, H:S Bispebjerg Hospital. PMID: 11107973 [PubMed - indexed for MEDLINE] 1542: Osteoporos Int. 2000;11(8):688-96. Related Articles, Links Comment in: •

Osteoporos Int. 2001;12(8):706.

Reference database for bone speed of sound measurement by a novel quantitative multi-site ultrasound device. Weiss M, Ben-Shlomo AB, Hagag P, Rapoport M. Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel. [email protected] The nonuniform skeletal involvement in osteoporosis argues for multi-site evaluation. The Sunlight Omnisense (Sunlight Ultrasound Technologies, Israel) is a multi-site device that measures speed of sound (SOS) at the appendicular skeleton. We report the reference database for SOS at the radius (RAD), tibia (TIB), metatarsus (MTR) and phalanx (PLX). The database was obtained from 1521 healthy Israeli women (age 20-90 years) out of 2051 respondents. SOS was determined in 97.6% of the participants at the PLX, 96.4% at the TIB, 93.6% at the RAD and 85.1% at the MTR; it was not measurable in 0.5%. Short-term coefficient of variation was lowest at the RAD and always less than 1%. Maximal SOS was noted at 35-45 years of age in three of the sites (RAD 4169 m/s, MTR 3663 m/s, PLX 4047 m/s, respectively) but 10 years earlier at the TIB (3939 m/s). In the perimenopausal period (age 46-55 years), SOS was always lower in post- as compared with premenopausal women (p<0.05). Immediately following the menopause, SOS annually declined close to the short-term CV: 16, 34, 37 and 13 m/s at the RAD, PLX, MTR and TIB, respectively. The average age-stratified SOS values at various measurement sites were highly correlated at the population level (0.96-0.99), but less so at the individual level (0.40-0.57). Therefore, multisite SOS measurements are better than single-site assessment. After 79 years of

age, the average T-score at the RAD and PLX was <--2.5. This is similar to that of dual-energy X-ray absorptiometry (DXA)-determined spine bone mineral density (BMD) and somewhat lower than hip BMD. Equivalent T-score curves obtained by percentile adjustment of SOS at various sites to that of the RAD (at age group 60-69 years) reveal convergence and indicate that 52-68% of women older than 79 years are osteoporotic. In conclusion, multi-site peripheral SOS measurements reveal age-dependent bone changes with a high degree of measurement precision and indicate a prevalence of osteoporosis similar to that obtained by DXA. PMID: 11095172 [PubMed - indexed for MEDLINE] 1543: J Adolesc Health. 2000 Dec;27(6):443-52. Related Articles, Links

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong. Lau JT, Yu A, Cheung JC, Leung SS. Centre for Clinical Trials and Epidemiological Research, the Chinese University of Hong Kong, Hong Kong. PURPOSE: To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes. METHODS: A cross-sectional questionnaire survey of 3355 participating secondary school students (response rate = 98%). RESULTS: Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care. CONCLUSIONS: This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students' attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health

care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers. Publication Types: •

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

PMID: 11090747 [PubMed - indexed for MEDLINE] 1544: J Hazard Mater. 2000 Dec 15;79(3):229-39. Related Articles, Links

Characteristics of heavy metals on particles with different sizes from municipal solid waste incineration. Chang MB, Huang CK, Wu HT, Lin JJ, Chang SH. Graduate Institute of Environmental Engineering, National Central University, 320, Chungli, Taiwan. Information on the concentration and size distribution of particles in the flue gas streams is essential for selecting and designing particle removal systems. Two municipal solid waste incinerators (MWIs) were selected for conducting flue gas sampling to determine the particulate distribution and heavy metals concentration on particles with different sizes by US EPA Method 5 sampling train and a cascade impactor. In addition, the characteristics of heavy metals contained on particles were investigated via isokinetic sampling of flue gas stream of air pollution control devices (APCDs). The experimental results indicated that average particulate matter (PM) concentrations at APCDs inlet were 2288.2+/825.9 and 3069.2+/-810. 0mg/Nm(3), while the concentrations of PM at stack were 1.51+/-0.20 and 14.81+/-4.52mg/Nm(3) in MWI-A and MWI-B, respectively. The differential mass size distribution of PM and differential elemental size distribution of Zn, Pb, and Cu in front of APCDs were of bimodal forms. Results indicate that Zn>Pb>Cu in order of mass concentration in each stage. The fine particles represent approximately 70% and the coarse particles account for the rest 30% of total particulate matters collected on eight stages for both incinerators. Zn, Pb and Cu on fine particles account for approximately 80% and those on the coarse particles are less than 20% of the total heavy metals collected on eight stages of the cascade impactor for both incinerators. Publication Types: •

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

PMID: 11077161 [PubMed - indexed for MEDLINE] 1545: Ann Trop Med Parasitol. 2000 Sep;94(6):591-606. Related Articles, Links

Mapping of lymphatic filariasis in India. Sabesan S, Palaniyandi M, Das PK, Michael E. Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, India. [email protected] The derivation of detailed epidemiological maps, at the relevant spatial resolution, is being increasingly recognized as vital to the effective design and implementation of successful programmes for the control of parasites and their vectors. Geographical information systems (GIS) and a recently complied database on the distribution of lymphatic filariasis in India have now been used to develop the first maps at district-level (i.e. the level at which control against this parasite will be enacted in India) of filariasis endemicity in this country. The derived maps indicate both the substantial extent as well as the marked variability in the geographical distribution of this disease in India. The causative infection and/or the symptomatic disease were detected in most (257) of the 289 districts surveyed up to 1995. Currently there may be up to 27.09 million microfilaraemics, 20.83 million cases of symptomatic filariasis, and about 429.32 million individuals potentially at risk of infection in the country. Probability mapping, based on data quantiles, clearly indicates that the risk of filarial infection in India is not constant throughout the country but exhibits strong regional trends. Filariasis in general may be a particular problem of the eastern half of the country. The results indicate the potentially vital role that GIS-based mapping approaches can play in the development of filariasis-control campaigns in India and elsewhere. Publication Types: •

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

PMID: 11064761 [PubMed - indexed for MEDLINE] 1546: N Z Med J. 2000 Sep 22;113(1118):390-4. Related Articles, Links

Enhanced surveillance of HIV infections in New Zealand, 1996-1998.

Paul C, Wilson M, Dickson N, Sharples K, Skegg DC. Department of Preventive and Social Medicine, University of Otago, Dunedin. AIM: To improve understanding of the HIV epidemic in New Zealand through use of an enhanced voluntary reporting system for new diagnoses of HIV. METHODS: Routine reporting of new HIV diagnoses by the two laboratories that perform confirmatory HIV antibody testing, to the Department of Health and later to the AIDS Epidemiology Group, has been in place since 1985. From January 1996, this was supplemented by a questionnaire about demographic characteristics and circumstances of HIV exposure sent to clinicians requesting the HIV test. RESULTS: From January 1996 to December 1998, 260 new diagnoses of HIV were reported (205 males, 55 females) and extra information was obtained from clinicians for 253 (97.3%) people. HIV diagnosis rate was highest for 'other' ethnicity and similar for European, Maori and Pacific Island ethnic groups. Sexual intercourse between men was the commonest mode of infection (43.5%), followed by heterosexual intercourse (40.0%) and injecting drug use (2.7%). Places of infection were New Zealand (38.5%), Australia (7.7%), 'other' overseas (45.4%) and unknown (8.5%). Heterosexual infections were acquired through contact with a person in or from a high prevalence area (mainly in Africa or Asia) for 86.7% of males and 68.2% of females. Second generation heterosexual transmission was rare. CONCLUSIONS: Introduction of an enhanced surveillance system has been successful. Results confirm continuing spread of HIV in New Zealand amongst men who have sex with men, and suggest low levels of heterosexual and injecting drug use transmission in New Zealand. Of major importance in the occurrence of heterosexual infection is the role of imported HIV. Publication Types: •

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

PMID: 11062813 [PubMed - indexed for MEDLINE] 1547: Rinsho Byori. 2000 Jul;48(7):627-31. Related Articles, Links

[The practice of teleconferencing in clinical pathology--networking among cancer-center-hospitals in various parts of Japan] [Article in Japanese] Fujita M.

Keiyukai Institute of Clinical Pathology and Health Sciences University of Hokkaido, Sapporo. In the last several years, we have been able to use a telemedicine system on a network among cancer-center-hospitals connected by light fibers(so-called Cancer Network) and attend teleconferences from each site in Japan at the same time using the same images. Every week we have many medical conferences using this network system. On the practical use of teleconferences, the ratio of clinical pathological images is very high, especially histopathological appreciation is important; that is, surgical slide conference, clinico-pathological conference, orthopedic tumor conference, image conferences about digestive organs, presentation of current topics in laboratory medicine and other issues are carried out by clinicopathological images. At present, images on teleconference are stillpictures and images in High Definition Television are clear and high capacity, and of sufficient quality for pathological diagnosis. However, the coincidence-rates of histopathological diagnosis among 15 pathologists between the tele-image method and direct microscopic method varied from 38-80%. It is necessary to try to experience the images of still-picture and also animated cartoon. In the near future, the present network may extend to cover a wide areas and attend to teleconferences in every medical facilities. By attending this network system, we are able to use clinicopathological information for clinical diagnosis, treatment, research and education. Publication Types: •

English Abstract

PMID: 11051787 [PubMed - indexed for MEDLINE] 1548: Soc Sci Med. 2000 Oct;51(8):1221-9. Related Articles, Links

Contract medicine arrangements in Hong Kong: an example of riskbearing provider networks in an unregulated environment. Brudevold C, McGhee SM, Ho LM. University of Hong Kong, Department of Community Medicine, Pok Fu Lam, People's Republic of China. [email protected] It is increasingly common in Hong Kong and elsewhere for employers to contract directly with physician networks to provide medical services to employees. These contracts are known in Hong Kong as contract medicine arrangements. In other countries and areas, managed care organizations are generally required by

regulation or legislation to ensure that services of adequate quality are provided to patients who are locked in to network providers. There are no such requirements in Hong Kong and concerns have been raised about potential quality and cost trade-offs in contract medicine arrangements. Satisfaction surveys were sent to contract medicine enrollees in one large company in Hong Kong. The response rate was 30% and analysis of non-respondent data shows that respondents were representative of their group. Comparison of satisfaction using logistic regression showed that risk-bearing networks paid by capitation had consistently lower satisfaction ratings across all major dimensions including access, interpersonal care, communication with the doctor, choice of doctor, and outcomes. These findings suggest that quality, at least as perceived by the patient, may be lower in these networks. The issue is of concern in Asia where infrastructures and data systems are not well developed to adequately monitor quality of care or protect patient interests. This study highlights the need to structure pre-paid provider networks and managed care organizations so that quality of care is not compromised. At a time when managed care concepts are being applied throughout Asia, we believe attention needs to be drawn to this problem. Publication Types: •

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

PMID: 11037212 [PubMed - indexed for MEDLINE] 1549: Public Health. 2000 Sep;114(5):413-5. Related Articles, Links Erratum in: •

Public Health 2001 Jan;115(1):82.

Geographical display of health information: study of hepatitis C infection in Karachi, Pakistan. Mujeeb SA, Shahab S, Hyder AA. Blood Transfusion Services, Jinnah Postgraduate Medical Center, Karachi 75510, Pakistan. The prevalence of hepatitis C and other infections is increasing in urban areas of developing countries. Data on such diseases are often limited to facility-based information. However, even this is not available in a usable form to health care providers, health managers and policy makers. We present a simple technique for visually displaying facility based prevalence information on hepatitis C using

basic geographic information system (GIS) techniques. We display the prevalence of hepatitis C for the city of Karachi, Pakistan for the first time. The distribution tends to indicate that there are areas of higher prevalence located in specific districts. There is also a trend of higher prevalence in less affluent urban areas. Such simple applications of mapping technology are useful for rapidly summarizing and displaying information in a contextually and spatially meaningful fashion, and its use should be encouraged for displaying health indicators in developing countries. PMID: 11035468 [PubMed - indexed for MEDLINE] 1550: Lupus. 2000;9(7):534-41. Related Articles, Links

Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus. Devins GM, Edworthy SM. Culture, Community, and Health Studies, Centre for Addiction and Mental Health (Clarke Division), University of Toronto, and University Health Network (Princess Margaret Hospital), Toronto, Ontario, Canada. [email protected] Our objective was to investigate whether quality of life in systemic lupus erythematosus (SLE) differs across ethnoracial groups and to identify factors that may explain race-related differences. Self-administered questionnaire data from 335 White, 40 Black, and 30 Asian women with SLE were obtained from a multicenter database. Measures assessed illness intrusiveness, psychological wellbeing, depressive symptoms, musculoskeletal pain, and learned helplessness. Extent of SLE disease activity was indexed by self-reported functional-system involvement. Educational attainment was indicated by number of years in school. Principal-components analysis reduced the four psychosocial measures to a single factor score. This represented psychosocial well-being In path analysis. Psychosocial well-being differed significantly across the three groups, with Whites reporting the highest, and Blacks the lowest, levels. Path analysis indicated that illness intrusiveness accounted for this race-related difference. Although disease activity was significantly associated with psychosocial wellbeing, it did not differ across ethnoracial groups. Illness intrusiveness and educational attainment emerged as independent mediators of the race-related difference in psychosocial well-being. We conclude that race-related quality-oflife differences exist among women with SLE and are mediated independently by illness intrusiveness and educational attainment. Publication Types:

• • • •

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

PMID: 11035420 [PubMed - indexed for MEDLINE] 1551: Sci Total Environ. 2000 Oct 2;259(1-3):31-43. Related Articles, Links

Health assessment for mercury exposure among schoolchildren residing near a gold processing and refining plant in Apokon, Tagum, Davao del Norte, Philippines. Akagi H, Castillo ES, Cortes-Maramba N, Francisco-Rivera AT, Timbang TD. National Institute for Minamata Disease, Japan. Artisanal gold-mining activities in the Philippines have proliferated since the early 1980s. Presently, environmental and health monitoring conducted by several governmental agencies is limited to the determination of total mercury only. Previous studies undertaken focused mainly on the exposure of adults and workers to mercury during mining/processing operations. However, in one area in Mindanao, mined ores are brought down and processed in the lowlands where residential communities are exposed to environmental pollutants resulting from gold processing/refining operations. The area of study is Apokon, Tagum, Davao del Norte, which has 29 gold processing and refining plants. Health complaints among schoolchildren in Apokon Elementary School were received by the Department of Health and were attributed to the mercury pollution in the environment. As part of a collaboration with the Health Department, UP-National Poisons Control and Information Service, the National Institute for Minamata Disease (NIMD), Japan, provided technical assistance in the analytical determination of mercury in biological and environmental samples. Elevated mercury concentrations were noted in some of the river systems up to 15 km from the mining areas. Environmental quality monitoring showed T-Hg sediment levels ranged from 0.553 to 66.471 microg/g dry wt. while water samples from river systems exhibited mercury levels from 72.8 to 78.4 ng/ml. Twenty-seven sediment samples from river systems near mining operations and seven water samples were also brought to the Institute for analysis. Fish samples collected showed levels ranging from 1.07 to 438.8 ng/g for total mercury and 0.71-377.18 ng/g for methylmercury. Methylmercury content in fish is predominant. All water and sediment samples collected from three sampling sites have elevated T-Hg level while three fish species have elevated T-Hg and methylmercury levels (WHO/CDC, 1994). Blood and hair samples from 162 schoolchildren aged 5-17

years were collected and analyzed at the NIMD for mercury analysis. Analytical procedures used in the NIMD for mercury testing were applied. Laboratory results showed that total mercury hair samples ranged from 0.278 to 20.393 microg/g while methylmercury hair results were from 0.191 to 18.469 microg/g. Methylmercury in hair showed levels from 45.96 to 99.81%. Total blood mercury levels ranged from 0.757 to 56.88 microg/l while Me-Hg blood levels ranged from 1.36 to 46.73 microg/l. It was determined that 10 children had elevated T-Hg blood levels while one child had high total and methylmercury levels in hair. A summary of physical examination results showed that the predominant findings include under-height, gingival discoloration, adenopathy, underweight and dermatologic abnormalities among children examined. PMID: 11032133 [PubMed - indexed for MEDLINE] 1552: Seishin Shinkeigaku Zasshi. 2000;102(7):640-52. Related Articles, Links

[A survey of drug utilization in psychiatric hospitals in Japan: comparison of 1973, 1979, and 1993] [Article in Japanese] Yamauchi K, Baba K, Ikegami N, Ono Y, Miyaoka H, Kamijima K. Department of Health Policy & Management, Keio University School of Medicine. This paper investigated the trend in prescription patterns in the treatment of psychiatric inpatients using a database of our 1993 survey as well as reports of surveys conducted by Ito et al. in 1973 and 1979. To make the database of our survey comparable with surveys in 1973 and 1979, we extracted and analyzed 1,164 cases which met the criteria of Ito's survey, requiring that patients were diagnosed as having schizophrenia and were hospitalized for two years or longer. The results were as follows: 1) The most common number of different drugs per patient increased from 4 in 1973 and 1979 to 8 in 1993. That of psychotropics increased from 2 to 5. That of neuroleptics increased from 2 to 3. 2) The most commonly prescribed neuroleptics were haloperidol followed by levomepromazine and chlorpromazine. While the top three neuroleptics had not changed, the mean daily dose of haloperidol rose from 8.4 mg in 1979 to 15.3 mg in 1993. Publication Types: • • •

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

PMID: 11026079 [PubMed - indexed for MEDLINE] 1553: Southeast Asian J Trop Med Public Health. 2000 Mar;31(1):91-5. Related Articles, Links

Factors associated with TT (tetanus toxoid) immunization among pregnant women, in Saparua, Maluku, Indonesia. Roosihermiatie B, Nishiyama M, Nakae K. National Institute of Health System Research and Development, Surabaya, Indonesia. [email protected] A cross sectional study was conducted at Saparua Health Center to determine factors associated with the administration of tetanus toxoid. In all, 64 pregnant women were recruited. The majority of the women were housewives, aged 17 to 30 years old, and having more than one child. They were educated to high school, knew some information on tetanus toxoid, and knew at least one of the tetanus symptoms. Almost all did not know the cause of tetanus. The logistic regression of knowledge on tetanus and TT immunization: mothers who heard of TT were 1.54 more likely to have been immunized than those who did not, while mothers who knew the use of tetanus toxoid were 2.15 times more likely to have been immunized than those who did not, and those who knew at least one of the tetanus symptoms were 1.86 times more likely to have been immunized than those who did not, respectively controlling other variables constant. Furthermore, women who had antenatal care were 30 times more likely to have been immunized than those who did not. Enhancing mothers knowledge on tetanus is important to increase the coverage of tetanus toxoid. Moreover, antenatal care would cause contact with sources of tetanus toxoid and hence increase the chance of having the immunization. At the same time, this decreases tetanus neonatorum. Considering the majority of pregnant women received information on tetanus from healthworkers, the use a variety of media would be advantageous. PMID: 11023073 [PubMed - indexed for MEDLINE] 1554: J UOEH. 2000 Sep 1;22(3):283-90. Related Articles, Links

[A report on symposium, "protection for personal information in epidemiological research and cancer registry"] [Article in Japanese] Hoshuyama T, Sakurazawa H.

Department of Environmental Epidemiology, University of Occupational and Environmental Health, Kitakyushu, Japan. A symposium on protection of personal information in epidemiological research and the compilation of a cancer registry was held at the National Cancer Center, Japan, on March 16, 2000. Participants discussed the use of personal health information in epidemiological research activities such as the compiling of a cancer registry to protect personal information. Legislation in Japan is pending in the near future. A total of thirteen domestic and foreign speakers and commentators shared opinions from various viewpoints and discussed the issue. It was proposed that protection regarding personal information should be legislated as soon as possible for the development of cancer registry; patients could be exempted from informed consent for utilization of personal health information, in particular, in public health activities such as the complication of a cancer registry and epidemiological research with the approval of an ethics review board; ethical guidelines including these steps should be established in Japan. An appropriate system of protection of personal information should be established through constructive discussion at frequent meetings and symposia which are open to the citizenry. Publication Types: •

English Abstract

PMID: 11019394 [PubMed - indexed for MEDLINE] 1555: Health Policy Plan. 2000 Sep;15(3):332-7. Related Articles, Links

A participatory approach to sanitation: experience of Bangladeshi NGOs. Hadi A. Research and Evaluation Division, BRAC, Dhaka, Bangladesh. [email protected] This study assesses the role of participatory development programmes in improving sanitation in rural Bangladesh. Data for this study came from a health surveillance system of BRAC covering 70 villages in 10 regions of the country. In-depth interviews were conducted with one adult member of a total of 1556 randomly selected households that provided basic socioeconomic information on the households and their involvement with NGO-led development programmes in

the community. The findings reveal that households involved with credit programmes were more likely to use safe latrines than others who were equally poor but not involved in such programmes. The study indicates that an unmet need to build or buy safe and hygienic latrines existed among those who did not own one. Such latent need could be raised further if health education at the grassroots level along with supervised credit supports were provided to them. Unlike conventional belief, the concept of community-managed jointly owned latrines did not seem a very attractive alternative. The study argues that social and behavioural aspects of the participatory development programmes can significantly improve environmental sanitation in a traditional community. PMID: 11012409 [PubMed - indexed for MEDLINE] 1556: Health Policy Plan. 2000 Sep;15(3):303-11. Related Articles, Links

Financing reforms for the Thai health card scheme. Pannarunothai S, Srithamrongsawat S, Kongpan M, Thumvanna P. Faculty of Medicine, Naresuan University, Phitsanulok, Thailand. The Thai health card scheme originated from a pilot study on community financing and primary health care in maternal and child health in 1983. The scheme later changed to one of voluntary health insurance and finally received a matching subsidy from the government. The coverage of the scheme is described by a U-curve, i.e. it started with 5% of the total population in 1987, declined to 3% in 1992, with an upturn to 14% in 1997. The upturn has been the result of concerns about universal coverage policy, together with reforms of fund management. The provincial fund is responsible for basic health, basic medical, referral, and accident and emergency services. The central fund takes 2.5% of the total fund to manage cross-boundary services and high cost care (a reinsurance policy). On average, the utilization rate of the voluntary health card was higher than that of the compulsory (social security) scheme. And amongst three variants of health cards, the voluntary health card holders used health services twice to three times more than the community and health volunteer card holders. Cost recovery was low, especially in the provinces with low coverage. In the province with highest coverage, cost recovery was as high as 90% of the non-labour recurrent cost. Only 10% of the budgeted fund for reinsurance was disbursed, implying considerable management inefficiency. The management information system as well as the management capacity of the Health Insurance Office should be strengthened. After comparing the health card with other insurance schemes in terms of coverage, cost recovery, utilization and management cost, it is recommended that this voluntary health insurance should be modified to be a compulsory insurance, with some other means of premium collection and minimal

co-payment at the point of delivery. Publication Types: • •

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

PMID: 11012405 [PubMed - indexed for MEDLINE] 1557: Health Policy Plan. 2000 Sep;15(3):279-86. Related Articles, Links

Improving the monitoring of immunization services in Kyrgyzstan. Weeks RM, Svetlana F, Noorgoul S, Valentina G. USAID/BASICS Project, Arlington, Virginia 22209, USA. Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system

improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work. PIP: Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. To reduce the burden of excessive record-keeping and reporting requirements, the working group identified four key indicators for the services delivery level: 1) diphtheria, pertussis, tetanus (DPT) immunization coverage rates for children less than 1 year of age; 2) contraindication rates for DPT; 3) usage of DPT vaccine; and 4) daily refrigerator temperature. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but also the new approach provided visible evidence that the MOH was approaching its objectives. The project demonstrated that giving health workers the basic epidemiological skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work. Publication Types: •

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

PMID: 11012402 [PubMed - indexed for MEDLINE] 1558: Ned Tijdschr Geneeskd. 2000 Sep 9;144(37):1785-9. Related Articles, Links

[Relation between ethnicity and reason for referral of new patients to the Internal Medicine outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt, 1997] [Article in Dutch] Manna DR, Bootsma AH, Lamberts SW, Mackenbach JP.

Erasmus Universiteit, Rotterdam. [email protected] OBJECTIVE: To inventory the ethnic composition of the patients referred to an internal medicine outpatient clinic of a Dutch academic hospital and to determine to what extent ethnic minorities differ from Dutch patients in terms of referral reasons, taking relevant background characteristics into account. DESIGN: Crosssectional analysis. METHOD: Data were collected on all new patients referred in 1997 for the first time to the internal medicine outpatient clinic of the Academic Hospital Dijkzigt, Rotterdam, the Netherlands, using the hospital information system (n = 3205). Patients were categorised into ethnic groups based on country of birth or name. Ethnic differences in referral reasons were tested for the 4 largest ethnic groups by means of logistic regression analysis with adjustment for age, sex, mean income of the zipcode area of the patients' residence and type of health insurance. RESULTS: The percentage of ethnic minorities amongst all referred patients was 22% (696/3205). The percentage of ethnic minorities among the patients referred from the catchment area of the outpatient clinic was 48% (209/440). Compared with Dutch patients Turkish patients were referred more often with stomach ache (odds ratio (OR): 4.26) and joint problems (OR: 7.16) as reasons. Moroccans were more often referred with stomach ache (OR: 4.10) and diabetes (OR: 4.51). Ethnic minorities were referred less often with dyslipidemia (Turks: OR: 0.11; Surinamese: OR: 0.17; Moroccans: 0 patients). Publication Types: •

English Abstract

PMID: 11004953 [PubMed - indexed for MEDLINE] 1559: Inj Prev. 2000 Sep;6(3):199-202. Related Articles, Links

Motor vehicle crashes in Pakistan: the emerging epidemic. Hyder AA, Ghaffar A, Masood TI. Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. [email protected] SETTING: Motor vehicle injuries are increasingly being recognized as a growing public health issue in the developing world. Pakistan is a developing country in South Asia where motor vehicle use has increased since independence in 1947. OBJECTIVE: This paper explores the magnitude and impact of injuries from motor vehicle crashes in Pakistan. METHODS: An exhaustive review of

published and gray literature, together with a detailed analysis of government data from 1956. RESULTS: The data indicate a persistent increase in the numbers of motor vehicle crashes, injuries, and fatalities. Changes in the reporting of rates are important to note in evaluating the data. Commercial vehicles contribute disproportionately to these motor vehicle injuries. CONCLUSIONS: There is a need to further the recognition of injuries as a public health issue in this country. Specific exploration of the epidemiological data; intersectoral collaboration between health, law, police and transport; and the development of appropriate information systems, will contribute to an appropriate response by Pakistan. Publication Types: • •

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

PMID: 11003185 [PubMed - indexed for MEDLINE] PMCID: PMC1730645

1560: Bull World Health Organ. 2000;78(7):884-90. Related Articles, Links

Building the evidence base for global tobacco control. Corrao MA, Guindon GE, Cokkinides V, Sharma N. American Cancer Society, Atlanta, GA 30329-4251, USA. The tobacco control movement needs a global information system permitting routine monitoring of the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. The Tobacco Control Country Profiles database, a data collection initiative led by the American Cancer Society in collaboration with WHO and the Centers for Disease Control and Prevention, represents the first step in the development of such a system. Baseline data on several indicators of tobacco use were obtained from 191 Member States of WHO, two Associate Members, Hong Kong Special Administrative Region of China (Hong Kong SAR), China (Province of Taiwan) and the West Bank and Gaza Strip. The methods used to compile the data are described in the present paper. Selected indicators from the database were analysed in order to demonstrate the potential utility and value of data derived from an information system devoted to tobacco control. The analyses covered gender-specific smoking prevalence by WHO Region, per capita cigarette consumption by Human Development Index (HDI) category, and average real annual percentage changes in cigarette prices between

1990 and 1999 for selected countries in each category. In 1998, men were almost four times more likely than women to be smokers. The prevalence of smoking among men was highest in the Western Pacific Region. The differential in genderspecific smoking prevalence was narrowest in the Region of the Americas and the European Region. It was wider in the South-East Asia Region and the Western Pacific Region. The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively. In the medium HDI category, China's growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption. Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries. The implications of the findings for future tobacco control efforts are discussed, as are issues surrounding the quality of available data, priorities for future data collection and the need to maintain and improve the information system in order to support such efforts. PMID: 10994261 [PubMed - indexed for MEDLINE] 1561: Methods Inf Med. 2000 Aug;39(3):238-40. Related Articles, Links

Subjective symptoms acquisition system in a health promotion system for the elderly. Committee of System Development, Council of Japan AMHTS Institutions. Tanaka Y, Shibata S, Ohtuka Y, Hattori M, Aoshima T, Tohyama S, Uchiyama A, Kashihara H, Tamura M, Tsuchiya A, Yoshida K, Sasamori N. Toshiba Medical Systems Co., Tokyo, Japan. [email protected] A previous report was concerned with the evaluation of quality of life using a Health Promotion System for the Elderly. In the present report, we describe one part of that system: a subjective symptoms acquisition and reporting system. The main purpose of this system is to permit any physician or nurse to uniformly employ questionnaires to acquire accurate subjective symptoms. This system is applied in three steps. First, the subjective answers to 21 questions displayed on a personal computer are obtained. These answers correspond to the basic subjective symptoms. Second, if a basic subjective symptom is "positive", more detailed questions are automatically generated. Finally, clear sentences regarding subjective symptoms are generated and output as a "finding report". This information is helpful to physicians and nurses in their health-counseling work. An artificial intelligence (AI) program based on "XpertRule" produces detailed questions which are generated by an interactive questionnaire using branching logical rules. PMID: 10992751 [PubMed - indexed for MEDLINE]

1562: Int J STD AIDS. 2000 Aug;11(8):536-44. Related Articles, Links

Employment and contextual impact of safe and unsafe sexual practices for STI and HIV: the situation in China. Wang SM, Gao MY. National Centre in HIV Social Research, The University New South Wales, Sydney, Australia. [email protected] China's dual employment system plays a crucial role in sexually transmitted infections (STIs) and HIV-related safe and unsafe sexual practices among young Chinese people. Social and psychological determinants of safe and unsafe sexual practices for HIV infection among young people in Sichuan, China were examined. Our findings indicate that changes in China's social structure and employment system impact upon the social contextual involvement and sociosexual practice of young Chinese people. The findings in the study suggest that the employment-related contextual involvement was a major predictor in the relationships between demography, information, and psychological risk-taking factors on one hand and the people's safe and unsafe sexual practices on the other. Self-employed people (officially called 'getihu') were more likely than the stateemployed people to engage in unprotected sex with casual sexual partners. As China undergoes social restructuring and many state-employed people are laid off, the risk may also extend into the broader non-self-employed population as more state-employed people become involved not only in the self-employed getihu's socioeconomic activities but also in their unconventional socio-sexual practices. Collective vulnerability to STI and HIV, due to the current socio-sexual practices of the getihu young people, has created a new frontier for STI and HIV prevention in today's China, as well as demonstrating the importance of collective action with STI and AIDS prevention strategies within relevant social and subcultural contexts. Publication Types: •

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

PMID: 10990339 [PubMed - indexed for MEDLINE] 1563: J Med Syst. 2000 Jun;24(3):195-211. Related Articles, Links

Medical markup language (MML) for XML-based hospital

information interchange. Araki K, Ohashi K, Yamazaki S, Hirose Y, Yamashita Y, Yamamoto R, Minagawa K, Sakamoto N, Yoshihara H. Miyazaki Medical College Hospital, Japan. Medical Markup Language (MML) has been developed over the last 6 years in order to create a set of standards by which medical data, within Japan and hopefully worldwide, can be stored, accessed and exchanged in any number of physical locates. The MML version 2.21 is characterized by XML as metalanguage, module structure for each document and enhancement of linking function among documents. Data exchange specification has been also added for query and reply. MML instances are composed of MML header and MML body. The MML header includes information for data transmission, while MML body includes several module items. One module item contains two elements: document information and module content. Nine MML module contents are defined at the present time: patient information, health insurance information, diagnosis information, lifestyle information, basic clinic information, particular information at the time of first visit, progress course information, surgery record information and clinical summary information. PMID: 10984873 [PubMed - indexed for MEDLINE] 1564: QJM. 2000 Sep;93(9):617-31. Related Articles, Links

Is there evidence for exogenous risk factors in the aetiology and spread of Creutzfeldt-Jakob disease? Hillier CE, Salmon RL. Welsh Combined Centres for Public Health, University of Wales College of Medicine, Cardiff, UK. [email protected] Publication Types: •

Meta-Analysis

PMID: 10984557 [PubMed - indexed for MEDLINE] 1565: Jt Comm J Qual Improv. 2000 Sep;26(9):538-46. Related Articles, Links

Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect. Kleschen MZ, Holbrook J, Rothbaum AK, Stringer RA, McInerney MJ, Helgerson SD. Pacifi-Care Asia Pacific, Tamuning, Guam. [email protected] BACKGROUND: Pneumococcal disease kills more people in the United States than any other vaccine-preventable bacterial disease, and a national health objective for the year 2000 is that at least 60% of eligible persons be immunized with pneumococcal vaccine. METHODS: An electronic care monitoring system was used to track immunization of patients with diabetes in a managed care plan who were receiving their care through a staff-model primary care clinic in Guam. In November 1998 a letter was sent to all patients not known to be immunized. The letter invited these patients to attend immunization clinics and waived usual copayment. Standing orders were also created for the clinic nurses to administer pneumococcal vaccines. In addition, a diabetes care status report was placed on each patient's medical record. RESULTS: The immunization rate for the 1,278 actively enrolled patients with diagnosed diabetes increased from 42% in October 1998 to 62% in January 1999. Compared to November 1995, 1996, and 1997, the number of pneumococcal immunizations increased more than 15-fold in November 1998. DISCUSSION: The combined use of patient outreach letters, special immunization clinics, standing orders, and practitioner reminders on medical records resulted in a rapid, marked increase in the pneumococcal immunization rate for patients with diabetes. The electronic care monitoring system is being used to target get interventions for improvement opportunities for an array of diabetes care measures, including regular foot care and eye exams. PMID: 10983294 [PubMed - indexed for MEDLINE] 1566: Isr Med Assoc J. 2000 Jul;2(7):510-2. Related Articles, Links

Clinical information system based on the medical smart card. Danon YL, Saiag E. Kipper Institute of Immunology and Human Genetics, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. [email protected] BACKGROUND: Over the last 5 years Israel has implemented a nationwide health insurance plan covering the entire population of the country. We have

developed a clinical information system based on electronic-chip health care medical smart cards. Health care cards are used in several European countries and chip smart cards have been successful in many sectors. Our project involves the community use of the MSC, thereby enabling health care professionals to skillfully employ card systems in the health care sector. This system can easily arrange electronic medical charts in clinics, facilitating the confidential sharing of personal health databases among health professionals. OBJECTIVES: To develop an MSC applicable for daily use in the community and hospital system. RESULTS AND CONCLUSIONS: The MSC project, currently underway in Israel and the USA, will aid in determining the costs, benefits and feasibility of the MSC. Successful implementation of the MSC in chosen clinics will promote a nationwide willingness to adopt this promising technology. Publication Types: • •

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

PMID: 10979323 [PubMed - indexed for MEDLINE] 1567: J Hazard Mater. 2000 Nov 3;78(1-3):19-39. Related Articles, Links

Comparative risk assessment: an international comparison of methodologies and results. Morgenstern RD, Shih J, Sessions SL. Resources for the Future, 1616 P Street, N.W., Washington, DC 200 36, USA. [email protected] Comparative risk assessment (CRA) is a systematic procedure for evaluating the environmental problems affecting a geographic area. This paper looks beyond the U.S. border and examines the experience with CRAs conducted in various developing countries and economies in transition, including Bangkok, Thailand, Cairo, Egypt and Quito, Ecuador, as well as other locations in Eastern Europe, Asia and Central and South America. A recent pilot CRA conducted in Taiwan is also considered. Comparisons are made of both the methodologies and the results across the relatively diverse international literature. The most robust finding is that conventional air pollutants (e.g., particulate matter and lead) consistently rank as high health risks across all of the CRAs examined. Given the varied nature of the settings studied in the CRAs, including level of economic development, urban-rural differences, and climate, this finding is particularly significant. Problems involving drinking water are also ranked as a high or medium health

risk in almost all the countries studied. This is consistent with the results of analyses conducted by the World Bank suggesting contamination, limited coverage and erratic service by water supply systems.Beyond the major air pollutants and drinking water, the CRA results diverge significantly across countries. A number of problems involving toxic chemicals, e. g., hazardous air pollutants, rank as high health risks in the US but do not appear as consistent areas of concerns in the other countries studied. This likely reflects the so-called "risk transition" - the shift from sanitation and infection disease problems to those involving industry, vehicles and toxic substances - that often occurs with economic development. It may also reflect the greater information about sources of toxic pollutants in the U.S. For other problems, there are important differences across the developing countries and economies in transition. For example, hazardous and (industrial) non-hazardous waste issues ranked as medium or low health risks in all the countries studied, except for Taiwan where unmanaged toxic waste sites were considered to pose high risks. While the generally low ranking is consistent with the notion that few people are directly exposed to hazardous and (industrial) non-hazardous waste, it is not entirely surprising that views might be different in Taiwan, where space is so limited and population density is so high.We suggest that the wide range of findings likely reflect genuine differences among the countries studied. However, we cannot entirely rule out the possibility that some of the observed similarities (and differences) arise from the (relatively) common methodologies employed. Publication Types: •

Comparative Study

PMID: 10978559 [PubMed - indexed for MEDLINE] 1568: Gan To Kagaku Ryoho. 2000 Aug;27(9):1347-53. Related Articles, Links

[Cost-effectiveness of cancer therapy] [Article in Japanese] Hisashige A. Dept. of Preventive Medicine, School of Medicine, University of Tokushima. Under recent healthcare reforms, the urgent need for establishing evidence-based healthcare and for economic evaluation has been emphasized. Cancer not only accounts for a major burden of diseases, but also has major economic impacts on both individual patients and society. Most cancer therapies are essentially highcost and high-technology, and provide uncertain outcomes. Concerns about the

appropriate choice and utilization of cancer therapy is increasing. However, economic evaluations for cancer therapy are lacking in a number of areas, despite recent advances. In Japan, to catch up with international trends, serious efforts to generate better evidence for economic evaluation of cancer therapy have recently been made. A league table for economic evaluation of cancer therapy in Japan has been constructed, based on results including preventive antiemetic treatment, breast conserving and post-adjuvant therapy for early breast cancer, bone marrow transplantation for leukemia, interferon treatment for hepatitis C with liver cirrhosis, and others. This information shows substantial possibilities for evaluating the value-for-money of cancer therapy. This may lead to the establishment of an effective and efficient healthcare system in Japan. Publication Types: • •

English Abstract Review

PMID: 10969588 [PubMed - indexed for MEDLINE] 1569: Harefuah. 1999 Jul;137(1-2):1-4, 88. Related Articles, Links

[The Israeli pharmaceutical market] [Article in Hebrew] Shani S, Shemer J. Pharmaceutical Policy and Economics Unit, Israeli Center for Health Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer. The pharmaceutical market in Israel has undergone many major changes over the past 2 years. We detail measures taken with regard to drug prices and utilization, from 1992 until 1995, when the National Health Insurance Law was implemented. This provides an information base for marketing and dispensing of drugs, economic planning in the public health system, and for physicians and pharmacists in clinical practice. The national expenditure on pharmaceuticals in 1994 was 9.4% of the annual national health expenditure. From this fact, and the number of registered drugs and the number of clinical trials conducted, it appears that our pharmaceutical market is quite diversified and well developed compared to other markets in the western world. This size advantage enables our sick funds to purchase drugs at much lower prices than the private sector. Publication Types:

•

English Abstract

PMID: 10959264 [PubMed - indexed for MEDLINE] 1570: Comput Nurs. 2000 Jul-Aug;18(4):197-206. Related Articles, Links

Computer knowledge, attitudes, and skills of nurses in People's Hospital of Beijing Medical University. Liu JE, Pothiban L, Lu Z, Khamphonsiri T. Nursing Department, People's Hospital, Beijing Medical University, China. The first Chinese Hospital Information Systems (HIS) was used as a pilot project at People's Hospital, of Beijing Medical University (BMU). To assess the computer knowledge, attitudes, and skills of nurses working in the hospital, and to examine the relationships among these factors, 169 staff nurses working on clinical units were surveyed by proportionate stratified random sampling. Computer knowledge, attitudes, and skills were measured, by a nurses' computer knowledge questionnaire (NCKQ), nurses' computer attitude scale (NCAS), and nurses' computer skill scale (NCSS), respectively, developed by the investigators. Data analysis showed that the overall computer knowledge and skills of nurses were at moderate levels and the computer attitudes were neutral. Nurses' computer skills were significantly and positively correlated with both computer knowledge and computer attitudes; however, no significant correlation was found between computer knowledge and computer attitudes. Strategies to enhance nurses' computer knowledge, attitudes, and skills were proposed. Publication Types: •

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

PMID: 10939189 [PubMed - indexed for MEDLINE] 1571: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 4:i-iv, 1-101. Related Articles, Links

Mekong malaria. Malaria, multi-drug resistance and economic development in the greater Mekong subregion of Southeast Asia. Singhasivanon P.

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. [email protected] This monograph brings together national malaria databases for 1996, 1997 and 1998 from the 6 countries comprising the Greater Mekong Subregion of Southeast Asia: Cambodia, China (southern provinces), Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam. The objective is to create a regional perspective in what is a global epicenter of drug resistant falciparum malaria, so to enhance the information flow required to improve malaria control on a regional basis in the context of economic and social change. Geographical Information Systems technology has been applied to the regional mapping of total reported malaria cases, malaria incidence, confirmed cases, parasite species distribution. There is great diversity in disease patterns in the 6 countries and at subnational administrative unit area level in each country, so that in the region as a whole there is marked asymmetry in disease distribution, with many areas of high endemicity. Focal expansion of maps in the vicinity of international border areas delineates the differential trans-border malaria distribution that presents a challenge for disease control. The malaria pattern is also depicted in environmental context against regional elevation and forest cover profiles, which affect mosquito breeding site distribution and agricultural activity. Data on resistance of falciparum malaria to a range of anti-malarial drugs summarise the historical and recent context of resistance development and spread in terms of geography and time frame. Data on population movement across international borders identify the magnitude of a major factor in the dispersal of malaria, including resistant parasite strains. Malaria control involves consideration of microeconomic capacity and operates in the broader context of macroeconomic policy: economic and social profiles of the region are included to provide this perspective. So too are maps depicting major economic development projects in the region, projects that have and will continue to have profound, dynamic impacts on malaria epidemiology. The geographic collation of regional malaria databases is thus placed in overall geographic, health, environmental and economic perspective. This beginning can form a basis for the development of an effective regional malaria surveillance system in the context of rapidly evolving social and infrastructural change, leading eventually to a multi-disease surveillance network. Publication Types: •

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

PMID: 10935286 [PubMed - indexed for MEDLINE] 1572: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 3:39-45. Related Articles, Links

External quality assurance in Malaysia. Nawawi H, Lim HH, Zakiah I. Department of Pathology, Hospital UKM, Kuala Lumpur, Malaysia. An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation. PMID: 10926257 [PubMed - indexed for MEDLINE]

1573: Harefuah. 1999 Mar 1;136(5):349-52, 420, 419. Related Articles, Links

[Quality assurance in the mental health department of the Israel Defense Forces] [Article in Hebrew] Mark M, Abramowitz MZ, Intrator O, Bodner E, Shklar R, Knobler HY. Mental Health Department, Medical Corps, Israel Defence Forces. A review of quality assurance in the mental health department of the Israel Defence Forces allowed the examination of certain unique elements of quality control which pertain to the military. These include the psychiatric medical board, the computerized documentation of appointments and sessions with soldiers, the psychiatric hospitalization database, control systems implemented in the draft boards, peer-review boards and supervision, and a special officer in charge of handling outside consultations and queries. There were other components of quality assurance and control as well. These instruments are vital in a dynamic system constantly striving to improve clinical performance. Future plans include the continued use and expansion of quality control boards, the inclusion of quality assurance in the curriculum of mental health officers, and the use of clinical guidelines in working with soldiers. All of this is in keeping with the principle of continuous quality improvement, with the aim of viewing the soldier in need of help as a client. Publication Types: •

English Abstract

PMID: 10914235 [PubMed - indexed for MEDLINE] 1574: Harefuah. 1998 Mar 1;134(5):348-51, 423. Related Articles, Links

[What has happened to patient satisfaction with the care in general hospitals in the years from 1993-1995?] [Article in Hebrew] Berg A, Yuval D.

JDC-Brookdale Institute of Gerontology and Human Development, Jerusalem. Patient satisfaction with the hospitalization process is an important element in the measurement of quality of care. Information from a survey of patients' experiences could therefore help hospitals improve their service, and provide decision-makers with relevant information. We present the findings of a study of some 4,500 patients, aged 18+, released from hospitals in the fall of 1993 and of 1995 from the wards of 9 acute care hospitals, psychiatric and geriatric wards excluded. Self-administered questionnaires were sent and returned by mail, with an overall response rate of 82%. Despite the many changes in Israel's health system in general and its hospital system in particular, and the social and demographic changes between those 2 periods, patient satisfaction remained constant. Of those discharged from medical or surgical wards, 70% were satisfied to a "great" or "ver great" extent with their hospital experience. There was improvement in most areas of hospitalization in the course of the 2 years. The greatest improvement was with regard to admission, nursing staff, hotel services, in patient satisfaction food and supplies. On the other hand there was deterioration in visiting conditions and hours. Satisfaction with physicians, nurses and hotel services had the strongest links with general satisfaction. Publication Types: •

English Abstract

PMID: 10909547 [PubMed - indexed for MEDLINE] 1575: Brain Res Mol Brain Res. 2000 May 31;78(1-2):146-53. Related Articles, Links

Point mutation associated with X-linked dominant Charcot-MarieTooth disease impairs the P2 promoter activity of human connexin32 gene. Wang HL, Wu T, Chang WT, Li AH, Chen MS, Wu CY, Fang W. Department of Physiology, Chang Gung University School of Medicine, KweiSan, Tao-Yuan, Taiwan, ROC. [email protected] Many lines of evidence suggest that connexin-32 gap junction is involved in the exchange of information and metabolites in the peripheral nervous system. It has been shown that connexin-32 protein and mRNA are expressed in Schwann cells that function as myelinating cells of the peripheral nervous system. The physiological importance of connexin-32 gap junctions in regulating the normal function of myelinating Schwann cell is indicated by recent findings that X-linked

dominant Charcot-Marie-Tooth disease, a hereditary peripheral neuropathy, is associated with the mutations of connexin-32 gene. Recently, we encountered a Taiwanese family affected with X-linked dominant Charcot-Marie-Tooth neuropathy. Therefore, we investigated the possible mutation in the coding and noncoding regions of the connexin-32 gene of affected members of this family. Our results suggest that a G-to-A transition at the position -215 (in relation to the transcription initiation site) of the nerve-specific P2 promoter region is associated with the pathogenesis of X-linked dominant Charcot-Marie-Tooth disease. Further experiments using the promoter assay indicate that G-to-A mutation at the position -215 greatly impairs the transcriptional activity of connexin-32 P2 promoter. These findings propose that a reduced expression of connexin-32 mRNA and protein in the myelin sheath could be responsible for the development of X-linked dominant Charcot-Marie-Tooth neuropathy. Publication Types: •

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

PMID: 10891594 [PubMed - indexed for MEDLINE] 1576: Ethn Health. 1999 Feb-May;4(1-2):5-18. Related Articles, Links

Surveillance for the impact in the UK of HIV epidemics in South Asia. Cliffe S, Mortimer J, McGarrigle C, Boisson E, Parry JV, Turner A, Mithal J, Goldberg D, Nicoll A. Public Health Laboratory Service AIDS & STD Centre, Communicable Disease Surveillance Centre, London, UK. OBJECTIVES: To determine whether, because of the extensive recent spread of HIV infection in South Asia, South Asians (those people who classify themselves as Indian, Pakistani, Bangladeshi or Sri Lankan in origin) resident in the UK were at increased risk of HIV infection and to review current surveillance systems for detecting any such increase. DESIGN: Analysis of: ethnic grouping and probable country of infection recorded on voluntary confidential reports of AIDS cases and newly diagnosed HIV infections; blood donation testing data; reports of imported gonorrhoea infections; country of birth data from the unlinked anonymous (UA) survey of Sexually Transmitted Disease (STD) clinic attenders; district of residence data from the UA survey of pregnant women; ethnic grouping of prevalent diagnosed HIV infections. RESULTS: Few reported AIDS cases or HIV infections were found in people of South Asian ethnic origin and few reported HIV or gonorrhoea infections were associated with exposure in South Asia. Data

derived from the UA programme suggested as yet no increase in HIV prevalence in either STD clinic attenders born in South Asia or in pregnant women resident in districts containing substantial numbers of ethnic South Asians. CONCLUSIONS: There was no evidence that South Asians resident in the UK are currently at greater risk of HIV infection than people of white ethnicity or, therefore, that south Asian heterosexuals are a group deserving priority in HIV prevention. However, as rapid spread of HIV infection is being recorded in the Indian subcontinent, continuous monitoring is necessary. This will be facilitated by improved collection of ethnic group information in all surveillance activities. PMID: 10887457 [PubMed - indexed for MEDLINE] 1577: Harefuah. 2000 Mar 15;138(6):465-8. Related Articles, Links

[The Israel Freedom of Information Law, 1998: implications with respect to the health care system] [Article in Hebrew] Yahalom Z, Shani S. Publication Types: •

Review

PMID: 10883161 [PubMed - indexed for MEDLINE] 1578: J Cancer Educ. 2000 Summer;15(2):82-5. Related Articles, Links

Promoting cancer prevention activities among Vietnamese physicians in California. Nguyen BH, Nguyen KP, McPhee SJ, Nguyen AT, Tran DQ, Jenkins CN. Vietnamese Community Health Promotion Project, Department of Medicine, University of California, San Francisco 94102, USA. BACKGROUND: To promote prevention and early detection of cancer, the authors conducted a three-year intervention targeting Vietnamese physicians in solo practice in California. METHODS: Twenty subjects who had received their medical training in Vietnam were recruited into a randomized controlled trial. The intervention included computerized or manual cancer screening reminders,

continuing medical education seminars, Vietnamese-language health education materials, newsletters, and oncology data-query programs. Evaluation included chart audits for eight targeted activities pre- and post-intervention. RESULTS: Before the intervention, annual physician performance rates were low for all eight activities: routine checkups (65.6%), Pap testing (13.8%), pelvic examinations (19.8%), clinical breast examinations (13.3%), mammography (6.4%), hepatitis B serologies (21.9%), hepatitis B immunizations (12.8%), and smoking cessation counseling (1.6%). After the intervention, performance rates increased significantly for smoking cessation counseling (p = 0.02), Pap testing (p = 0.004), and pelvic examinations (p = 0.01). CONCLUSIONS: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities. Publication Types: • • •

Clinical Trial Randomized Controlled Trial Research Support, U.S. Gov't, P.H.S.

PMID: 10879896 [PubMed - indexed for MEDLINE] 1579: Lancet. 2000 Jun 24;355(9222):2231-6. Related Articles, Links Comment in: • • • • • •

Lancet. 2000 Jun 24;355(9222):2248. Lancet. 2000 Sep 16;356(9234):1034-5. Lancet. 2000 Sep 16;356(9234):1035. Lancet. 2000 Sep 16;356(9234):1035. Lancet. 2000 Sep 16;356(9234):1036. Lancet. 2000 Sep 16;356(9234):1036.

North and South: bridging the information gap. Horton R. The Lancet, London, UK. [email protected] Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how

technical fixes--such as the internet--might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty. PMID: 10881907 [PubMed - indexed for MEDLINE] 1580: Mil Med. 2000 May;165(5):321-36. Related Articles, Links Comment in: • •

Mil Med. 2000 Aug;165(8):iii, 625. Mil Med. 2000 Sep;165(9):iv-v.

The role of the sand in chemical warfare agent exposure among Persian Gulf War veterans: Al Eskan disease and "dirty dust". Korényi-Both AL, Svéd L, Korényi-Both GE, Juncer DJ, Korényi-Both AL, Székely A. Hungarian Home Defense Forces, Hungary. The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. Signs and symptoms of Al Eskan disease have been termed by the news media "Persian Gulf syndrome." The dust becomes a warfare agent when toxic chemicals are microimpregnated into inert particles. The "dirty dust" concept, that the toxicity of an agent could be enhanced by absorption into inactive particles, dates from World War I. A growing body of evidence shows that coalition forces have encountered Iraqi chemical warfare in the theater of operation/Persian Gulf War to a much greater extent than early U.S. Department of Defense information had indicated. Veterans of that war were exposed to chemical warfare agents in the form of direct (deliberate) attacks by chemical weapons, such as missiles and mines, and indirect (accidental) contamination from demolished munition production plants and storage areas, or otherwise. We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-

intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses. Publication Types: •

Review

PMID: 10826378 [PubMed - indexed for MEDLINE] 1581: J Clin Virol. 2000 Jun;17(1):23-30. Related Articles, Links

An outbreak of enterovirus 71 infection in Taiwan, 1998: epidemiologic and clinical manifestations. Liu CC, Tseng HW, Wang SM, Wang JR, Su IJ. Department of Pediatrics, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, Taiwan, ROC. [email protected] BACKGROUND: An outbreak of enterovirus infections occurred throughout Taiwan in 1998. The diseases were manifectated with hand, foot, and mouth disease (HFMD), some associated with meningitis, encephalitis, or acute flaccid paralysis (AFP). OBJECTIVES: This study is aimed to characterize and analyze the epidermologic and clinical features during the outbreak. STUDY DESIGN: The epidemiologic information was collected from the Ministry of Health on passive surveillance; clinical and virological investigations were carried out at National Cheng Kung University Medical Center. RESULTS: Between April and December 1998, 405 children were hospitalized, and 78 patients died during this outbreak in Taiwan. There were 119 cases identified to be EV71 infection in Tainan and Chiayi areas; 105 cases by virus isolation and 14 by serological assay. The outbreak had a biphasic curve with peak in June and October, especially in the southern Taiwan. Seventy-two percent of patients were below 3 years of age. The spectrum of disease included HFMD in 54, HFMD with central nerve system (CNS) involvement in 37, herpangina in 12, aseptic meningitis in three, encephalitis/ meningoencephalitis in ten, acute flaccid paralysis in three. There was nine fatal cases complicated with neurogenic pulmonary edema. Myoclonus with sleep disturbance was the most important early sign of EV71 infection with CNS involvement. CONCLUSION: Our experience demonstrated that the EV71

isolated in Taiwan had strong dermatotropic as well as neurotropic tendencies. Early detecting CNS involvement and commencing aggressive therapy may reduce the mortality. Publication Types: •

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

PMID: 10814935 [PubMed - indexed for MEDLINE] 1582: Methods Inf Med. 1999 Dec;38(4-5):362. Related Articles, Links

Patient information maintained electronically: a new regulatory action in Japan. Matsumoto Y. Office of Medical Technology and Information Development, Health Policy Bureau, Ministry of Health and Welfare, Tokyo, Japan. [email protected] PMID: 10805029 [PubMed - indexed for MEDLINE] 1583: J Radiat Res (Tokyo). 1999 Dec;40 Suppl:155-64. Related Articles, Links

Biological dosimetry of atomic bomb survivors exposed within 500 meters from the hypocenter and the health consequences. Kamada N. Department of Cancer Cytogenetics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan. [email protected] Seventy-eight atomic bomb survivors were examined for biological dosimetry using chromosome abnormality. They had been exposed within 500 meters from the hypocenter in heavily shielded conditions and were found from NHK-RIRBM joint study carried out from 1966 to 1971. Estimation of the exposure doses for these survivors was made under the following steps; 1) calculation by DS86 system (physically estimated doses) in survivors who had been exposed within 1,500 meters and had precise records of exposure conditions. RBE for the neutron was defined as 10. 2) setting of exposure dose-chromosome aberration curve, and

3) observation of chromosome aberrations in the proximally exposed survivors, for whom biological doses were estimated. Estimation of the exposure doses were possible from the aberration rate of chromosome in the peripheral lymphocytes, even 25-40 years after the exposure. Of the 78 survivors, 96% were estimated to have exposed more than one Sv. Detection of transforming gene(s) of N and K RAS genes in DNAs from non-leukemic survivors was carried out as one of the biological investigations for these heavily exposed survivors. All four survivors examined showed N or K RAS gene mutation. Three of the four healthy survivors had cancer or leukemia 7-10 years after the examination. Further continuous follow-up study of these heavily exposed people will give us more information on the late effects of A-bomb radiation, which may arise in the future. PMID: 10805004 [PubMed - indexed for MEDLINE] 1584: Rinsho Byori. 2000 Mar;48(3):269-75. Related Articles, Links

[A cost-effectiveness analysis of a pre-visit testing system for new outpatients in primary care medicine] [Article in Japanese] Takemura Y, Ishida H, Inoue Y, Beck JR. Pathology/Information Technology Program, Baylor College of Medicine, Houston, Texas 77030-3498, USA. We evaluated cost-effectiveness parameters of common diagnostic test panels advocated by the Japan Society of Clinical Pathology in order to determine the validity of pre-visit testing of these test panels for new outpatients with some defined symptoms. The "Essential Laboratory Tests(ELT) (2)" panel was universally applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in the National Defense Medical College and its affiliated hospital. A "useful result(UR)", the unit of usefulness of the ELT, was assigned by assessing the impact of its results on physician's diagnosis- or decisionmaking. Patients were classified into 7 major symptom groups according to their chief complaint, and clinical effectiveness(UR/patient), economic efficiency(cost/UR) and cost-effectiveness(delta cost/delta UR) were analyzed in each patient group. Clinical effectiveness ranged from 1.38(renal/urinary tract symptoms) to 0.27 UR/patient(neurological symptoms) with a cost disparity from yen 1,222 to yen 5,946/UR between these patient groups. Substantial decreases in clinical effectiveness were demonstrated in all patient groups with the ELT(1)testing alone in a simulation study; however, cost-effectiveness parameters still remain in excellent values in the renal/urinary tract symptom and infection/inflammation-related symptom groups(1.13 and 0.77 UR/patient at a cost of yen 836 and yen 1,181/UR, respectively). The addition of some ELT(2)-

specific test items such as AST, ALT to the ELT(1) baseline panel improved clinical effectiveness of the ELT(1) in lassitude/exhaustive symptom group at a minimal cost increment. This study verified the validity of the ELT(1) as a panel for pre-visit testing in patients with renal/urinary tract symptoms and infection/inflammation-related symptoms, but not in those with other symptoms. Publication Types: • •

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

PMID: 10804836 [PubMed - indexed for MEDLINE] 1585: Public Health. 2000 Mar;114(2):133-6. Related Articles, Links

Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh. Rahman F, Andersson R, Svanström L. Department of Epidemiology and Biostatistics, Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh. Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Postmortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential

sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries. PMID: 10800153 [PubMed - indexed for MEDLINE] 1586: Health Policy Plan. 1999 Dec;14(4):342-53. Related Articles, Links

National Health Accounts development: lessons from Thailand. Tangcharoensathien V, Laixuthai A, Vasavit J, Tantigate NA, PrajuabmohRuffolo W, Vimolkit D, Lertiendumrong J. Health Systems Research Institute, Thailand. National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in

1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports. Publication Types: •

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

PMID: 10787650 [PubMed - indexed for MEDLINE] 1587: Int J Tuberc Lung Dis. 2000 Apr;4(4):345-9. Related Articles, Links

High rate of non-compliance with anti-tuberculosis treatment despite a retrieval system: a call for implementation of directly observed therapy in Saudi Arabia. Al-Hajjaj MS, Al-Khatim IM. King Saud University Medical College, Riyadh, Saudi Arabia. [email protected] SETTING: Taif Chest Hospital, Taif, Saudi Arabia. OBJECTIVES: Noncompliance with anti-tuberculosis drug therapy is recognised as a major cause of treatment failure, drug resistance and relapse. In Saudi Arabia, the problem of non-compliance is frequent and has serious implications which need urgent attention from the health-care authority. The objectives of this study were to define factors that affect compliance rate and to determine the appropriate

methods to modify these factors. DESIGN: We designed and tested a retrieval system to improve patient return for follow-up and drug collection after an initial hospital admission period in a large chest hospital in the western region of the country. RESULTS: Of 628 patients, 358 (57%) did not attend the first out-patient clinic visit. The retrieval system was successful in bringing back only 83 patients, reducing the default rate by only 13.2%. Various factors that may affect compliance were analysed in the remaining 275 (43.8%) non-compliant patients. CONCLUSION: Because many of these factors are difficult to change, we strongly support implementation of the WHO-recommended directly observed treatment (DOT) strategy in Saudi Arabia and other countries facing similar problems with tuberculosis control. PMID: 10777084 [PubMed - indexed for MEDLINE] 1588: Southeast Asian J Trop Med Public Health. 1999 Sep;30(3):427-31. Related Articles, Links

Cost-effectiveness analysis of lambdacyhalothrin-treated nets for malaria control: the patients' perspective. Butraporn P, Kamolratanakul P, Prasittisuk M, Prasittisuk C, Indaratna K. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. [email protected] The present study was undertaken to evaluate the cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT-spraying as a method of malaria control according to the patients' perspective among migrant populations in a high-risk area along the Thai-Myanmar border in Thailand. Ten hamlets comprising 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets comprising 294 houses and 1,315 inhabitants represented the DDT-treated area and another six hamlets with 171 houses and 695 inhabitants served as controls. Information as to consumer costs was obtained by interviewing 3,214 patients seeking care at all levels of the health care system in the study area. Analysis showed that the impregnated-net program was more cost-effective than the DDT-spraying program or surveillance alone (US$ 0.59 vs US$ 0.74 vs US$ 0.79 per 1 case of prevented malaria). We conclude that in a high-risk area such as along the Thai-Myanmar border in western Thailand, integrating the use of impregnated nets with large-scale primary health care programs is likely to constitute the most cost-effective method for controlling malaria according to the patients' perspective. Publication Types: • •

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

PMID: 10774647 [PubMed - indexed for MEDLINE] 1589: MMWR Morb Mortal Wkly Rep. 2000 Mar 31;49(12):248-53. Related Articles, Links

Imported dengue--United States, 1997 and 1998. Centers for Disease Control and Prevention (CDC). Dengue is a mosquito-transmitted acute viral disease caused by one of four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). Dengue is endemic in most tropical areas of the world and has occurred in U.S. residents returning from travel to such areas. CDC maintains a laboratory-based passive surveillance system for imported dengue among U.S. residents. The system relies principally on reports by clinicians to state health departments, which forward patient specimens to CDC for diagnostic testing. This report summarizes information about imported dengue cases among U.S. residents for 1997 and 1998, which indicates that most persons with a known travel history probably acquired infection in the Caribbean islands or Asia. PMID: 10774545 [PubMed - indexed for MEDLINE] 1590: Southeast Asian J Trop Med Public Health. 1998 Dec;29(4):669-84. Related Articles, Links Comment in: •

Southeast Asian J Trop Med Public Health. 1998 Dec;29(4):667-8.

Application of geographical information systems to co-analysis of disease and economic resources: dengue and malaria in Thailand. Indaratna K, Hutubessy R, Chupraphawan S, Sukapurana C, Tao J, Chunsutthiwat S, Thimasarn K, Crissman L. WHO Collaborating Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand. [email protected] Two vector-borne communicable diseases, malaria and dengue, are among a number of diseases of particular importance in relation to economic development in Southeast Asia and thus need to be assessed in relation to economic parameters in the region. Geographical Information Systems (GIS) provide one means of

comparing disease and resource data versus time and place, to facilitate rapid visualization by planners and administrators. Given that Thailand is a global epicenter of multidrug resistant falciparum malaria and of dengue hemorrhagic fever, both of which are mosquito-borne, application of GIS methods to these two diseases gives opportunity for comparison of resource needs and allocation in relation to disease epidemiologic patterns. This study examined per capita gross provincial product (GPPpc) and health care resources in relation to geographic distribution of malaria and dengue in Thailand. The two diseases vary greatly in overall seasonal patterns and in relation to provincial economic status, and present differing demands on resource utilization: planned integration of control of malaria and dengue could utilize such analyses in relation to resource sharing and consideration of allocative efficiency. The concentration of malaria (and to a lesser extent dengue) along international border areas underscores the desirability of multi-country coordination of disease management and control programs. Because socio-economic and disease data are collected by quite different means and in different time frames, there are some limitations to the dynamic interpolation of these two broad data sets, but useful inferences can be drawn from this approach for application to overall planning, at both national and multicountry levels. Publication Types: •

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

PMID: 10772545 [PubMed - indexed for MEDLINE] 1591: Turk J Pediatr. 1999;41 Suppl:27-34. Related Articles, Links

Multimedia and children in Turkey. Tuncer AM, Yalçin SS. Hacettepe University Institute of Child Health, Ankara, Turkey. Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood

obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available. Publication Types: •

Review

PMID: 10770073 [PubMed - indexed for MEDLINE] 1592: Turk J Pediatr. 1999;41 Suppl:7-12. Related Articles, Links

Children in Japan and multimedia. Shimauchi Y. Benesse Corporation, Japan. Many parents in Japan today are very concerned and have daily problems with their children over the following kind of issues concerning video games, multimedia, and similar devices. 1) Is children's enthusiasm for video games actually harming their growth (physically or mentally)? 2) Is there any way that video games can help children in the future? For example, will playing these games help children learn to use computers or develop their power of thought? 3) Will excessive enthusiasm for TV games undermine our basic lifestyle? Is the time they spend studying at home or playing outside actually decreasing? 4) Will the methods of communication brought about by computers, pagers, and cellular phones weaken human relations among children? 5) Will being immersed in a virtual world created by computers result in a diminished sense of reality? The causes of this uneasiness may be traced to parents' own anxieties and concerns about the exceedingly rapid growth of the "information society" of today, together with the fact that their children are directly caught up in the deluge of this

information and multimedia society. The development of media has coincided with the growth of today's adults, but children are immersed in a media-filled environment from the day they are born. In Japan, there are now children who can play video games before even learning to write. No one can predict what kind of adults these children will grow to be in the future, and it is fair to say that the most parents and children in Japan are being tossed about on the waves of this information explosion. At this international symposium, we hope to hear the many views that are held around the world concerning children and multimedia. PMID: 10770069 [PubMed - indexed for MEDLINE] 1593: J Manag Med. 1999;13(2-3):178-89. Related Articles, Links

Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine. Lian PC, Marnoch G. Department of Management Studies, University of Aberdeen, Scotland, UK. This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelinesbased medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit--less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings. PMID: 10747449 [PubMed - indexed for MEDLINE] 1594: Top Health Inf Manage. 2000 Feb;20(3):75-9. Related Articles, Links

Automation of practice management in a Lebanese University Health Clinic. Hamadeh G.

Department of Family Medicine, University Health Services, American University of Beirut, Lebanon. Interest in technology and the recognition that clinical practice analysis data is crucial for planning have stimulated the development of information management solutions at all levels in developing countries. The spectrum of such endeavors remains restrained due to the limitations in human resources skills. This paper describes an inexpensive operation for automating practice analysis in a Lebanese University Health Clinic. The system was developed in piecemeal fashion to accommodate the needs of the staff and their computer expertise. It demonstrates the impact of such automation on patient care, including missing medical records, appointment scheduling, referral rates, and repeat prescriptions. PMID: 10747437 [PubMed - indexed for MEDLINE] 1595: Mil Med. 2000 Mar;165(3):228-36. Related Articles, Links

Shipboard medical admissions during peacetime and combat support deployments. Blood CG. Medical Information Systems and Operations Research Department, Naval Health Research Center, San Diego, CA 92186-5122, USA. Hospitalizations aboard aircraft carriers were examined to ascertain differences in illness type attributable to theater of operations and combat deployment status. Percentage distributions and lengths-of-stay statistics of major diagnostic categories are provided and compared between Vietnam combat support and peacetime modes of operations and between Western Pacific and Mediterranean theaters of operations. Respiratory disease proportions were found to be significantly higher for Vietnam combat support deployments than during subsequent peacetime deployments. For peacetime deployments, the Western Pacific deployments had higher percentages of infective, respiratory, and skin disorders, whereas the Mediterranean theater had a larger proportion of total admissions accounted for by accidents. Publication Types: • • •

Comparative Study Historical Article Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10741089 [PubMed - indexed for MEDLINE]

1596: Sex Transm Dis. 2000 Mar;27(3):138-42. Related Articles, Links Comment in: •

Sex Transm Dis. 2000 Mar;27(3):143-5.

Epidemiologic trends of sexually transmitted diseases in China. Chen XS, Gong XD, Liang GJ, Zhang GC. Department of Epidemiology and Surveillance, National Center for STD and Leprosy Control, Chinese Academy of Medical Sciences, Nanjing. OBJECTIVE: To describe the current epidemiology of sexually transmitted diseases (STDs), we analyzed the time trends in distribution of reported cases of STDs in China from 1989 to 1998. STUDY DESIGN: Based on the computerized database of the National System of STD Surveillance, a retrospective study of STD cases reported from 1989 to 1998 was carried out. RESULTS: From 1989 to 1998, STD incidence increased significantly in men and women and demonstrated nonlinear growth trends, with the exception of gonorrhea incidence. Between 1990 and 1998, the incidence increased more in females (4.20 times) than that in males (3.79 times). Syphilis incidence increased approximately 20 times during this period at an average annual rate of 52.7%. Gonorrhea incidence increased 2.6 times during this period at an average annual rate of 11.4%, which reached a plateau from 1994 to 1997. Extramarital transmission as source of STD infection has significantly increased from 1995 to 1998. CONCLUSION: The incidence of STDs has continued to increase in China from 1989 to 1998. The epidemic patterns are different from rates in developed counties in which behavior interventions have been successfully implemented, suggesting the need for active behavioral-intervention programs in China. PIP: To describe the current epidemiology of sexually transmitted diseases (STDs), the authors analyzed the time trends in distribution of reported cases of STDs in China from 1989 to 1998. Based on the computerized database of the National System of STD Surveillance, a retrospective study of STD cases reported from 1989 to 1998 was carried out. From 1989 to 1998, STD incidence increased significantly in men and women and demonstrated nonlinear growth trends, with the exception of gonorrhea incidence. Between 1990 and 1998, the incidence increased more in females (4.20 times) than that in males (3.79 times). Syphilis incidence increased approximately 20 times during this period at an average annual rate of 52.7%. Gonorrhea incidence increased 2.6 times during this period at an average annual rate of 11.4%, which reached a plateau from 1994

to 1997. Extramarital transmission as source of STD infection significantly increased from 1995 to 1998. The incidence of STDs continued to increase in China from 1989 to 1998. The epidemic patterns are different from rates in developed counties in which behavior interventions have been successfully implemented, suggesting the need for active behavioral-intervention programs in China. Publication Types: •

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

PMID: 10726645 [PubMed - indexed for MEDLINE] 1597: Kekkaku. 2000 Feb;75(2):79-88. Related Articles, Links

[A study on tuberculosis cases among over-staying foreigners] [Article in Japanese] Yamamura J, Sawada T. Minatomachi Medical Center, Japan. An analysis was made on eighty-four cases of tuberculosis (TB) among overstaying foreigners during the past 9 years at Minatomachi Medical Center. All of them did not enroll in any health insurance system because they were illegal immigrants. Most of them were in their twenties and thirties. The ratio of male to female was four to one. By ethnic origin, the proportion was highest among Filipinos (30%), followed by Koreans (23%), Pakistanis (13%) and Indians (7%). Half of them had been in Japan for more than two years. Most patients sought care due to symptoms rather than as a result of the efforts of public health centers to screen foreigners. The proportion of extrapulmonary TB among all types of TB was 35% overall. Compared with pulmonary TB cases, patient's as well as doctor's delay was more marked among extrapulmonary TB cases. Forty cases were treated at Minatomachi Medical Center and forty-four cases were referred to another hospitals. The default rate including repatriation was as high as 41%, and the reasons for this high defaulting rate were as follows: 1. Language barrier, 2. Worry for loosing work during treatment, 3. Worry for high medical costs because of no coverage by a health insurance scheme, 4. Lack of information on medical systems and TB, 5. Worry for forced repatriation by the immigration office. In addition, some cases were not followed up due to unkind behaviour of attending physicians. The following measures are needed to prevent the epidemic of tuberculosis among overstaying foreigners and our societies. a) To provide free medical check-ups b) To provide easy access to medical facilities c) To utilize the

tuberculosis prevention law d) To follow up patient thoroughly and strictly e) To explain TB in their mother languages f) To change the immigration law and its system g) To make liaison with other organizations such as medical facilities and NGOs, including foreign ones, and exchange informations h) To build good human relations with patients. Publication Types: •

English Abstract

PMID: 10723940 [PubMed - indexed for MEDLINE] 1598: Stud Health Technol Inform. 1999;68:720-5. Related Articles, Links

TIDE: an intelligent home-based healthcare information & diagnostic environment. Abidi SS. Health Informatics Research Group, School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia. The 21st century promises to usher in an era of Internet based healthcare services-Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance. PMID: 10724989 [PubMed - indexed for MEDLINE] 1599: Stud Health Technol Inform. 1999;68:453-6. Related Articles, Links

Applying data mining in healthcare: an info-structure for delivering 'data-driven' strategic services.

Abidi SS. Health Informatics Research Group, School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia. Presently, there is a growing demand from the healthcare community to leverage upon and transform the vast quantities of healthcare data into value-added, 'decision-quality' knowledge, vis-à-vis, strategic knowledge services oriented towards healthcare management and planning. To meet this end, we present a Strategic Knowledge Services Info-structure that leverages on existing healthcare knowledge/data bases to derive decision-quality knowledge-knowledge that is extracted from healthcare data through services akin to knowledge discovery in databases and data mining. PMID: 10724926 [PubMed - indexed for MEDLINE] 1600: Stud Health Technol Inform. 1999;68:283-8. Related Articles, Links

Telemedicine in the Malaysian Multimedia Super Corridor: towards personalized lifetime health plans. Abidi SS, Yusoff Z. Health Informatics Research Group, School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia. The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare delivery patterns by way of implementing a person-centred and wellness-focused healthcare system. This paper introduces the Malaysian Telemedicine vision, its functionality and associated operational conditions. In particular, we focus on the conceptualisation of one key Telemedicine component i.e. the Lifetime Health Plan (LHP) system--a distributed multimodule application for the periodic monitoring and generation of health-care advisories for all Malaysians. In line with the LHP project, we present an innovative healthcare delivery info-structure-LifePlan--that aims to provide life-long, pro-active, personalised, wellnessoriented healthcare services to assist individuals to manage and interpret their health needs. Functionally, LifePlan based healthcare services are delivered over the WWW, packaged as Personalised Lifetime Health Plans that allow individuals to both monitor their health status and to guide them in healthcare planning. PMID: 10724889 [PubMed - indexed for MEDLINE]

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1601: Acta Trop. 2000 Feb 25;75(1):95-108. Related Articles, Links

Study of the dog population and the rabies control activities in the Mirigama area of Sri Lanka. Matter HC, Wandeler AI, Neuenschwander BE, Harischandra LP, Meslin FX. Swiss Federal Office of Public Health, Bern. [email protected] The national health authorities of Sri Lanka have adopted a combined strategy of rabies vaccination and stray dog removal to control endemic dog rabies. Despite the control efforts, an increase of animal and human rabies cases has occurred since 1994. As a consequence, a project to evaluate the national rabies control program has been started and a study focussing on the dog population and rabies control activities in a limited area of Mirigama was conducted. Information on canine abundance and the accessibility of dogs for rabies vaccination was obtained by a household survey, vaccination of dogs against rabies at several vaccination points, collar-marking, and transect line recapture. The number of unvaccinated dogs was estimated by using Bayesian methodology. The estimated number of dogs per square kilometre was 87 (95% credibility interval: 80, 93) for owned dogs and 108 (100, 116) for owned and ownerless dogs. Coverage after the immunisation campaign was 57.6% (53.3, 61.9%) if vaccination at the vaccination points was considered and 66% (60.4, 72.0%) if recently provided vaccination by private veterinarians was also taken into account. The proportion of households with at least one dog vaccinated varied between 59.1 and 94.2% within the catchment area of the different vaccination points. Unvaccinated dogs were puppies (12%), ownerless dogs (57%), and owned dogs, which were not presented for vaccination (31%). In order to improve the rabies immunisation coverage among dogs and to achieve complete elimination of rabies it was recommended that the 95% catchment area of each vaccination point be assessed, the distribution of vaccination points in the vaccination area be redefined if necessary, a system for the vaccination of dogs missing the vaccination campaign for dog owner-specific reasons be established, and an inexpensive marking system be used for vaccinated dogs. Publication Types: •

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

PMID: 10708011 [PubMed - indexed for MEDLINE] 1602: J Formos Med Assoc. 1999 Nov;98(11):767-72. Related Articles, Links

Recent advances in telemedicine. Chen HS, Guo FR, Lee RG, Lin CC, Chen JH, Chen CY, Kuo TS, Hou SM. Department of Medical Informatics and Family Medicine, National Taiwan University, Taipei, Taiwan. With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health care, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in highbandwidth telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the Web. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household. Publication Types: • •

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

PMID: 10705694 [PubMed - indexed for MEDLINE] 1603: Soc Sci Med. 2000 Mar;50(6):763-71. Related Articles, Links

Trends in and determinants of mortality in the elderly population of Matlab, Bangladesh.

Mostafa G, van Ginneken JK. Health and Demographic Surveillance Programme, Public Health Sciences Division, International Centre for Diarrhoeal Disease, Research, Dhaka, Bangladesh. [email protected] Longitudinal data collected from the Demographic Surveillance System (DSS) in Matlab, a rural area in Bangladesh, are used for determining trends in and determinants of mortality of the elderly population (60 yr and over) in 1974-1996. The old-age mortality rate is high in Matlab, 1.2 times that of Sri Lankan and 1.5 times that of the Swedish elderly population in a comparable period. Mortality among the elderly population declined in 1974 1982, but much less so in 19821996. Proportional hazards models were used for examining determinants of mortality in a sample of about 10,000 elderly persons. This multivariate analysis used information on several social and economic variables derived from the 1982 census and mortality data of this population which was followed prospectively in 1982-1992. Marital status was the single most important determinant: widows and widowers had 1.5 to 2 times higher risk of death compared to couples where both husbands and wives were alive. Social support in old age by children also plays a role, especially for women: women living with at least one son or daughter had 18% lower mortality than women living in a household without sons or daughters. Socioeconomic factors are also important. Those who had at least some education or were relatively affluent had lower mortality than those with no education or who were less affluent. Publication Types: • •

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

PMID: 10695976 [PubMed - indexed for MEDLINE] 1604: Nippon Koshu Eisei Zasshi. 2000 Jan;47(1):79-86. Related Articles, Links

[A survey on drug-related service by homehelper in the Japanese home care system] [Article in Japanese] Sakai N, Fukushima N, Matsumoto K, Matsuda S. Department of Division of Social Pharmacy, Kyoritsu College of Pharmacy. The purposes of this study are a) to determine whether homehelpers attend to

drug-related service of elder care-recipients at home and b) to determine what cooperating human resources were utilized. A structured questionnaire survey was conducted in 1997 with 403 homehelpers who provided in home care to dependent elderly person. Of the total, 19% subjects did deal with care recipients' medication. Regarding the type of service, the highest proportion of subjects had assisted by picking up medicine from pharmacy and talking it to the care recipients' home. Results showed that physicians and home visiting nurses were the most depended upon human resources in the home health care system among health, medical and welfare facilities. Results also suggested that many homehelpers are not aware that pharmacists are readily available resources for providing home health care. Hence we conclude that the respondents tend to rely on physicians or home visiting nurses to respond to care recipients care, and pharmacists should be made aware of the necessity of providing the appropriate drug-related information to physicians or home visiting nurses. Publication Types: •

English Abstract

PMID: 10695341 [PubMed - indexed for MEDLINE] 1605: J R Soc Med. 1999 Dec;92(12):626-7. Related Articles, Links Comment in: •

J R Soc Med. 2000 Mar;93(3):161-2.

Attitudes to organ donation among South Asians in an English high street. Ahmed W, Harris S, Brown E. Chelsea and Westminster Hospital, London, UK. In the UK, people of South Asian origin are at more than twice the risk of endstage renal failure encountered in the Caucasian population but are underrepresented among organ donors. Difficulties with matching mean that few donated kidneys are suitable for transplantation to South Asian recipients. A survey of attitudes in 100 South Asian adults was conducted in the main street of Southall, Middlesex. 90 of those questioned were aware of organ transplantation and 69 had heard about donor cards. However, the 16% who carried a donor card was lower than the 28% reported in the general population. The main reason for

the low organ donation rate by South Asians seemed to be lack of knowledge, and this could be remedied by more targeting of information in the Asian media. PMID: 10692883 [PubMed - indexed for MEDLINE] PMCID: PMC1297467

1606: Med Law. 1999;18(4):589-99. Related Articles, Links

The Israeli Law of Freedom of Information 1998--implications with respect to the healthcare system. Yahalom Z, Shani S. Legal Section, Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel. The right of the Israeli public to get information from state authorities has been based until recently only on Israeli Supreme Court rulings. In 1998, a Law of Freedom of Information was enacted. The new Law tries to follow the rulings of the Israeli Supreme Court regarding freedom of information, in establishing substantive statutory arrangements. Publication Types: •

Review

PMID: 10687364 [PubMed - indexed for MEDLINE] 1607: J Am Board Fam Pract. 2000 Jan-Feb;13(1):11-6. Related Articles, Links

Adolescent preventive health visits: a comparison of two invitation protocols. Knishkowy B, Palti H, Schein M, Yaphe J, Edman R, Baras M. Family Medicine, Department of Social Medicine, Hadassah Medical Organization and the Braun School of Public Health and Community Medicine of the Hebrew University and Hadassah, Jerusalem, Israel. BACKGROUND: Adolescent health care in family practice at times creates

conflicting responsibilities for parents and their teenagers. In the context of a new adolescent preventive health program in a family practice setting, we compared attendance rates using two invitation protocols, the protocols differing in their emphasis on adolescent autonomy vs parental responsibility. METHODS: One hundred six teenagers in the seventh and tenth grades were invited for preventive health visits with the family nurse and physician using two protocols. Protocol 1 involved obtaining parental consent before approaching the adolescent. With protocol 2, an invitation letter and parental consent form were mailed to the teenager, while a letter of explanation was sent concurrently to the parents. In each case, the letter of invitation was followed up by a telephone call for those who did not respond. The spontaneous response rate (a positive response after receiving the letter), agreement to attend rate (a positive response after receiving the letter or being telephoned), and the attendance rate were determined according to grade, sex, and protocol. RESULTS: The spontaneous response rate was 21%, the agreement to attend rate was 75%, and the attendance rate was 44%. Attendance rates were higher for the girls compared with the boys (54% vs 35%, P = .08) and for the seventh graders compared with the tenth graders (53% vs 31%, P = .03). The spontaneous response rate was lower among the tenth graders using protocol 2 (8% vs 37.5% with protocol 1, P = .04), while the agreement to attend rate and attendance rate did not differ for the two protocols. CONCLUSIONS: Nearly one half of this population of adolescents attended preventive health visits at the family nurse's and physician's initiative. A followup telephone call after the initial written invitation resulted in increased participation, while approaching the teenager or parent initially did not make a difference in attendance. This pilot study shows the potential for initiating an adolescent health program in the family practice setting. Publication Types: • •

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

PMID: 10682880 [PubMed - indexed for MEDLINE] 1608: J Biosoc Sci. 2000 Jan;32(1):89-98. Related Articles, Links

The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh. Rahman MO. Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.

This paper uses prospective data from the Matlab surveillance system in rural Bangladesh to demonstrate that initially co-resident spouses and sons have a major impact on the subsequent mortality of old people, with significant differences by the sex of the elderly person, and the age of the son. Spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. Finally, this analysis suggests that the impact of spouses and sons on mortality in old age is not substantially mediated through changes in elderly economic status. PIP: This study uses a prospective data with a large sample size from rural Bangladesh to examine the impact of co-resident spouses and sons on the subsequent mortality of old people, with significant differences depending on the sex of the elderly person and the age of the son. Findings revealed that spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. In conclusion, it is clear that in the study population, the presence of co-resident sons and spouses acts in a complex way to affect mortality in old age, with elderly women being particularly vulnerable to these effects. No single mechanism can fully explain the varying impact of spouses and sons. Not only may different mechanisms (protection through increased social integration/enhanced stress buffering/improved information networks, protection through improved economic status, and selection into co-residences on the basis of health status) be operative in the case of spouses versus son, but more than one mechanism may be responsible in each case. PMID: 10676061 [PubMed - indexed for MEDLINE] 1609: Cancer Nurs. 2000 Feb;23(1):64-70. Related Articles, Links

Middle Eastern Asian Islamic women and breast self-examination. Needs assessment. Rashidi A, Rajaram SS. Methodist Health System, Omaha, Nebraska, USA. This exploratory, descriptive research study examined the knowledge and frequency of breast self-examination (BSE) among Middle Eastern Asian Islamic

immigrant women residing in a major metropolitan U.S. city. The purposive sample consisted of 39 Middle Eastern Asian Islamic immigrant women ranging in age from 20 to 48 years (mean, 33; SD, 8.29). The sample was recruited from women who attended a local mosque. Data was collected by asking a list of seven questions based on Champion's BSE tool that assessed knowledge and frequency of BSE. Sociodemographic information also was collected. The results indicated that 33 women (85%) had heard of breast self-examination, and 29 women (74%) had not examined their breasts for lumps. None of the participants had examined her breasts monthly for lumps during the past year. Most of the women had not learned about BSE from a health professional, nor had they undergone a clinical breast examination (CBE). The results of this research show that Middle Eastern Asian immigrant women may be a population overlooked by health care professionals in the education of BSE. Suggestions to improve breast cancer screening practices among this population are provided. PMID: 10673809 [PubMed - indexed for MEDLINE] 1610: Fam Pract. 2000 Feb;17(1):42-5. Related Articles, Links

Patient adherence to family practitioners' recommendations for breast cancer screening: a historical cohort study. Giveon S, Kahan E. Department of Family Medicine, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. BACKGROUND: Breast cancer is the most prevalent malignancy among women in Israel, and routine screening is recommended for early detection. In 1997, a health management organization primary care centre in rural Israel established a 1-year programme wherein family physicians were encouraged to remind their patients to undergo breast cancer examinations. This study evaluates the impact of the physicians' intervention on patient compliance. METHODS: Family practitioners from two practices were requested to discuss the importance of early breast cancer detection with all eligible patients who visited the clinic for any reason and to assist them in scheduling an appointment for screening. The files of the patients who received the recommendation were stamped accordingly. On completion of the programme, the physicians' files were audited, and the potential candidates for breast cancer screening were divided into two groups: those who had received the intervention (n = 251) and those who had not (n = 187); results were also compared with those of a third group of patients who had gone for an examination on their own initiative (n = 100) prior to the study (i.e. did not require intervention). A random sample of half the patients also completed an ad hoc questionnaire covering sociodemographic variables and the impact of the

doctors' intervention on their behaviour. RESULTS: Patients in the intervention group showed a significantly greater change in behaviour regarding breast cancer screening than the controls (32% versus 13%, P = 0.001). This change was manifested particularly in the group of women aged 50-74 years who received the recommendation for mammography to be performed (according to the guidelines). CONCLUSION: Although this is a study in only two practices, the results suggest that primary care physicians can significantly alter the behaviour of their patients regarding regular breast examinations. The use of a special reminder can also help the individual doctor to ensure that each patient has been properly instructed. Publication Types: •

Comparative Study

PMID: 10673487 [PubMed - indexed for MEDLINE] 1611: Neurol Res. 2000 Jan;22(1):127-30. Related Articles, Links

Actualities in hydrocephalus classification and management possibilities. Mori K. Department of Neurosurgery, Kochi Medical School, Japan. Retrospective analysis in co-operative study of hydrocephalus at institutions of members of the Research Committee on Intractable Hydrocephalus sponsored by the Ministry of Health and Welfare of Japan was performed to determine the functional prognosis. For clinico-epidemiological study we classified non-tumoral hydrocephalus into eight types based on its etiology and the time of onset. Analysis of the 1,450 cases of hydrocephalus stored in the database obtained from the study was performed in order to find intractable factors in terms of factors related to patients and management. Analysis of the cases stored in the database revealed that the following types and conditions were found to be intractable factors: 1. Early fetal hydrocephalus. 2. Overt neonatal hydrocephalus. 3. Hydrocephalus associated with such severe brain malformations as hydranencephaly, holoprosencephaly and lissencephaly. 4. Hydrocephalus associated with severe brain damage. 5. Hydrocephalus associated with epilepsy. 6. Hydrocephalus shunted late after detection. 7. Hydrocephalus complicated by a shunting operation. It is impossible to determine prior to treatment whether or not a shunting operation is indicated for the patient with intractable factors, however, they may be a useful pre-operative indicator of prognosis. For the management of hydrocephalus, secondary intractable hydrocephalus may be preventable if we

treat it appropriately before it becomes intractable. Publication Types: • •

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

PMID: 10672591 [PubMed - indexed for MEDLINE] 1612: Nippon Koshu Eisei Zasshi. 1999 Dec;46(12):1094-100. Related Articles, Links

[Midterm achievement and problems of all municipal health and welfare plans for the elderly in Yamagata Prefecture] [Article in Japanese] Gotou J, Yasumura S, Imuta H, Abe H, Katura T, Watanabe Y, Hoshino A, Suzuki I. Yamagata School of Health Science, Department of Nursing. PURPOSE: This study was made for providing information in the preparation of Social Welfare Systems in municipalities. METHODS: Based on seven official reports by Yamagata Prefecture, quantitative data on health and welfare services were analyzed. We investigated the midterm achievement and problems of a Municipal Health and Welfare Plan for the Elderly in all 44 municipalities by mail survey (response rate 100%). The questionnaire included the progress situation of the plan, the existence of an assessment organization, and the characteristics of the plan. RESULTS: Both health service and welfare service achieved targets level to a degree. Concerning the progress situation, "The midterm achievement is not satisfactory" for 65.9% (29 municipalities). The main reasons were "budgets" (93.1%, 27 municipalities) and "lack of manpower" (75.9%, 22 municipalities) all of which indicates "lack of home helpers". 58.6% of all 44 municipalities were reconsidering the plan. In assessment organization existed in 31.8% (14 municipalities) of all municipalities. CONCLUSION: It is necessary that analysis should consider not only use of quantitative data but also qualitative one. The major problems found are that community characteristics were not reflected and the opinion of inhabitants were not considered. Publication Types: • •

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

PMID: 10658474 [PubMed - indexed for MEDLINE] 1613: Eur J Med Res. 2000 Jan 26;5(1):23-5. Related Articles, Links

Emergency medicine and air rescue in India: future perspectives. Sachdev KS. Privat Hospital, DLF Qutab Enclave, Phase-II, Gurgaon/New Delhi, India. [email protected] 76.7% of Indian population lives in rural areas. About 160,000 primary health care centres and subcentres, established all over the country, are responsible for the emergency care in the countryside. A centre, manned by a qualified doctor, a nurse/midwife and paramedics, with basic equipment and facilities has to manage all types of medical emergencies in a population of 3000 - 5000. A patient who survives this emergency care has to be transferred to higher secondary / tertiary centre. In metropolitan areas there are larger hospitals some of them having well equipped casualty departments supervised by specialists, but the number of patients are so large that the management of emergency goes often haywire. Patient transport system is very inadequate. The ambulances are scarce and mostly not well equipped. Air rescue which is the most desired, because of the distances and road conditions, is only in a rudimentary state. Existing infrastructure more than 400 airports, airstrips and many helipads, well qualified flying personnel and well maintained small and large aircrafts is sufficient to have a well functioning Air Rescue system. But it is prohibitively expensive. Most individuals are neither able to afford Air Rescue on their own cost nor they are insured. With the growth of economy and ever increasing awareness of medical facilities, the demand of better standards of emergency medicine is going up. In next 20 years a different scenario is expected. Availability of information technology, privatization of insurance system and medical facilities and better transport system and roads in the coming years will facilitate a well functioning emergency medicine and air rescue in India. PMID: 10657285 [PubMed - indexed for MEDLINE] 1614: Diabetologia. 1999 Dec;42(12):1395-403. Related Articles, Links Erratum in: •

Diabetologia 2000 May;43(5):685.

Comment in: •

Diabetologia. 2000 Oct;43(10):1334-6.

Worldwide increase in incidence of Type I diabetes--the analysis of the data on published incidence trends. Onkamo P, Väänänen S, Karvonen M, Tuomilehto J. Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland. AIMS/HYPOTHESIS: Several reports on the incidence of Type I (insulindependent) diabetes mellitus have suggested that the incidence is increasing. The aim of this study was to find out whether the incidence is increasing globally or restricted to a selected populations only and to estimate the magnitude of the change in incidence. METHODS: During 1960 to 1996 37 studies in 27 countries were carried out. To fulfil the inclusion criteria the study periods ranged from 832 years. The temporal trend was fitted by linear regression, with the logarithm of the age-standardized incidence as the dependent variable and the calendar year as the independent variable. Then, the regression coefficient (x 100%) is approximately the average relative increase in incidence per year (as percentage). RESULTS: Results from the pooled data from all 37 populations showed that the overall increase in incidence was 3.0% per year (95% CI 2.6; 3.3, p = 0.0001). The statistically significant increase was found in 24 of 37 populations including all high incidence (> 14.6 per 100000 a year) populations. The relative increase was, however, steeper in the populations with a lower incidence. The correlation between logarithm of the incidence and the increase in incidence was r = -0.56, p = 0.0004. CONCLUSION/INTERPRETATION: The incidence of Type I diabetes is increasing worldwide both in low and high incidence populations. By the year 2010 the incidence will be 50 per 100000 a year in Finland and also in many other populations it will exceed 30 per 100000 a year. PMID: 10651256 [PubMed - indexed for MEDLINE] 1615: Indian J Med Res. 1999 Oct;110:115-22. Related Articles, Links

HIV seroprevalence & awareness about AIDS among pregnant women in rural areas of Pune district, Maharashtra, India. Kunte A, Misra V, Paranjape R, Mansukhani N, Padbidri V, Gonjari S, Kakrani V, Thakar M, Mehendale S.

Bharati Vidyapeeth Medical College, Pune. The present unlinked anonymous study was done among sexually active rural women to assess the extent of spread of HIV and its awareness. Peripheral blood samples were collected on filter paper strips from 1251 pregnant women residing in villages in three Primary Health Centres in Pune district of Maharashtra. Elutes were tested for HIV antibodies in two different ELISA systems. Awareness on HIV/AIDS was assessed using a structured questionnaire. Fifteen (1.2%) samples were detected to be HIV seropositive. HIV seroprevalence was significantly higher among villages situated close to highways (P < 0.025). Majority (> 95%) of the participating women were housewives. Although 70 per cent were aware of the existence of AIDS, only 33 per cent knew about all the main modes of HIV transmission. Their main sources of information on AIDS were health camps, health workers (70%) and television (45%). Awareness was associated with higher level of literacy (P < 0.001). Many women had misconceptions about the modes of spread of HIV. Greater emphasis needs to be placed on instituting longterm and sustainable strategies to create awareness among young couples with an emphasis on involvement of health workers in rural areas. PMID: 10645097 [PubMed - indexed for MEDLINE] 1616: Sangyo Eiseigaku Zasshi. 1999 Nov;41(6):190-201. Related Articles, Links

[Actual conditions of occupational health activities in small-scale enterprises in Japan: system for occupational health, health management and demands by small-scale enterprises] [Article in Japanese] Hirata M, Kumagai S, Tabuchi T, Tainaka H, Andoh K, Oda H. Department of Occupational Health, Osaka Prefectural Institute of Public Health, Japan. In order to clarify the real conditions of occupational health services (OHS) in small-scale enterprises (SSEs) in Japan, we analyzed questionnaires recovered from 765 SSEs in the area of a city neighboring Osaka City (recovery rate, 69.3%). The SSEs included 358 SSEs with 1 to 4 workers (46.8% of total SSEs), 203 with 5 to 9 (26.5%), 163 with 10 to 29 (21.3%) and 41 with 30 to 49 (5.4%). The main types of businesses were manufacturing (374, 48.9% of total SSEs), wholesale/retail trade/restaurants (153, 20.0%), community, social and personal services (132, 17.3%) and construction (72, 9.4%). Health examinations were performed in 47.7% of SSEs. The reason for the lack of examinations were "shortage of time" (33.3% of SSEs lacking health examination) and "employees

do not want to be examined" (28.1%). Some health promotion measures were conducted in 29.2% of SSEs. Health examination (59.0% of SSEs), health promotion (36.5%), measure of mental health (25.9%) and information service for employers and employees (25.5%) were demanded by SSEs as OHS. Financial subsidies and economical incentives were demanded by 46.4% and 28.8% of SSEs, respectively. Regional occupational health center in this area was poorly known among SSEs (8.2%), but health examination (48.4%), information service (37.5%), assessment of work method and advice to improve (19.8%) and environment measurement (12.4%) are demanded of the center by SSEs. Publication Types: • •

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

PMID: 10637944 [PubMed - indexed for MEDLINE] 1617: J Med Syst. 1999 Oct;23(5):377-87. Related Articles, Links

New approach to the medical information system for quality management in patient care: development of Problem Mapping System. Okuhara Y, Kitazoe Y, Narita Y, Kurihara Y, Matsuura K, Saibara T, Onishi S, Kagiyama A, Inaoka N. Center of Medical Information Science, Kochi Medical School, Oko-cho, Nankoku, Japan. A new type of medical information system named Problem Mapping System (PMap) has been developed, which aids physicians with solving patients' problems. With this system, physicians can define the problems of in-patients, monitor their progress clearly, and share information efficiently. In P-map, a list of problems, such as disease names, can be set for each inpatient easily. The progress of each problem is clearly shown using progress lines on a time axis. Physicians can save the Subjective Objective Assessment Plan (SOAP) notes which are linked to each problem. At the final stage of patient care, a discharge summary can be made easily. With the aid of this system, the quality of patient care is improved due to the following: (1) physicians can make the best decision; (2) medical staff in the same team can provide the best medical treatment; (3) evaluation of each medical treatment is easy; (4) saved data can be used effectively for education and research; (5) the system can improve cooperation with other medical institutes by providing discharge summary information which can be distributed using e-mail; and (6) the system can improve patients' understanding for the purpose of

informed consent by providing clear and well organized information to patients. PMID: 10587918 [PubMed - indexed for MEDLINE] 1618: Crit Care Med. 1999 Nov;27(11):2351-7. Related Articles, Links Comment in: •

Crit Care Med. 1999 Nov;27(11):2570-1.

Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile? Ip SP, Leung YF, Ip CY, Mak WP. Department of Geriatrics, Caritas Medical Center, Sham Shui Po, Kowloon, Hong Kong. OBJECTIVES: To study the outcomes of elderly patients in a high-dependency care unit and to evaluate the costs and benefits of a geriatric high-dependency unit (GHDU). DESIGN: Prospective data collection and analysis. SETTING: Geriatric high-dependency unit. PATIENTS: One hundred fifty patients > or =70 yrs of age who had been admitted to the GHDU over a 10-month period were investigated during their treatment and rehabilitation. MEASUREMENT AND MAIN RESULTS: The patients' Acute Physiology and Chronic Health Evaluation (APACHE) II scores and Simplified Acute Physiology Scores (SAPS) were recorded. The APACHE II scores and SAPSs provided a close correlation with the patients' mortality (correlation coefficients were 0.97 and 0.92, respectively). The SAPS proved to have a better linear relationship with the elderly patients' mortality in comparison with APACHE II scores. Most of the elderly patients included in the study were suffering from multiple premorbid medical problems. Overall, the mortality rate up to 1 month after discharge from the hospital was 48%. For patients ranging in age from 70 to 84 yrs, the 1-month mortality was 39.6%; however, for patients > or =85 yrs of age, the 1-month mortality was 68.1%. The mortality ratio was 0.96 (for all patients), 0.88 (for those ages 70-84 yrs), and 1.05 (for those age 85 yrs and above). For patients with nil organ system failure, the mortality rate was 32%. For patients with one organ system failure, the mortality increased to 48%. For patients with two organ system failures, the mortality rate was 86%. Survival for patients with three or more organ system failures was unprecedented. Survivors and nonsurvivors were compared. Three poor-prognosis groups were identified: group 1, patients who had received preadmission cardiopulmonary resuscitation; group 2, patients with a recent history of malignant diseases; and group 3, patients who had been mechanically

ventilated. All three groups had a significantly higher mortality than those without these factors (p<.05). Patients in the 85 yrs and above group had a significantly higher mortality rate than those in the 70- to 84-yr age group (p<.05). Patients with SAPS and APACHE II scores >20 and >30, respectively, had a poor prognosis. The geriatric outcome scoring system (GOSS) was used as the functional outcome test for the survivors. The GOSS has three components: activities of daily living, mobility status, and social condition. At 1 month after discharge, 66.7% of the survivors returned to their premorbid activities of daily living abilities, 79.5% maintained their mobility status, and 91.7% remained at the same social environment. No survivors deteriorated more than one grade in any of the three components measured by the GOSS. The severity-of-illness scores, percentage of mechanical ventilation utilization, mortality rate, length of GHDU stay, and total hospital stay were comparable with those of other intensive care units (ICUs). The cost of 1 GHDU bed-day was equivalent to 24% of 1 ICU bedday. CONCLUSION: The prognostic information that we gathered from an unselected group of critically ill elderly patients is useful. The GHDU achieved treatment results similar to those achieved by an ICU and is therefore seen as an innovative way of treating critically ill elderly patients. High-dependency care for the elderly patient is worthwhile. Publication Types: •

Comparative Study

PMID: 10579247 [PubMed - indexed for MEDLINE] 1619: Soc Sci Med. 1999 Dec;49(12):1599-614. Related Articles, Links

Social network influences on reproductive health behaviors in urban northern Thailand. Bond KC, Valente TW, Kendall C. Department of International Health and Development, Tulane School of Public Health and Tropical Medicine, Washington, DC 20036, USA. [email protected] Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of

ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships. Publication Types: • •

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

PMID: 10574232 [PubMed - indexed for MEDLINE] 1620: Radiat Res. 1999 Dec;152(6 Suppl):S145-8. Related Articles, Links

Population study in the high natural background radiation area in Kerala, India. Nair MK, Nambi KS, Amma NS, Gangadharan P, Jayalekshmi P, Jayadevan S, Cherian V, Reghuram KN. Regional Cancer Centre, Trivandrum 695 011, Kerala, India. A comprehensive survey of the population exposed to high-level natural radiation is presented. The population living in Karunagappally taluk in Kerala, India, presents a unique opportunity for studies on the health effects of chronic exposure to low-level radiation. The environmental radiation emanates largely from the thorium deposited mostly along coastal areas. In certain locations on the coast, it is as high as 70 mGy/year and on average is 7.5 times the level seen in interior areas. Using portable scintillometers, radiation levels in more than 66,306 houses were measured; outside levels were also measured in the same house compound. Of the total population of 400,000, 100,000 lived in areas with high natural radiation. Information on lifestyle, socio-demographic features, occupation, housing, residence history, and tobacco and alcohol use was obtained by houseto-house visits and enumeration of every resident individual. A population cancer registry system has been established to obtain cancer incidence rates. In this preliminary analysis, there is no evidence that cancer occurrence is consistently higher because of the levels of external gamma-radiation exposure in the area. Further dosimetry-level studies are needed along with biological studies. Studies

of soil, thoron-in-breath, and the radon-thoron levels in houses are ongoing, and further case-control analyses are continuing. Publication Types: •

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

PMID: 10564957 [PubMed - indexed for MEDLINE] 1621: Mil Med. 1999 Oct;164(10):731-6. Related Articles, Links

The patient flow of marine disease and nonbattle injury conditions within a multi-echelon system of care. Walker GJ, Blood CG. Medical Information Systems and Operations Research Department, Naval Health Research Center, San Diego, CA 92186-5122, USA. Hospitalization data were extracted for Marines who incurred disease and nonbattle injuries in Vietnam from 1965 through 1969, and the inter-echelon movement of each patient who was hospitalized at an echelon II or III facility was tracked until the treatment was completed or until the patient was moved to a continental U.S. facility. The inter-echelon flow of treatment for different types of diagnosis categories was also examined. Results showed that approximately threefourths of the patients admitted to echelon II or III facilities had no further treatment recorded at a higher echelon of care. Less than one-fifth of the patients required treatment at an echelon IV or echelon V facility. Of the major diagnostic categories, those with infective or parasitic diseases had the lowest percentage of patients treated at echelon IV or V facilities. Publication Types: •

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

PMID: 10544629 [PubMed - indexed for MEDLINE] 1622: Health Policy. 1999 Jun;47(3):195-205. Related Articles, Links

Impact of HIV/AIDS on the national economy of India.

Anand K, Pandav CS, Nath LM. Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. BACKGROUND INFORMATION: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a major public health problem in India. In general, it affects mainly young people who are at their most productive part of life. Despite initial fears that AIDS will be disastrous for the economy, recent experience and estimations have shown that there is a need for reappraisal of its economic impact on society. RESEARCH QUESTION: From the viewpoint of the society of India, what is the total cost and equivalent annual cost of HIV infections for the period 1986-1995 (10 years) in India? METHODS: Type of analysis: Cost-descriptive based on predictive modelling cohort analysis using human capital approach. A discount rate of 5% was used. The cost of HIV infections include (i) loss of productivity among HIV patients due to sickness and death, (ii) productivity loss due to caregivers of AIDS patients, and (iii) cost of management of AIDS patients. To estimate the loss of productivity due to premature death attributable to AIDS, a life table approach using two cohorts, one with and one without HIV/AIDS infection at assumed rates was used. The demographic data of 1991 census were used. The difference in the person-years lived in the two scenarios gave the person-years lost due to HIV/AIDS. This was calculated separately for rural and urban areas. To convert this to monetary terms, national per capita income for 1992-93 of Rs. 5529 was used. The data on the days of inpatient care and the cost of management of AIDS patients were based on currently available data and 'expert opinion'. We analysed, using three different sets of assumptions for determination, the low, medium and high estimates of the impact of HIV/AIDS in India. Some of the costs were not included in the present analysis: (i) use of antiviral AZT, (ii) cost of retraining of new workforce, (iii) cost of strengthening of health care system, (iv) cost of research and development, (v) cost of communication activities, (vi) cost of prevention of vertical transmission, and (vii) the intangible cost of pain and suffering to the patients and their families. RESULTS: The total cumulative number of HIV-infected persons in India until 1995 was estimated to be 1.5 million (low estimate), 2.5 million (medium estimate) and 4.5 million (high estimate). The estimated total annual cost (in billion Rupees) of HIV/AIDS in India under low, medium and high assumptions was 6.73, 20.16 and 59.19, respectively. Cost of treatment of AIDS and loss in productivity were the two major components of the cost. CONCLUSIONS: The estimated annual cost of HIV/AIDS appears to be about 1% of the GDP of India if based on high assumptions. However, as mentioned earlier, all costs of HIV have not been taken into account. Its significance has to be assessed in the context of annual growth of GDP (3.5%) and cost of other major diseases in India. PMID: 10538918 [PubMed - indexed for MEDLINE]

1623: Kekkaku. 1999 Sep;74(9):667-75. Related Articles, Links

[Current epidemiological trend of tuberculosis among foreigners in Japan] [Article in Japanese] Yoshiyama T, Ishikawa N, Hoshino H, Ohkado A. Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan. In Japan, the proportion of foreign patients among the total tuberculosis patients is still very small, but their problems in tuberculosis case finding and treatment require intensive control activities as in other low prevalence countries with higher proportion of foreign-born cases. The latest national survey for the foreign tuberculosis patients conducted in 1996 shows the epidemiological status between 1990 and 1993. The number of foreign tuberculosis patients in 1993 was 484, consisting of 1.0% of the total new patients in Japan. The new case rate among foreigners was estimated to be 53 per 100,000 against 38 for whole Japan in 1993. Compared with the figure in the 1993 survey, the number of foreign patients declined from 585 in 1992 to 484 in 1993. However, the number of bacillary positive tuberculosis patients in 1992 was 230 and almost the same as in 1992. The decline or stagnation of total number of tuberculosis patients can be due either to the decrease in the foreign population inflow into Japan (real decline), or partially to the reduction of overdiagnosis in X ray examination and the possible loss of some cases in the 1996 survey method. A manual sorting method from the registration cards was used at each public health center, since there is no item of country of origin in the routine tuberculosis surveillance system, and some cards might have already been displaced by the time of the survey for patients who were excluded from the registry, either cured, died or defaulted. The average treatment completion rate (1991-93) among foreign patients was 51%, which was much lower than the national figure of 81% for the same years. Moreover the rate showed deteriorating trend by year. For more accurate information, the foreigner's data must be taken in the national tuberculosis surveillance system and control activities for foreigners need to be strengthened. Publication Types: •

English Abstract

PMID: 10535280 [PubMed - indexed for MEDLINE]

1624: Bull World Health Organ. 1999;77(8):641-50. Related Articles, Links

Mortality and causes of death in Jordan 1995-96: assessment by verbal autopsy. Khoury SA, Massad D, Fardous T. Department of Community Medicine, University of Jordan, Amman, Jordan. Mortality indicators and causes of death in Jordan were assessed by verbal autopsy. A random sample of 100 clusters of ca. 300 households each were monitored for one year by notification assistants selected from the study area itself. Registered deaths were reported to research assistants who visited the family to complete the verbal autopsy form, which was structured and contained about 100 questions. Causes of death were determined by two physicians according to preset algorithms. A total of 965 deaths were reported among 198,989 persons, giving a crude death rate of 5 per 1000 population per year. The three leading causes of death were diseases of the circulatory system, malignancies and accidents. In the absence of a health information system, verbal autopsy as implemented in Jordan can serve as a reliable substitute. PIP: This paper presents an assessment of mortality indicators and causes of death in Jordan during 1995-96 using verbal autopsy. A random sample of 200,000 subjects were divided into 100 clusters, with each cluster representing 1300 households. Two physicians determined the causes of death. Registered deaths were reported by the completion of a verbal autopsy form, which was structured and contained some 100 questions. Among 198,989 persons, 965 deaths were reported, indicating a crude death rate of 5 per 1000 population per year. The three leading causes of death were diseases of the circulatory system, malignancies, and accidents. Publication Types: •

Comparative Study

PMID: 10516786 [PubMed - indexed for MEDLINE] 1625: Am J Ophthalmol. 1999 Sep;128(3):345-51. Related Articles, Links

A population-based study on the incidence of severe ocular trauma in Singapore.

Wong TY, Tielsch JM. Singapore National Eye Center and Singapore Eye Research Institute. [email protected] PURPOSE: To define the epidemiology of severe ocular trauma in Singapore. METHODS: A population-based incidence study involving all Singapore citizens and residents. Two government-administered databases were used to capture information on severe ocular trauma in Singapore. The national hospital discharge database provided information on incident episodes of hospitalized ocular injury, defined as any ocular injury requiring hospitalization. The national medical savings database provided information on incident episodes of open globe injury, defined as any open globe injury requiring acute ophthalmic surgery. The 1990 Singapore Census was used as denominator data. RESULTS: From 1991 to 1996, the overall annual incidence rate of hospitalized ocular injury was 12.6 per 100,000, and the annual incidence rate of open globe injury was 3.7 per 100,000. Nearly 15% of open globe injury was associated with an intraocular foreign body. Although a 20% decline in the rate of hospitalization over this 6-year period was observed, no distinct time trend in the rate of open globe injury was seen. Men had fourfold higher rates of injury than women. A bimodal age pattern of ocular injury was observed, with a peak in injury rates in young adults and another in people over 70 years. Racial variation in rates of injury was seen in men but not in women (with Indian men having twice the risks than either Chinese or Malay men). CONCLUSIONS: Severe ocular trauma in Singapore varied with age (highest in young adults and elderly), gender, and race (highest in Indian men), suggesting demographic-specific differences in exposure to high-risk injury settings. PMID: 10511030 [PubMed - indexed for MEDLINE] 1626: J Epidemiol. 1999 Aug;9(4):235-9. Related Articles, Links

Health related research in Bangladesh: MEDLINE based analysis. Rahman M, Laz TH, Fukui T. Department of General Medicine and Clinical Epidemiology, Kyoto University School of Medicine, Kyoto University Hospital, Japan. BACKGROUND: Health research is not a priority sector in Bangladesh. By and large, physicians and academicians are neither interested nor are they properly trained to conduct quality research. The objective of this study is to quantify the volume of researches related to health in Bangladesh with a view to propose remedial measures. METHODS: Data regarding health research, originating from Bangladesh during the period of 1990-1996, were extracted from MEDLINE

database using certain inclusion criteria. Data on name of the institution, main author (Bangladeshi or foreigner), country of publication, and research topics were abstracted and analyzed using descriptive statistics. RESULTS: A total of 580 (on average 83 per year) articles met the inclusion criteria. About two-third (64.0%) of the researches were from International Center for Diarrheal Disease Research, Bangladesh, followed by Institute of Post Graduate Medicine & Research with 5.7%. Seven medical colleges and one dental college collectively contributed 5.8%. Infectious diseases was the single largest (54.8%) topic dealt with, followed by non-infectious diseases (7.7%), and nutrition and nutritionrelated diseases (6.9%). CONCLUSION: The number of research articles from Bangladesh is very small possibly owing to the lack of proper training and funding shortage. Incorporating research methodology in both graduate and postgraduate medical education, appointing researchers in clinical and academic departments and allocating more funding towards research activities are necessary to boost health related research activities in Bangladesh. PMID: 10510580 [PubMed - indexed for MEDLINE] 1627: Clin Chem. 1999 Oct;45(10):1752-61. Related Articles, Links

Common diagnostic test panels for clinical evaluation of new primary care outpatients in Japan: a cost-effectiveness evaluation. Takemura Y, Ishida H, Inoue Y, Beck JR. Department of Pathology and Information Technology Program, Baylor College of Medicine, Houston, TX 77030-3498, USA. [email protected] BACKGROUND: The Japan Society of Clinical Pathology (JSCP) has developed a guideline for common diagnostic test utilization in new primary care outpatients. To determine the scientific and economic validity of the JSCP panel testing system, we analyzed cost-effectiveness parameters of test panels advocated. METHODS: The "Essential Laboratory Tests" panel (2) [ELT(2) panel], a package of common diagnostic tests added to the ELT(1) baseline health-status screening panel, was applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in an academic medical center during 1991 to 1997. A "useful result" (UR) of testing was defined as a finding that contributed to a change in a physician's diagnosis- or decision-making, relating to a "tentative initial diagnosis" (TID) obtained from history and physical examination alone. RESULTS: Clinical usefulness was demonstrated in 259 patients with ELT(2), in whom 398 URs were generated. Clinical effectiveness (UR/TID) ranged from 1.65 (hematological) to 0.088 (neurological disease), with a cost disparity from yen1251 ( approximately $10) to yen23 037 ( approximately $200) per UR. A total of 1137 tests generated URs. We further assessed the clinical effectiveness

and economic efficiency (cost/UR) of ELT(1) and restructured panels. Use of the ELT(1) alone generated 244 URs in 167 patients. The poor efficiency of the ELT(1) panel was markedly improved with the addition of certain ELT(2)specific tests in liver/pancreatobiliary, metabolic/endocrine, and cardiovascular disease groups. CONCLUSIONS: A wide disparity in the utility of ELT panels in different patient groups does not support the JSCP recommendation of their routine use for new outpatients. Selective test combinations should be used in selected patient groups. PMID: 10508121 [PubMed - indexed for MEDLINE] 1628: Fam Pract. 1999 Aug;16(4):369-74. Related Articles, Links

Access to and use of out-of-hours services by members of Vietnamese community groups in South London: a focus group study. Free C, White P, Shipman C, Dale J. Dept of General Practice and Primary Care, Kings College School of Medicine and Dentistry, London, UK. BACKGROUND: Communication difficulties, lack of knowledge of services and the appropriateness of services influence access to health care services by black and ethnic minority groups. These problems may be accentuated outside normal working hours. This may be so particularly for those who do not speak English as a first language, as interpreting services across the UK are extremely limited in the out-of-hours period. OBJECTIVE: We aimed to describe the experiences and perceptions of members of the Vietnamese community groups in seeking out-ofhours health services and to identify potential solutions from participants' perspectives. METHOD: This qualitative study used a focus group methodology. Participants were members of three established community groups in the South London boroughs of Southwark and Lewisham. Participants attended six focus groups which were conducted in Cantonese and Vietnamese. RESULTS: Participants did not know about GPs' out-of-hours arrangements. And their access to the range of services normally available was limited. They were unable to communicate with health care professionals or answering services and were unaware of out-of-hours interpreting arrangements. Generally, participants were dependent on other people in gaining access to services. Some participants had used 999 services despite communication problems. Participants' experienced delays in seeking health care services and confusion regarding the medicines and advice given. CONCLUSIONS: Communication difficulties limited knowledge of and access to out-of-hours services for the Vietnamese participants. Direct contact with interpreters in the out-of-hours period was suggested as a means of

increasing participants' ability to gain access to services. Health service planners need to be aware of the difficulties experienced by such groups if issues of equity in gaining access to health care services are to be addressed. PMID: 10493707 [PubMed - indexed for MEDLINE] 1629: J Korean Med Sci. 1999 Aug;14(4):351-8. Related Articles, Links

Productivity of SCI Korean medical papers: 1996-1997. Lee CS. Department of Library and Information Science, Sookmyung Women's University, Seoul, Korea. [email protected] In order to investigate the extent and growth of SCI publication activity of Korean medicine, DIALOG's SCISearch database was searched and the number of SCI Korean medical papers in each medical specialty was measured by publication year and by document type for 1996 and 1997. The percentage contribution of Korean medical papers to SCI database and the SCI publication productivity ratio were analyzed for each of 57 medical specialties. The data obtained in this study was compared with the data representing the 1980s and the data for the first half of the 1990s. The absolute productivity of SCI Korean medical papers as measured by the number of SCI Korean papers has increased about ten times from 306 papers in 1990 to 3,261 papers in 1997. More than 15% of SCI Korean publication output has resulted from six Korean medical journals indexed in SCI from 1995. The relative productivity of SCI Korean medical papers as measured by the percentage contribution from Korea to SCI and by its corresponding productivity ratio is not as impressive as the absolute productivity and its growth rate. It has increased three times from 0.245% to 0.642% during the same period. The relative productivity of SCI Korean medical publication output is not as great as the SCI Korean publication output of all sciences combined (1.02%). Publication Types: •

Review

PMID: 10485612 [PubMed - indexed for MEDLINE] 1630: Nippon Koshu Eisei Zasshi. 1999 May;46(5):402-11. Related Articles, Links

[Progress of the stroke registry system by public health centers, and

factors associated with its advancement] [Article in Japanese] Murakami S, Nagano K, Tatara K, Baba S, Hitsumoto S, Sako T. Department of Public Health, Osaka University Medical School. In Japan, a community-based stroke registry was started in 1992 based on the policy of the central government. There are mainly two objectives in this registry system. One is to analyze factors related to the incidence of stroke, and the other is to support home care of stroke patients after leaving the hospital. This system has experienced many difficulties, such as obtaining appropriate information smoothly from the hospitals. Therefore, we investigated all 895 public health centers in Japan through a questionnaire sent by mail, in February 1996. We obtained valid replies from 612 (68%) of the public health centers by March 1996. Results showed that 75% of health centers have established a stroke registry system. Some health centers have promoted the system since 1984. In these systems, the flows of information are mainly of two types: ones which flow to the health centers from the hospitals and the ones which flow to the municipalities. In the former, the number of registered cases were significantly higher and the registry was functioning better than the latter. It has become clear that the health center plays a key role in the successful development of a stroke registry system. Publication Types: • •

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

PMID: 10483133 [PubMed - indexed for MEDLINE] 1631: Hokkaido Igaku Zasshi. 1999 Jul;74(4):265-6. Related Articles, Links

[Promotion of information network system for health and medicine] [Article in Japanese] Matsumoto Y. Office of Medical Technology and Information Development, Ministry of Health and Welfare, Tokyo, Japan. PMID: 10480031 [PubMed - indexed for MEDLINE]

1632: Int J Med Inform. 1999 Jul;55(1):83-5. Related Articles, Links

The future of health informatics. Cesnik B. Centre of Medical Informatics, Faculty of Medicine, Monash University, Frankston, Victoria, Australia. [email protected] Whatever a future vision for health informatics entails, it must take into account the evolving nature of the field, a growing trend towards primary and preventive care and the explosive growth in global networking as exemplified by the Internet. While, historically, storage and retrieval of data has been the main target for information systems development, the need to capture knowledge itself is becoming the focus for development. In parallel, education in health informatics for tomorrow's healthcare professionals is now essential. The Asia Pacific Association for Medical Informatics (APAMI) is a regional group of the International Medical Informatics Association (IMIA). While the newest of the IMIA regional organizations, its growth and activities in the Asia Pacific region aim to advance health informatics. Its triennial conferences act as a means of promoting and monitoring the growth of our field in this region, APAMI itself is a part of the future of health informatics. PMID: 10471244 [PubMed - indexed for MEDLINE] 1633: Int J Med Inform. 1999 Jul;55(1):47-59. Related Articles, Links

The application of a computerized problem-oriented medical record system and its impact on patient care. Ho LM, McGhee SM, Hedley AJ, Leong JC. Department of Community Medicine, The University of Hong Kong, Hong Kong. The present computer system is the first of its kind based on problem-oriented medical record (POMR) design developed and operated in a hospital in Hong Kong. It went live in May 1996 with two workstations installed in the medical record office (MRO). Doctors have no direct access to it. They dictate medical notes on tape using either structured or free dictation format, and the tape is brought to the MRO for processing. The principal aim of this study is to study the impact of the computer system on patient care. Retrospective review of medical records and in-depth interviews were conducted to study the quality of medical

records and doctor's opinions. A total of 400 manual and 398 computerized patient records were randomly selected for review. The completeness of the manual notes and computerized notes using free dictation format were about the same. The computerized records using structured dictation format may be more complete than those using free dictation format. The in-depth interview shows that most doctors preferred structured medical records but some disagreed with too detailed a level of structuring. They were not familiar with POMR, and some even thought that breaking down the record by problem was not possible. All felt that the present system would not directly affect patient care, but some said that it would facilitate research. In conclusion, since the utility of the information mainly depends on the doctors' efforts, commitment to the agreed structure and subsequent routine audit of computerized medical records are essential to make sure that diagnoses are accurately coded and information is correctly structured. Publication Types: •

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

PMID: 10471240 [PubMed - indexed for MEDLINE] 1634: Int J Med Inform. 1999 Jul;55(1):23-31. Related Articles, Links

High quality image oriented telemedicine with multimedia technology. Takeda H, Minato K, Takahasi T. Department of Medical Information Science, Osaka University Hospital, Suita, Japan. Researchers at Osaka and Kyoto University hospital performed three experiments, beginning in 1995, which looked at high quality-oriented telemedicine. This paper describes the system design for the three projects. Experiment 1 applied highdefinition TV images and B-ISDN for distance learning and medical information exchange. Experiment 2 developed a super high-definition medical image filing system and the images were transmitted via B-ISDN for teleconferences and experiment 3 utilized digital, high-definition, TV images and communication satellites for teleconferences. Multimedia and communication technologies were considered to be fundamental components of telemedicine. The three projects were evaluated initially for quality of images, operability and utility. The experimental design and its implementation showed that it was possible to provide high quality image-oriented telemedicine in the health care environment. Obstacles to establishing practical telemedicine are also discussed.

Publication Types: •

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

PMID: 10471238 [PubMed - indexed for MEDLINE] 1635: Lancet. 1999 Mar 20;353(9157):1003-4. Related Articles, Links

Success with the DOTS strategy. Mushtaque A, Chowdhury R. BRAC, Dhaka, Bangladesh. PMID: 10459928 [PubMed - indexed for MEDLINE] 1636: Am J Emerg Med. 1999 Jul;17(4):408-11. Related Articles, Links

Emergency department-based telemedicine. Chi CH, Chang I, Wu WP. Department of Emergency Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan. Although many studies have been published concerning clinical telemedicine, little information is available about emergency department (ED)-based telemedicine programs. An ED-based telemedicine program was initiated in April 1996 involving the National Cheng Kung University Hospital (NCKUH) and the Provincial Peng-Hu Hospital (PPHH) under a pilot project supported by the Department of Health. This is the first telemedicine program for remote offshore island service in Taiwan. The program is synchronous in nature to the practice of telemedicine. The role of the emergency physician includes giving initial suggestions, arranging consultations, coordination, and the organization of other medical tasks, such as accompanying some of the transfers. During the 12-month period, this system was used in 275 consultations, including 24 specialty and/or subspecialty department/sections, and more than 100 members of the medical staff have participated in this project since. In a survey, 89.4% of physicians in the PPHH and 82.2% of the physicians in NCKUH rated the system as very comfortable to work with and satisfactory. According to these observations, an

ED-based telemedicine program is a feasible method for carrying out remote consultations. Successful development of the partnership and program of telemedicine is based on the active participation and coordination of the medical personnel and technicians between the cooperating hospitals. Publication Types: •

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

PMID: 10452445 [PubMed - indexed for MEDLINE] 1637: Psychiatr Serv. 1999 Aug;50(8):1043-8. Related Articles, Links

The goals and limitations of Israel's psychiatric case register. Lichtenberg P, Kaplan Z, Grinshpoon A, Feldman D, Nahon D. Mental Health Services Section, Israel Ministry of Health, Jerusalem. [email protected] The Israeli Ministry of Health maintains a psychiatric case register that includes basic demographic and clinical information for all psychiatric hospital admissions since 1950. Currently, the case register includes information about some 130,000 people who have been hospitalized. The case register is an important tool in many aspects of mental health care planning, such as delineating problem populations, developing interventions, assessing the ramifications of policies, enacting programs for quality control, and conducting research. In certain situations stipulated by law, some information in the case register is shared with other authorities. Although the full potential of the psychiatric case register has not been exploited so far, creation of additional linkages with other databases and increased application of case register data in field studies could enhance its usefulness. PMID: 10445652 [PubMed - indexed for MEDLINE] 1638: Public Health Rev. 1998;26(3):271-92. Related Articles, Links

Research in medical sciences in Israel, 1994-97, an overview of institutions, investigators, and funding. Berns DS.

Medical Research Organization, Ministry of Health, Jerusalem, Israel. [email protected] This is a summary of the second effort to characterize medical research activities in Israel (1994-97). The study relies on responses to a questionnaire sent to all participants in the first survey (1991-94) and to additional, including younger, investigators. There were 1450 direct responses this time versus 1088 the first time. The distribution of investigators is 60% hospital-based versus 40% in basic sciences. The average number of funding sources per investigator has decreased from 2.6 to 2.2; however the percentage of funded investigators has increased from 60% to 70%. The greatest concentration of funded investigators remains at the Hebrew University and Hadassah Medical Center, followed by Tel Aviv University and associated hospitals. The Chief Scientist's Office of the Ministry of Health funds more than 40% of funded investigators (more than double the next highest funding source, the US-Israel Binational Fund), followed in decreasing order by the National Academy of Sciences, Ministry of Science, German-Israeli Foundation for Scientific Research and Development (GIF), Israel Cancer Society, and NIH. The percentage of funded hospital-based investigators has increased from 59% to 62%; however, funding remains higher for basic science investigators. There has been an increase in the percentage of Ph.D.'s working in a hospital environment and an interesting anomaly is that the nonacademic-affiliated Ph.D. investigators in hospitals have been successful in receiving funding, so now a greater percentage of nonacademic hospital staff are funded than academic staff (69% versus 61%). PMID: 10444965 [PubMed - indexed for MEDLINE] 1639: Eur J Clin Pharmacol. 1999 Jun;55(4):325-32. Related Articles, Links

"Doi moi" and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam. Chuc NT, Tomson G. Department of Public Health Sciences, Division of International Health Care Research, Karolinska Institutet, Stockholm, Sweden. Vietnam, a developing country, has had comparatively good health and human survival at low cost. The economic reform changed the health care system, and private pharmacies during the last 5 years have taken over a majority of the drug distribution. Problems include weaknesses in drug regulation and reported increases in antibiotic resistance. This case study, a purposive sample of two private pharmacies in Hanoi, explored management, including dispensing, inventory and financing, using the concept of triangulation. Observations and

interviews of customers were complemented by stock inventory and interviews of the pharmacy staff. Drugs were classified according to the ATC code and the essential drug list of Vietnam. Pretested protocols were used. In all 1833 encounters were studied during the 2 weeks, out of which 286 were children. Less than 1% of customers came with prescriptions and 94.9% decided by themselves which drugs to buy. Antibiotics represented 17%, of which 90% were broad spectrum. Ampicillin dominated, both in children and adults. Some 50% of the antibiotics were given for 2.5 days or less. Less than 50% of the drugs were essential drugs (ED) on dispensing and even less on inventory. Antibiotics and vitamins were the most commonly sold drugs and, overall, brand names dominated. Little if any drug information was observed. Antibiotics were said to represent the most profitable drugs, according to the pharmacy staff. More than 20% of all products were combination drugs, including irrational and popular products with antibiotics and corticosteroids and combinations of aspirin, phenacetin and caffeine. This study shows an unexpectedly high proportion of customers, being "Tu Lam Bac Sy" (their own doctors), deciding themselves which drugs to buy. Although the "Doi moi" renovation has led to much improved drug availability, at least in urban setting, our case study highlights major problems in need of urgent actions. In particular the prevailing practices regarding antibiotics and combination drugs need to be seriously scrutinized and drug regulatory mechanisms should be enforced. Publication Types: •

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

PMID: 10424327 [PubMed - indexed for MEDLINE] 1640: Kaohsiung J Med Sci. 1999;15 Suppl:S21-6. Related Articles, Links

Managing information to manage family health: the HAMIS and FAMUS programs of the Philippines. Marte BA, Remotigue T, Schwefel D. Health and Management Information System (HAMIS), Department of Health, Philippines. PMID: 10422416 [PubMed - indexed for MEDLINE] 1641: EDTNA ERCA J. 1999 Jan-Mar;25(1):12-4. Related Articles, Links

Informing the UK's South Asian communities on organ donation and transplantation. Khan Z, Randhawa G. Faculty of Health Care & Social Studies, University of Luton, UK. There is a growing demand for human organs for transplantation, particularly of the kidney among the UK's South Asian population which, due to problems with histocompatibility can only be met with a significant increase in the number of Asian donors. Specific attempts have only recently been made to attract donors from South Asian communities using 'ethnically-targeted mass media'. A recent pilot study sought to evaluate the effectiveness of these initiatives in providing information with regards to organ donation for the South Asian population. The findings show that detailed information related to transplantation activity had been learned only through the experience of people undergoing transplants within the community and has been transmitted through various informal networks rather than through the resources provided by the Department of Health. This paper provides an overview of who the South Asians are and how these community networks were established. Publication Types: •

Review

PMID: 10418370 [PubMed - indexed for MEDLINE] 1642: Soc Sci Med. 1999 Aug;49(4):519-30. Related Articles, Links

Diarrheal disease risk in Matlab, Bangladesh. Emch M. Department of Geography, University of Northern Iowa, Cedar Falls 50614, USA. [email protected] The objective of this research project is to assess risk for diarrheal disease in rural Bangladesh by analyzing the complex and dynamic interaction of biological, socioeconomic, cultural/behavioral and environmental factors over time and space. Risk factors of cholera and non-cholera water diarrheal disease are calculated to compare the relative importance of risk for several independent variables. Diarrheal disease data were collected for people who were hospitalized

at the International Centre for Diarrhoeal Disease Research (ICDDR) hospital from January 1, 1992 to December 31, 1994. Using laboratory and hospital records, cases were assigned to one of two diarrhea disease categories (cholera or non-cholera watery diarrhea) that were used as dependent variables in the analysis stage of the research. Age-matched individuals were randomly chosen from the community to be controls. Information was collected for independent variables that were hypothesized to be related to watery diarrhea. This information was collected by administering questionnaires, obtaining secondary data from the ICDDR's demographic surveillance system records and community health worker record books and calculating variables using a geographic information system database. Sanitation and water availability and use are extremely important in the effort to reduce secondary cholera and non-cholera, watery diarrhea transmission. Water use and availability variables were more important for non-cholera watery diarrheal risk than for cholera but nevertheless they were important for both. Socioeconomic status is an important indirect cause of both of these diseases because poverty is the root cause of many of the other variables, such as lack of sanitation and clean water. Flood-control was related to both types of diarrhea but it is not understood why. Since the Bangladesh Flood Action Plan will continue to build and maintains flood-control embankments, it is important to investigate whether there is a pattern to this relationship throughout the country and to investigate why the relationship exists. PMID: 10414811 [PubMed - indexed for MEDLINE] 1643: J Expo Anal Environ Epidemiol. 1999 May-Jun;9(3):192-9. Related Articles, Links

Assessment of disinfection by-products in drinking water in Korea. Shin D, Chung Y, Choi Y, Kim J, Park Y, Kum H. Department of Preventive Medicine and Public Health, College of Medicine, Yonsei University, Seoul, Korea. [email protected] The main purpose of applying the chlorination process during water treatment is for disinfection. Research results, however, indicate that disinfection byproducts (DBPs) including trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), haloketones (HKs), and chloropicrin (CP) can be produced by the chlorination process. Some of these DBPs are known to be potential human carcinogens. This 3-year project is designed to establish a standard analysis procedure for DBPs in drinking water of this country and investigate the distribution and sources of specific DBPs. The occurrence level of DBPs in drinking water was below 50 micrograms/l in most cases. THMs in plant effluent accounted for 60% of all DBPs measured, whereas HAAs accounted for 20%, HANs 12%, HKs 5% and CP 3%. Chloroform was found to be the major THMs compound (77%), followed by bromodichloromethane (BDCM, 18%) and

bromoform (BF, 3%). The concentration of DBPs formed in distribution systems increased from those detected in plant effluent. Comparison of humic acid and sewage as precursors for THMs formation showed that humic acid was the major THMs precursor. Results would play an important role in exposure assessment as a part of the risk assessment process, and would give basic information for establishment of DBPs reduction and management procedures. Publication Types: •

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

PMID: 10412668 [PubMed - indexed for MEDLINE] 1644: Nervenarzt. 1999 May;70(5):476-8. Related Articles, Links

[Help in explaining to Turkish-speaking patients about the central affects of pharmaceuticals. Fact or fiction?] [Article in German] Schepker R, Okur H. Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Rheinische Kliniken Essen/Institut, Universität GH Essen. Handouts in their mother tongue might be helpful in informing patients who do not speak German about medications that are prescribed. A survey among 97 producers of CNS active drugs used in neurology and psychiatry showed that only two patient information leaflets on preparations and nine on specific disorders are available in Germany. The producers who answered were mostly open-minded and mentioned causes like the legal situation and logistic problems. Publication Types: •

English Abstract

PMID: 10407845 [PubMed - indexed for MEDLINE] 1645: Psychiatr Serv. 1999 Jul;50(7):869-70, 885. Related Articles, Links

The computerized lab alert system for patient management in clinical care. Modai I, Sigler M, Kurs R. Sha'ar Menashe Mental Health Center, Hadera, Israel. PMID: 10402605 [PubMed - indexed for MEDLINE] 1646: Am J Epidemiol. 1999 Jul 1;150(1):51-7. Related Articles, Links

Prevalence and determinants of prone sleeping position in infants: results from two cross-sectional studies on risk factors for SIDS in Germany. Schlaud M, Eberhard C, Trumann B, Kleemann WJ, Poets CF, Tietze KW, Schwartz FW. Dept. of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Germany. The authors investigated whether there was a decline in infants sleeping prone and other modifiable risk factors for sudden infant death syndrome (SIDS) in Germany, where, as in some other countries, no nationwide intervention campaign against the prone sleeping position had been initiated. Data were obtained from parents by mailed questionnaires in two cross-sectional studies in 1991 (n = 3,330) and 1995 (n = 3,124). Prevalence of prone sleeping decreased from 37.6% to 8.7% (p < 0.05) in the German population and from 44.1% to 32.0% (p < 0.05) in the Turkish immigrant population. Parents who laid their infants prone in 1995 were less likely to follow advice from physicians, public media, and other parents (relative risks < 0.5, p < 0.05) and were more likely to have a low educational level, to be <20 years old, to be single parents, to have two or more children, to be raised in West Germany, or to be of Turkish ethnicity. Although the information on prone sleeping being a risk factor for SIDS became known among the population, these data suggest that subgroup-specific public intervention campaigns may be needed to reduce the prevalence of prone sleeping even further in those countries where no nationwide campaign has been initiated. PMID: 10400554 [PubMed - indexed for MEDLINE] 1647: J Med Ethics. 1999 Jun;25(3):247-53.

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Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Pang MC. Hong Kong Polytechnic University, China. The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. PMID: 10390681 [PubMed - indexed for MEDLINE] PMCID: PMC479218

1648: Stud Health Technol Inform. 1998;52 Pt 2:1297-300. Related Articles, Links

Development and evaluation of regional health database systems. Ogushi Y, Haruki Y, Okada Y, Takahashi M, Shimizu M, Izumi Y, Watabe T, Kobayashi S, Okuyama J, Kurita Y. Tokai University, School of Medicine. [email protected] We have developed information systems for regional public health in some areas. These systems have the following functions: (1) to register results of examinations, life style, follow-up data, diseases, (2) to output some reports and statistics for daily jobs, (3) to make a personal health database, (4) to display

stored data by character, trend graph, radar chart or bar chart, (5) to analyze regional health problems, (6) to extract dada about persons with some conditions, (7) to compare data among some examinations, (8) to analyze risk factors. Each database can be transferred to mini-notebook type personal computers. So, they can be used anywhere and any time. Some access controls are performed for security. The systems are used in routine works, health consultation for persons and health education for groups. We have evaluated the systems and got some useful results. Using the systems, daily jobs can be performed with good accuracy and less labor, each subject can understand one's health status easily and clearly, grasps of health problems can be made quantitatively and health projects can be planned by scientific methods. PMID: 10384669 [PubMed - indexed for MEDLINE] 1649: Stud Health Technol Inform. 1998;52 Pt 2:1282-6. Related Articles, Links

Telemedicine and medical informatics in the multimedia super corridor: the Malaysian vision. Abidi SS, Goh A, Yusoff Z. School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia. [email protected] The practice of medicine, with its wide range of environmental conditions and complex dependencies, has long been used as a test bed for various advanced technologies. Telemedicine, as conceptualised within the Multimedia Super Corridor (MSC) context, is seen as the application of several relatively mature technologiesartificial intelligence (AI), multimedia communication and information systems (IS) amongst othersso as to benefit a large cross-section of the Malaysian population. We will discuss in general terms the Malaysian vision on the comprehensive MSC telemedicine solution, its functionality and associated operational conditions. In particular, this paper focuses on the conceptualisation of one key telemedical component i.e. the Lifetime Health Plan (LHP) system, which is eventually intended to be a distributed multi-module application for the periodic monitoring and generation of health-care advisories for upwards of 20 million Malaysians. PMID: 10384666 [PubMed - indexed for MEDLINE] 1650: Stud Health Technol Inform. 1998;52 Pt 2:977-80. Related Articles, Links

Information system for a periodic examination and health

promotion center. Cho B, Yoo T, Huh BY, Cho S, Jeon H. Department of Family Practice, Seoul National University Hospital, Korea. The periodic examination and health promotion center (PEHPC) in Seoul National University Hospital has developed and adopted an information system supported by computers which use an electronic medical record to improve the quality of patient care, advance the science of medicine, lower health care costs, and enhance the education of health care professionals. This information system adopted the concept of incomplete and evolutionary systems to conduct the pursuit of practicalness and efficacy. It has increased efficiency to save costs and to enhance the quality of the medical service. It has also activated clinical research due to ease of managing data. We are also preparing for telecare. Telecare and WWW-using information system is postponed because the protection of a patients privacy is not established. PMID: 10384606 [PubMed - indexed for MEDLINE] 1651: Stud Health Technol Inform. 1998;52 Pt 1:suppl 23-7. Related Articles, Links

Issues facing system vendors as we approach the 21st century and expected roles--implementing a hospital information system providing greater patient satisfaction. Asonuma M. Fujitsu Limited, Japan. PMID: 10384548 [PubMed - indexed for MEDLINE] 1652: Stud Health Technol Inform. 1998;52 Pt 1:433-7. Related Articles, Links

Patient information exchange guideline MERIT-9 using medical markup language MML. Kimura M, Ohe K, Yoshihara H, Ando Y, Kawamata F, Hishiki T, Ohashi K, Sakusabe T, Tani S, Akiyama M. Department of Medical Informatics, Hamamatsu University, Japan. [email protected]

To realize clinical data exchange between healthcare providers, there must be many standards in many layers. Terms and codes should be standardized, syntax to wrap the data must be mutually parsable, then transfer protocol or exchange media should be agreed. Among many standards for the syntax, HL7 and DICOM are most successful. However, everything could not be handled by HL7 solely. DICOM is good for radiology images, but, other clinical images are already handled by other "lighter" data formats like JPEG, TIFF. So, it is not realistic to use only one standard for every area of clinical information. For description of medical records, especially for narrative information, we created SGML DTD for medical information, called MML (Medical Markup Language). It is already implemented in more than 10 healthcare providers in Japan. As it is a hierarchical description of information, it is easily used as a basis of object request brokering. It is again not realistic to use MML solely for clinical information in various level of detail. Therefore, we proposed a guide-line for use of available medical standards to facilitate clinical information exchange between healthcare providers. It is called MERIT-9 (MEdical Records, Images, Texts,--Information eXchange). A typical use is HL7 files, DICOM files, referred from an MML file in a patient record, as external entities. Both MML and MERIT-9 are research projects of Japanese Ministry of Health and Welfare, and the purpose is to facilitate clinical data exchanges. They are becoming to be used in technical specifications for new hospital information systems in Japan. PMID: 10384494 [PubMed - indexed for MEDLINE] 1653: Stud Health Technol Inform. 1998;52 Pt 1:429-32. Related Articles, Links

Standardization of the nationwide health examination in Korea. Huh BY, Yoo T, Cho S, Suh SY, O SW, Park MS. Seoul National University Hospital Family Medicine, Korea. [email protected] The Korea Medical Insurance Corporation has held the periodic Health Examination for the public servants and teachers from 1977 as a nationwide health preventive task. But the Health Examination result is not computerized rather than paperwork, so the use of the Health Examination is limited and the results of Health Examination can not be stored or interchangeable between hospitals or health examination centers in this system. So we planed the Standardization of the Nationwide Health Examination project and developed the Health Examination computer program in 1996. The object of standardized program is to contribute to cost-effective analysis of each item or other studies about the factors influences development of diseases. And now, an Exhibition work for the standardization is being held with the Health Examination computer program. At the ending of the Exhibition work, we will evaluation and revision

the computerized program for standardization process. PMID: 10384493 [PubMed - indexed for MEDLINE] 1654: Stud Health Technol Inform. 1998;52 Pt 1:75-9. Related Articles, Links

The survey on the completeness of the medical records as the basis for producing valuable health information. Kang S, Kim KA. School of Public Health, Seoul National University. [email protected] The core of the health information system in the hospitals lies in the medical records, which contain all the data concerning diseases and practices. Then questions arise whether the medical records contain all the data needed in the reliable, complete and timely manners while meeting standards for confidentiality. In this study, we reviewed medical records of 11 general tertiary care hospitals in Seoul, Korea, according to the criteria we made based on the JCAHO's hospital accreditation manual. The focus of review was whether the medical records contain the valuable information fully and in timely manners. But the result was no better than our expectations. More caution should be given for the EPR software engineers to catch up all the information needed from the medical records. We also examine the cause of variation among hospitals and want to give basic information concerning the medical records for implementing the standardized EPR and suggest the method for keeping complete health information. PMID: 10384423 [PubMed - indexed for MEDLINE] 1655: Eur J Pediatr. 1999 Jun;158(6):525-6. Related Articles, Links

Low erythrocyte docosahexaenoic acid in malnourished, often breast-fed, Pakistani infants: a matter of concern? Smit EN, Woltil HA, Boersma ER, Muskiet FA. PIP: This article provides valuable information on the importance of long-chain polyunsaturated fatty acids (LCPUFAs) for the development of the central nervous system, including visual acuity. It was believed that breast milk contains a large range of LCPUFAs, including docosahexaenoic (DHA) and arachidonic acids which cannot be found in formula milks for term infants; but low RBC LCPUFAs have been observed in malnourished children receiving breast milk and

weaning food low in fat. In these children, it has been postulated that the synthesis of LCPUFAs from their precursors is decreased making them more dependent on an adequate LCPUFA intake. Several studies were conducted to test this hypothesis. It was observed that although malnourished children in North Pakistan received breast milk, yet poor DHA status of these malnourished breastfed children is caused by a marginal DHA status of these mothers. Further studies are needed though to establish the relationship between maternal nutrition during lactation and children RBC DHA levels receiving breast milk. Publication Types: •

Letter

PMID: 10378406 [PubMed - indexed for MEDLINE] 1656: Mil Med. 1999 Jun;164(6):423-7. Related Articles, Links

The patient flow of wounded marines within a multi-echelon system of care. Walker GJ, Blood CG. Medical Information Systems and Operations Research Department, Naval Health Research Center, San Diego, CA 92186-5122, USA. Hospitalization data were extracted for Marines wounded in Vietnam from 1965 to 1969 to examine the echelon flow of treatment care for different types of injuries. The inter-echelon movement of each patient who was hospitalized at an echelon II or III facility was tracked until the treatment was completed or until the patient was moved to a facility in the continental United States. Results showed that approximately half of the admissions to echelon II or III facilities had no further treatment recorded at a higher echelon of care. Almost one-fourth of the patients required treatment at an echelon IV facility, and more than one-third were admitted to an echelon V facility. Publication Types: •

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

PMID: 10377712 [PubMed - indexed for MEDLINE] 1657: Fam Med. 1999 Jun;31(6):426-31.

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Medical investigations requested by patients: how do primary care physicians react? Cohen O, Kahan E, Zalewski S, Kitai E. Department of Family Medicine, Rabin Medical Center, Petah Tiqva, Israel. BACKGROUND AND OBJECTIVES: We investigated the characteristics of patients who request medical investigations and the type of tests requested to study the manner in which primary care physicians react to these requests. METHODS: The study was conducted within the framework of a national health insurance system. Twelve primary care practices from three randomly chosen clinics with different population characteristics participated in the study. The attending physicians were instructed to ask all patients who presented to the clinics within a 7-month period and requested a medical test to complete a questionnaire, indicating the type of test(s) requested and the reason. The physicians were asked to rate the manner in which the patient made the request, their own reaction to the request, and whether they ordered the tests that were requested. RESULTS: During the survey period, 12,322 patients visited the clinics, of whom 295 (2.4%) were reported by a physician to have requested a medical investigation. More-educated patients were more likely to request tests for disease prevention. The types of tests requested were imaging scans, laboratory (blood) tests, and others. The main reason for the request was symptoms (60%), followed by disease prevention (25%). More than 30% of the requests generated self-reported negative feelings in the physician. Physician compliance with patient requests was not significantly correlated with the reason for the request. Laboratory tests were ordered significantly more often than other types. There was a strong correlation between physicians' compliance with the request and physicians' feelings about the request. CONCLUSION: Our findings raise questions about the frequency with which physicians order tests solely in response to patients' requests and provide information about circumstances in which patients make requests for medical investigations. PMID: 10367207 [PubMed - indexed for MEDLINE] 1658: Am J Infect Control. 1999 Jun;27(3):254-7. Related Articles, Links

Prevalence of nonreporting behavior of sharps injuries in Taiwanese health care workers. Shiao JS, McLaws ML, Huang KY, Ko WC, Guo YL.

China Junior College of Medical Technology, Taiwan, Republic of China. BACKGROUND: Health care workers (HCWs) were surveyed to identify factors associated with nonreporting behavior of sharps injuries (SIs) in Taiwan. METHODS: We surveyed 10,469 full-time medical, nursing, technical, and supporting personnel employed at 16 randomly selected hospitals from 132 available accredited teaching hospitals in Taiwan. Information about the most recent injury and reporting behavior after an SI were collected from July 1996 to June 1997 by using a pretested structured questionnaire. Eleven categories, including an open-ended option, were provided for participants to explain their nonreporting behavior. RESULTS: Questionnaires were completed by 82.6% (8645) of our sample, of whom 87.3% reported to have experienced a recent SI. A used item was the most commonly (P <. 001) involved item in an SI, and SIs with a used item were significantly more likely (odds ratio 3.6; CI 95%, 3.03-4.26; P <. 001) to be reported compared with an SI that involved unused items. A total of 81.8% of injuries were not reported, with job category significantly affecting reporting behavior (P <.001). Medical staff had the highest nonreporting rate (85.2%). Although attendees of a prevention program were statistically more likely (P <.001) to report an injury compared with nonattendees, the level of reporting in both groups was not encouraging (21.3% and 17.2%, respectively). All reasons given for nonreporting were disconcerting, but none more so than the use of subjective assessment of risk by 21.7% of HCWs who did not report their injuries. Other reasons for not reporting SIs included that the item was unused (34%) and that the HCW was too busy to report the SI (14.9%), unaware of reporting requirements (14. 4%), or immune to hepatitis B virus (12.4%). CONCLUSIONS: With 82% of SIs in Taiwanese HCWs going unreported, the expected national incidence will be seriously underestimated and impact the appropriateness of prevention programs. The very low rate of reporting suggests that the current reporting system requires simplification. Because most injuries involved used items, the reporting systems also should include a more responsive management component. The results also suggest that the current prevention programs, currently provided by the general nursing department, require expert content knowledge in infection control if nonreporting and SIs are to be reduced. Publication Types: •

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

PMID: 10358228 [PubMed - indexed for MEDLINE] 1659: Health Policy Plan. 1999 Mar;14(1):11-7. Related Articles, Links

Injuries in Pakistan: directions for future health policy.

Ghaffar A, Hyder AA, Mastoor MI, Shaikh I. Health Services Academy, Islamabad, Pakistan. Injuries result in major financial and productivity losses to nations while inflicting tremendous personal burden on the injured and their families. Two-thirds of the global deaths from injuries occur in the developing world, consuming substantial health sector resources. Pakistan is a developing country with a population of 136 million and no reported estimate of the national impact of injuries. This study presents a profile of injuries in Pakistan, estimates the impact on the country and recommends strategies to further delineate this important public health problem. A methodical review of published, unpublished and government literature was undertaken and data collected for all types of injuries principally over the 19821994 period. Motor vehicle injuries, homicides, assaults, work-related injuries, poisonings and risk factors have been included. Selected epidemiological estimates have been generated and the WHO motorization index has been used to assess road-side accident risk. The lack of reliable data and under-reporting of work-related injuries is revealing. The rising time trend in all injuries, the significant loss of life from injuries and the age of those injured have a critical impact on the national economy and health system. Data on injuries in Pakistan are primarily recorded by police authorities and used for legal purposes. Pakistan must institute an information system to evaluate the true impact of injuries and develop national safety standards. Implementation of such standards is especially important for road traffic safety and occupational health in industrial units within the country. Publication Types: •

Review

PMID: 10351465 [PubMed - indexed for MEDLINE] 1660: Int J Lepr Other Mycobact Dis. 1998 Dec;66(4):445-50. Related Articles, Links

Sensitivity and specificity of methods of classification of leprosy without use of skin-smear examination. Croft RP, Smith WC, Nicholls P, Richardus JH. Danish Bangladesh Leprosy Mission, Nilphamari, Bangladesh. [email protected] PMID: 10347564 [PubMed - indexed for MEDLINE]

1661: Health Serv Manage Res. 1998 Nov;11(4):255-64. Related Articles, Links

An efficient fault-tolerant order entry management information system based on special distributed client/server architecture. Chuang CT. Institute of Health Services Administration, China Medical College, Taichung, Taiwan, Republic of China. [email protected] An automatic order entry system is very important for the processing of outpatient information, not only helping doctors to enter their orders directly but also reducing errors of communication. Many hospitals are anxious to set up a direct order entry system but are concerned about possible system failures. In this paper we report on an effective and efficient fault-tolerant order entry management system which satisfies the requirements for out-patient order entry. From the results of experiments on a prototype we found that the system was user friendly and reduced the time taken. Doctors are able to enter their orders more easily, accurately and quickly by selecting from the standardized and personalized menus to be found in the system. PMID: 10338694 [PubMed - indexed for MEDLINE] 1662: Pharmacoeconomics. 1998 Oct;14(4):365-83. Related Articles, Links

A review of the economics of the prevention and control of rabies. Part 1: Global impact and rabies in humans. Meltzer MI, Rupprecht CE. National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. [email protected] The existing literature on the economics of rabies and its control can be characterised as a poorly documented set of cost estimates with insufficient information to allow replication of the analyses. Most articles have numerous 'violations' of the standard recommended procedures for assessing the burden of disease and the cost and benefits of interventions. Per capita costs are often crudely extrapolated from small to large populations without allowing for geographic differences in incidence. Furthermore, most studies do not distinguish between financial charges and true economic costs, and only a few articles contain a multiyear framework, complete with discounting of future costs and

benefits. With the exception of the increase in average incidence of postexposure prophylaxes (PEPs) in Asia, the average incidences of both human-rabies cases and PEPs in Africa, the Americas and Europe have not changed significantly over time. There are, however, large differences between countries within a region and regional averages can conceal notable changes in incidences over time for a given country. The largest number of human-rabies cases occur in developing countries due to the low levels of vaccination among dogs, the high cost of biologicals for PEP and problems of availability. The costs (1995 values) of PEP range from $US1707 per person in Massachusetts, US, to $US2.50 for a complete series of vaccinations (without immunoglobulin) using sheep-derived vaccines in Karachi, Pakistan. Most studies which reported the cost of PEP, however, provided only direct medical costs and did not consider indirect costs such as lost productivity due to death, permanent disability or time spent while receiving medical care. Given the expense of controlling rabies in dogs and wildlife, there is an urgent need to develop a cheaper human-rabies vaccine or further refine the 'low-dose' PEP regimes. PEP is often given unnecessarily, and experience with expert consultations systems and algorithms has shown that the rate, and therefore total cost, of PEP can be significantly reduced. However, because it may be difficult to identify lesions from a bite by a bat, algorithms may be of less value when dealing with possible exposure to bat rabies. Using US prices and values, only 2 individuals per 1000 possible contacts have to be at risk from bat rabies in order for it to be economically justifiable to give PEP to all those potentially exposed to bat rabies. With regard to pre-exposure vaccination, routine use of pre-exposure has generally not been shown to be cost effective. Publication Types: •

Review

PMID: 10344905 [PubMed - indexed for MEDLINE] 1663: IHRIM. 1998 Nov;39(4):14-7. Related Articles, Links

Challenges of health care delivery system beyond 2000 AD. Mogli GD. Ministry of Health, Sultanate of Oman. PMID: 10344799 [PubMed - indexed for MEDLINE] 1664: Int J Lang Commun Disord. 1998;33 Suppl:102-7. Related Articles, Links

Prioritisation in speech and language therapy departments in Scotland and Malaysia. Santiago C, Stansfield J. Department of Speech and Language Sciences, Queen Margaret College, Edinburgh. This study investigates how prioritisation in health services have influenced speech and language therapy (SLT) services in Scotland in prioritising their caseload. Additionally, it evaluates how current prioritisation systems may contribute towards the development of the SLT service in Malaysia. Health, education and social agencies in Malaysia were contacted and a literature review was conducted. Information on prioritisation systems used in Malaysia was unavailable. Prioritisation systems from seven SLT departments within Scotland were investigated, of which three SLT managers took part in semi-structured interviews. The findings show that prioritisation is influenced by a combination of factors and that the principles could only be applied to the Malaysian SLT service if consideration is given to the political, economical, social, geographical and cultural factors. Publication Types: •

Comparative Study

PMID: 10343674 [PubMed - indexed for MEDLINE] 1665: J Health Hum Serv Adm. 1998 Spring;20(4):502-19. Related Articles, Links

The Japanese health care system: citizen complaints, citizen possibilities. Yajima R, Takayanagi K. University of Missouri, Kansas City, USA. The Japanese health care system is sometimes considered one of the best in the world because it appears to have achieved universal coverage, high quality, and a comparatively low level of expenditure. But under compulsory national health insurance and the uniform fee schedule which has worked well so far, various problems have been produced in Japan. A growing number of persons believe some reform or readjustment may be required. Following a brief review of the

Japanese health care system which includes health insurance mechanisms, the relationship among physicians, hospitals and clinics, and the impact of these structures on access to care are explored. The resulting cost of care and the quality of care are then addressed. The lack of consumer information and the nature of the physician-patient relationship related to cultural factors are important components of this health care system. These latter factors are in the process of change and the likely direction of their influence upon the Japanese health care system is explored. PMID: 10338723 [PubMed - indexed for MEDLINE] 1666: Hokkaido Igaku Zasshi. 1999 Jan;74(1):3-6. Related Articles, Links

[Role of information system for the health care delivery in community] [Article in Japanese] Kaihara S. National Okura Hospital, Tokyo, Japan. Sophisticated information technologies have been applied in hospitals as well as in clinics. However, almost no information system has been developed which links hospitals and clinics. Medical care and welfare services are still separated activities and there are no information systems which exchange the data between the two sectors. Emergency medical information systems have been developed in the past, but they are usually used only for the exchange of bed occupancy information. Doctors started using the Internet, but there have been few medical books in Japanese in cyber space. Initiatives of medical personnel who are engaged in the daily health care delivery are necessary to solve the above stated problems. Some promising systems are emerging by the efforts of pioneers. Administrative agencies should assist the efforts of these initiatives to improve the community health care delivery. In the near future, the information systems will have some influence on the shape of medical care. Patient's medical data will be disclosed to patients. Specialty of hospitals will be also disclosed to the public. As a result, doctors will start to seek for more objective evidence for their medical care to patients. Clinical practice guidelines will be produced for common diseases in Japan as in Europe. Hospitals will cooperate with each other in the delivery of care, because it will be impossible for one hospital to give all types of care to patients. Hospitals in a community will function as if a virtually single hospital even though they are different in management. Publication Types:

•

English Abstract

PMID: 10331055 [PubMed - indexed for MEDLINE] 1667: Am J Crit Care. 1999 May;8(3):140-8. Related Articles, Links

Cardiovascular risk factors and cardiac surgery outcomes in a multiethnic sample of men and women. Verderber A, Castelfranco AM, Nishioka D, Johnson KG. University of Hawaii at Manoa, School of Nursing, Honolulu, USA. BACKGROUND: Cardiovascular disease is more prevalent in some ethnic groups than in others, as are risk factors stemming from cultural practices and values. Data on the health status of Asians and Pacific Islanders are scarce and sporadic, and data on the 2 groups are usually combined for analysis. OBJECTIVE: To determine ethnic and sex-related differences among white, Japanese, and Pacific Island subjects in cardiovascular risk factors and outcomes after coronary artery bypass graft surgery. METHODS: Data were collected from a random sample of 41 men and 19 women scheduled for nonemergent coronary artery bypass graft surgery: 19 white, 18 Japanese, and 23 Pacific Island/Hawaiian subjects. Subjects were interviewed about risk factors before surgery and were followed up for the first 20 hours after surgery. Problems that occurred during the remainder of the hospital stay were assessed by chart review. Instruments used included the Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II, and the Therapeutic Intervention Scoring System. RESULTS: Pacific Island and Japanese subjects differed significantly in their demographic and clinical characteristics. Pacific Islanders tended to have a more difficult postoperative course than did white subjects, whereas Japanese patients tended to have fewer problems and an easier postoperative course than other subjects. CONCLUSIONS: Further study of ethnic variations in risk factors and surgical outcomes, especially variations in comorbidities, age at the onset of signs and symptoms, and postoperative complications, is needed. Combining data obtained from Japanese and Pacific Island subjects for data analysis most likely will result in a loss of important information. Publication Types: • •

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

PMID: 10228654 [PubMed - indexed for MEDLINE]

1668: Med Lav. 1998;89 Suppl 2:S123-8. Related Articles, Links

Epidemiologic survey on organophosphate-induced delayed polyneuropathy (OPIDP) among patients recovered from Methamidophos poisoning. Sun DH, Zhou HD, Xue SZ. Department of Occupational Health, Shanghai Medical University, China. As Methamidophos (MAF) is currently responsible for half of the pesticide intoxications and fatality cases in China, the need to assess the frequency and the characteristics of the OPIDP among the victims who recovered from MAF poisoning is obvious. One-hundred and four subjects suffering from MAF intoxication were selected according to their medical records in the local rural hospitals in the Mu-du suburb of Su-Zhou, and the Shi-Qiu suburb of Nanjing. Face-to-face interviews were performed during home visits to all selected subjects, with the only exception of 4 patients. In those cases, information was provided by their kin relatives. Fourteen cases of delayed polyneuropathy (OPIDP) were identified: all patients who suffered from OP poisoning and had OPIDP showed a typical clinical course. The overall incidence of OPIDP was surprisingly high: 13.5%. The risk of OPIDP was associated with the severity of the intoxication. No association was found between OPIDP incidence and sex, age or treatment with dexametholone during the acute phase of the disease (RR = 0.98, p = 0.79). All 14 cases of OPIDP recovered in one and a half year without any permanent disability. Publication Types: •

Comparative Study

PMID: 10217933 [PubMed - indexed for MEDLINE] 1669: Science. 1999 Mar 26;283(5410):1990-2. Related Articles, Links

Chinese center sues over study coverage. Dan Z, Lei X. Publication Types:

•

News

PMID: 10206897 [PubMed - indexed for MEDLINE] 1670: Soc Sci Med. 1999 Apr;48(7):939-50. Related Articles, Links

NGOs in community health insurance schemes: examples from Guatemala and the Philippines. Ron A. South East Asia and the Pacific Advisory Team (SEAPAT), International Labour Office, Legaspi Village, Makati City, Philippines. [email protected] In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process. PMID: 10192560 [PubMed - indexed for MEDLINE] 1671: Bull World Health Organ. 1998;76(6):591-8.

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Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India. Ganatra BR, Coyaji KJ, Rao VN. KEM Hospital Research Centre, Pune, India. A total of 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study, which compared deaths with the survivors of similar pregnancy complications. The cases took significantly longer to seek care and to make the first health contact after the decision to seek care was taken. They also travelled significantly greater distances through a greater number of health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: residing in and not away from the village; presence of a resident nurse in the village; having an educated husband and a trained attendant at delivery; and being at the woman's parents' home at the time of illness. Other significant findings showed that deaths due to domestic violence were the second-largest cause of deaths in pregnancy, that more than two-thirds of maternal deaths were underreported in official records, and that liveborn infants of maternal deaths had a markedly higher risk of dying in the first year of life. This study points to the need for information-education-communication (IEC) efforts to increase family (especially male) preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system. PIP: Maternal deaths account for 13% of all deaths among reproductive-aged women in India. 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study comparing deaths with the survivors of similar pregnancy complications. Mothers who died took significantly longer to seek care and to make the first health contact after deciding to seek care. They also travelled significantly farther through more health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of living in rather than away from villages, having a resident nurse in the village, having an educated husband and a trained attendant at delivery, and being at the woman's parents' home at the time of illness. Domestic violence was the second largest cause of deaths in pregnancy, more than two-thirds of maternal deaths were underreported in official records, and liveborn infants of maternal deaths had a significantly higher risk of dying during the first year of life. Informationeducation-communication efforts to increase family preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system are needed.

Publication Types: • •

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

PMID: 10191555 [PubMed - indexed for MEDLINE] 1672: Int J Health Plann Manage. 1998 Jan-Mar;13(1):47-67. Related Articles, Links

Willingness to pay for rural health insurance through community participation in India. Mathiyazhagan K. Institute for Social and Economic Change, Nagarbhavi, Bangalore, India. The main objective of this article is to examine the willingness to pay for a viable rural health insurance scheme through community participation in India, and the policy concerns it engenders. The willingness to pay for a rural health insurance scheme through community participation is estimated through a contingent valuation approach (logit model), by using the rural household survey on health from Karnataka State in India. The results show that insurance/saving schemes are popular in rural areas. In fact, people have relatively good knowledge of insurance schemes (especially life insurance) rather than saving schemes. Most of the people stated they are willing to join and pay for the proposed rural health insurance scheme. However, the probability of willingness to join was found to be greater than the probability of willingness to pay. Indeed, socio-economic factors and physical accessibility to quality health services appeared to be significant determinants of willingness to join and pay for such a scheme. The main justification for the willingness to pay for a proposed rural health insurance scheme are attributed from household survey results: (a) the existing government health care provider's services is not quality oriented; (b) is not easily accessible; and, (c) is not cost effective. The discussion suggests that policy makers in India should take serious note of the growing influence of the private sector and people's willingness to pay for organizing a rural health insurance scheme to provide quality and efficient health care in India. Policy interventions in health should not ignore private sector existence and people's willingness to pay for such a scheme and these two factors should be explicitly involved in the health management process. It is also argued that regulatory and supportive policy interventions are inevitable to promote this sector's viable and appropriate development in organizing a health insurance scheme.

PMID: 10178583 [PubMed - indexed for MEDLINE] 1673: Can Fam Physician. 1999 Mar;45:690-2, 695-7. Related Articles, Links

Childbirth customs in Vietnamese traditions. Bodo K, Gibson N. Department of Public Health Sciences and Family Medicine, University of Alberta, Edmonton. OBJECTIVE: To examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment. QUALITY OF EVIDENCE: The information in this paper is based on a review of the literature, supplemented by interviews with members of the Vietnamese community in Edmonton, Alta. The literature was searched with MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Sciences Abstracts (1984 to present). Emphasis was placed on articles and other texts that dealt with Vietnamese customs surrounding childbirth, but information on health and health care customs was also considered. Interviews focused on the accuracy of information obtained from the research and the correlation of those data with personal experiences of Vietnamese community members. MAIN MESSAGE: Information in the texts used to research this paper suggests that traditional Vietnamese beliefs and practices surrounding birth are very different from the biomedical view of the Canadian medical system. The experiences and beliefs of the members of the Vietnamese community support this finding. Such cultural differences could contribute to misunderstandings between physicians and patients and could affect the quality and efficacy of health care provided. CONCLUSIONS: A sensitive and open approach to the patient's belief system and open and frank communication are necessary to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees. Education and awareness of cultural differences are necessary for physicians to provide the best and most effective health care possible. PIP: A review of the literature dating back to 1966, supplemented by interviews with members of the Vietnamese community in Edmonton, Alberta, was conducted to examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment. The available data suggest that traditional Vietnamese beliefs and practices regarding birth are very different from the biomedical view held by the Canadian medical system. The experiences and beliefs of the Vietnamese respondents support this finding. Such cultural

differences could contribute to misunderstandings between physicians and patients, and affect the quality and efficacy of health care provided. A sensitive and open approach to the patient's belief system, and open and frank communication are needed to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees. Publication Types: •

Review

PMID: 10099808 [PubMed - indexed for MEDLINE] PMCID: PMC2328405

1674: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 1998;(116):132-6. Related Articles, Links

[Preparation of the database and the homepage on chemical accidents relating to health hazard] [Article in Japanese] Yamamoto M, Morita M, Kaminuma T. [email protected] We collected the data on accidents due to chemicals occurred in Japan, and prepared the database. We also set up the World Wide Web homepage containing the explanation on accidents due to chemicals and the retrieval page for the database. We designed the retrieval page so that users can search the data from keywords such as chemicals (e.g. chlorine gas, hydrogen sulfide, pesticides), places (e.g. home, factory, vehicles, tank), causes (e.g. reaction, leakage, exhaust gas) and others (e.g. cleaning, painting, transportation). Publication Types: • •

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

PMID: 10097523 [PubMed - indexed for MEDLINE] 1675: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 1998;(116):92-100.

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[Development of NIHS Information and Computing Infrastructure (NICI)] [Article in Japanese] Nakata K, Nakano T, Takai T, Kaminuma T. [email protected] We describe the development of NICI, which we extended during June 1996 to May 1998. The direct lines between our Experimental Stations for Medicinal Plants at Tsukuba and Tsukuba Node for Inter Ministry Network, and newly opened Pharmaceuticals and Medical Devices Evaluation Center at Minato-ku and NIHS at Setagaya-ku in Tokyo, were constructed. Although the main frame in NIHS at Setagaya is not different since May 1996, we provided many databases and useful information on Drugs, Foods and Chemicals, constructing the interface between World Wide Web and databases. Our Home Page was timely updated. Publication Types: • •

English Abstract Review

PMID: 10097516 [PubMed - indexed for MEDLINE] 1676: Drug Saf. 1999 Feb;20(2):95-107. Related Articles, Links

The Internet and drug safety: what are the implications for pharmacovigilance? Cobert B, Silvey J. Schering-Plough Research Institute, Kenilworth, NJ 07090, USA. [email protected] Use of the Internet is becoming widespread throughout the world. Its use in the domain of drug safety and pharmacovigilance is spreading rapidly. Governments and industry have taken the lead in developing extensive web sites. The US Food and Drug Administration (FDA), the European Agency for the Evaluation of Medicinal Products (EMEA) and other agencies have developed sites containing enormous amounts of information both on pharmacovigilance in general and on

specific drugs in particular. Under the US 'Freedom of Information Act' the FDA has put major parts of its adverse event database on line. Regulatory documents are also available from the FDA site or from hyperlinks described in the site. The US Center for Drug Evaluation and Research updates its site most days and maintains a free automated e-mail announcement service of these updates. Similarly, the EMEA updates its site frequently and publishes extensive material including regulatory documents, guidelines, European Public Assessment Reports on newly approved medications and other useful information. A free update service by e-mail is also available. Although English is the primary language used on the EMEA site, some of the information is available in other languages. Pharmaceutical companies are not using the Internet for pharmacovigilance yet. Rather, the Internet is being used for promotion of their products and for informing consumers on general information on diseases, for financial and investor data and for employment opportunities, etc. Other organisations such as lobbies, consumer groups and medical journals are also beginning to use the Internet. The electronic transmission of safety information, using the standards developed by the International Conference on Harmonization, is currently being tested for the transmission of individual patient adverse event information between companies and governments. In addition, the FDA has begun to accept adverse events from healthcare providers and consumers directly on line using an electronic version of its MedWatch form. It is expected that these developments will change the nature of the way pharmacovigilance is carried out. Significant issues will arise from this including privacy concerns. The European Union's 1995 directive on 'the protection of individuals with regard to the processing of personal data and on the free movement of such data (95/46/EC)' went into effect in October 1998. The enabling legislation now being passed by the member states will produce significant changes in the way companies and governments handle individual patient data in order to assure the privacy and protection of individuals. Publication Types: •

Review

PMID: 10082068 [PubMed - indexed for MEDLINE] 1677: Fam Pract. 1998 Dec;15(6):569-70. Related Articles, Links

Awareness of and attitude of elderly subjects regarding health care and welfare in rapidly ageing population in Japan. Takei Y, Shimada O, Orimo K. Kuni Medical Center and Spa, Agatsuma, Gunma, Japan.

OBJECTIVES: We aimed to obtain information on the degree of knowledge and understanding about the current systems of health care and welfare held by the elderly, in order to achieve comprehensiveness in family practice. METHOD: We conducted a study on the awareness of healthy elderly persons by direct interview. The study was carried out in Kuni Village in a remote mountainous region in Japan, where the elderly population accounts for 24.8% of the total population. The subjects were self-dependent in their daily living activities and were aged 65 years and older. RESULTS: The subjects' knowledge of health care and welfare systems was generally good, and the degree of their utilization of these systems was also good. But 83.3% of those who did not want to utilize the welfare system indicated their preference to depend on their family for support. CONCLUSION: Family physicians must endeavour to offer comprehensive care to their patients by including these systems for rapidly ageing communities. Publication Types: •

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

PMID: 10078799 [PubMed - indexed for MEDLINE] 1678: MMWR CDC Surveill Summ. 1999 Feb 26;48(1):1-23. Related Articles, Links

Malaria surveillance--United States, 1995. Williams HA, Roberts J, Kachur SP, Barber AM, Barat LM, Bloland PB, Ruebush TK 2nd, Wolfe EB. Epidemic Intelligence Service, Epidemiology Program Office, CDC, USA. PROBLEM/CONDITION: Malaria is caused by four species of Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. Occasionally, cases occur in the United States through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. REPORTING PERIOD: Cases with onset of illness during 1995. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smears are reported to local and/or state health departments by health-care providers and/or laboratory staff. Case investigations are conducted by local and/or state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS: CDC

received reports of 1,167 cases of malaria with onset of symptoms during 1995 among persons in the United States or one of its territories. This number represents an increase of 15% from the 1,014 cases reported for 1994. P. vivax, P. falciparum, P. malariae, and P. ovale were identified in 48.2%, 38.6%, 3.9%, and 2.2% of cases, respectively. More than one species was present in three patients (0.3% of total). The infecting species was not determined in 80 (6.9%) cases. The number of reported malaria cases acquired in Africa (n=519) remained approximately the same as in 1994 (n=517); cases acquired in Asia increased by 32.4% (n=335); and cases acquired in the Americas increased by 37.4 % (n=246). Of 591 U.S. civilians who acquired malaria abroad, 15.6% had followed a chemoprophylactic drug regimen recommended by CDC for the area where they had traveled. Nine patients became infected in the United States. Of these nine cases, five were congenitally acquired; one was acquired by organ transplantation; and one was acquired by a blood transfusion. For two of the nine cases, the source of infection was unknown. Six deaths were attributed to malaria. INTERPRETATION: The 15% increase in malaria cases in 1995 compared with 1994 resulted primarily from increases in cases acquired in Asia and the Americas, most notably a 100% increase in the number of cases reported from South America. This change could have resulted from local changes in disease transmission, travel patterns, reporting errors, or a decreased use of effective antimalarial chemoprophylaxis. In most reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country where they acquired malaria. ACTIONS TAKEN: Additional information was obtained concerning the six fatal cases and the nine infections acquired in the United States. Malaria prevention guidelines were updated and distributed to health-care providers. Persons traveling to a malarious area should take the recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently develops a fever or influenza-like symptoms should seek medical care; investigation should include a blood smear for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC. PMID: 10074931 [PubMed - indexed for MEDLINE] 1679: Nippon Koshu Eisei Zasshi. 1998 Dec;45(12):1162-70. Related Articles, Links

[Lifestyle, mental health, and awareness of health among Japanese bus drivers] [Article in Japanese] Hara S, Yanagi H, Okuno J, Azuma K, Yuzawa T, Hirano C, Tomura S, Tsuchiya S.

Institute of Community Medicine, University of Tsukuba. To examine lifestyle, mental health and awareness of health, a self-administered questionnaire survey was performed among 751 employees of a bus company in a rural city of Japan. From 597 (79.5%) respondents, we analyzed 130 male bus drivers and age-matched 130 male clerks. The questionnaire included eleven questions about lifestyle and mental health, three questions about awareness of health, and questions on personal concern about specific parts of the body or diseases, and health information they needed. Answers for lifestyle and mental health were classified into the categories of "good" or "not good" practices recommended by Breslow and Morimoto. The results were as follows; 1) Over 80 percent of subjects of both groups had good awareness of health, but bus drivers had significantly worse lifestyle with regard to nutritional intake (p < 0.05), daily walking (p < 0.001), sports (p < 0.05), and sleeping hours (p < 0.001). 2) Bus drivers had significantly greater prevalence of concern about their cardiovascular system, esophagus and gastrointestinal system, and joints and bones than clerks (p < 0.05). 3) Bus drivers had a significantly greater need for information about nutritional intake (p < 0.001), and methods for prevention of diseases (p < 0.01). From these results, the discrepancy between awareness of health and lifestyle seen in this study, especially in food intake, walking time, sports participation, and sleep, may have resulted from the bus driver's characteristics of job, for example, long and irregular working hours. Therefore, effective guidance on health and lifestyle changes to restore balance and improve their lifestyle. Publication Types: •

English Abstract

PMID: 10067083 [PubMed - indexed for MEDLINE] 1680: Novartis Found Symp. 1998;217:24-35; discussion 35-41. Related Articles, Links

The epidemiology of tuberculosis in South Africa. Donald PR. Department of Paediatrics and Child Health, Faculty of Medicine, University of Stellenbosch, Tygerberg, South Africa. Reports by reliable observers indicate that tuberculous disease did not occur to any great extent amongst South Africa's indigenous peoples prior to European colonization. Colonization introduced sources of infection and caused rapid urbanization for purposes of commerce and trade. By the start of the 20th century tuberculosis was recognized as a common health problem amongst the Black and

Coloured peoples of South Africa. National notification commenced in 1921 and an incidence of 43 per 100,000 rose to 365 per 100,000 in 1958 and declined to 162 per 100,000 in 1986 before rising again to 221 per 100,000 in 1993. High incidences have been consistently recorded amongst the Coloured population of the Western Cape Province: in 1993 713 per 100,000 compared to the national incidence of 225 per 100,000. Using a computerized geographical information system the precise distribution of tuberculosis in two adjacent underprivileged, mainly Coloured communities, with a combined population of 34,000, is being studied. From 1985 to 1994 4044 notified tuberculosis cases gave an incidence of about 1200 per 100,000, varying from 78 to 3150 per 100,000 for the 39 enumerator subdistricts used for census purposes, and was highest in those with the lowest income. Of 5345 housing units 1835 (34%) housed at least one case of tuberculosis and 483 (9%) three or more cases. IS6110 DNA fingerprinting of strains from this community has shown a high degree of strain diversity (209 out of 334 strains evaluated). Clustering, indicative of recent transmission, was found in only 30% of isolates in this high tuberculosis incidence community. Publication Types: •

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

PMID: 9949799 [PubMed - indexed for MEDLINE] 1681: Pediatrics. 1999 Feb;103(2):E18. Related Articles, Links

Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. Khan WA, Dhar U, Salam MA, Griffiths JK, Rand W, Bennish ML. International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. BACKGROUND AND OBJECTIVE: Alterations in consciousness, including seizures, delirium, and coma, are known to occur during Shigella infection. Previous reports have suggested that febrile convulsions and altered consciousness are more common during shigellosis than with other childhood infections. Those reports, however, have been from locations where S dysenteriae type 1 was not common, thus making it difficult to assess the specific contribution that S dysenteriae type 1 infection, and Shiga toxin, might make to the pathogenesis of altered consciousness in children with shigellosis. In this study we seek to determine the prevalence, risk factors, and outcome of altered consciousness in children with shigellosis in Bangladesh, a country where

infection with all four species of Shigella is common. We particularly focus on the importance of metabolic abnormalities, which we have previously shown to be a common feature of shigellosis in this population. METHODS: This study was conducted at the Diarrhea Treatment Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh in Dhaka, Bangladesh, which provides care free of charge to persons with diarrhea. During 1 year, a study physician identified all inpatients infected with Shigella by checking the logs of the Clinical Microbiology Laboratory daily. Study physicians obtained demographic and historical information by reviewing the patient charts and by interviewing patients, or their parents or guardians, to confirm or complete the history of illness obtained on admission. Patients were categorized as being conscious or unconscious based on a clinical scale; having a seizure documented in the hospital; or having a seizure by history during the current illness that was not witnessed by medical personnel. Patient outcome was classified as discharged improved, discharged against medical advice, transferred to another health facility, or died in the Treatment Centre. Laboratory examinations were ordered at the discretion of the attending physician; all such information was recorded on the study form. Clinical management was by the attending physician. Factors independently predictive of a documented seizure, or of unconsciousness, were determined using a multiple logistic regression analysis. For this analysis variables associated with unconsciousness or a documented seizure in the analysis of variance or chi2 analyses were entered into the regression equation and eliminated in a backward stepwise fashion if the probability associated with the likelihood ratio statistic exceeded .10. RESULTS: During this 1-year study, 83 402 persons with diarrhea came to the Treatment Centre for care, and 6290 patients were admitted to the inpatient unit. Shigella was isolated from a stool or rectal swab sample of 863 (13.7%) of the inpatients. Seventy-one (8%) of the inpatients with shigellosis were >/=15 years old; 61 (86%) were conscious; 10 (14%) were unconscious; none had either a documented seizure or a seizure by history during this illness. Seven hundred ninety-two patients were <15 years old (92%); 654 (83%) were conscious; 73 (9%) were unconscious; 41 (5%) had a documented seizure (compared with >/=15-year age group); 24 (3%) had a seizure by history during this illness. Of the 41 patients with documented seizures, 19 (46.3%) had a seizure at the time of admission, and 22 (53.7%) had a seizure after admission. Twenty-five (61.0%) of the 41 patients with documented seizures were reported to have a seizure during this illness before coming to the Treatment Centre. Clinical features that are known to cause altered consciousness-fever, severe dehydration, hypoglycemia, hyponatremia, or meningitis-were present in 38 (92.7%) of the 41 patients in whom a seizure was witnessed and in 67 (91.8%) of the 73 patients who were unconscious. Nineteen (46. 3%) of the patients who had a seizure documented had two of these five features, 4 (9.8%) had three, and 1 (2. (ABSTRACT TRUNCATED) Publication Types: •

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

PMID: 9925864 [PubMed - indexed for MEDLINE] 1682: Southeast Asian J Trop Med Public Health. 1998 Jun;29(2):201-12. Related Articles, Links Comment in: •

Southeast Asian J Trop Med Public Health. 1998 Jun;29(2):189-90.

International population movements and public health in the Mekong region: an overview of some issues concerning mapping. Stern A. Asian Research Center for Migration, Institute of Asian Studies, Chulalongkorn University, Bangkok, Thailand. Geographical Information Systems (GIS) have many important applications in local, regional and global situation analysis, especially in relation to planning and implementation thereof. The complex issues involved in population movement between neighboring countries offer a good example of the assistance that GIS applications can provide to transborder public health planning. The Greater Mekong Subregion (GMS) involves 6 countries, among which greatly increased population movement is occurring for a variety of reasons. This movement carries with it high risks of disease dispersal and thus presents a major challenge to disease control. This paper addresses the questions of sources, access and presentation of a wide variety of data that is needed by planners to develop more appropriate cooperative approaches to public health management in the GMS, with the main focus on contributions from mapping. Publication Types: •

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

PMID: 9886100 [PubMed - indexed for MEDLINE] 1683: Southeast Asian J Trop Med Public Health. 1998 Jun;29(2):191-200. Related Articles, Links Comment in: •

Southeast Asian J Trop Med Public Health. 1998 Jun;29(2):189-90.

Factors influencing malaria endemicity in Yunnan Province, PR China (analysis of spatial pattern by GIS). Geographical Information System. Hu H, Singhasivanon P, Salazar NP, Thimasarn K, Li X, Wu Y, Yang H, Zhu D, Supavej S, Looarecsuwan S. Yunnan Provincial Health Bureau, Kunming, PR China. This study is an initial attempt to apply disease mapping through Geographical Information System (GIS) with multiple regression analysis to determine the nature and extent of factors influencing malaria transmission in Yunnan Province, PR China, particularly in border areas. Secondary county-based data covering the period 1990 to 1996 were collected and analyzed. The malaria situation in Yunnan Province as a whole is influenced mainly by the combined effects of the physical environment, the presence of efficient vector species, and mobile population along international borders with Myanmar, Lao PDR and Vietnam. Publication Types: •

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

PMID: 9886099 [PubMed - indexed for MEDLINE] 1684: J Epidemiol. 1998 Dec;8(5):278-84. Related Articles, Links

Estimated number of patients with chronic renal failure but not with end-stage renal disease in Japan: comparisons between two estimation methods. Wakai K, Nakai S, Shinzato T, Kawamura T, Tamakoshi A, Aoki R, Kojima M, Lin Y, Nakayama T, Maeda K, Ohno Y. Department of Preventive Medicine, Nagoya University School of Medicine, Japan. We estimated the number of patients with chronic renal failure (CRF) but not with end-stage renal disease (ESRD) in Japan by two methods: a nationwide survey and an estimation using incidence rates of ESRD among CRF patients as well as the number of incident ESRD. The former estimated the number of patients with CRF but not with ESRD as 154,000 (95% confidence interval 139,000-168,000), while so did the latter as 142,000 (133,000-150,000). It follows that the number of

CRF patients including ESRD could amount to more than 300,000, which would give a substantial impact on public health in Japan. Despite some own methodological issues in estimation, the two estimates were reasonably in good agreement: supporting their methodological validity in estimation, since sources of errors appeared to be quite independent of each other. Publication Types: •

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

PMID: 9884477 [PubMed - indexed for MEDLINE] 1685: Int J Obes Relat Metab Disord. 1998 Dec;22(12):1164-71. Related Articles, Links Comment in: •

Int J Obes Relat Metab Disord. 2003 Mar;27(3):287-8.

Body mass index and percent body fat: a meta analysis among different ethnic groups. Deurenberg P, Yap M, van Staveren WA. Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, The Netherlands. OBJECTIVE: To study the relationship between percent body fat and body mass index (BMI) in different ethnic groups and to evaluate the validity of the BMI cutoff points for obesity. DESIGN: Meta analysis of literature data. SUBJECTS: Populations of American Blacks, Caucasians, Chinese, Ethiopians, Indonesians, Polynesians and Thais. MEASUREMENTS: Mean values of BMI, percent body fat, gender and age were adapted from original papers. RESULTS: The relationship between percent body fat and BMI differs in the ethnic groups studied. For the same level of body fat, age and gender, American Blacks have a 1.3 kg/m2 and Polynesians a 4.5 kg/m2 lower BMI compared to Caucasians. By contrast, in Chinese, Ethiopians, Indonesians and Thais BMIs are 1.9, 4.6, 3.2 and 2.9 kg/m2 lower compared to Caucasians, respectively. Slight differences in the relationship between percent body fat and BMI of American Caucasians and European Caucasians were also found. The differences found in the body fat/BMI relationship in different ethnic groups could be due to differences in energy balance as well as to differences in body build. CONCLUSIONS: The results show that the relationship between percent body fat and BMI is different among different ethnic groups. This should have public health implications for the

definitions of BMI cut-off points for obesity, which would need to be populationspecific. Publication Types: •

Meta-Analysis

PMID: 9877251 [PubMed - indexed for MEDLINE] 1686: Public Health Rep. 1998 Jun;113 Suppl 1:58-66. Related Articles, Links

Community-based outreach HIV intervention for street-recruited drug users in Madras, India. Kumar MS, Mudaliar S, Daniels D. Institute of Mental Health, Punarjeevan Drug Treatment Centre, Madras. [email protected] OBJECTIVE: Community-based outreach to drug injectors is an important component of human immunodeficiency virus (HIV) prevention strategy. The purpose of this chapter is to evaluate the effectiveness of community-based outreach HIV intervention that has been implemented in two locations in the city of Madras, India, to reduce risk behaviors for HIV transmission. METHODS: Baseline data were collected for street-recruited injecting drug users (IDUs) at two outreach locations in Madras, India (n = 250), and follow-up data are available at 18 months (n = 61). Baseline (n = 150) and follow-up data (n = 87) were obtained from control group of IDUs recruited from locations at which outreach services were not utilized. RESULTS: Significant decline in injecting risk behavior was noted at 18-month follow-up from baseline for the IDUs recruited from outreach locations. CONCLUSION: Results indicate that outreach service for drug users produce significant changes in injecting risk behavior but that sexual risk behavior is difficult to change. There are problems in implementing and evaluating the interventions, and the research findings are limited because HIV serodata were not studied for all participants. Publication Types: • • •

Clinical Trial Controlled Clinical Trial Multicenter Study

PMID: 9722810 [PubMed - indexed for MEDLINE] PMCID: PMC1307727

1687: Sangyo Eiseigaku Zasshi. 1998 Sep;40(5):214-21. Related Articles, Links

[A survey on return to work and fitness for work in Japan: the systems provided in corporate regulations and their application] [Article in Japanese] Tanaka M, Hoshuyama T, Takahashi K, Ito T, Okubo T. Department of Environmental Epidemiology, University of Occupational Environmental Health, Fukuoka, Japan. We conducted a survey to evaluate the current situation and the application of systems for return to work (RTW) and fitness for work (FFW) in Japanese companies. Self-administered questionnaires were mailed to 351 occupational health (OH) physicians listed in the membership directory of the Japan Society for Occupational Health published in 1990. The item of information sought were the size and industrial type of the company, the organization of OH staff, the process of assessment of RTW, the provision for sick leave in corporate regulations, the FFW criteria, and job training systems for RTW. Of the 145 companies from which questionnaire replies were received from OH physicians (response rate: 41%), 123 (85%) were manufacturing industries. When classified according to the number of employees, 41 (28%) had 3000 or more, 66 (46%) had between 1000 and 2999, 26 (18%) had 999 or fewer and 12 (8%) were unknown. 144 companies (99%) had provisions on temporary retirement in their corporate regulations. As for who makes compensation during temporary retirement, 66 (48%) and 61 (44%) companies answered "both company and health insurance society" and "health insurance society alone," respectively. 136 companies (94%) carried out assessment of RTW, and involved OH professionals and other related staff in the process of assessment. In the majority of cases, the OH physicians were in charge of the decision-making process on RTW and were authorized to make the final decision. In the companies with 3000 or more employees, the cases of longer-term sick leave were assessed in a more complete process than those of shorter-term sick leave. 119 companies (88%) conducted on additional health examination to assess the employee's FFW. Sixty-four companies (47%) had standardized criteria on FFW. One hundred and eighteen companies (83%) had job training systems for employees' RTW, and they mainly introduced restricting one's job and/or reducing one's work-load. It was suggested that complete systems for RTW and FFW were more available among companies with 3000 or more employees than

among companies with 2999 or fewer employees. Publication Types: •

English Abstract

PMID: 9836333 [PubMed - indexed for MEDLINE] 1688: J Adv Nurs. 1998 Oct;28(4):786-93. Related Articles, Links

Moving into the information era: does the current nursing paradigm still hold? Spitzer A. The Cheryl Spencer Department of Nursing, University of Haifa and the Technion, Mount Carmel, Israel. The transition into the information era is characterized by society's passage through three crossroads representing a change from: (a) technology to posttechnology; (b) rigid jobs and hierarchies to dejobbing and vanishing hierarchies; and (c) limited competition to competition dominating all markets. These transitions have caused dramatic changes in the health care system at large and escalating problems that cannot be solved within the current paradigm of nursing. Among the nursing problems that were identified are those including difficulties in: (a) defining the relative contribution of nursing vis a vis other health professions; (b) the scope and dimensions of nursing authority; (c) implementing all aspects of the nursing intervention; (d) actualizing caring in nursing intervention; and (f) implementing the nursing process as a major thinking process in the profession. The analysis of the state of nursing suggests that the current clinical paradigm fails to consolidate the economic and quality issues into the core of nursing. It is not capable of solving central professional problems and emerging dilemmas. Considering that under the current paradigm, nursing has difficulties in highlighting to clients and the system alike where nursing can make a difference, it is questionable whether such a paradigm can ensure the existence of nursing in the future. PMID: 9829667 [PubMed - indexed for MEDLINE] 1689: Ann Pharmacother. 1998 Nov;32(11):1234-8. Related Articles, Links

Information contents of drug advertisements: an Indian experience. Lal A. Department of Pharmacology, University College of Medical Sciences, Shahdara, Delhi, India. [email protected] OBJECTIVE: To critically analyze the drug information contained in Indian pharmaceutical advertisements. DESIGN: Analysis of pharmaceutical advertisements supplied by drug representatives (DRs) to prescribers from July 1, 1995, to June 30, 1996. SETTING: A university-affiliated urban teaching hospital in India. PARTICIPANTS: 585 pharmaceutical ad pamphlets. MAIN OUTCOME MEASURES: The ads supplied by DRs to physicians in different clinical departments of the hospital were collected. These were distributed to different systems/categories and a special reference to fixed-dose drug combinations was given. The drug information contained in these ads was evaluated by using a checklist, framed by incorporating the World Health Organization ethical guidelines for medicinal drug promotion and some relevant items from other studies. RESULTS: The most frequently occurring ads were for antimicrobial agents. The ads on fixed-dose drug combinations constituted 37.9% of the total. More than 85% of the ads mentioned the generic name, brand name, contents, and pharmaceutical dosage forms, as well as the name and address of the company. The information concerning adverse effects, precautions, contraindications, warnings, major interactions, ingredients known to cause problems, pharmacology, drug overdose, references, drug storage, and cost was present in less than 40% of these ads. CONCLUSIONS: There has been inadequate information in pharmaceutical ads supplied by DRs to the physicians in India. The current scenario could be improved by formulating some definite legislative guidelines for the minimum level of information to be included in pharmaceutical ads and adhering to that legislation. PMID: 9825093 [PubMed - indexed for MEDLINE] 1690: Can J Public Health. 1998 Sep-Oct;89(5):301-7. Related Articles, Links Comment in: •

Can J Public Health. 1999 Jan-Feb;90(1):65, 71.

A proposed optimal health care system based on a comparative study conducted between Canada and Japan.

Akaho E, Coffin GD, Kusano T, Locke L, Okamoto T. Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Japan. OBJECTIVES: Every country wants a good health care system for all citizens with minimum expenditure. By comparing health care systems in Canada and Japan, both of which have a universal health care system for all citizens in its own country, an attempt was made to visualize or search for an optimal health care system. METHOD: Data and information obtained were tabulated and compared from the standpoint of the effectiveness of the health insurance system and the feasibility of its application so as to propose an optimal health care system. RESULTS AND CONCLUSIONS: Some of the suggestions and proposals made for an optimal health care system for all citizens include implementation and/or establishment of minimal user fees, centralized rational decision-making processes, private delivery system of health care, centralized computer-aided patient record system, insurance monitoring system, patient education, and physician guidelines. Publication Types: • •

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

PMID: 9813913 [PubMed - indexed for MEDLINE] 1691: Paediatr Perinat Epidemiol. 1998 Oct;12 Suppl 2:142-55. Related Articles, Links

Managing data for a randomised controlled clinical trial: experience from the WHO Antenatal Care Trial. WHO Antenatal Care Trial Research Group. Pinol A, Bergel E, Chaisiri K, Diaz E, Gandeh M. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organisation, Geneva, Switzerland. The World Health Organisation, in collaboration with four developing countries, is conducting a randomised controlled clinical trial to evaluate a new programme of antenatal care. In a city or region in Argentina, Cuba, Saudi Arabia and Thailand, 53 clinical units were randomly allocated to provide either the new programme or the programme currently in use. This paper describes the organisation of the data management system used to collect the data. Each woman

participating in the trial is uniquely identified, and information such as her name, address and expected delivery date is recorded in the trial 'subject number list'. If the clinic belongs to the intervention group, information about the woman's eligibility is recorded on the classification form. Details of the outcome of the pregnancy are indicated on two additional case report forms: the antenatal hospital admission form and the summary form. When forms are completed by the investigators, they are submitted to the country data coordinating centre (CDCC). The CDCCs are responsible for the processing of the country study forms. This includes verification of the batch of forms, data capture into computer files, data verification, data validation, production of query sheets for data problems, maintenance and updating of study master files. All operations on data such as additions or modifications are performed using transaction processing. At monthly intervals, recruitment reports and transaction files are sent to the trial coordinating centre in Geneva. All transaction files are processed to accumulate data on the trial's consolidated master files. A monthly report including number of women recruited in the trial, adverse events reported by the countries, recruitment charts by clinic and analyses on eligible women in the intervention group is prepared and submitted to the data safety and monitoring committee. A workshop was organised in 1995, before the start of the trial, to introduce the data management system to the four participating countries. Annual site visits were made to each CDCC to monitor progress. Additional visits were made when major or critical problems could not be solved by the CDCC. At the closure of data collection, a visit is made to review and assess all data management procedures including form filling, maintenance of registers, computer files, query sheets, data modifications. In addition, final cleaning of the data is performed, and an analysis file is produced for inclusion in the centralised trial analyses and in the country-specific analyses. Based on the experience gained in this trial, the decentralised data management model can be advocated only if CDCCs that will be involved in the trial are already in place with competent and experienced staff. Uniformity of the data management system and of standard operating procedures across countries is also a crucial issue for the effective management of the data collection phase. Publication Types: • •

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

PMID: 9805727 [PubMed - indexed for MEDLINE] 1692: Paediatr Perinat Epidemiol. 1998 Oct;12 Suppl 2:75-97. Related Articles, Links

Methods for economic evaluation alongside a multicentre trial in

developing countries: a case study from the WHO Antenatal Care Randomised Controlled Trial. Mugford M, Hutton G, Fox-Rushby J. School of Health Policy and Practice, University of East Anglia, Norwich, UK. The WHO is testing a new rationalised programme of antenatal care in a multicentre randomised trial. The motivation for this trial arose from the current uncertainty about the effectiveness of different approaches to provision of routine antenatal care. Decision makers also lack information about the costs of providing routine antenatal care and the cost-effectiveness of one programme over another. Such information will be needed before the final choice of programme can be made. The WHO trial provides an ideal opportunity to estimate and compare the incremental costs and cost-effectiveness of the new programme in four countries (Argentina, Cuba, Saudi Arabia, Thailand). A separate economic component has been organised to measure the costs of antenatal care. Methods for cost identification and measurement, and methods for economic analysis in the context of an international study are based on current recommendations for the conduct of economic evaluations alongside trials. However, several aspects require further development. In particular, this includes defining standard methods for costing in different countries; measuring women's costs of access to care; and making comparisons across international settings. The economic evaluation will also inform similar multicentre international trials and investigate issues of generalisability beyond trial settings. PIP: Economic estimations at the technology assessment stage of health interventions permit early recognition of the relative efficiencies of health care interventions and allow those that are expensive and have limited health effects to be discouraged from widespread adoption. The World Health Organization (WHO) Antenatal Care Randomized Controlled Trial includes a component aimed at estimating the incremental costs and cost-effectiveness of a new rationalized program of prenatal care relative to those associated with the standard prenatal care package. 2400 pregnant women attending 53 clinics in Argentina, Cuba, Thailand, and Saudi Arabia have been enrolled. The central concern is that the new program of prenatal care does not result in higher overall costs to either the health care system or women receiving care than the currently practiced model. Resources included in the unit cost estimation are staff, drugs and medications, materials, equipment, vehicles, utilities, and buildings and land. Monthly costing data are being collected at all study sites in Cuba and Thailand over a 12-month period and a questionnaire has been developed to assess the costs borne by women. Data from these two sources will be collated to produce tables of costs at the health facility, country, and international levels. The reliability of the results should be enhanced by the association of the economic analysis with a carefully designed randomized trial intended to minimize bias in terms of differences in the quantities of services used.

Publication Types: • •

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

PMID: 9805724 [PubMed - indexed for MEDLINE] 1693: Singapore Med J. 1998 Jun;39(6):251-5. Related Articles, Links

Studying the mental health of a nation: a preliminary report on a population survey in Singapore. Fones CS, Kua EH, Ng TP, Ko SM. Department of Psychological Medicine, National University Hospital, Singapore. AIM: A Singapore Mental Health Survey was designed to study the prevalence and pattern of psychiatric morbidity of the general population. Community surveys reveal the true pattern of mental disorders, free from any self-selection into, or referral within the health care system. METHODS: A cross-sectional survey design was used to estimate the point prevalence of minor psychiatric morbidity (MPM) in an area-probability sample drawn from different regions. Disproportionate quota sampling yielded approximately equal numbers of Chinese, Malays and Indians for inter-ethnic comparison. The General Health Questionnaire, 28-item version (GHQ-28) measured psychoemotional symptoms in 3,020 subjects aged between 13-65 years. The GHQ-28 was validated against ICD-10 psychiatric diagnoses derived from structured psychiatric interview with the Composite International Diagnostic Interview (CIDI). RESULTS: The optimal cut-off point for the GHQ-28 was determined to be 4/5 for Chinese, and 5/6 for Malays and Indians. Using the validated ethnic-specific cut-offs, MPM rate for Chinese was 17.4%, Malays 15.1% and Indians 17.8%. The population MPM prevalence rate was estimated to be 16.6% after standardisation with population census data. Specific types of ICD-10 psychiatric disorders which give rise to MPM were mainly anxiety and depressive disorders. Twelve percent of individuals with MPM had at least one ICD-10 disorder in the previous year. CONCLUSION: Two-staged methodology is an efficient, cost-effective approach to study population prevalence of mental illness. Screening instruments utilised should be validated specifically for the culture and setting. Information from population surveys of psychiatric morbidity are important for the planning of mental health services for the country. Publication Types:

•

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

PMID: 9803812 [PubMed - indexed for MEDLINE] 1694: Lancet. 1998 Jul 4;352(9121):58-61. Related Articles, Links Comment in: •

Lancet. 1998 Oct 3;352(9134):1153-4.

Disease surveillance at district level: a model for developing countries. John TJ, Samuel R, Balraj V, John R. Department of Clinical Virology, Christian Medical College Hospital, Vellore, Tamil Nadu, India. For over a decade we have maintained within a district of 5 million people, a system of prompt reporting of cases of childhood vaccine-preventable diseases, encephalitis, meningitis, hepatitis, and rabies; together with a sentinel laboratory surveillance of cholera, typhoid fever, malaria, HIV infection and antimicrobialresistance patterns of selected pathogens. The system combined government and private sectors, with every hospital enrolled and participating. Reports were scanned daily on a computer for any clustering of cases. Interventions included investigations, immunisation, antimicrobial treatment, health education, and physical rehabilitation of children with paralysis. All vaccine-preventable diseases have declined markedly, whilst malaria and HIV infections have increased steadily. Annual expense was less than one US cent per head. The reasons for the success and sustainability of this model include simplicity or reporting procedure, low budget, private-sector participation, personal rapport with people in the network, regular feedback of information through a monthly bulletin, and the visible interventions consequent upon reporting. This district-level disease surveillance model is replicable in developing countries for evaluating polio eradication efforts, monitoring immunisation programmes, detecting outbreaks of old or new diseases, and for evaluating control measures. Publication Types: •

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

PMID: 9800768 [PubMed - indexed for MEDLINE] 1695: Stud Fam Plann. 1998 Sep;29(3):291-9. Related Articles, Links

The introduction and use of Norplant implants in Indonesia. Tuladhar J, Donaldson PJ, Noble J. RH-FP Management Information Systems, Bangkok, Thailand. In this study, patterns of Norplant use in Indonesia are reviewed to assess the implications of this experience for the introduction of new contraceptive methods. Data from the Norplant Use-Dynamics Study and the 1994 Indonesia Demographic and Health Survey are analyzed, and patterns of acceptance, continuation, and removal are described. Acceptance of Norplant has increased steadily since it was first introduced. The method is now used by more than 5 percent of all married women of reproductive age. Continuation rates among Norplant users are higher than among users of the IUD. One factor behind high continuation rates may be that a substantial proportion of acceptors were not told that removal before five years was possible. Results indicate that deficits occurred in the quality of service delivery and that a need exists for improved provider training, better supervision, and clearer and better-enforced guidelines regarding women's right to have Norplant removed on demand. PIP: Norplant implants, introduced to Indonesia's national family planning program in 1986, are currently used by more than 5% of married women of reproductive age. Most Indonesian Norplant acceptors are rural women 25-34 years of age with some primary education and 2 or more living children; they tend to receive the implants from public health centers, private midwives, and health posts. A substantial proportion of Norplant users had the implants inserted during mass campaigns (safaris) in Indonesia's rural areas. On the basis of continuation rates, Norplant appears to be more popular among Indonesians than the IUD or sterilization. This report, based on data from the Norplant Use Dynamics Study and the 1994 Indonesia Demographic and Health Survey, assesses the service quality associated with introduction of this method. The survey data indicate that, although acceptors are aware of Norplant's 5-year effectiveness, few were counseled about potential side effects or the possibility of early removal. The data further identified deficiencies in terms of provider training, supervision, and clear guidelines regarding a woman's right to have the implants removed on demand. Lacking in Indonesia is the presence of consumer groups and advocates to play a watchdog role and disseminate information to potential acceptors. The inadequate counseling received by many Norplant acceptors requires attention from family planning program managers. Also needed is a policy shift from a preoccupation with increasing the numbers of family planning acceptors to an emphasis on client

satisfaction. Publication Types: •

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

PMID: 9789322 [PubMed - indexed for MEDLINE] 1696: Methods Inf Med. 1998 Sep;37(3):247-53. Related Articles, Links

Using a WWW-based mail user agent for secure electronic mail service for health care users. Kiuchi T, Ohe K, Kaihara S. University Medical Information Network Center, Tokyo, Japan. [email protected] WWW-based user interface is presented for secure electronic mail service for healthcare users. Using this method, communications between an electronic mail (WWW) server and users (WWW browsers) can be performed securely using Secure Socket Layer protocol-based Hypertext Transfer Protocol (SSL-HTTP). The mail can be encrypted, signed, and sent to the recipients and vice versa on the remote WWW server. The merit of this method is that many healthcare users can use a secure electronic mail system easily and immediately, because SSLcompatible WWW browsers are widely used and this system can be made available simply by installing a WWW-based mail user agent on a mail server. We implemented a WWW-based mail user agent which is compatible with PEMbased secure mail and made it available to about 16,000 healthcare users. We believe this approach is effective in facilitating secure network-based information exchange among medical professionals. PMID: 9787624 [PubMed - indexed for MEDLINE] 1697: J Epidemiol. 1998 Aug;8(3):168-75. Related Articles, Links

Japanese intake of flavonoids and isoflavonoids from foods. Kimira M, Arai Y, Shimoi K, Watanabe S. Department of Applied Bioscience, Tokyo University of Agriculture, Japan.

The intake of flavonoids and isoflavonoids was estimated based upon a preliminary database of 40 food items, covering at least 80% of total food consumption. Fifty volunteer women in "I-City" recorded the weight of all dietary intake for 3 days in September 1996, and received a health check-up, as well as laboratory examination. The data was analyzed in relation to the various food factors. Average daily intake per capita of flavonoids was as follows: 4.9 mg kaempferol, 8.3 mg quercetin, 1.5 mg rutin, 0.6 mg myricetin, 0.3 mg luteolin, 0.01 mg myricitrin, 0.4 mg fisetin, and 0.3 mg eriodictyol. Total intake from vegetables and fruits was less than 10 mg 16.2 mg (range: 3.18-35.61 mg) and 23.27 mg (4.62-52.12 mg) of isoflavones, such as daidzein and genistein, respectively, were taken per day, and total isoflavone intake was 39.46 mg (7.8087.73 mg). Chief component analysis on ingested vitamins, flavonoids and isoflavonoids was carried out. Factor 1 was mainly composed of flavonoids and antioxidant vitamins. Factor 1 was positively associated with age and the level of HDL cholesterol and negatively related to the level of triglycerides. Factor 2, which was mainly composed of isoflavonoids, was positively associated with creatinine and uric acid levels. So far, these factors did not show a significant association with bone density and other health indices, such as BMI and blood pressure. PMID: 9782673 [PubMed - indexed for MEDLINE] 1698: Nippon Saikingaku Zasshi. 1998 Aug;53(3):519-29. Related Articles, Links

[RAPD typing of Campylobacter jejuni and comparison with Lior's or Penner's serotyping system] [Article in Japanese] Ono K, Yamamoto K, Niwa A. Section of Food Microbiology, Saitama Institute of Public Health. Campylobacter jejuni were isolated from 7 epidemic outbreaks (121 isolates), 15 patients with gastroenteritis, chicken meats (47 isolates) and chicken cecal contents (70 isolates). The isolates and one standard strain of C. jejuni JCM2013 were analysed by randomly amplified polymorphic DNA method (RAPD). Total of 254 C. jejuni isolates were divided 68 different RAPD types which included strains that did not to divided by Lior's or Penner's serotyping system. To compare the similarities of RAPD patterns among the isolates, the amplification patterns of DNA were estimated by means of the Dice coefficient, and clustering of strains was based on the unweighted average pair group method (UPGMA) to facilitate the plotting of a dendrogram. It suggests that amplification band patterns of human isolates were different from those of chicken ones. Thus additional information given from RAPD profiles serves for epidemiological investigation

and RAPD analysis is recommended as rapid and effective typing method. Publication Types: • •

Comparative Study English Abstract

PMID: 9780736 [PubMed - indexed for MEDLINE] 1699: Public Health Rev. 1998;26(1):73-7. Related Articles, Links

Sources of nutritional data in Israel. Kaluski DN, Meir C, Rotem N, Zadka P. Department of Nutrition, Ministry of Health, Jerusalem, Israel. PMID: 9775724 [PubMed - indexed for MEDLINE] 1700: Public Health Rev. 1998;26(1):55-63. Related Articles, Links

Experiences with dietary assessment in the Middle East. Harrison GG. Department of Community Health Sciences, UCLA School of Public Health and Associate Director, UCLA Center for Human Nutrition 90095, USA. PMID: 9775722 [PubMed - indexed for MEDLINE]