H & C Management

301: Int J Health Care Finance Econ. 2007 Sep;7(2-3):217-31.
Related Articles, Links
The organization and financing of end-stage renal disease treatment

in Japan.
Fukuhara S, Yamazaki C, Hayashino Y, Higashi T, Eichleay MA, Akiba T,

Akizawa T, Saito A, Port FK, Kurokawa K.
Department of Epidemiology and Healthcare Research, Kyoto University

Graduate School of Medicine and Public Health, Kyoto, Japan.
fukuhara@pbh.med.kyoto-u.ac.jp
End-stage renal disease (ESRD) affects 230,000 Japanese, with about 36,000
cases diagnosed each year. Recent increases in ESRD incidence are attributed
mainly to increases in diabetes and a rapidly aging population. Renal
transplantation is rare in Japan. In private dialysis clinics, the majority of
treatment costs are paid as fixed fees per session and the rest are fee for service.
Payments for hospital-based dialysis are either fee-for-service or diagnosis-
related. Dialysis is widely available, but reimbursement rates have recently been
reduced. Clinical outcomes of dialysis are better in Japan than in other countries,
but this may change given recent ESRD cost containment policies.
Publication Types:
• Review
PMID: 17690980 [PubMed - indexed for MEDLINE]
302: Nurse Educ Pract. 2007 Sep;7(5):323-31. Epub 2006 Nov 22.
Learning to nurse in China--structural factors influencing

professional development in practice settings: a phenomenological
study.
Shen J, Spouse J.
School of Health, The First Affiliated Hospital of Chongqing Medical University,

No. 176, Daping Region, Changjiang Road, Yuzhong District, Chongqing
400016, China. cysh2001@yahoo.com
This paper describes findings from a stratified phenomenological investigation

into Chinese nursing students' experiences of learning in practice placements. The
investigation was undertaken in China whilst studying at an English University
for a post-graduate degree. With the transition of Chinese nursing education into
higher education institutions, clinical nursing experience remains a fundamental
factor in students' preparation for qualification. This small phenomenological
study sought to understand the kinds of experiences students encounter, the
factors that supported or inhibited their learning and the ways in which learning in
practice could be enhanced. This paper concentrates on the structural factors that
influenced students' learning. These structural factors included; the opportunities
available for students to learn, students' participation in clinical nursing activities;
the relationship that placement staff were willing to engage in with the students
and the prevailing learning climate of the placement setting.
303: Br J Gen Pract. 2007 Aug;57(541):643-9.
Health locus of control and use of conventional and alternative care:

a cohort study.
Tokuda Y, Takahashi O, Ohde S, Ogata H, Yanai H, Shimbo T, Fukuhara S,

Hinohara S, Fukui T.
Clinical Practice Evaluation and Research Centre, St Luke's Life Science

Institute, Tokyo, Japan. tokuyasu@orange.ocn.ne.jp
BACKGROUND: Health locus of control influences health-related behaviour, but

its association with healthcare use is unclear. AIM: To investigate the association
between individuals' health locus of control and the use of conventional and
alternative health care. DESIGN OF STUDY: Prospective cohort study.
SETTING: A nationally representative random sample of community-dwelling
adult households in Japan. METHOD: Health locus of control, symptom-related
visits to physicians, and the use of dietary and physical complementary and
alternative medicine (CAM) was measured. Dietary CAM included supplements,
such as herbs and vitamins. Physical CAM included manipulations, such as
acupuncture and acupressure. RESULTS: Of the 2453 adult participants studied,
2103 (86%; 95% CI [confidence interval] = 84 to 88%) developed at least one
symptom during the 31-day study period. Of these symptomatic adults, 639
visited physicians (30%; 95% CI = 28 to 32%), 480 used dietary CAM (23%;
95% CI = 21 to 25%), and 156 (7%; 95% CI = 6 to 9%) used physical CAM. The
likelihood of visiting a physician was not related significantly to individuals'
health locus of control. Increased use of dietary CAM was weakly associated with
control by spiritual powers (P = 0.028), internal control (P = 0.013), and less
control by professionals (P = 0.020). Increased use of physical CAM was
significantly associated with control by spiritual powers (P = 0.009) indicating a
belief that supernatural forces control individuals' health status. CONCLUSION:
The likelihood of visiting a physician is not affected by individuals' health locus
of control. Control by spiritual powers is involved with increased CAM use.
Internal control is weakly associated with greater use of dietary CAM;
professional control is weakly associated with less use of dietary CAM.
Publication Types:
• Multicenter Study
• Research Support, Non-U.S. Gov't
PMCID: PMC2099670 [Available on 08/01/08]
304: Nurs Health Sci. 2007 Sep;9(3):228-33.
Health status, trends, and issues in Sri Lanka.
Jayasekara RS, Schultz T.
Discipline of Nursing, JBI Research Unit, School of Population Health and

Clinical Practice, The University of Adelaide, Adelaide, SA 5005, Australia.
rasika.jayasekara@adelaide.edu.au
It is widely recognized that better health is a prerequisite for the overall economic
and social development of a nation. Sri Lanka, like many other countries
experiencing the epidemiological transition, will have to make effective decisions
on health-care service management and the development of education and training
programs for health-care professionals. This paper provides a comprehensive
review of current health service administration, health status, trends and issues,
and health financing and resource allocation in Sri Lanka. The review revealed
that Sri Lanka has achieved a relatively high health status given a low level of
spending on its health-care services; however, Sri Lanka still experiences vital
health problems in all stages of the life cycle, mainly related to lifestyle and the
epidemiological transition associated with widespread societal and economic
crises.
Publication Types:
• Review
305: Nurs Health Sci. 2007 Sep;9(3):221-7.
Nursing competency and organizational climate as perceived by staff

nurses in a Chinese university hospital.
Ying L, Kunaviktikul W, Tonmukayakal O.
Faculty of Nursing, Chiang Mai University, 10 Intavaroros Sriphum, Chiang Mai

50200, Thailand. chinaliuying2004@gmail.com
Nursing competency is important to ensure patient safety and improve the quality
of nursing care. Based on competency-based human resource management
strategies, the organizational climate can positively influence nursing
competency. However, a review of the literature indicated that there were no
studies about the relationship between nursing competency and organizational
climate in the People's Republic of China. This descriptive, correlational study
examined the relationship between nursing competency and the organizational
climate. The sample consisted of 243 staff nurses who completed the
questionnaire worked at one university hospital in Liao Ning Province. The
findings showed that there was a significantly moderate positive relationship
between nursing competency and organizational climate. The study results
suggested that Chinese nurse managers should maintain and provide a positive
organizational climate to improve nursing competency.
306: Psychol Rep. 2007 Jun;100(3 Pt 1):915-23.

Disabled children in special education programs in Taiwan: use of
mental health services and unmet needs.
Liang HY, Chang HL.
Department of Child Psychiatry Chang Gung Children's Hospital, Kweishan,

Taoyuan, Taiwan.
Despite national health insurance coverage in Taiwan, many health care needs
remain unmet. In the current study, the behavior and emotional problems of 1,042
disabled children in special education programs were evaluated using the Chinese
version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report
Form (TRF). Using the 60th percentile on the two tests as a cutoff representing a
clinical indication, students who reached this cutoff point but did not receive
mental health services in the past six months were considered to have "unmet
mental health needs." Of the special education students in the study 73.9%
reached clinical indications, but did not receive mental health care.
Publication Types:
307: East Mediterr Health J. 2007 May-Jun;13(3):492-504.
Quality improvement programme for diabetes care in family

practice settings in Dubai.
Khattab MS, Swidan AM, Farghaly MN, Swidan HM, Ashtar MS, Darwish
EA, Al Mazrooei AK, Mohammad AA.
Primary Health Care Sector, Department of Health and Medical Services, Dubai,
United Arab Emirates. msKhattab@dohms.gov.ae
A continuous quality improvement programme for the care of registered diabetes

patients was introduced in 16 government-affiliated primary health care centres in
Dubai. Quality improvement teams were formed, clinical guidelines and
information systems were developed, diabetes nurse practitioners were introduced
and a team approach was mobilized. Audits before and after the introduction of
the scheme showed significant improvements in rates of recording key clinical
indicators and in their outcomes. For example, the proportion of patients with
glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with
LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic
blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.
Publication Types:
• Evaluation Studies
308: Epidemiol Infect. 2008 Apr;136(4):436-48. Epub 2007 Aug 9.
Part I. Analysis of data gaps pertaining to Salmonella enterica

serotype Typhi infections in low and medium human development
index countries, 1984-2005.
Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED.
Enteric Diseases Epidemiology Branch, National Center for Zoonotic,

Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention,
Atlanta, GA 30333, USA. jcrump@cdc.gov
There are only 10 contemporary, population-based studies of typhoid fever that

evaluate disease incidence using blood culture for confirmation of cases. Reported
incidence ranged from 13 to 976/100 000 persons per year. These studies are
likely to have been done preferentially in high- incidence sites which makes
generalization of data difficult. Only five of these studies reported mortality. Of
these the median (range) mortality was 0% (0-1.8%). Since study conditions
usually involved enhanced clinical management of patients and the studies were
not designed to evaluate mortality as an outcome, their usefulness for generalizing
case-fatality rates is uncertain. No contemporary population-based studies
reported rates of complications. Hospital-based typhoid fever studies reported
median (range) complication rates of 2.8% (0.6-4.9%) for intestinal perforation
and case-fatality rates of 2.0% (0-14.8%). Rates of complications other than
intestinal perforation were not reported in contemporary hospital-based studies.
Hospital-based studies capture information on the most severe illnesses among
persons who have access to health-care services limiting their generalizability.
Only two studies have informed the current understanding of typhoid fever age
distribution curves. Extrapolation from population-based studies suggests that
most typhoid fever occurs among young children in Asia. To reduce gaps in the
current understanding of typhoid fever incidence, complications, and case-fatality
rate, large population-based studies using blood culture confirmation of cases are
needed in representative sites, especially in low and medium human development
index countries outside Asia.
Publication Types:
• Research Support, N.I.H., Extramural

• Review
309: Int Nurs Rev. 2007 Sep;54(3):288-94.
Jordanian women's perceptions of post-partum health care.
Khalaf IA, Abu-Moghli FA, Mahadeen AI, Callister LC, Al-Hadidi M.
University of Jordan, Faculty of Nursing, Amman, Jordan.
PURPOSE: This qualitative descriptive study aimed to explore Jordanian

childbearing women's perceptions of their needs for health care and the post-
partum healthcare services they received. METHODS: Twenty-four Jordanian
childbearing women participated in the focus groups. Discussions focused on
infant and maternal health concerns, access to post-partum health care, including
family-planning services, the characteristics and behaviour of healthcare
providers, and suggestions for the provision of quality maternal post-partum
health care. FINDINGS: The majority of the women indicated that most of the
services perceived and provided during the post-natal period were related to child
care. They indicated that they attend post-natal visits mostly for treatment, family
planning and/or child care and stated that they have not been told about the post-
natal visits during pregnancy, or after giving birth. CONCLUSIONS: Study
findings provided insight and understanding of women's perspectives on post-
partum health care and implied a need to translate qualitative findings into clinical
practice guidelines. It is suggested that the Jordanian Ministry of Health develops
a comprehensive plan to improve educational offerings for post-partum women,
and ensure that all healthcare facilities offer affordable and high-quality post-
partum health care.
Publication Types:
310: Int Nurs Rev. 2007 Sep;54(3):280-7.
Diabetes knowledge and glycemic control among Chinese people

with type 2 diabetes.
He X, Wharrad HJ.
heather.wharrad@nottingham.ac.uk
BACKGROUND: Diabetes self-management education (DSME) is a key

component of effective glycemic control and an important part of clinical diabetes
management. The effects of DSME in China have not been investigated.
OBJECTIVES: To identify factors that could enhance the quality of Chinese
DSME programmes. The relationship between patients' diabetes knowledge and
their glycemic control was explored. METHODS: A non-experimental cross-
sectional study was undertaken in a large Shanghai hospital in China. Forty
inpatients and 60 outpatients with type 2 diabetes mellitus were recruited. A
Chinese version of the Diabetes Knowledge Scale was used to assess subjects'
diabetes knowledge and collect demographic data and HbA1c levels. RESULTS:
The mean diabetes knowledge scores among Chinese with type 2 diabetes was
22.1 +/- 3.76 out of a possible 30 marks. There was no difference in overall
diabetes knowledge in people with HbA1c <7%, indicating good control and
those with HbA1c >or=7%, indicating suboptimal glycemic control (t = -0.811, P
= 0.419). However, there were differences in scores between the two groups for
some specific questions on sick day management and food substitution.
Moreover, sociodemographic characteristics such as age and occupation were
significantly correlated with diabetes knowledge; age was negatively correlated
with diabetes knowledge and white-collar workers had the highest mean
knowledge score and housewives the lowest. CONCLUSION: Sociodemographic
characteristics need to be considered when developing diabetes self-management
programmes for Chinese people with type 2 diabetes.
311: J Med Liban. 2007 Apr-Jun;55(2):59-62.

[Recommendations on the relationship between surgeons and
anesthesiologists as part of the health care team]
[Article in French]
Daher M.
Service de Chirurgie générale, Hôpital Saint-Georges-CHU, Beyrouth, Liban.

mndaher@inco.com.lb
Surgeon and anesthesiologist work as a team. Physicians of different but

complementary specialties, they work jointly in the management of the patient
during the pre, per and postoperative periods, with the main objective of ensuring
the best quality of care and the greatest safety. However, the unprecedented
development of new technologies during the last decades, deeply modified the
conditions of exercise of these two specialities. Thus, the practice of anaesthesia
is not only necessary for performing the surgical act, but also for diagnostic and
therapeutic techniques using high technologies. So, from a traditional partner of
the surgeon, the anesthetist became the privileged collaborator of a great number
of specialists. Within these teams, the anesthetist must achieve his/her task in all
independence, as stated in the Lebanese Code of Ethics. I will try in this message
to point out the responsibilities of each of the two partners in this joint practice.
The practice of a shared activity, in the same place, for the benefit of the patient,
requires a preliminary definition of roles, in the mutual respect of competencies
and responsibilities of each specialist, based on the respect of the rules edicted in
the Code of Ethics.
Publication Types:
• English Abstract
312: Sante Publique. 2007 Jan-Feb;19 Suppl 1:S97-106.
[North-South transfers and professional learning appropriateness]
[Article in French]
Canonne F.
313: East Mediterr Health J. 2007 Mar-Apr;13(2):408-19.
Attitudes to evidence-based medicine of primary care physicians in

Asir region, Saudi Arabia.
Khoja TA, Al-Ansary LA.
Executive Board of the Health Ministers Council for GCC States, Riyadh, Saudi
Arabia.
A questionnaire survey was made of primary health care physicians in Asir

region, Saudi Arabia in 1999 to explore their awareness of and attitude towards
evidence-based medicine. The 272 respondents welcomed the principles of
evidence-based medicine. Awareness and use of extracting journals, review
publications and databases was low. Pharmaceutical company sponsored journals
were the most commonly read. Bibliographic databases could only be accessed by
13% of respondents and the Internet by only 6%. There was only partial
understanding of technical terms used in evidence-based medicine. Absence of a
local library and increased patient workload were seen by most respondents as the
main obstacles to practising evidence-based medicine.
Publication Types:
314: Arch Pediatr Adolesc Med. 2007 Aug;161(8):740-3.
Enhancing patient safety during pediatric sedation: the impact of

simulation-based training of nonanesthesiologists.
Shavit I, Keidan I, Hoffmann Y, Mishuk L, Rubin O, Ziv A, Steiner IP.
Emergency Department, Meyer Children's Hospital, Rambam Medical Center,

Haifa, Israel. i_shavit@rambam.health.gov.il
OBJECTIVE: To evaluate the impact of simulation-based education on patient

safety during pediatric procedural sedation. DESIGN: A prospective,
observational, single-blind, controlled study of pediatric procedural sedation
outside the operating room. SETTING: Two university teaching hospitals in
Israel. PARTICIPANTS: Nonanesthesiologists, with or without training in
simulation-based education on patient safety, who routinely perform procedural
sedation outside the operating room. These comprise full-time pediatricians
practicing emergency medicine and a cohort of pediatric gastroenterologists.
INTERVENTION: The study investigators used the internally developed, 9-
criteria Sedation Safety Tool to observe and evaluate nonanesthesiologists who
were trained in sedation safety and compared their performance with that of
colleagues who did not receive similar training. OUTCOME MEASURE: For
each of the 9 criteria on the evaluation form, odds ratios and 95% confidence
intervals were calculated to compare the actions of the individuals in the 2 study
groups. RESULTS: Thirty-two clinicians were evaluated. Half of the physicians
were graduates of the simulation-based sedation safety course. Significant
differences in performance pertaining to patient safety were found between those
physicians who did and those who did not complete simulation-based training.
CONCLUSIONS: Pediatric procedural sedations conducted by simulator-trained
nonanesthesiologists were safer. The simulation-based sedation safety course
enhanced physician performance during pediatric procedural sedation.
Publication Types:
• Clinical Trial
315: Harefuah. 2007 May;146(5):337-40, 407.
[Temporal trends in characteristics of diabetic subjects in Beer

Sheba in two cohorts: 1988-90 and 1996-97 is immigration part of
these trends?]
[Article in Hebrew]
Bilenko N, Biderman A, Rosen S, Weitzman S.
Ministry of Health, Southern District, Beer Sheba.

BACKGROUND: Israel is a country with high immigration rates. In previous
studies, immigrants were found to have a relatively higher risk for cardiovascular
diseases, higher rates of hypertension, as well as overall mortality rates. In this
study we examined whether patient characteristics in the diabetic population of
selected clinics in Beer Sheba differed between the years 1988 and 1997, and if
immigration could explain these differences. METHODS: All known diabetic
patients diagnosed at age 30 and older were enrolled in the study from 3 clinics in
Beer Sheba in the years 1988-90 (Cohort 1), and from one of those clinics in
1996-97 (Cohort 2). Demographic, behavioral, clinical and biochemical
characteristics of the two cohorts were compared, paying special attention to
recent immigrants (< 10 years in Israel). RESULTS: About 17% of Cohort 1 and
47% of Cohort 2 were recent immigrants. Patients from Cohort 1 were
significantly younger and had lower BMI compared to Cohort 2. They had higher
systolic (148+/-22 vs. 141+/-21, p<0.001) and diastolic (83+/-12 vs. 80+/-10,
p<0.001) blood pressure. More patients from Cohort 2 were on oral hypoglycemic
medications (56% vs. 75%, p<0.001). Glucose control by HbAlc was better in
patients from Cohort 2. The differences between cohorts were maintained after
stratification by immigration status. CONCLUSIONS: Diabetes-related
characteristics of patients differed during the seven-year period and were not
explained by immigration status. Improvement in care and more intensive
management of patients with diabetes may explain, at least partially, the described
differences.
Publication Types:
316: Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):647-50. Epub 2007 Jul 25.
Comment in:
• Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):650-1.

• Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):651.
Venous trauma in the Lebanon War--2006.
Nitecki SS, Karram T, Hoffman A, Bass A.

Department of Vascular Surgery, Rambam Medical Center, P.O. Box 9602, Haifa
36091, Israel. s_nitecki@rambam.health.gov.il
OBJECTIVES: Reports on venous trauma are relatively sparse. Severe venous

trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or
external and rarely may lead to hypovolemic shock. Repair of major extremity
veins has been a subject of controversy and the current teaching is to avoid
venous repair in an unstable or multi-trauma patient. The aim of the current paper
is to present our recent experience in major venous trauma during the Lebanon
conflict, means of diagnosis and treatment in a level I trauma center. METHODS:
All cases of major venous trauma, either isolated or combined with arterial injury,
admitted to the emergency room during the 33-day conflict were reviewed.
RESULTS: Out of 511 wounded soldiers and civilians who were admitted to our
service over this period, 12 (2.3%) sustained a penetrating venous injury either
isolated (5) or combined with arterial injury (7). All injuries were secondary to
high velocity penetrating missiles or from multiple pellets stored in long-range
missiles. All injuries were accompanied by additional insult to soft tissue, bone
and viscera. The mean injury severity score was 15. Severe external bleeding was
the presenting symptom in three cases of isolated venous injury (jugular, popliteal
and femoral). The diagnosis of a major venous injury was made by a CTA scan in
five cases, angiography in one and during surgical exploration in six cases. All
injured veins were repaired: three by venous interposition grafts, four by end to
end anastomosis, three by lateral suture and two by endovascular techniques.
None of the injuries was treated by ligation of a major named vein. Immediate
postoperative course was uneventful in all patients and the 30-day follow-up (by
clinical assessment and duplex scan) has demonstrated a patent repair with no
evidence of thrombosis. CONCLUSIONS: Without contradicting the wisdom of
ligating major veins in the setup of multi-trauma or an unstable patient, our
experience indicates that a routine repair of venous trauma can be safely and
effectively performed in young patients. Postoperative course is not compromised
and late sequelae of venous interruption may be prevented.
317: J Wound Ostomy Continence Nurs. 2007 Jul-Aug;34(4):407-11.
Clinical and epidemiologic evaluation of pressure ulcers in patients

at a university hospital in Turkey.
Leblebici B, Turhan N, Adam M, Akman MN.
Baskent University Faculty of Medicine, Department of Physical Medicine and

Rehabilitation, Ankara, Turkey.
OBJECTIVE: We sought to measure the incidence of pressure ulcer development

at a university health center in Turkey, and to determine whether the Waterlow
Pressure Sore Risk (PSR) Scale score predicted pressure ulcer development,
stage, or number of ulcers. DESIGN: We prospectively evaluated patients who
were hospitalized at our university-based medical center. SETTING AND
SUBJECTS: We analyzed data from 22,834 patients hospitalized at the Baskent
University Adana Teaching and Medical Research Center in Ankara, Turkey from
January 1, 2004 to December 31, 2004, including 360 patients who developed
pressure ulcers. INSTRUMENTS: The Waterlow PSR Scale was used to assess
pressure ulcer risk. In addition, age, sex, the ward or unit in which the patient was
hospitalized, reason for hospitalization, and location and stage of ulcers were
collected on a data form designed specifically for this study. METHODS: A
single nurse physiotherapist assessed all patients daily during their hospitalization.
When a pressure ulcer was diagnosed by the nurse physiotherapist, a physician
staged the pressure ulcers based on the US National Pressure Ulcer Advisory
Panel (NPUAP) staging system. RESULTS: Three hundred sixty out of 22,834
patients developed 1 or more pressure ulcers, resulting in an incidence rate of
1.6%. Most ulcers (59.2%) occurred in patients hospitalized in the intensive care
unit (n = 213). A positive correlation between the Waterlow PSR Scale score and
number of ulcers per patient (r: 0.178, P < .01) was identified. No significant
correlation was found linking Waterlow PSR Scale score and ulcer stage or the
development of a single ulcer. CONCLUSION: We found significantly lower
pressure ulcer incidence rates than those commonly reported in the literature,
which we believe is principally attributable to short hospital stays and a strong
emphasis on preventive nursing care. While high Waterlow PSR scale Scores
correlated positively with development of multiple ulcers, this did not predict
ulcer stage or the presence of a single pressure ulcer.
318: Isr J Psychiatry Relat Sci. 2007;44(1):47-53.
Selecting and implementing evidence-based practices in psychiatric

rehabilitation services in Israel: a worthy and feasible challenge.
Roe D, Hasson-Ohayon I, Lachman M, Kravetz S.
Rutgers University Institute for Health, Health Care Policy, and Aging Research,
New Brunswick, NJ, USA. droe@univ.haifa.ac.il
Major recent conceptual and legal advancements in Israel have generated a
profound shift in the services provided for people with severe mental illness.
Perhaps the most influential development has been the passage of the act for the
rehabilitation of persons with a psychiatric disability in the community in the year
2000. In this paper we argue that the psychiatric rehabilitation services defined by
the recent legislation lack explicit standards or criteria for selection, and thus
could benefit from incorporating interventions that evidence has shown to be
effective in assisting clients to achieve desirable outcomes. We propose a
practical five-step plan to facilitate the implementation of these evidence-based
practices including creating demand, selecting the EBPs, preparing practitioners
and agencies, monitoring and feedback, and ensuring sustainability. The
importance of an ongoing dialogue between stakeholders to facilitate the
integration of research evidence, clinical expertise and rehabilitation values to
improve the quality of service is discussed.
319: Int J Health Serv. 2007;37(2):291-320.
Health care reform and the paradox of efficiency: "writing in"

culture.
Anderson JM, Tang S, Blue C.
School of Nursing, University of British Columbia, Vancouver, Canada.

anderson@nursing.ubc.ca
Widespread global migration is occurring at the same time that health care
delivery systems in Western nations are undergoing major restructuring. The call
for health care to be more efficient, economical, and responsive to diverse cultural
populations has come from several sectors, including governments and
researchers. This has led to policies to address perceived deficiencies in health
care services. The authors draw on their research at health care institutions in a
western Canadian city to probe, first, how the concept of culture is interpreted
within organizations; and second, how culture is "written into health systems" as
they undergo restructuring. Meanings and interpretations of culture are not
transparent; moreover, "writing in" culture is not simply a matter of health care
providers learning about their clients' "belief systems" and being sensitive to these
beliefs. Belief systems and people's experiences of the care they receive are
negotiated within highly complex "organizational cultures," located in broader
macroeconomic and political structures, and discourses that shape how health care
systems are organized. The authors consider whether current discourses on cost
containment are in competition with providing equitable health care services to
diverse client populations.
Publication Types:
320: Bangladesh Med Res Counc Bull. 2006 Aug;32(2):43-8.
Head and neck squamous cell carcinoma (HNSCC) 5 year study at

BSMMU.
Siddiquee BH, Alauddin M, Choudhury AA, Akhtar N.
Deptt. of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka.
Head and Neck Squamous Cell Carcinoma (HNSCC) are generally similar in their
clinical features, epidemiology and etiology although their natural and clinical
history and treatment differ. Despite lot of improvement in diagnostic and
management technique, there is little improvement in survival rate over the last
few decades. This study was carried-out in a multidisciplinary tertiary level
hospital (BSMMU), with a country-wide catchment area to see the burden of
HNSCC existing in our country and their clinical pattern. The overall incidence
rate of HNSCC in this study was (0.15%) i.e. 150 person in 1,00,000 population.
Male incidence (0.19%) was higher than female (0.12%). This study revealed that
carcinoma of the larynx (25.22%) and pyriform fossae (20.57%) were the main
culprit, whereas buccal carcinoma was the main component (37.70%) in the
female series. Highest incidence was found in the 6th decade in both sexes. As the
treatment of HNSCC may be time consuming, requires multidisciplinary
approach, demands lot of clinical, social and financial consideration, therefore,
the best treatment can be offered through a combined board consisting of
Surgical, Radiation, Medical oncologists, Histopathologist and Speech therapist
as required.
321: BMC Clin Pharmacol. 2007 Jul 28;7:8.

Evaluation of the prevalence and economic burden of adverse drug
reactions presenting to the medical emergency department of a
tertiary referral centre: a prospective study.
Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ.
Department of Clinical Pharmacology, Seth GS Medical College and KEM

Hospital Parel, Mumbai, India. dr.kevinpatel@yahoo.com
BACKGROUND: Adverse drug reactions (ADRs) are now recognized as an

important cause of hospital admissions, with a proportion ranging from 0.9-7.9%.
They also constitute a significant economic burden. We thus aimed at determining
the prevalence and the economic burden of ADRs presenting to Medical
Emergency Department (ED) of a tertiary referral center in India METHODS: A
prospective, observational study of adult patients carried out over a 6 week period
in 2005. The prevalence of ADRs, their economic burden from the hospital
perspective, severity, and preventability were assessed using standard criteria.
RESULTS: A total 6899 patients presented during the study period. Of these,
2046 were admitted for various reasons. A total of 265/6899 patients had ADRs
(3.84 %). A total of 141/265 was admitted due to ADsR, and thus ADRs as a
cause of admissions were 6.89% of total admissions. A majority (74.71%) were
found to be of moderate severity. The most common ADRs were anti-tubercular
drug induced hepatotoxicity, warfarin toxicity and chloroquine induced gastritis.
The median duration of hospitalization was 5 days [95% CI 5.37, 7.11], and the
average hospitalization cost incurred per patient was INR 6197/- (USD 150). Of
total ADRs, 59.62% (158/265) were found to be either definitely or potentially
avoidable. CONCLUSION: The study shows that ADRs leading to hospitalization
are frequent and constitute a significant economic burden. Training of patients
and prescribers may lead to a reduction in hospitalization due to avoidable ADRs
and thus lessen their economic burden.
PMCID: PMC1963321
322: Rinsho Byori. 2007 Jun;55(6):540-3.
[Role of a clinical laboratory center as a correlational center for

infection control]
[Article in Japanese]
Hiramatsu K.
Safety Management Center and Infection Control Center, Oita University

Hospital, Oita.
The prevention of hospital acquired infection is one of the most critical

managements for the maintenance of high clinical quality. Surveillance such as
the isolation rate of MRSA (methicillin resistant Staphylococcus aureus), MDRP
(multidrug-resistant Pseudomonas aeruginosa) and catheter associated blood
stream infection rate are useful tools for infection control. In these surveillances,
the clinical laboratory center plays an important role in hospitals. Recent studies
have shown that community-acquired MRSA has spread rapidly in the United
States and clonal MDRP has also spread in Japan. In our studies, similar
genotyped MDRP was isolated from several hospitals in the same region. These
results suggested that infection control associated with regional hospitals is
important to prevent the spread of antimicrobial resistant pathogens. The clinical
laboratory center should also play an important role in regional infection control.
Publication Types:
• Review
323: J Clin Nurs. 2007 Aug;16(8):1587-8.
Comment on:
• J Clin Nurs. 2007 Jan;16(1):168-78.
Commentary on Hjelm K, Bard K, Nyberg P and Apelqvist J (2007)

management of gestational diabetes from the patient's perspective--a
comparison of Swedish and Middle-Eastern born women. Journal of
Clinical Nursing 16, 168-178.
Mander R.
School of Health, University of Edinburgh, Edinburgh, UK. r.mander@ed.ac.uk
Publication Types:
• Comment
324: J Clin Nurs. 2007 Aug;16(8):1571-9.
Evaluating effects of a prenatal web-based breastfeeding education

programme in Taiwan.
Huang MZ, Kuo SC, Avery MD, Chen W, Lin KC, Gau ML.
Delivery Ward, Shin Kong Wu Ho-Su Memorial Hospital, and Graduate Institute
of Nurse-Midwifery, National Taipei College of Nursing, Taiwan.
AIMS: The objectives of this study were to evaluate a web-based breastfeeding

education programme provided to primigravida in the third trimester of pregnancy
with the aim of deepening breastfeeding knowledge and enhancing skills. The
study was conducted at a hospital in Taiwan. BACKGROUND: Education is the
cornerstone supporting the framework of lactation and breastfeeding. Web-based
instruction is an efficient way to provide education. DESIGN: A quasi-
experimental design was used. METHODS: The target population was women at
29-36 weeks gestation using the Internet on regular basis. The primigravida were
assigned to either the control group (n=60) or the experimental group (n=60)
according to time sequence. RESULTS: Women who received web-based
breastfeeding education had a higher mean breastfeeding knowledge score and
more positive attitude about breastfeeding. In addition, generalized estimating
equations (GEE) model was used to examine the breastfeeding rate at different
time points. After adjusting for the time trend and infant birth weight, there was a
significant effect in exclusive breastfeeding for the experimental group. On the
other hand, the web-based breastfeeding education programme also had a
significant effect on mixed feeding rate for the experimental group.
CONCLUSION: Results suggest that web-based breastfeeding education may
contribute to breastfeeding knowledge and attitude and improved breastfeeding
rate. RELEVANCE TO CLINICAL PRACTICE: Web-based breastfeeding
education programme can achieve success in promoting breastfeeding and
provide health professionals with an evidence-based intervention.
Publication Types:
325: J Clin Nurs. 2007 Aug;16(8):1550-60.
Postpartum Taiwanese women: their postpartum depression, social

support and health-promoting lifestyle profiles.
Chen CM, Kuo SF, Chou YH, Chen HC.
College of Nursing, Taipei Medical University, Taipei, Taiwan.
BACKGROUND: To reach the Millennium Development Goals, maternal health-

promoting behaviours need to be encouraged after childbirth; little is known about
the health-promoting behaviour among first-time mothers during their postpartum
period. AIM: To examine levels of engagement in health-promoting behaviours
and related factors among postpartum women in Taiwan. METHODS: This cross-
sectional study was conducted through a convenience sample of 122 qualified
women. Participants self-completed a questionnaire and mailed it back using a
stamped, self-addressed envelope from July to September 2003. Instruments of
this study included a demographic questionnaire as well as three Likert-type
scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal
Depression scale and a self-developed social support scale. RESULTS: The
average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD
1.35), with exercise rated lowest among the six subscales. Postpartum women
perceived that they had high levels of social support from their mothers-in-law,
mothers and husbands. An astonishing 42.6% of women experienced postnatal
depression. Based on results of multiple regressions, 25% of the variance in
health-promoting lifestyle practices was explained by postpartum depression and
social support. Social support was found to predict all subscales significantly
except exercise. Postpartum depression can significantly predict self-
actualization, interpersonal relationships, nutrition and stress management. All
modifying factors were excluded from the regression model. CONCLUSIONS:
This study validates the theoretical relationships among concepts in the Health
Promotion Model. Nursing interventions are recommended which are tailored to
enhance women's social support and decrease their depression to promote their
pursuit of healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE: This
study highlights the implications of social support to nursing practice, especially
in Chinese culture which has a strict ritual during a women's postpartum period.
Findings of this study provide information and data for service planning and
community care to support postpartum care in the communities.
Publication Types:
326: J Clin Nurs. 2007 Aug;16(8):1525-33.
Conducting clinical post-conference in clinical teaching: a

qualitative study.
Hsu LL.
Graduate Institute in Health Allied Education, National Taipei College of

Nursing, Taipei, Taiwan. llhsu@mail1.ntcn.edu.tw
AIM AND OBJECTIVE: The aim of this study was to explore nurse educators'
perceptions regarding clinical postconferences. Additional aims included the
exploration of interaction characteristics between students and faculty in clinical
postconferences. BACKGROUND: Nursing students are challenged to think and
learn in ways that will prepare them for practice in a complex health care
environment. Clinical postconferences give students the opportunity to share
knowledge gained through transformative learning and provide a forum for
discussion and critical thinking. Faculty members must guide students as the latter
participate in discussions, develop problem-solving skills and express feedings
and attitudes in clinical conferences. METHODS: The study used qualitative
research methods, including participant observation and an open-ended
questionnaire. Participant observers watched interaction activities between
teachers and students in clinical postconferences. A total of 20 clinical
postconferences, two conferences per teacher, were observed. The Non-
Numerical Unstructured Data Indexing Searching and Theory-building qualitative
software program was used in data analysis. CONCLUSIONS: Research findings
indicated that, of the six taxonomy questions, lower-level questions (knowledge
and comprehensive questions) were mostly asked by faculty members'
postclinical conferences. The most frequently used guideline was task orientation,
which is related to practice goals and was found in discussions of assignments,
reading reports, discussions of clinical experiences, role plays, psychomotor skill
practice, quizzes and student evaluations. RELEVANCE TO CLINICAL
PRACTICE: It is an essential responsibility of nurse educators to employ
postconferences to assist students in applying their knowledge in practical
situations, in developing professional values and in enhancing their problem
solving abilities.
327: J Clin Nurs. 2007 Aug;16(8):1506-15.
Predictors of recognition and practice of family nursing among

healthcare professionals in Japan.
Takemoto H, Hagihara A, Kinoshita M, Matsuoka M, Baba M, Nobutomo K.
Department of Health Services Management and Policy, Graduate School of

Medicine, Kyushu University, Higashi-ku, Fukuoka, Japan. h-t@umin.ac.jp
BACKGROUND: Although many nurses have become aware of the importance

of family-centered nursing, very little is known about the advanced knowledge
and intervention skills of family nursing in Japan. OBJECTIVES: We examined
the characteristics of their recognition of family nursing and factors related to the
practice of family nursing. METHODS: The subjects were nursing staff at a large
hospital in Fukuoka, Japan (n=596). A study using self-administered
questionnaires was conducted in October 2002. Factor analysis and multiple
linear regression analysis were used to analyse the data. RESULTS: Of 596
nurses, 376 returned questionnaires (63.6%). The study achieved the following
findings. (1) The nurse's recognition of family nursing had four subscales: skills
required to interview family members to construct a trusted relationship;
assessment of family structure and family functioning; interventional skills of
family nursing; and skills to collect information on family members. (2) The
predictors of family nursing recognition were 'gender', 'job position in hospital',
'individual experience of caring for their family members', 'length of clinical
experience' and 'types of wards where they work'. (3) The predictors of practice of
family nursing were 'interventional skills of family nursing', 'skills to collect
information on family members' and the 'total of four skills'. CONCLUSIONS: It
is implied that the acquisition of knowledge and skills of family nursing in
hospital settings are invaluable to consciousness-raising and practice of family
nursing. RELEVANCE TO CLINICAL PRACTICE: As the factors related to
practice or recognition of family nursing have been identified, the present findings
are useful for hospital administrators who want to promote family nursing in their
hospitals.
328: J Clin Nurs. 2007 Aug;16(8):1444-53.
Mobbing in the workplace by peers and managers: mobbing

experienced by nurses working in healthcare facilities in Turkey and
its effect on nurses.
Yildirim A, Yildirim D.
Nursing Administration Department, Florence Nightingale School of Nursing,

Istanbul University, Sisli/Istanbul, Turkey. aytolany@mynet.com
AIM: This research was conducted as a descriptive and cross-sectional study with
the purpose of determining the mobbing experienced by nurses who work in
healthcare facilities in Turkey, its emotional, social and physiological effects on
the nurses and the actions that the individuals take to escape from the mobbing.
BACKGROUND: The term 'mobbing', which includes workplace terrorizing,
pressure, frightening, belittling and psycho-terror, is defined as the presence of
systematic, directed, unethical communication and antagonistic behaviour by one
or more individuals. These actions that occur frequently and continue for a long
time are the most serious and effective causes of workplace stress. The person
who is the target of the mobbing is left without help, without protection and alone
in the workplace. Individuals who are exposed to psychological abuse experience
physiological, psychological and social problems that are related to high levels of
stress and anxiety. DESIGN AND METHOD: The research participants were 505
nurses of whom 325 (64%) worked in public and 180 (36%) in private hospitals.
All of the participants were female. A questionnaire developed by the researchers
in the light of information in the literature was used for data collection and had
four sections including the participants' demographic characteristics and questions
asking about mobbing behaviours, reaction to mobbing incidents and actions
taken to escape from the mobbing. The data were collected between October and
December 2005 by giving an envelope to the participants and then collecting the
responses in the closed envelope. FINDINGS: The overwhelming majority
(86.5%) of the nurses participating in the research reported facing mobbing
behaviour in the workplace in the last 12 months. The nurses working at private
hospitals faced statistically significantly more mobbing behaviours than those at
public hospitals (p<or=0.02). It was determined that the nurses who faced
mobbing behaviours gave various physiological, emotional and social reactions to
these incidents. The most common behaviours exhibited by the participants to
escape mobbing was 'to work harder and be more organized' and 'to work more
carefully to avoid criticism'. In addition 10% of the participants stated that they
'consider committing suicide sometimes.' RELEVANCE TO CLINICAL
PRACTICE: Mobbing behaviours in the workplace need to be defined and
appropriate policies and procedures need to be developed and shared with all
employees to prevent the development of these behaviours. In addition, managers
should adopt an open managerial approach to prevent the development of these
behaviours.
329: Acta Oncol. 2007;46(6):852-8.
Increasing trend in the incidence of cervical cancer among the

elderly in Korea: a population-based study from 1993 to 2002.
Jo H, Jeon YT, Hwang SY, Shin HR, Song YS, Kang SB, Lee HP, Kim JW.
Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul

National University, Seoul, Korea.
Cancer is primarily a disease of older adults. However, little data is available on

the clinical features of cervical cancer in elderly patients. We investigated the
trends in incidence and clinical features associated with cervical cancer among the
elderly in Korea during the period of 1993-2002. We obtained data from the
National Cervical Cancer Incidence Database, which was constructed in
collaboration with the Korea Central Cancer Registry (KCCR) and Korea
Gynecologic Cancer Registry (KGCR). A total of 44 191 women with cervical
cancer were diagnosed between 1993 and 2002. Patients were divided into three
groups based on age: </=49 years (Group 1), 50-69 years (Group 2), and>/=70
years (Group 3). During this period, upward incidence trends were noted in Group
3 while constant and downward incidence trends were noted in Groups 1 and 2,
respectively. Pooled analysis across years revealed that squamous cell carcinoma
and advanced stage (IIB, III, and IV) were more common in Group 3 than in
Groups 1 and 2. With regard to primary treatments in the elderly patients, surgery
appeared to be performed increasingly despite the fact that advanced stage (IIB,
III, and IV) was more common in Group 3 than in Groups 1 and 2. Our findings
suggest that the incidence of cervical cancer in the elderly is increasing in Korea,
while it is decreasing overall. The current health service must emphasize
education for the elderly about cervical cancer prevention while concentrating on
screening.

330: Emerg Med J. 2007 Aug;24(8):550-2.
Effect of teleradiology upon pattern of transfer of head injured

patients from a rural general hospital to a neurosurgical referral
centre.
Ashkenazi I, Haspel J, Alfici R, Kessel B, Khashan T, Oren M.
Surgery B Department, Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
i_ashkenazi@yahoo.com
OBJECTIVE: To assess the effect of teleradiology upon the need for transfer of
head injured victims requiring hospitalisation but referred initially to a rural level
2 trauma centre without neurosurgical capacity. METHODS: Head injured
patients requiring hospitalisation, admitted to a rural level 2 trauma centre
between August 2003 and August 2005, were identified. A digitalised copy of the
computed tomographic (CT) scan was transferred to the neurosurgical referral
centre via teleradiology and was available for review by the neurosurgeon on-call,
who then, together with the trauma surgeon in the rural level 2 trauma centre,
decided whether to transfer the patient to the neurosurgical referral centre.
RESULTS: Of 209 trauma victims with neurosurgical pathology in need of
hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of
the patients were hospitalised in the rural level 2 trauma centre for observation.
Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-
trauma, was stabilised after damage control laparotomy only to succumb to an
enlarging epidural haematoma. Another patient was transferred 2 days after
admission because of difficulty in clinical evaluation due to a previously existing
neurological disorder, but no active treatment was necessary. All other 81 patients
recovered uneventfully. CONCLUSIONS: Selective head injured patients with
pathological CT scan may be safely managed in level 2 trauma centres. A
committed trauma team in the rural trauma centre, neurosurgical consultation and
availability of a teleradiology system are requisites. Currently existing transfer
criteria should be carefully re-evaluated.
Publication Types:
• Comparative Study

331: Epilepsia. 2007 Dec;48(12):2217-23. Epub 2007 Jul 25.
Convulsive status epilepticus: clinical profile in a developing

country.
Murthy JM, Jayalaxmi SS, Kanikannan MA.
Department of Neurology, The Institute of Neurological Sciences, CARE

Hospital, Hyderabad, India. jmkmurthy@satyam.net.in
PURPOSE: In developing countries optimal care of status epilepticus (SE) is

associated with major barriers, particularly transportation. METHODS: A
prospective study of SE was performed between 1994 and 1996 to determine the
clinical profile, response to treatment and outcome, Glasgow Outcome Scale
(GOS). RESULTS: Of the 85 patients admitted, the mean age was 33 years (8-75
years), 16% <16 years of age. The mean duration of SE before admission was
18.02 h (1-72 h). Only 23 (28%) patients, all locals, presented within <3 h of
onset. Etiology included acute symptomatic (54%), remote symptomatic (7%),
cryptogenic (19%), and established epilepsy (20%). Central nervous system
infections accounted for 24 (28%) of the etiologies. Seventy-five (88%) patients
responded to first-line drugs and 10 (12%) required second-line drugs. The mean
duration of SE was significantly long in nonresponders (Mean +/- SD: 32.6 +/-
20.11 vs. 15.2 +/- 18.32, p < 0.006). Duration (p < 0.01; OR 1.04, 95% CI 1.01-
1.07) and acute symptomatic etiology (p < 0.038; OR 10.38, 95% CI 1.13-95.09)
were the independent predictors of no-response to first-line drugs. Of the nine
deaths (10.5%), eight were in acute symptomatic group. Predictors of mortality
included female sex (p < 0.017, OR 13.41, 95% CI 1.59-115.38) and lack of
response to first-line drugs (p < 0.0001, OR 230.27, 95% CI 8.78-6037.19).
Longer duration was associated with poor GOS 1-4 (p = 0.001). Of the 37 patients
with <6 h, 81% had GOC5 outcome. CONCLUSION: This study suggests that
longer duration of SE and acute symptomatic etiology are independent predictors
of lack of response to first-line drugs. Failure to respond to first-line drugs and
duration predict the outcome.
Publication Types:
332: Acta Psychiatr Scand. 2007 Aug;116(2):125-8.

Comment in:
• Acta Psychiatr Scand. 2007 Aug;116(2):155; author reply 155-6.
Can health workers diagnose dementia in the community?
Jacob KS, Senthil Kumar P, Gayathri K, Abraham S, Prince MJ.
Department of Psychiatry, Christian Medical College, Vellore, India.

ksjacob@cmcvellore.ac.in
OBJECTIVE: This study attempted to evaluate sensitivity, specificity and

predictive values of the diagnosis of dementia made by trained community health
workers. METHOD: A total of 1,000 subjects over the age of 65 years were
recruited for the study. The community health workers identified nine subjects as
having dementia. This was compared against an education adjusted diagnosis of
dementia made in accordance with the 10/66 dementia research group protocol.
RESULTS: The sensitivity and specificity of the community health worker
diagnosis was 3.8% and 99.4% respectively. The false positive rate and positive
predictive values were 55.6% and 44.4%, respectively. The false negative rate and
negative predictive value were 10.3% and 89.7% respectively. Similar values
were obtained against a DSM IV diagnosis. Subjects with dementia who were
correctly diagnosed by the community health workers and those whose condition
was missed did not differ significantly on socio-demographic and clinical
variables. CONCLUSION: Informal screening by community health workers
resulted in low sensitivity and positive predictive values. Screening strategies in
situations of low prevalence are not effective.
Publication Types:
333: J Med Microbiol. 2007 Aug;56(Pt 8):1086-96.

Diarrhoeagenic Escherichia coli and other causes of childhood
diarrhoea: a case-control study in children living in a wastewater-
use area in Hanoi, Vietnam.
Hien BT, Trang do T, Scheutz F, Cam PD, Mølbak K, Dalsgaard A.
Department of Microbiology, National Institute of Hygiene and Epidemiology,

Hanoi, Vietnam. hien.nihe@gmail.com
A case-control study was conducted to identify the aetiology of diarrhoeal

diseases in pre-school children in a suburban area of Hanoi where the use of
untreated wastewater in agriculture and aquaculture is a common practice. Stool
specimens and clinical information were collected from 111 pairs of children with
diarrhoea and healthy controls. A total of 73 cases (66 %) and 41 controls (36 %)
had an enteric pathogen. The pathogens most often associated with diarrhoea were
rotavirus (17 % of cases) and Entamoeba histolytica (15 %), followed by Shigella
(5 %). Diarrhoeagenic Escherichia coli (DEC) was found in 23 % of both patients
and controls. Characterization of DEC by serotyping, antimicrobial susceptibility
test and PFGE showed that DEC represented by different pathotypes belonged to
various serotypes. Except for three enterotoxigenic E. coli strains, typing by
PFGE revealed no correlation between pathotype and serotype of DEC strains.
This suggests a high prevalence of a variety of DEC subtypes in this area. For this
particular region, vaccine development strategies targeting rotavirus and Shigella
are likely to be of public health benefit, whereas the role of DEC and preventive
measures need to be further elaborated.
Publication Types:
334: J Paediatr Child Health. 2008 Jan;44(1-2):57-61. Epub 2007 Jul 19.
Pre-admission consultation and late referral in infants with neonatal

cholestasis.
Lee WS.
Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala
Lumpur, Malaysia. leews@um.edu.my
AIMS: To study factors leading to delayed referral in neonatal cholestasis at a

tertiary centre in Malaysia. METHODS: A prospective, observational study on
consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric
liver unit in Malaysia. RESULTS: Thirty-one of the 65 (43%) patients studied
encountered delay or had an inappropriate action taken before referral. Factors
leading to delayed referral, which adversely affected the outcome of biliary atresia
(BA) and neonatal acute liver failure, were repeated reassurances by medical and
paramedical staff (n = 17, 26%), failure of hospital services at the referring
hospital (n = 7, 11%) and parental refusal for referral (n = 5, 8%). Only three
(14%) of the 22 patients who developed liver failure had liver transplantation
(LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-
year survival rate (native liver and LT) was 41%. CONCLUSIONS: Repeated
false reassurance, failure of hospital services and parental refusal all contributed
to delayed referral in neonatal cholestasis. In addition to education of medical and
public health workers, and parents on the importance of early referral in neonatal
cholestasis, health authorities in Malaysia should consider the feasibility of
universal stool colour screening in newborn infants to improve the outcome of
BA.
335: Nucl Med Commun. 2007 Aug;28(8):661-6.
Nuclear medicine scans in Beijing: insights from the Beijing Quality

Control Centre Survey 2005-2006.
Hongwei S, Jianhua G, Shengzu C.
Department of Nuclear Medicine, Cancer Hospital, Beijing, China.
OBJECTIVE: To survey nuclear medicine scans carried out in Beijing during

2005. METHODS: Forty-two nuclear medicine departments were surveyed by
using mailed questionnaires sent during September 2006. RESULTS: By the end
of January 2007, 30 out of 42 hospitals had replied to our survey. The estimated
annual number of SPECT procedures was 6.72 per 1000 population during 2005.
Among SPECT applications, whole-body bone scans (n=23,090) were performed
with the highest frequency, followed by myocardial perfusion imaging
(n=19,092), and renal function imaging (n=10,287). The estimated number of
myocardial perfusion scintigraphy scans was 1530 procedures per million
population. The annual number of PET procedures was 0.25 per 1000 population.
Most of these PET and SPECT examinations used relative monotonous
radiotracers and most patients were in the age group of 40-70 years. However, for
each cancer and each type of application, age distributions slightly varied. In
addition, the analysis of gender distribution revealed that the number of male
patients was higher than for female patients. CONCLUSION: The number of
nuclear medicine scans carried out in Beijing during 2005 was considerable, with
unbalanced clinical applications. Excluded myocardial perfusion scintigraphy, the
frequencies of some applications were still lower than in western countries.
Furthermore, most procedures used relatively monotonous radiotracers. Most
patients were in the age group of 40-70 years and were male.
336: N Engl J Med. 2007 Jul 12;357(2):115-23.
Comment in:
• N Engl J Med. 2007 Jul 12;357(2):175-6.

• N Engl J Med. 2007 Oct 11;357(15):1555-6; author reply 1556.
• N Engl J Med. 2007 Oct 11;357(15):1555; author reply 1556.
Clinical outcomes of breast cancer in carriers of BRCA1 and

BRCA2 mutations.
Rennert G, Bisland-Naggan S, Barnett-Griness O, Bar-Joseph N, Zhang S,

Rennert HS, Narod SA.
Clalit Health Services, National Cancer Control Center and Department of

Community Medicine and Epidemiology, Carmel Medical Center and B.
Rappaport Faculty of Medicine, Technion, Haifa, Israel. rennert@tx.technion.ac.il
BACKGROUND: Some features of breast cancer in women with a BRCA1

mutation suggest that hereditary breast cancer has a poor outcome. We conducted
a national population-based study of Israeli women to determine the influence, if
any, of a BRCA1 or a BRCA2 mutation on the prognosis in breast cancer.
METHODS: We obtained data on all incident cases of invasive breast cancer that
were diagnosed from January 1, 1987, to December 31, 1988, and recorded in the
Israel National Cancer Registry. We requested a paraffin-embedded tumor block
or an unstained slide and the corresponding pathological and clinical records for
all such cases. DNA extracted from the tumor specimens was analyzed for the
three founder mutations in BRCA1 and BRCA2. For each subject, available
pathological and oncologic records were reviewed. RESULTS: We were able to
retrieve a pathological sample from 1794 of 2514 subjects (71%). Among those
women, we obtained medical records for 1545 (86%). A BRCA1 or BRCA2
mutation was identified in 10% of the women who were of Ashkenazi Jewish
ancestry. The adjusted hazard ratios for death from breast cancer were not
significantly different among mutation carriers and noncarriers (hazard ratio
among BRCA1 carriers, 0.76; 95% confidence interval [CI], 0.45 to 1.30; P=0.31;
hazard ratio among BRCA2 carriers, 1.31; 95% CI, 0.80 to 2.15; P=0.28). Among
women who were treated with chemotherapy, the hazard ratio for death among
BRCA1 carriers was 0.48 (95% CI, 0.19 to 1.21; P=0.12). CONCLUSIONS:
Breast cancer-specific rates of death among Israeli women are similar for carriers
of a BRCA founder mutation and noncarriers. Copyright 2007 Massachusetts
Medical Society.
Publication Types:
337: J Med Assoc Thai. 2007 Jun;90(6):1089-96.
Combination of acute stroke unit and short-term stroke ward with

early supported discharge decreases mortality and complications
after acute ischemic stroke.
Suwanwela NC, Eusattasak N, Phanthumchinda K, Piravej K, Locharoenkul

C.
Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn

University, Rama IV Rd, Bangkok 10330, Thailand.
fmednsu@md2.md.chula.ac.th
BACKGROUND: The stroke unit has been established as a standard care for
stroke. However, it has not been widely established in developing countries due to
the lack of understanding and limited resources. OBJECTIVE: To compare the
complications and mortality of stroke patients admitted in the stroke unit and
short-term ward with those admitted in the general medical ward. MATERIAL
AND METHOD: The authors prospectively collected data of acute stroke patients
who were admitted after the set up of the stroke unit and stroke short-term ward in
2003, and compared with the data of those who were admitted in a general
medical ward in 2001. All acute stroke patients who presented within seven days
of the onset were admitted and those who had final diagnosis of ischemic stroke
or transient ischemic attack (TIA) were studied. Patients in the stroke unit were
taken care of by a multidisciplinary team approach under clinical guidelines and a
care map. The short-term ward is a part of the general medical ward and stroke
patients were treated by a multidisciplinary team followed by homecare treatment.
The endpoints were mortality rate, neurological and medical complications during
admissions, and the mean length of stay. RESULTS: Seven hundred and ninety-
four patients were studied. Three hundred and eighty-seven patients were
admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three
hundred and one cases were treated in the acute stroke unit whereas 106 were
admitted in the short-term ward. There was no difference in stroke risk factors and
stroke subtypes between the two groups, except for dyslipidemia and cigarette
smoking, which were more prevalent in patients admitted in 2003. Patients in the
stroke unit and the short-term ward had significantly less mortality than those in
the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit
and the short-term ward were 16.8%, compared to 26% of those admitted into the
general medical ward. Significantly less brain edema, hemorrhagic infarction,
urinary tract infection, pneumonia, and pressure sore were also observed. The
length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and
8.09 days, respectively. CONCLUSION: Combination of organized acute stroke
unit and short-term ward with early supported discharge reduces the mortality and
complications of ischemic stroke patients during admission as well as the length
of stay when compared to the general medical ward. The present study reassures
that the combination is useful for hospitals in developing countries, which have
limited number of beds in their stroke units.
338: Diabetes Care. 2007 Oct;30(10):2690-4. Epub 2007 Jul 10.
Relationship among alcohol, body weight, and cardiovascular risk

factors in 27,030 Korean men.
Sung KC, Kim SH, Reaven GM.
Department of Medicine, Sungkyunkwan University, Kangbuk Samsung Hospital,

Seoul, Korea.
OBJECTIVE: Recent studies suggest a lower risk for overweight/obesity in

moderate alcohol drinkers. However, the validity of this relationship and its
impact on the putative benefits of alcohol consumption on cardiovascular disease
(CVD) risk has not been well evaluated. RESEARCH DESIGN AND
METHODS: We assessed the impact of BMI on the relationship between alcohol
consumption and CVD risk factors (blood pressure, lipid panel, and glucose and
insulin concentrations) in 27,030 healthy Korean men with no major
comorbidities or medication intake seen in a large urban Korean hospital.
RESULTS: BMI and overweight prevalence increased linearly with alcohol
intake (P < 0.001). Alcohol intake was also positively associated with blood
pressure and triglyceride, HDL, and fasting glucose concentrations (P < 0.001)
and negatively associated with LDL and insulin concentrations (P < 0.001). With
nondrinkers as the reference group, the odds ratio for having insulin in the top
quartile also declined linearly when adjusted for age, BMI, smoking, and exercise,
with the heaviest drinkers (>40 g/day) having an odds ratio of 0.71 (95% CI 0.62-
0.82) (P < 0.001). The relationship between alcohol and CVD risk factors was
similar in normal-weight and overweight individuals. CONCLUSIONS: Alcohol
intake is associated with increasing BMI and several metabolic abnormalities,
including higher fasting glucose. Paradoxically, it is also associated with lower
insulin concentrations. The clinical significance of these findings needs further
investigation.
339: J Med Syst. 2007 Jun;31(3):166-72.
Efficiency measurement for hospitals owned by the Iranian social

security organisation.
Hajialiafzali H, Moss JR, Mahmood MA.
Discipline of Public Health, Schiool of Population Health and Clinical Practice,

The University of Adelaide, South Australia, 5005 Australia.
hossein.hajialiafzali@adelaide.edu.au
This study used Data Envelopment Analysis (DEA) to examine the relative
efficiency of hospitals owned by the Iranian Social Security Organization, which
is the second largest institutional source of hospital care in that country. Using
data for the year 2002, 26 of the 53 hospitals were deemed to be efficient.
Inefficient hospitals had an average score of 90%, implying a potential reduction
in all inputs on average by about 10% with no impact on output levels. In addition
to the conventional DEA measurement, efficient hospitals were ranked by
calculating super-efficiency scores, by identifying weak efficient hospitals, and by
determining the frequency of peers. The study provides useful information for
improving hospital management, rationalizing resource allocation, and improving
services provided by hospitals.
Publication Types:
340: J Travel Med. 2007 Jul-Aug;14(4):254-8.
There is need for antigen-based rapid diagnostic tests to identify

common acute tropical illnesses.
Wilde H, Suankratay C.
Queen Saovabha Memorial Institute, and Division of Infectious Diseases, King

Chulalongkorn University Hospital, Thai Red Cross Society, Bangkok 10330,
Thailand. wildehenry@yahoo.com
Enteric fever, typhus, leptospirosis, dengue, melioidosis, and tuberculous

meningitis present urgent diagnostic problems that require experience and clinical
judgment to make early evidence-based management decisions. Basic and applied
research dealing with reliable antigen-based diagnostics has been published and
confirmed for several of these infections. This should have initiated commercial
production but has not. Established international firms see little profit in such
diagnostic kits since they would be used in poor countries with little prospects for
return of investment capital. We attempt to illustrate this issue, using common
causes of acute febrile illnesses in the Southeast Asian region. We believe that
rapid diagnostic technology could prevent significant delay in starting appropriate
therapy, reduce hospital expenses, and even save lives.
Publication Types:
• Review
341: Mil Med. 2007 Jun;172(6):634-9.

The factors affecting length of stay of the patients undergoing
appendectomy surgery in a military teaching hospital.
Demir CC, Celik Y, Gider O, Yağci G, Sahin B, Tufan T, Akdeniz A, Sen D.
Department of Health Services Management, Gulhane Military Medical

Academy, 06018 Etlik, Ankara, Turkey.
The principal objectives of this study were to identify the main predictors of the
length of postoperative hospital stay for patients undergoing appendectomy in a
military training hospital in Turkey, to examine the effects of each significant
predictor, and to justify to hospital health care managers the reasons why an
increase in effective use of hospital utilization resources is needed and so
important. This study gives the results of a 2-year retrospective study conducted
at Gulhane Military Medical Academy between January 2003 and January 2005.
The medical files of 417 patients undergoing appendectomy during this 2-year
period were reviewed. A number of demographic and clinical patient
characteristics were examined to determine their significance in lengthening the
post-operative and total hospital stay. After taking all demographic and clinical
patient characteristics into account, it was determined that those patients who
were temporary or short-term service members and whose medical complications
were more severe were more likely to stay in the hospital for longer periods.
Despite its limitations, the study reveals that factors affecting variations in
resource utilization can be minimized by following very simple administrative
procedures. Furthermore, the results could increase awareness among hospital
managers of the significant factors involved for health care providers in
modifying their behavior concerning resource utilization decisions.
342: Int J Dent Hyg. 2007 Aug;5(3):145-50.
Dental hygiene residential care in a 3-year dental hygiene education

programme in Japan: towards dysphagia management based on the
dental hygiene process of care.
Nishimura T, Takahashi C, Takahashi E.
Miyagi Advanced Dental Hygienist College, Sendai, Miyagi, Japan.
This paper reports an evaluation of a residential care practice, which was part of a
'Dysphagia Management' course introduced into a 3-year dental hygiene
curriculum in Japan. The clinical practice was performed at a care facility for the
elderly people. Dental hygiene interventions, which consisted mainly of
professional oral care, were implemented on a client who was bed-bound after
suffering from a stroke. As the client had severe tension in muscles around oral
cavity, it was difficult for the facility care workers to provide daily oral hygiene
care. The goals of the dental hygiene care plan included decreasing tension of oral
muscles and reducing periodontal inflammation and halitosis. The dental hygiene
interventions were given once a month for 5 months. Evaluation in the fifth month
demonstrated relaxation of oral muscles, decrease in plaque accumulation, and
improvements in levels of gingival inflammation, indicating the partial
achievements of the initial goals. Possibilities for revision of the care plan could
call for more active involvement of the facility care workers and client-centered
goal setting. This learning experience provided an opportunity for continuing
intervention and evaluation of dental hygiene care for the same client. The
positive results of our limited interventions further confirmed the importance of
professional oral care in organic and functional improvements in oral health for
the elderly people.
Publication Types:
• Case Reports
343: Nurs Adm Q. 2007 Jul-Sep;31(3):244-53.
Nurse/physician conflict management mode choices: implications for

improved collaborative practice.
Hendel T, Fish M, Berger O.
Department of Nursing, School of Health Professions, Sackler Faculty of

Medicine, Tel Aviv University, Tel Aviv, Israel. tdhendel@zahav.net.il
In today's complex healthcare organizations, conflicts between physicians and

nurses occur daily. Consequently, organizational conflict has grown into a major
subfield of organizational behavior. Researchers have claimed that conflict has a
beneficial effect on work group function and identified collaboration as one of the
intervening variables that may explain the relationship between magnet hospitals
and positive patient outcomes. The purpose of this study was to identify and
compare conflict mode choices of physicians and head nurses in acute care
hospitals and examine the relationship of conflict mode choices with their
background characteristics. In a cross-sectional correlational study, 75 physicians
and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann
Conflict Mode Instrument. No difference was found between physicians and
nurses in choice of the most frequently used mode in conflict management. The
compromising mode was found to be the significantly most commonly chosen
mode (P = .00) by both. Collaborating was chosen significantly more frequently
among head nurses (P = .001) and least frequently among physicians (P = .00).
Most of the respondents' characteristics were not found to be correlated with
mode choices. The findings indicate a need to enhance partnerships in the clinical
environment to ensure quality patient care and staff satisfaction.
344: Clin Calcium. 2007 Jul;17(7):1022-8.
[Absolute risk for fracture and WHO guideline. Fracture risk

assessments recommended by World Health Organization and
Japanese guidelines for prevention and treatment of osteoporosis
2006]
Nakamura T; World Health Organization.
University of Occupational and Environmental Health, Department of Orthopedic

Surgery.
Bone mineral density (BMD) is a strong predictor of osteoporotic fractures.

However, the increase in fracture risk is not steep, rather gentle, for the decline in
BMD values. Postmenopausal women with osteopenia (T scores between - 2.5
and - 1.0) may also be at risk. Case finding strategies such as the combination of
BMD and appropriate clinical risk factors for fracture are shown to identify
subjects at high fracture risk. World Health Organization developed a fracture risk
assessment tool, recommending its exploitation in the case findings. Under these
circumstances, Japan guideline 2006 provided new criteria for the
pharmacological intervention to prevent fragility fracture, besides the
conventional criteria for diagnosing osteoporosis.
Publication Types:
• Review
345: Clin Calcium. 2007 Jul;17(7):1015-21.
[Absolute risk for fracture and WHO guideline. WHO model for
assessing absolute risk of fracture]
Iki M; World Health Organization.
Kinki University School of Medicine, Department of Public Health.
Goal for management of osteoporosis is prevention of fractures, although the

diagnosis of osteoporosis is made according to bone mineral density (BMD)
which plays a great role in monitoring the effectiveness of treatment. However,
there are many countries and regions where BMD measurement is not available in
primary health care. Even if it is available, BMD shows limited validity in
predicting fracture risk. A research group of the World Health Organization
(WHO) has developed absolute risk assessment models for fracture incorporating
several clinical risk factors with and without BMD. The present paper described
the outline of these models and addressed several issues when applying these
models to the primary medical care and preventive practice in Japan.
Publication Types:
• Review
346: Rev Iberoam Micol. 2007 Jun;24(2):113-7.
Tinea unguium in the north-west of Iran (1996-2004).
Kazemi A.
National Public Health Management Center, Infectious and Tropical Diseases
Research Center & Biotechnology Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran. Hassan5628@yahoo.com
Tinea unguium is a common mycosis in many part of the world including Iran.
The prevalence of this mycosis varied depending on time, health level and
geographical location. To stabilise the etiological, epidemiological and risk
factors of tinea unguium in North-west Iran, a study of patients with suspected
dermatophyte infections of their nails was carried out between 1996 and 2004.
During this study 590 (354 females and 236 males) patients with clinical
presentation of fungal infection in fingernails, toenails or in the both sites, were
investigated using direct microscopy and culture of clinical samples. Tinea
unguium was documented in 41 cases (7%) and among positive cases, 16 cases
(39% total positive cases) were female and 25 cases (61% total positive cases)
were male. Seventeen patients (41% total positive cases) had tinea unguium in
their finger nails and 24 patients (59% total positive cases) had infection in their
toe nails. According to the isolated etiologic agent, 66% (19 cases) of tinea
unguium infections were caused by zoophilic drematophytes, 31% (9 cases) were
caused by anthropophilic drematophytes and 3% (1 case) were caused by
geophilic dermatophytes. With regard of sex, tinea unguium did not show a
significant difference. The highest prevalence of tinea unguium was found in
patients between 11 and 40 years of age. In conclusion the current results
identified the etiological agents and epidemiological aspects of tinea unguium in
North-west Iran. Tinea unguium in this region is associated with animal
husbandry and direct or indirect contact with their products (wool, leather).
347: J Midwifery Womens Health. 2007 Jul-Aug;52(4):398-405.
Midwifery education and maternal and neonatal health issues:

challenges in Pakistan.
Rukanuddin RJ, Ali TS, McManis B.
The Aga Khan University, School of Nursing, Karachi, Pakistan.

rafat.jan@aku.edu
Although numerous health care interventions have been implemented in Pakistan,

the high maternal and neonatal mortality rates still remain a challenge. Developed
countries have reduced maternal and neonatal mortality rates by improving the
skill and knowledge levels of nurse-midwives. This paper reviews maternal and
neonatal health issues, challenges in current midwifery education, and the role of
government and international agencies in Pakistan. The exact maternal and
neonatal mortality rates in Pakistan are unknown; a census has not occurred since
1998, and data provided in more recent studies were presented in summary
format. A number of factors that contribute to the high mortality rate could easily
be controlled by using competent nurse-midwives throughout all levels of the
Pakistani health care system. A reduction in the maternal mortality rate is likely to
occur if the Pakistan government and international agencies work together to
implement specific recommendations in maternal and neonatal health. These
recommendations include: 1) holding an invitational conference; 2) strengthening
the existing midwifery and Lady Health Visitor curricula; 3) pilot testing an
expanded midwifery program; and 4) advocating for and obtaining political
commitments and resources for midwifery education.
Publication Types:
• Review
348: Telemed J E Health. 2007 Jun;13(3):257-68.
An internet-based interactive telemonitoring system for improving

childhood asthma outcomes in Taiwan.
Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF.
Department of Pediatrics, College of Medicine, National Cheng Kung University,

Tainan, Taiwan, Republic of China.
A randomized, controlled trial was conducted to assess the effectiveness of Blue

Angel for Asthma Kids, an Internet-based interactive asthma educational and
monitoring program, used in the management of asthmatic children. One hundred
sixty-four (n = 164) pediatric patients with persistent asthma were enrolled and
randomized into two study groups for a 12-week controlled trial. The intervention
group had 88 participants who were taught to monitor their peak expiratory flows
(PEF) and asthma symptoms daily on the Internet. They also received an
interactive response consisting of a self-management plan from the Blue Angel
monitoring program. The control group had 76 participants who received a
traditional asthma care plan consisting of a written asthma diary supplemented
with instructions for self-management. Disease control was assessed by weekly
averaged PEF values, symptom scores, and asthma control tests. Adherence
measures were assessed by therapeutic and diagnostic monitoring. Outcome was
assessed by examining quality of life and retention of asthma knowledge. The
data were analyzed by comparing results before and after the trial. At the end of
trial, the intervention group decreased nighttime (-0.08 +/- 0.33 vs. 0.00 +/- 0.20,
p = 0.028) and daytime symptoms (-0.08 +/- 0.33 vs. 0.01 +/- 0.18, p =0.009);
improved morning (241.9 +/- 81.4 vs. 223.1 +/- 55.5, p =0.017) and night PEF
(255.6 +/- 86.7 vs. 232.5 +/- 55.3, p =0.010); increased adherence rates (p < 0.05);
improved well-controlled rates (70.4% vs. 55.3%, p < 0.05); improved knowledge
regarding self-management (93.2% vs. 70.3%, p < 0.05); and improved quality of
life (6.5 +/- 0.5 vs. 4.3 +/- 1.2 on a 7-point scale, p < 0.05) when compared with
conventional management. The Internet-based asthma telemonitoring program
increases selfmanagement skills, improves asthma outcomes, and appears to be an
effective and well-accepted technology for the care of children with asthma and
their caregivers.
Publication Types:
• Clinical Trial
• Randomized Controlled Trial
349: Intern Med. 2007;46(13):927-31. Epub 2007 Jul 2.
Prescription of nonsteroidal anti-inflammatory drugs and co-

prescribed drugs for mucosal protection: analysis of the present
status based on questionnaires obtained from orthopedists in Japan.
Tsumura H, Tamura I, Tanaka H, Chinzei R, Ishida T, Masuda A, Shiomi H,

Morita Y, Yoshida M, Kutsumi H, Inokuchi H, Doita M, Kurosaka M,
Azuma T.
Department of Gastroenterology, Kobe University School of Medicine.
OBJECTIVE: Recently guidelines for the treatment and prevention of ulcers

induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been
established. The aim of the present study was to examine factors influencing
orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-
associated gastrointestinal adverse events. METHODS: We sent a questionnaire
to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire
was used to collect information on NSAID prescriptions (drug name,
pharmaceutical form, doses, and duration of use) and associated drugs, especially
gastroprotective drugs. RESULTS: Two hundred eight (51.7%) orthopedists
returned the questionnaire. The most frequently used NSAIDs, in descending
order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors
(80%) reported patients with abdominal symptoms associated with NSAIDs. Of
these doctors, 59% treated the symptoms by themselves, and prescribed
gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs)
(26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors
(PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced
the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent
NSAID-associated gastrointestinal events, including gastroprotective drugs
(44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported
that they prescribed medicines for NSAID-associated gastrointestinal events on
the basis of their experience (23%), by considering medical insurance restrictions
(17%), and by referring to information provided by pharmaceutical company
representatives (16%). CONCLUSION: Most orthopedists prescribe some type of
drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We
therefore strongly recommend that the guidelines be made more widely known to
gastroenterologists and to physicians in every field of clinical practice, including
orthopedics.
350: Clin Neurol Neurosurg. 2007 Sep;109(7):571-7. Epub 2007 Jun 27.
Prediction of functional outcome of ischemic stroke patients in

northwest China.
Liu X, Lv Y, Wang B, Zhao G, Yan Y, Xu D.
Department of Neurology, Xijing Hospital, Fourth Military Medical University,

Xi'an, China.
OBJECTIVES: To identify the clinical factors which predicted the outcome of

ischemic stroke patients in northwest China. PATIENTS AND METHODS: We
retrospectively reviewed 489 consecutive patients with ischemic stroke admitted
to the Neurology Department of Xijing Hospital. Demographic, clinical and
laboratory data were recorded. Follow-up assessments were performed by
telephone interviews or letters. The clinical outcome was assessed by using the
modified Rankin Scale (mRS) and categorized as good (score 0-2) or poor (score
3-6) outcomes. Univariate and multivariate logistic regression analyses were
performed to explore predictors of ischemic stroke. RESULTS: The follow-up
period was up to 47 months (mean, 28.3 months). Fifty-five patients (11.2%) were
lost. Among these 434 patients, 244 (56.2%) patients had good outcome and 190
(43.8%) had poor outcome. The poor outcome was associated with old age (OR:
3.505; CI 95%: 2.100-5.849), lower educational level (OR: 0.686; CI 95%: 0.570-
0.825), having stroke history (OR: 2.481; CI 95%: 1.442-4.268), and higher
NIHSS total score (OR: 2.619; CI 95%: 1.584-4.330). CONCLUSION: The
results suggest that age, the educational level, stroke history, and NIHSS score are
useful in the prediction of functional outcome of ischemic stroke in Chinese
northwest area.
351: BMC Med Ethics. 2007 Jun 29;8:8.
An eight-year follow-up national study of medical school and

general hospital ethics committees in Japan.
Akabayashi A, Slingsby BT, Nagao N, Kai I, Sato H.
Department of Biomedical Ethics, Graduate School of Medicine University of

Tokyo University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
akirasan-tky@umin.ac.jp
BACKGROUND: Ethics committees and their system of research protocol peer-

review are currently used worldwide. To ensure an international standard for
research ethics and safety, however, data is needed on the quality and function of
each nation's ethics committees. The purpose of this study was to describe the
characteristics and developments of ethics committees established at medical
schools and general hospitals in Japan. METHODS: This study consisted of four
national surveys sent twice over a period of eight years to two separate samples.
The first target was the ethics committees of all 80 medical schools and the
second target was all general hospitals with over 300 beds in Japan (n = 1457 in
1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee
structure, (2) frequency of annual meetings, (3) committee function, and (4)
existence of a set of guidelines for the refusal of blood transfusion by Jehovah's
Witnesses. RESULTS: Committee structure was overall interdisciplinary.
Frequency of annual meetings increased significantly for both medical school and
hospital ethics committees over the eight years. The primary activities for medical
school and hospital ethics committees were research protocol reviews and policy
making. Results also showed a significant increase in the use of ethical guidelines,
particularly those related to the refusal of blood transfusion by Jehovah's
Witnesses, among both medical school and hospital ethics committees.
CONCLUSION: Overall findings indicated a greater recognized degree of
responsibilities and an increase in workload for Japanese ethics committees.
Publication Types:
PMCID: PMC1925100
352: J Assoc Physicians India. 2007 Mar;55:198-202.
Spectrum of renal disorders in a tertiary care hospital in Haryana.
Aggarwal HK, Yashodara BM, Nand N, Sonia , Chakrabarti D, Bharti K.
Department of Nephrology and Med V, Pt BDS, Postgraduate Institute of Medical

Sciences, Rohtak-124 001, Haryana, India.
INTRODUCTION: There is a paucity of data pertaining to spectrum of renal

diseases in various parts of India. Available literature has emphasized more on
specific clinical syndromes of renal diseases rather than over all spectrum. The
present study highlights specimen of symptomatic renal disorders at a tertiary care
hospital in Haryana and will find place for better resource management and
planning. MATERIALS AND METHODS: It included 1806 patients either
presenting for the first time to nephrology outpatient department of admitted
between Jan 1996 - Dec 2001 to the institute. The study was retrospective for five
years (1996-2000) and prospective for one year. Records of all these patients were
analyzed and patients were grouped in different renal syndromes. RESULTS:
Mean age of patients was (38.79 +/- 15.15 years) with male preponderance in all
renal syndromes. Chronic renal failure (CRF) was the commonest presentation
(56.02%). Nephrotic syndrome accounted for 22.36% whereas acute renal failure
(ARF) was seen in 12.84%. Other presentations were acute nephritic syndrome
(6.75%) and asymptomatic urinary abnormality (AUA) (0.99%). Chronic
glomerulonephritis (CGN) (39.32%) and diabetic nephropathy (DN) (19.16%)
were leading causes of CRF. Medical ARF accounted for 2/3rd of the cases of
ARF and surgical etiology was seen in 1/5th of causes whereas obstetric cause
was responsible for 1/7th of the cases. Minimal change disease (MCD) (33.33%)
was the commonest cause of primary nephrotic syndrome followed by
membranoproliferative glomeruolonephritis (MPGN). Secondary glomerular
diseases were found in 21.28%. Post-streptococcal glomerulonephritis (PSGN)
was the commonest cause of nephritic syndrome (37.70%). CONCLUSION: It is
the first large study of its kind from a tertiary health care centre of Haryana. Male
patients in their peak of life (3rd and 4th decade) were the major candidates
requiring renal care with CRF as the commonest presentation and diabetic
nephropathy as the second commonest cause of CRF after CGN. We need more
Indian studies on spectrum of renal diseases for better available resource
management.
353: Pediatr Infect Dis J. 2007 Jul;26(7):565-71.
Effectiveness of Haemophilus influenzae type B conjugate vaccine on

prevention of pneumonia and meningitis in Bangladeshi children: a
case-control study.
Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD,

Moulton LH, Black RE, Santosham M.
Department of International Health, Johns Hopkins Bloomberg School of Public

Health, Baltimore, MD 21205, USA. abaqui@jhsph.edu
BACKGROUND: Few Asian countries have introduced Haemophilus influenzae

type b (Hib) conjugate vaccine because of its cost and uncertainty regarding
disease burden. METHODS: To estimate the effectiveness of Hib conjugate
vaccine in preventing pneumonia and meningitis in children age <2 years, an
incident case-control study was conducted in a birth cohort of about 68,000
infants in Dhaka city, Bangladesh. DPT vaccine was systematically replaced by a
combined Hib-DPT vaccine in selected immunization centers of the study area.
Four matched community- and 2 hospital-controls were randomly selected for
each confirmed case of pneumonia and meningitis from the study area.
RESULTS: About 35% of the infants received each of the 3 doses of Hib-DPT
vaccine. There were 2679 children who had a chest roentgenogram. For 475
children, a radiologist and a pediatrician independently identified substantial
alveolar consolidation. Following at least 2 doses of Hib vaccine, the preventable
fractions [95% confidence intervals (CI)] using community and hospital controls
were 17% (-10% to 38%) and 35% (13% to 52%) respectively. Of these 475
cases, 2 radiologists with the World Health Organization concurred with the
findings for 343 patients, yielding preventable fractions of 34% (6% to 53%) and
44% (20% to 61%). Fifteen confirmed Hib meningitis cases were identified; the
preventable fractions (95% CI) using community and hospital controls,
respectively, were 89% (28% to 100%) and 93% (53% to 100%).
CONCLUSIONS: The study documented that significant fractions of pneumonia
and meningitis in Bangladeshi children age <2 years can be prevented by the Hib
conjugate vaccine.
Publication Types:
• Controlled Clinical Trial

• Research Support, U.S. Gov't, Non-P.H.S.
354: Nephron Clin Pract. 2007;106(4):c157-61. Epub 2007 Jun 26.
Natural history and prognostic factors of IgA nephropathy

presented with isolated microscopic hematuria in Chinese patients.
Shen P, He L, Li Y, Wang Y, Chan M.
Department of Nephrology, Shuguang Hospital, Shanghai University of

Traditional Chinese Medicine, Shanghai, PR China.
BACKGROUND/AIMS: IgA nephropathy (IgAN) with isolated microscopic

hematuria (IMH) is prevalent in Asian countries including China. However, the
natural history of IgAN with IMH has not yet been clarified. The aim of this study
was to review the natural course and prognostic factors of IgAN with IMH in
Chinese patients. METHODS: We retrospectively studied 135 patients (43 males
and 92 females) followed up for a mean period of 92 +/- 28 months. In order to
identify factors associated with renal progression, clinical and pathological data at
onset were reviewed. RESULTS: During the follow-up period, hematuria of 16
patients (12%) disappeared while persistent microscopic hematuria was seen in
119 patients (88%), and proteinuria was present in 39 patients (29%). The
prevalence of hypertension was 32% (43 patients), and 20% (27 patients)
developed renal insufficiency. The prevalence of proteinuria and hypertension in
the microalbuminuria group was significantly higher than those in the
normoalbuminuria group. Poor renal outcome is usually associated with
hematuria, microalbuminuria, and tubulointerstitial lesions. CONCLUSION:
IgAN with IMH may not imply favorable outcome, so early diagnosis and careful
follow-up are clinically significant. Hematuria, microalbuminuria, and
tubulointerstitial lesions are useful markers to identify those patients at high risk
for renal progression. Copyright 2007 S. Karger AG, Basel.
355: J Am Osteopath Assoc. 2007 May;107(5):181-9.
Diagnosis and management of posttraumatic stress disorder in

returning veterans.
Reeves RR.
Chief of Mental Health, G.V. (Sonny) Montgomery VA Medical Center (11M),

1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116, USA.
roy.reeves@med.va.gov
As the conflict in Iraq continues, public health authorities in the United States
anticipate that many returning soldiers will suffer from posttraumatic stress
disorder (PTSD). Initially, most of these veterans are likely to consult their
primary care physicians about health problems. However, the diagnosis of PTSD
is often missed in primary care settings. The author encourages physicians to
become better prepared to recognize this disorder in their patients and initiate
proper treatment or appropriate referral. Current diagnostic approaches and
treatment modalities for combat-related PTSD are reviewed-with an emphasis on
clinical procedures for the primary care physician.
Publication Types:
• Review
356: Rev Iberoam Micol. 2007 Mar;24(1):38-40.
Sporotrichosis in Iran.
Kazemi A, Razi A.
National Public Health Management Center (NPMC) and Immunology and

Parasitology Department, Biotechnology Research Center (BRC), Tabriz
University of Medical Sciences Tabriz, Iran. Hassan5628@yahoo.com
This report describes a 23 year-old male florist gardener diagnosed with

subcutaneous sporotrichosis caused by the dimorphic pathogenic soil fungus
Sporothrix schenckii. The patient had several small skin lesions over the left
upper arm with ascendant chains of enlarged lymph nodes.Sporothrix schenckii
was detected from clinical samples by direct microscopy and culture and its
ability to switch from mould to yeast form at 37 degrees C. The patient was
successfully treated with long-term potassium iodide and advised to wear gloves
and long sleeves when handling any kind of plant material.
Publication Types:
• Case Reports
357: Arch Intern Med. 2007 Jun 25;167(12):1297-304.
Lower risk of tuberculosis in obesity.
Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung G, Law WS, Tam
CM, Chan CK, Chang KC.
Tuberculosis and Chest Service, Department of Health, The University of Hong

Kong, and Tuberculosis and Chest Unit, Grantham Hospital, Wanchai Chest
Clinic, 99 Kennedy Rd, Wanchai, Hong Kong, China. cc_leung@dh.gov.hk
BACKGROUND: Obesity is increasingly prevalent in both developed and

developing areas. Although undernutrition is well associated with tuberculosis,
few studies have systematically examined the association with obesity. Method A
cohort of 42 116 individuals 65 years or older enrolled at 18 health centers for
elderly patients in Hong Kong, China (which has a tuberculosis incidence of
approximately 90 per 100,000 population), in 2000 were followed up
prospectively through the territory-wide tuberculosis registry for the development
of active tuberculosis from 3 months after enrollment until December 31, 2005,
using the identity card number as the unique identifier. The association with body
mass index (BMI; calculated as weight in kilograms divided by the square of
height in meters), as categorized by the Asian standards, was assessed with the
control of other baseline characteristics. RESULTS: Obese (BMI>or=30) and
overweight (BMI, 25 to <30) individuals were at significantly lower risks of
developing active tuberculosis than normal-weight individuals (BMI, 18.5 to
<25), with hazard ratios (95% confidence intervals) of 0.36 (0.20-0.66) and 0.55
(0.44-0.70), respectively, after adjustment for baseline demographic, social, and
clinical variables. An inverse linear association was observed predominantly for
pulmonary but not extrapulmonary tuberculosis. This association persisted after
controlling for potential confounders or excluding individuals with known
tuberculosis risk factors. CONCLUSIONS: Obesity is associated with a lower risk
of active pulmonary tuberculosis in the older population of Hong Kong. The
presence of such a strong but selective association across the whole spectrum of
BMI could have major biological, clinical, and/or epidemiological implications.
Further studies are indicated to explore the underlying mechanisms, potential
clinical utilities, and possible epidemiological consequences.
Publication Types:
358: Heart. 2008 Mar;94(3):354-9. Epub 2007 Jun 25.
Ethnic differences in healthcare-seeking behaviour and management

for acute chest pain: secondary analysis of the MINAP dataset 2002-
2003.
Ben-Shlomo Y, Naqvi H, Baker I.
Department of Social Medicine, University of Bristol, Bristol, UK. y.ben-

shlomo@bristol.ac.uk
OBJECTIVE: To examine whether there are ethnic differences in the healthcare-

seeking behaviour and management of patients with chest pain. DESIGN:
Prospective cohort of patients attending accident and emergency departments with
chest pain. SETTING: Hospitals in England and Wales from 1 January 2002 to 31
December 2003. PARTICIPANTS: Patients with chest pain. MAIN OUTCOME
MEASURES: Whether patients arrived by ambulance, whether they received
thrombolysis and the time it took from symptom onset to arrive at hospital and
receive thrombolysis. RESULTS: South Asian patients were less likely to arrive
by ambulance (age and sex adjusted odds ratio 0.64, 95% CI 0.60 to 0.69,
p<0.001) regardless of admission diagnosis. Overall, they were more likely to
receive thrombolysis (adjusted multivariable odds ratio 1.19, 95% CI 1.10 to 1.30,
p<0.001) and the difference was more marked if they had non-specific ECG
changes for heart disease rather than definite evidence of a myocardial infarction.
There was no evidence of an important clinical delay in South Asians receiving
thrombolysis after arrival at hospital. CONCLUSIONS: There are ethnic
differences in healthcare-seeking behaviour and the way doctors manage South
Asians with chest pain. The relative underuse of ambulances by South Asians
may either reflect cultural differences or geographical proximity to hospitals.
Doctors may have a lower threshold for giving thrombolytic therapy to South
Asian men with chest pain possibly because they are aware of the increased risk
of coronary heart disease in this population.
359: Circ J. 2007 Jul;71(7):1128-30.
Price disparity of percutaneous coronary intervention devices in

Japan and the United States in 2006.
Yasunaga H, Ide H, Imamura T, Ohe K.
Department of Planning, Information and Management, University of Tokyo

Hospital, Tokyo, Japan. yasunagah-jyo@h.u-tokyo.ac.jp
BACKGROUND: The price disparity between Japan and foreign countries for
medical devices is a controversial issue. Price differences existed between Japan
and USA for various medical devices in early 2005, so in the present study, a
more precise and detailed investigation of the latest market prices of medical
devices between Japan and USA was conducted in 2006, focusing on coronary
stents and percutaneous transluminal coronary angioplasty (PTCA) catheters, for
an evaluation of the efficacy of current Japanese policies. METHODS AND
RESULTS: Japanese market prices were obtained from 31 university hospitals,
and US market prices were obtained from 1 hospital chain and 2 group-
purchasing organizations. The price ratio (Japanese market price/US market price)
was determined to be 1.2-1.4 for drug-eluting stents (DES), 1.6-2.4 for non-DES,
and 4.1-5.1 for PTCA catheters. CONCLUSIONS: Results showed that the price
disparity was relatively small for DES, but still significant for non-DES and
PTCA catheters. Radical measures must be taken to improve the fundamental
causes of price disparity and might include reviewing the implementation of the
Japanese Pharmaceutical Affairs Law, abolishing the reimbursement price system
for medical devices, and establishing centers of clinical excellence.
Publication Types:
360: Circ J. 2007 Jul;71(7):1004-12.
Characterization of outpatients with systolic dysfunction in a

Japanese community by total enumeration.
Okura Y, Ohno Y, Suzuki K, Taneda K, Ramadan MM, Mitsuma W,

Tanaka K, Kashimura T, Ito M, Ishizuka O, Kato K, Hanawa H, Honda Y,
Kodama M, Aizawa Y.
Division of Cardiology, First Department of Internal Medicine, Niigata University

Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan.
okuray@med.niigata-u.ac.jp
BACKGROUND: The prevalence of congestive heart failure (CHF) is increasing

with the aging of the community. Management of patients with systolic
dysfunction (SD) is important for prevention of CHF, but there is little
information regarding the burden of SD on Japanese communities. METHODS
AND RESULTS: In order to delineate the epidemiological and clinical
characteristics of SD patients, the medical records of patients from Sado Island
were collected and summarized in 2003. From the 5 years prior to 2003, data for
497 patients were extracted. The mortality rate was significantly higher compared
with the general population; and the total number of survivors had decreased to
410 by 2003. The proportion of SD patients in the general population increased
sharply after the age of 65 years in males and 70 years in females, reaching 3.3%
and 1.7% for men and women, respectively, in their 80 s. In 49% of the patients,
the Charlson comorbidity index was > or = 2, whereas 24% of females led a
solitary life. CONCLUSIONS: The total count of outpatients with SD is
progressively increasing with age. These patients have multiple comorbidities,
making the outcome of SD a poor one. The gender difference in disease
characteristics and living conditions should be taken into consideration when
establishing preventive strategies for CHF in Japanese communities.
Publication Types:
361: Circ J. 2007 Jul;71(7):995-1003.
Prevalence, awareness and treatment of cardiovascular risk factors

in patients at high risk of atherothrombosis in Japan.
Yamazaki T, Goto S, Shigematsu H, Shimada K, Uchiyama S, Nagai R,

Yamada N, Matsumoto M, Origasa H, Bhatt DL, Steg PG, Ikeda Y; REACH
Registry Investigators.
Department of Clinical Epidemiology and Systems, Graduate School of Medicine,

University of Tokyo, Tokyo, Japan. yama-tky@umin.ac.jp
BACKGROUND: The REduction of Atherothrombosis for Continued Health

(REACH) Registry is an international observational study of patients with, or at
risk of, atherothrombotic disease. Japanese patients were analyzed to clarify
national prevalence and treatment. METHODS AND RESULTS: Almost 68,000
outpatients were recruited worldwide with 5,193 in Japan. Among the Japanese
patients, 83.7% had established vascular disease (symptomatic) and 16.3% had
risk factors only (asymptomatic). Of the symptomatic patients, 14.0% had
atherothrombotic lesions in more than 1 vascular bed, with 0.8% having lesions in
3 areas: brain, heart, and peripheral arteries. The prevalence of additional
atherothrombotic risk factors among symptomatic patients was independent of the
vascular lesion. Obesity was recorded in 10.6% and 42.1% of patients according
to the National Cholesterol Education Program and Japanese guidelines,
respectively. Pharmacologic intervention for risk factors was inadequate: only
37.7% of diabetic patients received antidiabetic medication, 79.6% of
hypertensive patients used antihypertensives, and 74.0% received antiplatelet
agents. The use of statins (44.1%) and aspirin (54.7%) was less common than
seen in REACH globally. CONCLUSIONS: Japanese patients enrolled in
REACH share many similarities with the global population, but with some
important differences. Long-term follow-up will determine the impact of these
factors on the development of atherothrombotic events.
Publication Types:

362: J Clin Nurs. 2007 Jul;16(7B):234-42.
Nurses' perceived and actual level of diabetes mellitus knowledge:

results of a cluster analysis.
Chan MF, Zang YL.
School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon,

Hong Kong SAR, China. hsmfchan@inet.polyu.edu.hk
AIMS: Nurses' perceived and actual diabetes knowledge was explored by

identifying profiles of nurses working in two hospitals in Hong Kong.
Relationships between nurses' perceived and actual diabetes knowledge are
explored. BACKGROUND: In non-specialist clinical settings in Hong Kong,
nurses provide diabetes self-management education to patients, therefore, nurse's
knowledge and skill in giving diabetes care is very important. Though patients'
perceptions are important, if patients solely select and set their own priorities for
learning about and managing diabetes, their care could be compromised by
knowledge deficits. METHOD: A descriptive correlational survey was conducted
during the period September 2004 to July 2005 in two local hospitals in Hong
Kong. 245 nurses completed a structured questionnaire. Nurses' demographic
data, competence, perceived and actual diabetes mellitus knowledge were
collected. RESULTS: Two-step cluster analysis yielded three clusters: Cluster 1
nurses were characterized by relatively good competence and high diabetes
knowledge than nurses in Clusters 2 and 3. Cluster 3 nurses reported low
competence and diabetes knowledge than nurses in Clusters 1 and 2. Cluster 2
was a large group of nurses holding both positive and moderate competence and
diabetes knowledge. Statistically significant differences were found between
clusters. Overall, nurses' perceived diabetes knowledge was statistically
significant correlated with actual knowledge (r(s) = 0.32). CONCLUSIONS:
Nurses have the responsibility to educate patients with correct and updated
information, therefore, knowledge should be provided and maintained to a certain
standard. RELEVANCE TO CLINICAL PRACTICE: Lack of knowledge among
nursing staff has contributed to diabetes patients receiving inadequate health care
instruction. As indicated by the results of this study, 'tailor-made' educational
programmes should be designed to meet the learning needs of each subgroup.
Expertise and nurse education should be recognized when such educational
programmes are designed.
Publication Types:
363: J Clin Nurs. 2007 Jul;16(7):1367-73.
Effect of the diabetes outpatient intensive management programme

on glycaemic control for type 2 diabetic patients.
Song MS, Kim HS.
Department of Nursing, Dongham Health College, Suwon, Korea.
AIM: The purpose of this study was to examine the effect of the diabetes
outpatient intensive management programme (DOIMP) on glycaemic control over
a 12 week follow-up period for type 2 diabetic patients in Korea.
BACKGROUND: Diabetic complications can be prevented if the glycaemic
status of diabetes patients is maintained within a nearly normal range. Patient
education is critical in controlling blood glucose levels of patients with diabetes
within the optimal range. METHODS: DOIMP was composed of
multidisciplinary education, complication monitoring and telephone counselling.
Twenty-five patients in the intervention group participated in the DOIMP and 24
patients in the control group were briefed on the conventional description of
diabetes mellitus by diabetes education nurses. RESULTS: Patients in the
intervention group had a mean decrease of 2.3%, which those in the control group
having a mean decrease 0.4% in glycosylated haemoglobin (HbA(1)c). There was
no difference between the two groups in the change in fasting blood glucose
(FBG) and two-hour postprandial blood glucose (2-h PBG). The proportion of the
patients with HbA(1)c <7% was higher in the intervention group than in the
control group at the post-test compare with the pretest. CONCLUSION: DOIMP
can reduce HbA(1)c in type 2 diabetes patients. RELEVANCE TO CLINICAL
PRACTICE: These findings indicated that DOIMP could be effective in
glycaemic control in type 2 diabetes patients.
Publication Types:

364: J Clin Nurs. 2007 Jul;16(7):1353-60.
Effects of the diabetic patients' perceived social support on their

quality-of-life.
Göz F, Karaoz S, Goz M, Ekiz S, Cetin I.
Dicle Universitesi, Diyarbakir Atatürk Sağlik Yüksek Okulu, Diyarbakir, Turkey.

fugengoz@dicle.edu.tr
AIM: The aim of this descriptive study was to determine effects of the diabetic
patients' perceived social support on theirs life qualities. BACKGROUND: Type
2 diabetes and its treatment effects patients' quality of life. Quality-of-life is
important for people with diabetes and their health care providers. Social support
for diabetic adults has been shown to benefit disease management and adjustment.
RESEARCH DESIGN: This research was conducted with 66 type 2 diabetic
patients who came for control to the diabetes policlinic between May and June
2003 at diabetes polyclinic in Kocaeli State Hospital of Marmara Region in
Turkey. Informed consent was obtained from patients. Data were collected by
using the quality-of-life scale (SF-36), perceptional social support scale and the
questionnaire prepared by the researchers. METHOD: For the analysis of data,
Mann-Whitney U-test, Kruskal-Wallis test, Pearson and Spearman correlation
analysis have been employed. RESULTS: Perceived social support and quality-
of-life were increased together. Male patients' and retired patients' quality life
score and perceived social support were high. Meanwhile when educational level
was increased, perceived social support and quality-of-life were increased. The
quality life scores and perceived social support scores were high in patients who
living alone and used oral antidiabetic drugs. CONCLUSIONS: If perceived
social support and quality-of-life were increased together, it means social support
increases quality-of-life. That is why nurses must try to plan some strategies for
increase social support of patients. RELEVANCE TO CLINICAL PRACTICE:
Assessment of social support of type 2 diabetic patients may assist in determining
individualized goals and strategies. Enhanced social support in diabetes self-
management may subsequently improve metabolic control, self-management and
psychosocial adjustment to diabetes.
365: J Clin Nurs. 2007 Jul;16(7):1302-12.

Comment in:
• J Clin Nurs. 2008 Jun;17(11):1530-1.
An RCT of adherence therapy for people with schizophrenia in

Chiang Mai, Thailand.
Maneesakorn S, Robson D, Gournay K, Gray R.
Institute of Psychiatry, King's College London, London, UK.
AIM: The aim of this paper was to evaluate the effectiveness of adherence
therapy-a brief intervention based on compliance therapy and motivational
interviewing techniques-in a sample of people with schizophrenia in Thailand.
BACKGROUND: Poor adherence is problematic, but knowledge about how to
improve medication adherence is limited. Studies focusing on the effects of
interventions used to improve adherence have produced inconsistent outcomes
and have been mainly conducted in western countries. METHODS: An
exploratory single blind randomized controlled trial was conducted in Chiang
Mai, Thailand. Thirty-two patients with schizophrenia were randomly allocated to
receive eight weekly sessions of adherence therapy or continue with their
treatment as usual. Patients were assessed at baseline and after nine weeks. The
primary outcome was overall psychotic symptoms. Secondary outcomes were
general functioning, attitude towards and satisfaction with antipsychotic
medication and medication side effects. RESULTS: The findings of this study
indicated that patients who received adherence therapy significantly improved in
overall psychotic symptoms, attitude towards and satisfaction with medication
compared with treatment as usual but no significant difference was found in
general functioning or side effects compared with treatment as usual.
RELEVANCE TO CLINICAL PRACTICE: Adherence therapy has a positive
impact on patients' psychiatric symptoms, attitude towards and satisfaction with
medication. Nurses can effectively deliver adherence therapy following intensive
training.
Publication Types:

366: J UOEH. 2007 Jun 1;29(2):169-81.
[An investigation of factors affecting job satisfaction among

psychiatric nurses--focussed on stress-coping and a character
tendency]
Kubo Y, Nagamatsu Y, Takeyama Y, Anan A, Kawamoto R, Kanayama M,

Murase C.
Department of Clinical Nursing II, School of Health Sciences, University of

Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555,
Japan.
The relation between stress, stress coping behavior and job satisfaction was
investigated for psychiatric nurses who work in the northern part of Kyushu and
the Chugoku district of Japan. As a result, the people with high job satisfaction
had a tendency for the stress coping ability to be high, the daily stress of the
people with low job satisfaction was high, and a relation with the character which
is the individual characteristic was also seen. In the relation between stress
management factor and job satisfaction, those who can have change of action by a
hobby, amusement, etc., those with a strong tolerance to stress and the people
with social support showed a tendency for job satisfaction to be high. The people
especially with a high degree of satisfaction with their professional status showed
the tendency for the stress management factor to be high. On the contrary, the
people with a high stressor of daily hassles showed the tendency for job
satisfaction to be low. Moreover, anger, nervousness and the people with a
tendency to take a Type A action pattern showed the tendency for job satisfaction
to be low. From these findings, it is suggested that a stressor or not only coping
behavior but character tendency is related to job satisfaction.
Publication Types:
367: Biomed Instrum Technol. 2007 May-Jun;41(3):208-10.

Educating clinical personnel--it begins with the BMET.
Shah AV, Hamid A.
Commission for the Advancement of Healthcare Technology Management in

Asia.
368: Clin Infect Dis. 2007 Jul 15;45(2):241-9. Epub 2007 Jun 4.
Comment in:
• Clin Infect Dis. 2007 Jul 15;45(2):250-3.
Postpartum tuberculosis incidence and mortality among HIV-

infected women and their infants in Pune, India, 2002-2005.
Gupta A, Nayak U, Ram M, Bhosale R, Patil S, Basavraj A, Kakrani A,

Philip S, Desai D, Sastry J, Bollinger RC; Byramjee Jeejeebhoy Medical
College-Johns Hopkins University Study Group.
Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore,

MD 21287, USA. agupta25@jhmi.edu
BACKGROUND: In contrast with many other countries, isoniazid preventative

therapy is not recommended in clinical care guidelines for human
immunodeficiency virus (HIV)-infected persons with latent tuberculosis (TB) in
India. METHODS: Seven hundred fifteen HIV-infected mothers and their infants
were prospectively followed up for 1 year after delivery at a public hospital in
Pune, India. Women were evaluated for active TB during regular clinic visits, and
tuberculin skin tests were performed. World Health Organization definitions for
confirmed, probable, and presumed TB were used. Poisson regression was
performed to determine correlates of incident TB, and adjusted probabilities of
mortality were calculated. RESULTS: Twenty-four of 715 HIV-infected women
who were followed up for 480 postpartum person-years developed TB, yielding a
TB incidence of 5.0 cases per 100 person-years (95% confidence interval [CI],
3.2-7.4 cases per 100 person-years). Predictors of incident TB included a baseline
CD4 cell count <200 cells/mm(3) (adjusted incident rate ratio [IRR], 7.58; 95%
CI, 3.07-18.71), an HIV load >50,000 copies/mL (adjusted IRR, 3.92; 95% CI,
1.69-9.11), and a positive tuberculin skin test result (adjusted IRR, 3.08; 95% CI,
1.27-7.47). Three (12.5%) of 24 women with TB died, compared with 7 (1.0%) of
691 women without TB (IRR, 12.2; 95% CI, 2.03-53.33). Among 23 viable
infants with mothers with TB, 2 received a diagnosis of TB. Four infants with
mothers with TB died, compared with 28 infants with mothers without TB (IRR,
4.71; 95% CI, 1.19-13.57). Women with incident TB and their infants had a 2.2-
and 3.4-fold increased probability of death, respectively, compared with women
without active TB and their infants, controlling for factors independently
associated with mortality (adjusted IRR, 2.2 [95% CI, 0.6-3.8] and 3.4 [95% CI,
1.22-10.59], respectively). CONCLUSIONS: Among Indian HIV-infected
women, we found a high incidence of postpartum TB and associated postpartum
maternal and infant death. Active screening and targeted use of isoniazid
preventative therapy among HIV-infected women in India should be considered to
prevent postpartum maternal TB and associated mother-to-child morbidity and
mortality.
Publication Types:
• Clinical Trial, Phase III

369: Disabil Rehabil. 2007 Jun 15-30;29(11-12):935-48.
Evaluation of CIR-whirlwind wheelchair and service provision in

Afghanistan.
Armstrong W, Reisinger KD, Smith WK.
Center for International Rehabilitation, Chicago, Illinois 60611, USA.

engineeringsupport@cirnetwork.org
PURPOSE: The Center for International Rehabilitation (CIR) developed a

wheelchair provision strategy that combines central fabrication with regional
distribution and local service provision by trained practitioners. A field study was
initiated in Kabul, Afghanistan to evaluate this plan. METHOD: The CIR-
Whirlwind Wheelchair (study wheelchair) is an adult size, manual wheelchair
designed to be adjustable to accommodate the individual user and durable to
withstand rugged terrain. Manufactured in India, the study wheelchairs, with seat
cushions, were packaged as kits and shipped to Afghanistan. Local practitioners
in Kabul were trained on user assessment, fitting and training, and wheelchair
assembly, maintenance and repair. One hundred subjects with previous
experience of independently propelling a manual wheelchair participated in the
study. This 4-month study entailed three subject visits for initial wheelchair fitting
and training and then follow-up at 3 and 10 weeks. Subject training included
wheelchair use and maintenance, and wheelchair skill activities. RESULTS: The
study wheelchair was rated favorably by the subjects in all of five categories.
Adjustments made to the wheelchairs during the study were typical for
maintaining or improving the fit or function of a manual wheelchair. With the
exception of brake handles, the need to repair or replace components on the
wheelchairs was minimal. The subjects' proficiency at wheelchair skill activities
increased throughout the study. CONCLUSIONS: Data collected indicates that
the study wheelchair performed very well. The data also served to identify those
aspects of the wheelchair that may require additional development and testing
prior to further production. To gain additional information on long term
wheelchair use and performance, the CIR plans to extend this study by
interviewing the same subjects at nine and fifteen months from the date they
originally received the study wheelchair.
Publication Types:
• Clinical Trial
370: BMC Health Serv Res. 2007 Jun 19;7:90.
Integration in primary community care networks (PCCNs):

examination of governance, clinical, marketing, financial, and
information infrastructures in a national demonstration project in
Taiwan.
Lin BY.
Institute of Health Service Administration, China Medical University, Taiwan.

yenju1115@hotmail.com
BACKGROUND: Taiwan's primary community care network (PCCN)

demonstration project, funded by the Bureau of National Health Insurance on
March 2003, was established to discourage hospital shopping behavior of people
and drive the traditional fragmented health care providers into cooperate care
models. Between 2003 and 2005, 268 PCCNs were established. This study
profiled the individual members in the PCCNs to study the nature and extent to
which their network infrastructures have been integrated among the members
(clinics and hospitals) within individual PCCNs. METHODS: The thorough
questionnaire items, covering the network working infrastructures--governance,
clinical, marketing, financial, and information integration in PCCNs, were
developed with validity and reliability confirmed. One thousand five hundred and
fifty-seven clinics that had belonged to PCCNs for more than one year, based on
the 2003-2005 Taiwan Primary Community Care Network List, were surveyed by
mail. Nine hundred and twenty-eight clinic members responded to the surveys
giving a 59.6 % response rate. RESULTS: Overall, the PCCNs' members had
higher involvement in the governance infrastructure, which was usually viewed as
the most important for establishment of core values in PCCNs' organization
design and management at the early integration stage. In addition, it found that
there existed a higher extent of integration of clinical, marketing, and information
infrastructures among the hospital-clinic member relationship than those among
clinic members within individual PCCNs. The financial infrastructure was shown
the least integrated relative to other functional infrastructures at the early stage of
PCCN formation. CONCLUSION: There was still room for better integrated
partnerships, as evidenced by the great variety of relationships and differences in
extent of integration in this study. In addition to provide how the network
members have done for their initial work at the early stage of network forming in
this study, the detailed surveyed items, the concepts proposed by the managerial
and theoretical professionals, could be a guide for those health care providers who
have willingness to turn their business into multi-organizations.
Publication Types:
PMCID: PMC1931593
371: J Prev Med Pub Health. 2007 May;40(3):249-58.
[Antihypertensive drug medication adherence of people with

disabilities and its affecting factors in Korea]
[Article in Korean]
Park JH, Shin Y, Lee SY, Park JH.
National Cancer Center, Department of Health Policy and Management, Seoul

National University College of Medicine, Korea.
OBJECTIVES: The aims of this study were to estimate the antihypertensive

medication adherence in people with a disability and a history of taking
antihypertensive medication, and to identify the factors affecting medication
adherence. METHODS: The National Health Insurance claims data were linked
with the National Disability Registry. People with a disability, who received a
prescription of antihypertensives, were identified from a total of 85,098 cases.
Cumulative medication adherence (CMA) was used as an indicator of medication
adherence. A CMA>80% was defined as appropriate medication adherence.
Multiple logistic regression analysis was used to identify the factors affecting
medication adherence. RESULTS: The average CMA in a total of 85,098 patients
was 79.5%. The appropriate adherence (CMA>or=80%) rate was 54.5% and
20.5% of patients had a CMA<50%. Multiple logistic regression analysis revealed
that the probability of appropriate adherence decreased with decreasing number of
prescription days per visit, increasing number of providers, the patients'
residential area moving from urban to rural areas, and when patients have an
internal organ disability, auditory impairment, mobility impairment.
CONCLUSIONS: The adherence to antihypertensive medication in people with a
disability is influenced by various socio-economic, clinical and regional factors.
In particular, the disabled who have locomotive and communication disabilities
and internal organ impairments have a higher probability of under-adherence to
antihypertensive medication adherence in Korea.
Publication Types:
372: J Contin Educ Health Prof. 2007 Spring;27(2):105-10.
Integrating hospital-acquired lessons into community health

practice: optimizing antimicrobial use in Bangalore.
Biswas R, Dineshan V, Narasimhamurthy NS, Kasthuri AS.

Department of Medicine, Vydehi Institute of Medical Sciences and Research
Centre, Whitefield, Bangalore, India. rakesh7biswas@gmail.com
INTRODUCTION: Even as antimicrobial resistance is a serious public health

concern worldwide, the uncertainties of diagnosis and treatment of fever strongly
influence community practitioners toward prescribing antibiotics. To help
community practitioners resolve their diagnostic questions and reduce the
unnecessary use of antibiotics for viral fevers, thus helping to contain antibiotic
resistance, we suggest fever-charting and monitoring fever patterns for two days.
METHODS: This was a qualitative study, with relevant quantitative descriptions.
Patients presenting with recent onset fever to the Vydehi Institute of Medical
Sciences (VIMS) and Research Centre, Bangalore, India, were monitored with
simple fever charting and managed based on their fever patterns for two days.
Initially only antipyretics were given in optimal doses; if the fever showed a
continuous pattern suggestive of septicemia, antibiotics were instituted for
typhoid, the commonest organism to cause sepsis in a community setting short of
pointers to other causes. The different clinical profiles of these patients of viral
and enteric fevers were circulated among the community practitioners, and an
assessment of their approach was made. Finally, it was revealed to the
practitioners how successful management of the patient was possible without
antibiotics. RESULTS: During the study period, 4289 patients presented to
VIMS. The antibiotic prescribing rate when given the clinical profiles of true
patients with viral fevers was high among community practitioners. Community
practitioners agreed that in a controlled hospital setting, the results could be
spectacular, but the challenges were different in community practice. There was
an initial reluctance to use fever charting due to fear of patient noncompliance.
DISCUSSION: Fever charting can be an invaluable means to help differentiate
viral and enteric fevers and thus help reduce unnecessary antibiotic prescriptions
for viral fevers.
373: J R Army Med Corps. 2007 Mar;153(1):44-51.
Reflections on medical aspects of ISAF IX in Afghanistan.
Bricknell MC.
Headquarters Allied Rapid Reaction Corps, BFPO 40. martin@bricknell.net
This paper is a personal review of my experience as the Medical Adviser in the

NATO Headquarters of International Assistance Force (ISAF) in Afghanistan
from August 2006 to February 2007. It is in 5 sections, medical plans and
operations, clinical issues, supporting the Afghan Security Forces Medical
Services, supporting Health Sector Reconstruction and Development and
preventive medicine. It concludes with a short summary of personal lessons.
374: PLoS Med. 2007 Jun;4(6):e191.
Comment in:
• PLoS Med. 2007 Jun;4(6):e216.
Ethnic disparities in diabetes management and pay-for-performance

in the UK: the Wandsworth Prospective Diabetes Study.
Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A.
Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust,

London, United Kingdom. c.millett@imperial.ac.uk
BACKGROUND: Pay-for-performance rewards health-care providers by paying

them more if they succeed in meeting performance targets. A new contract for
general practitioners in the United Kingdom represents the most radical shift
towards pay-for-performance seen in any health-care system. The contract
provides an important opportunity to address disparities in chronic disease
management between ethnic and socioeconomic groups. We examined disparities
in management of people with diabetes and intermediate clinical outcomes within
a multiethnic population in primary care before and after the introduction of the
new contract in April 2004. METHODS AND FINDINGS: We conducted a
population-based longitudinal survey, using electronic general practice records, in
an ethnically diverse part of southwest London. Outcome measures were
prescribing levels and achievement of national treatment targets (HbA1c < or =
7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or
193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP,
and total cholesterol increased significantly after the implementation of the new
contract. The extents of these increases were broadly uniform across ethnic
groups, with the exception of the black Caribbean patient group, which had a
significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95%
confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81)
relative to the white British patient group. Variations in prescribing and
achievement of treatment targets between ethnic groups present in 2003 were not
attenuated in 2005. CONCLUSIONS: Pay-for-performance incentives have not
addressed disparities in the management and control of diabetes between ethnic
groups. Quality improvement initiatives must place greater emphasis on minority
communities to avoid continued disparities in mortality from cardiovascular
disease and the other major complications of diabetes.
Publication Types:
PMCID: PMC1891316
375: J Nurs Care Qual. 2007 Jul-Sep;22(3):266-71.
Inpatient satisfaction with nursing care and factors influencing

satisfaction in a teaching hospital in China.
Liu Y, Wang G.
Department of Nursing, Union Hospital of Tongji Medical College, Huazhong

University of Science and Technology, Wuhan, China. yilanl@yahoo.com
This study examined inpatient satisfaction with nursing care in a teaching hospital
in China. Patient satisfaction with nursing care was assessed by a self-designed
questionnaire administered to 320 inpatients selected by a convenience sampling
method. The patients had a relatively high level of satisfaction with nursing care.
Patients' age, educational background, occupation, methods of payment, and
hospital wards were main factors influencing their satisfaction with nursing care.
The study provides a new tool for measuring patient satisfaction with nursing care
in China.
Publication Types:

376: Pharm World Sci. 2008 Jan;30(1):24-30. Epub 2007 Jun 12.
Self-medication patterns in Amman, Jordan.
Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M.
Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy,

University of Jordan, Amman 11942, Jordan. ayousef@ju.edu.jo
OBJECTIVE: The classification of medicine as Prescription-Only-Medicine

(POM) and Over-The-Counter (OTC) drugs in Jordan is present but not yet
enforced on community pharmacies, the fact that allows access of the public to a
wider range of medications that otherwise are provided only on prescription. This,
of course, has its implications on safety and effectiveness of the pharmacotherapy
in question. This research aims to establish a baseline data concerning the extent
of self-medication among Jordanians, and to assess possible factors associated
with self-medication, so that future interventions can be documented and planned.
SETTING: A total of 155 out of Amman's 900 community pharmacies.
METHODS: A cross-sectional observational study using a pre-piloted
questionnaire was conducted. Over 800 customers who visited the pharmacies
over a period of 4 months were interviewed and their non-prescription drug
requests patterns were recorded to assess the prevalence of self-medication and
offered justification. RESULTS: Self-medication was a common practice among
Jordanians (42.5%). The variable that was associated with extent of self-
medication was respondents' age, where patients younger than 16 years and those
older than 60 years were less likely to self-treat. The most common reasons for
self-medication were that the ailments were too minor to see a doctor (46.4%), the
long waiting time to be seen by doctors (37.7%) and avoiding the cost of doctors'
visits (31.4%). People tended to select medication based on advice received from
pharmacy staff (14.2%), friends/neighbors (17.6%) or informal advice from other
health professionals like dentists and nurses (21.9%). Alternatively, patients
selected products based on their previous experiences with similar symptoms
(27%) or similar diseases (33.5%). CONCLUSIONS: Self-medication is a
common health care practice in Jordan, where people are becoming increasingly
familiar with drugs and their brand names. Self-medication behavior varied
significantly with a number of socio-economic factors. Unfortunately, only a
small percentage of patients engaged pharmacy personnel in therapeutic
consultations beyond briefly mentioning a symptom.
Publication Types:

377: Indian J Dermatol Venereol Leprol. 2007 May-Jun;73(3):176-8.
Chromoblastomycosis in Nepal: a study of 13 cases.
Pradhan SV, Talwar OP, Ghosh A, Swami RM, Shiva Raj KC, Gupta S.
Department of Pathology, Manipal College of Medical Science and Manipal

Teaching Hospital, Pokhara, Nepal. pradhanseema30@yahoo.com
BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by

several pigmented fungi commonly seen in tropical and subtropical climates.
AIM: To evaluate the epidemiologic, clinical and pathological characteristics of
chromoblastomycosis in our patients. METHODS: This retrospective and
prospective study was conducted at the Manipal Teaching Hospital, Pokhara,
Nepal. Clinical features and histopathology of all the cases diagnosed as
chromoblastomycosis during the last eight years were studied. RESULTS: A total
of 13 cases of chromoblastomycosis were diagnosed during the period of 1999-
2006. The disease was seen predominantly in middle-aged male farmers and those
from rural areas. The lesions commonly involved the lower extremity and were
single or multiple in number. They clinically presented as verrucous or nodular
growths. Out of these 13 cases, three were diagnosed clinically as squamous cell
carcinoma and one as psoriasis. The histopathological features included sclerotic
bodies in 12 cases (92%), microabscess formation in 10 cases (76.9%),
pseudoepitheliomatous hyperplasia in nine cases (69.2%) and granuloma in eight
cases (61.5%). CONCLUSION: Farming is the commonest occupation in patients
with chromoblastomycosis. Early histological diagnosis helps in effective
management of the condition.
378: West J Nurs Res. 2008 Feb;30(1):54-72. Epub 2007 Jun 8.
Clinical constructions by nurses in Korea, Norway, and the United

States.
Kim HS, Ellefsen B, Kyung Ja Han , Alves SL.
Buskerud University College, University of Rhode Island, USA.

suziekim@regencydv.com
Nursing practice involves engagement of nurses in clinical fields through

deliberation and enactment. In the phase of deliberation, nurses observe,
recognize, form ideas about and decide on clinical situations, and construct
clinical pictures. Clinical pictures are critically connected to nursing enactments,
thus it is important to discover how nurses arrive at clinical pictures. The purpose
of this article is to describe how nurses construct meanings of clinical situations
and arrive at specific clinical pictures. The results are from a clinical fieldwork
study replicated in Korea, Norway, and the United States, with samples of nurses
working in acute-care hospitals. Data were collected through participant
observations and in-depth interviews. A general model of clinical construction
was derived from the results, which specifies four dimensions (i.e., problem,
progress, status, and particularism) as the bases for clinical picture evocations.
Clinical pictures are constituted by nurses' elicitations of meanings of clinical
situations on these dimensions.
Publication Types:
379: Arch Psychiatr Nurs. 2007 Jun;21(3):132-40.
Effects of a bereavement intervention program in middle-aged

widows in Korea.
Kang HY, Yoo YS.
Christian College of Nursing, Nam-gu, Gwangju, South Korea.

moohykang@naver.com
Dan-jeon is a meditative practice composed of both breathing and stretching

exercises causing life energies to circulate blood throughout the body. Following
a bereavement intervention program composed of Dan-jeon breathing sessions, a
self-help group activity, and a health check, an experimental group showed
significantly greater decrements in grief levels and symptoms of stress over a
control group who received only a health check. Among the participants, there
were no significant differences in immune response, percentages of T
lymphocytes, helper T lymphocytes (Th), suppressor T lymphocytes (Ts), B
lymphocytes, natural killer cells, monocytes, and Th:Ts ratios.
Publication Types:
380: BMC Infect Dis. 2007 Jun 6;7:54.
Imported Crimean-Congo hemorrhagic fever cases in Istanbul.
Midilli K, Gargili A, Ergonul O, Sengöz G, Ozturk R, Bakar M, Jongejan F.
Istanbul University, Cerrahpaşa Medical Faculty, Microbiology and Clinical

Microbiology Department, Istanbul. kmidilli@istanbul.edu.tr
<kmidilli@istanbul.edu.tr>
We described a series of imported cases of Crimean-Congo Hemorrhagic Fever

(CCHF) in Istanbul and investigated the genetic diversity of the virus. All the
suspected cases of CCHF, who were applied to the health centers in Istanbul,
were screened for CCHF virus (CCHFv) infection by using semi-nested
Polymerase Chain Reaction (PCR) following RT-PCR. Simultaneous blood
samples were also sent to the national reference laboratory in Ankara for serologic
investigation. In 10 out of 91 patients, CCHFv was detected by PCR, and among
9 out of 10, anti-CCHFv IgM antibodies were also positive. Clinical features were
characterized by fever, myalgia, and hemorrhage. The levels of liver enzymes,
creatinine phosphokinase, and lactate dehydrogenase were elevated, and bleeding
markers were prolonged. All the cases were treated with ribavirin. There was no
fatal case. All the strains clustered within the same group as other Europe/Turkey
isolates.
PMCID: PMC1905914
381: J Nurs Res. 2007 Jun;15(2):117-26.

An oral historical study of the development of the discipline of

military nursing in Taiwan from 1948 to 1970.
Mu PF, Lin S.
Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan.

peifan@ym.edu.tw
In an attempt to redress the gap in Chinese nursing and military history, this study
aims to provide an understanding of the nature of military nursing development
from 1948 to 1970. The National Defense Medical Center (NDMC) was
established in 1902 and is recognized as the first military medical school in
Chinese history. In 1949, in order to continue her studies, Prof. Fu-I Chao
followed the school, when it moved from mainland China to Taiwan. The school's
move was a result of the defeat on mainland China of the nationalist government
led by Generalissimo Chiang Kai-Shek. The researchers adopted an oral history
approach. This consisted of a literature review, the collection of photographs, a
review of formal documents and four face-to-face in-depth interviews with Prof.
Chao. After data collection, content analysis was performed on the information
collected. The study explored the development of the discipline of military
nursing in its historical, social, and economic context. Four themes emerged.
These were a personal history of experience and growth, the foundation phase of
nursing, the developmental phase of nursing, and the historical developments and
trends in nursing. Prof. Chao's comments reveal how the students missed their
parents and families, the special friendships among them, and the love and care
that they received from Chief Mei-Yu Chow and Director Chih-Teh Loo. Tribute
is paid to their resilience in the face of hardship, and their industry during the
initial development of the nursing profession. The results also provide the
suggestions of creating a history of health-care that privileges new meanings
about military nursing's past and worth.
Publication Types:
• Historical Article
382: Pediatr Endocrinol Rev. 2007 Mar;4(3):237-8.

The 40th Annual Meeting of the Japanese Society for Pediatric
Endocrinology (JSPE), Hamamatsu, Japan, 27-29 September 2006.
Tanaka T.
Department of Clinical Laboratory Medicine, National Center for Child Health

and Development, Tokyo, Japan. tanaka-t@ncchd.go.jp
Publication Types:
• Congresses
383: Ann Acad Med Singapore. 2007 May;36(5):338-42.
Improved median survival for glioblastoma multiforme following

introduction of adjuvant temozolomide chemotherapy.
Back MF, Ang EL, Ng WH, See SJ, Lim CC, Chan SP, Yeo TT.
The Cancer Institute, National University Hospital, Singapore.

mback@nsccahs.health.nsw.gov.au
INTRODUCTION: The use of adjuvant temozolomide (TMZ) in patients

managed with surgery and adjuvant radiation therapy (RT) for glioblastoma
multiforme (GBM) has been demonstrated to improve median and 2-year survival
in a recent large international multicentre study. To confirm this result in routine
clinical practice, an audit of the management and outcome of patients with GBM
at The Cancer Institute Radiation Oncology was performed. MATERIALS AND
METHODS: All patients with GBM managed radically at The Cancer Institute
Radiation Oncology from May 2002 to 2006 were entered into a prospective
database. Patient, tumour and treatment factors were analysed for association with
the outcome of median survival (MS). Survival was calculated using the Kaplan-
Meier technique and correlation was assessed using Cox proportional hazards
regression. RESULTS: Forty-one patients with GBM were managed with radical
intent over the 4- year period. The median age was 54 years and 66% were
Eastern Cooperative Oncology Group (ECOG) 0-1 performance status.
Macroscopic, subtotal and biopsy alone procedures were performed in 61%, 29%
and 10% of patients, respectively. The median time from surgery to RT was 26
days. Adjuvant TMZ was used in 44% of patients (n = 18). The MS of the total
group was 13.6 months, with a 24% 2-year overall survival. The use of TMZ was
associated with improved MS (19.6 versus 12.8 months; P = 0.035) and improved
2-year survival (43% versus 0%). A requirement of dexamethasone dose greater
than 4 mg at the end of RT (P = 0.012) was associated with worse survival, but
there was no association of MS with age, ECOG, tumour size or extent of surgery.
CONCLUSION: The median and 2-year survival outcomes are comparable to the
results of the European Multicentre Study and justify the continued use of TMZ in
routine clinical practice.
384: Hong Kong Med J. 2007 Jun;13(3):221-7.
Delayed presentation and treatment of newly diagnosed pulmonary

tuberculosis patients in Hong Kong.
Leung EC, Leung CC, Tam CM.
TB and Chest Service, Centre of Health Protection, Department of Health, Hong

Kong. eric_leung@dh.gov.hk
OBJECTIVE: To measure patients' and providers' delays in the presentation and

treatment of newly diagnosed pulmonary tuberculosis. DESIGN: Retrospective
study using structured questionnaires. SETTING: Tuberculosis and Chest Service,
Centre of Health Protection, Department of Health. PARTICIPANTS:
Tuberculosis patients notified to the Department of Health, selected by systematic
sampling of all notifications in the first 2 weeks of every even month in the year
2004. MAIN OUTCOME MEASURES: Health-seeking behaviour of pulmonary
tuberculosis patients, including respective demographic, clinical, and disease
factors. RESULTS: Of a total of 6262 notified tuberculosis patients in 2004, 1662
(26.5%) were recruited into the study; of these, 42.6% first presented to private
doctors, and 57.4% to the public sector. The diagnosis of tuberculosis was made
in 13.7% of these patients by the former and 86.3% by the latter. The median
patient delay (elapsed time from symptoms to medical consultation) and provider
delay (elapsed time from medical consultation to treatment) were both 20 days;
25th to 75th percentiles being 7-37 and 6-55 days, respectively. Longer patient
delay was associated with positive sputum smear and culture, and more extensive
radiological disease. On multiple regression analysis, unemployment
independently predicted longer patient delay, while haemoptysis predicted shorter
patient and total delay. Patients older than 60 years, with no initial sputum and
chest X-ray examination predicted longer provider and total delays.
CONCLUSIONS: Our patient and provider delays compared favourably with
those of other countries, and very likely reflect easy service access. Adverse
social factors and non-specific presentations prolong patient delay, whilst older
age and unavailable bacteriological/radiological evidence delay diagnosis and
treatment.
385: BMC Public Health. 2007 Jun 5;7(147):96.
How do nurses and teachers perform breast self-examination: are

they reliable sources of information?
Demirkiran F, Balkaya NA, Memis S, Turk G, Ozvurmaz S, Tuncyurek P.
Psychiatric Nursing, Adnan Menderes University School of Health, Genclik Cad,

No:7, Aydin, Turkey. demkr_fat@yahoo.com
BACKGROUND: Breast cancer is the most common cause of cancer-related

deaths among women worldwide. The aim of the present study was to determine
and compare knowledge, behavior and attitudes among female nurses and
teachers concerning breast self-examination (BSE). METHODS: Two-hundred
and eighty nine women working in Aydin, Turkey (125 nurses and 164 teachers)
were included in the study. The data were collected using a questionnaire
designed to measure the knowledge, attitudes and behavior of the groups.
Analysis involved percentiles, chi2 tests, t tests and factor analysis. RESULTS:
The knowledge of nurses about BSE was higher than that of teachers (81.5%
versus 45.1%; p < 0.001). BSE practice parameters (i.e. age groups, indications,
frequency) were similar (p > 0.05), whereas skills in performing self-examination
were higher in nurses (p < 0.001). Fear of having breast cancer is the most
frequent reason for performing BSE. Among nurses, the reasons for failure to
perform BSE were the absence of prominent breast problems (82%) and
forgetting (56.4%). The teachers who did not perform BSE said that the reasons
were lack of knowledge on how to perform self-examination (68.9%) and absence
of problems (54%). Both groups had unacceptable technical errors in the
performance of BSE. CONCLUSION: We conclude that nurses and teachers
should be supported with information enabling them to accomplish their roles in
the community. To improve BSE practice, it is crucial to coordinate continuous
and planned education.
Publication Types:
PMCID: PMC1904443
386: East Mediterr Health J. 2007 Jan-Feb;13(1):160-7.
Internists in training; what do they know about inhalers?
Alamoudi OS, Al-Mohammadi R.
Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi

Arabia. dramoudi@yahoo.com
The study tested the knowledge of internal medicine residents in recognizing the
types and demonstrating the ways of using 6 different inhalers. Of the residents
61%, 49%, 78% and 90% were unable to recognize commonly used devices (a
metered dose inhaler, Turbuhaler, Diskus and Diskhaler respectively), while 24%,
53%, 81% and 93% were unable to demonstrate the correct the ways of using
them. None of the residents (0%) were able to recognize or to demonstrate the use
of Rotahaler and Aerolizer correctly. None of them had received any formal
education about the use of the inhalers during their training, while only 2% had
attended sessions with medical educators.
387: Birth. 2007 Jun;34(2):123-30.
Effect of delivery method and timing of breastfeeding initiation on

breastfeeding outcomes in Taiwan.
Chien LY, Tai CJ.
Institute of Clinical and Community Health Nursing, National Yang-Ming

University, and Department of Traditional Chinese Medicine, Taipei Medical
University Hospital, Taiwan.
BACKGROUND: Few studies have examined the independent effect of delivery

method and timing of breastfeeding initiation on the prevalence of breastfeeding.
The objectives of this study were to examine the effect of method of delivery and
timing of breastfeeding initiation on the prevalence of breastfeeding at 1 and 3
months after delivery using a national sample from Taiwan. METHODS: The
study population of 2,064 women who gave birth to infants without congenital
anomalies at hospitals in Taiwan from June through October 2003, inclusively,
participated in a postal questionnaire survey. RESULTS: Multivariate ordinal
logistic regression analysis showed that women with cesarean delivery had a
lower odds of breastfeeding at 1 and 3 months after delivery. Women with
assisted vaginal delivery had lower odds of breastfeeding at 3 months after
delivery compared with women with unassisted vaginal delivery. Initiation of
breastfeeding within 30 minutes of delivery was associated with higher odds of
breastfeeding at 1 and 3 months after delivery. Women who did not initiate
breastfeeding during hospital stay but breastfed at 1 month after delivery had
lower odds of breastfeeding at 3 months after delivery. CONCLUSIONS: The
findings suggest the importance of conservative use of operative obstetrical
intervention due to its negative impact on breastfeeding. Health professionals
need to support mothers who have experienced cesarean and assisted vaginal
delivery to increase their breastfeeding. Hospital staff should improve practice
with respect to early initiation of breastfeeding.
Publication Types:
388: Int J Clin Pharmacol Ther. 2007 May;45(5):264-70.
Atypical antipsychotic therapy for treatment of schizophrenia in

Hong Kong Chinese patients--a cost analysis.
Law WL, Hui HY, Young WM, You JH.
Hospital Authority, Hong Kong SAR.
OBJECTIVE: To evaluate the direct medical cost of atypical antipsychotic

therapy for schizophrenia among Hong Kong Chinese patients and to identify
factors affecting the cost of treatment. METHODS: In this retrospective database
analysis, patient data were retrieved from three Hong Kong public hospitals.
Patients aged 2 18 years who received an initial prescription for olanzapine,
risperidone, quetiapine or amisulpride between April 1 and September 30, 2003;
and had an ICD-10-coded diagnosis of schizophrenia were included. Patient data
were collected for a maximum duration of 1 year before and after treatment
initiation. Primary outcome measures were the schizophrenia-related direct
medical costs. Demographic and clinical factors were analyzed by multiple
regression analysis to identify influential factors for the cost of atypical
antipsychotic therapy. RESULTS: A total of 325 patient records were reviewed
and 82 patients were included in the analysis. Cost per patient per month for clinic
visits (US$ 67 +/- 41 versus US$ 78 +/- 41), medications (US$ 8 +/- 12 versus
US$ 97 +/- 83), and the total cost per patient per month (US$ 314 +/- 898 versus
US$ 431 +/- 914) increased significantly after treatment initiation (US$ 1 = HK$
7.8). Previous duration of hospitalization (RR = 1.00, 95% CI = 1.00 1.01),
history of substance abuse (RR = 1.26, 95% CI = 1.05 1.52) and use of depot
antipsychotics (RR = 1.22, 95% CI = 1.05 - 1.42) were associated with higher
cost of atypical antipsychotic therapy. CONCLUSION: The total direct medical
cost increased significantly after initiation of atypical antipsychotic therapy in a
cohort of Chinese patients with schizophrenia. History of drug abuse, use of depot
antipsychotics and prior duration of hospitalization were positive predictors of
cost of therapy.
Publication Types:
389: J Contin Educ Nurs. 2007 May-Jun;38(3):122-31.
Outcomes of continuing education in the care of children with

asthma for pediatric healthcare providers.
Cheng YF, Hsu LN, Yang KD, Yeh SH, Shu SS.
Department of Nursing, Chang Gung Memorial Hospital, Kohsiung, Taiwan.
In this study, the authors assessed the knowledge of healthcare providers

regarding asthma care, examined the outcomes of continuing education for
asthma care, and explored the relationships among demographic characteristics of
the healthcare providers and the improvement in asthma care knowledge. Thirty-
one pediatricians and 38 nurses in the pediatric units of a medical center
completed a questionnaire before and after an asthma care program. Pediatricians
and pediatric nurses provided correct answers to asthma care questions 84.45%
and 61.97% of the time, respectively, before the program and 93.06% and 88.03%
of the time, respectively, after the program, which was a significant improvement
(p < .001). No significant correlations or differences were found between the
changes in asthma care knowledge and the demographic characteristics of
healthcare providers. Results from this study suggest that continuing education
can improve the knowledge of asthma care among pediatric healthcare providers.
Publication Types:
390: Clin Rheumatol. 2008 Jan;27(1):29-33. Epub 2007 Jun 1.
Use of complementary and alternative medicine by rheumatoid

arthritis patients in Korea.
Lee MS, Lee MS, Yang CY, Lee SI, Joo MC, Shin BC, Yoo WH, Shin YI.
Department of Rheumatology, School of Medicine, Wonkwang University, Iksan,

South Korea.
This study measured the prevalence of use of complementary and alternative

medicine (CAM) in Korean patients with rheumatoid arthritis (RA). A trained
nurse conducted 20-min questionnaire-based interviews at the hospitals when
each patient visited as an outpatient. The questionnaire included questions on
demographic information, clinical information, and the use of CAM. Of the 153
respondents, 125 (82%) had used CAM; 37% of those who used CAM had started
taking CAM products following suggestions from family members and other
relatives. In users of CAM, 35% considered that it improved the symptoms of RA,
and 14% felt it was effective in achieving psychological relaxation. We
categorized treatment into six CAM categories used by the respondents: 84.0% of
patients used traditional Oriental medical treatments, 70.4% used plant- and
animal-derived over-the-counter health care products, and 13.6% used manual
therapies. Most RA patients (64%) would like to try a new type of CAM. About
half of the respondents (48%) expected to receive information about CAM from
their general practitioner even if most (72%) did not discuss their use of CAM
with their doctor. Most of the RA patients in this study used CAM, and half
reported beneficial effects. Despite the presence of adverse side effects, patients
tended to use CAM without discussing it with their main physicians, suggesting
that physicians should be actively involved in the prescription and use of CAM.
Publication Types:
391: Southeast Asian J Trop Med Public Health. 2007 Mar;38(2):328-38.
Program issues in delivering targeted STI services through the

public sector in the Greater Mekong region.
O'Farrell N.
Pasteur Suite, Ealing Hospital, London, Unted Kingdom.

Nigel.ofarrell@lshtm.ac.uk
This review discusses the delivery of targeted STI services for both female sex
workers (FSWs) and other high-risk groups through the public sector in the
Greater Mekong region. Vaginal discharge algorithms for the general population
are also discussed. High STI rates that justify targeted interventions have been
reported recently amongst FSW in Cambodia, Lao PDR and Vietnam. Such
interventions need to take into account the different patterns of sex work in the
three countries. In Cambodia, there are large numbers of brothel-based FSWs
although this pattern is changing as more brothels are closed by the authorities. In
Lao PDR, services targeted towards reducing the burden of HIV/STI in
FSW/service women are probably best delivered through NGO-led clinics. In
Vietnam, commune based district health centers appear to offer better services for
FSW than STI clinics. Male clients of FSW are an important group to target, but
reaching such a heterogeneous population is difficult. Provision of quality STI
drugs to those places where men present with STI symptoms should be a priority.
The optimal way to manage STIs in FSWs is still unclear in this region. Clinical
and laboratory specialists are keen to promote laboratory tests for STIs but there
is an over reliance on direct staining techniques. In areas with high STI
prevalences, periodic presumptive treatment could offer an effective option to
reduce STI levels in high-risk groups until syndromic management algorithms are
evaluated for local use. Social patterns of sex work are changing continually and
require close monitoring in the future so that services can be adapted to these
changes.
Publication Types:
• Review
392: Southeast Asian J Trop Med Public Health. 2007 Jan;38(1):62-8.
Opportunistic infections and HIV clinical disease stage among

patients presenting for care in Phnom Penh, Cambodia.
Kong BN, Harwell JI, Suos P, Lynen L, Mohiuddin S, Reinert S, Pugatch D.
University Research CO, LLC, Phnom Penh, Cambodia.
This prospective, cross-sectional study sought to assess the spectrum of HIV-

associated complications and disease stage among individuals presenting for first-
time care in Phnom Penh, Cambodia between November 2001 and September
2002. One hundred patients participated in this study. All study participants
presented with advanced stages of HIV disease. Seventy-four percent of the
subjects had CD4 cell counts <50 cells/mm3. Tuberculosis was the most common
AIDS-defining illness among participants, with a prevalence of 43%. A spectrum
of other opportunistic infections, including cryptosporidiosis (13%), severe
bacterial infections (12%), cryptococcosis (12%), and Pneumocystis jiroveci
pneumonia (10%), was identified. These findings underscore the need for
widespread HIV treatment and prevention in this setting. Increased screening for
HIV and routine health maintenance for those infected are urgently needed in
order to facilitate management of both opportunistic infections and the secondary
prevention of HIV infection.
Publication Types:
393: Med Teach. 2007 Feb;29(1):e22-5.
Physician assistants: education, practice and global interest.

Legler CF, Cawley JF, Fenn WH.
College of Allied Health and Nursing, Department of Health Science, Nova

Southeastern University, Ft. Lauderdale, FL 33328, USA. Legler@Nova.edu
BACKGROUND: In the United States, the physician assistant (PA) model has
proven to be a cost-effective way to train quality primary care providers with a
high degree of acceptance of the PA role by patients and other healthcare
providers. AIM: Discuss PA model as it pertains to other countries. METHODS:
Review of relevant literature related to physician assistant education, practice and
global interest. RESULTS: Several countries including the United Kingdom,
Scotland, Canada, The Netherlands, Taiwan, South Africa and Ghana are
exploring or re-exploring the concept of the physician assistant as a way to
quickly and efficiently train and employ autonomous and flexible health workers
to address their nation's healthcare needs. CONCLUSIONS: Physician assistant
education is efficient and flexible and the PA model can be easily adapted to the
specific health system needs of other nations. In addition, many PA programs
have affiliation agreements with institutions outside of the United States to host
PA students for clinical rotations and there is an ever-growing interest by students
in international rotations. The Physician Assistant Education Association along
with the American Academy of Physician Assistants is actively involved with
sharing information about the PA profession with other countries.
394: Int J Clin Pract. 2007 Jul;61(7):1086-90. Epub 2007 May 30.
Comment in:
• Int J Clin Pract. 2007 Jul;61(7):1074.
Comparison of risk-adjustment models using administrative or

clinical data for outcome prediction in patients after myocardial
infarction or coronary bypass surgery in Korea.
Park HK, Yoon SJ, Ahn HS, Ahn LS, Seo HJ, Lee SI, Lee KS.
Department of Health Policy and Management, College of Medicine, Cheju

National University, Cheju University Street Jeju-city, Jeju Province, Korea.
OBJECTIVE: The objectives of this study were to compare the performance
indicators of risk-adjustment models based on administrative and clinical data in
Korea, and to assess whether administrative data alone is useful for comparing
quality of care. METHODS: Outcome was defined as death within 30 days of
discharge. For administrative data, the risk factors were; age, sex, and 11 past
histories and two past major procedures, which were retrospectively chased in
National Health Insurance database using patient Identification Number. For
clinical data, the severity score of the three risk-adjustment measures
[MedisGroups, Disease Staging (DS) and Computerized Severity Index (CSI)]
was used as the independent predictors of 30-day mortality. Risk-adjustment
models were developed by logistic regression analysis for 13,885 Acute
Myocardial Infarction (AMI) and 2115 Coronary Artery Bypass Graft (CABG)
patients based on administrative data and for 208 AMI patients and 478 CABG
patients using clinical data. Performances of models were examined using c-
statistic and Hosmer-Lemeshow statistic. RESULTS: The results obtained showed
the superiority of the clinical model. For AMI, the c-statistic of the administrative
model was 0.696, and those of the CSI, DS and MedisGroups models were 0.772,
0.861 and 0.988 respectively. For CABG, the c-statistic of the administrative
model was 0.568, and those of the CSI, DS and MedisGroups models were 0.665,
0.731 and 0.816 respectively. CONCLUSION: Our results indicate that risk-
adjustment model only using administrative data are probably not useful for
assessing quality of care in Korea.
Publication Types:
395: Indian Pediatr. 2007 May;44(5):339-43.
Antiretroviral therapy in children: Indian experience.
Natu SA, Daga SR.
Department of Pediatrics, B.J. Medical College and Sassoon General Hospital,

Pune, Maharashtra, India. sanjaynatu@gmail.com
BACKGROUND : There is a paucity of reports on Highly Active Antiretroviral

therapy (HAART) in children. We studied feasibility and effectiveness fixed dose
combination (FDC) of lamivudine, nevirapine and stavudine in HIV infected
children. DESIGN: Interventional study. SETTING: A Tertiary care center.
SUBJECTS: Twenty five consecutive HIV positive antiretroviral naive children
older than 18 months. METHODS: The study subjects were started on weight-
appropriate doses of the FDC and followed up for 6 months. Weight, CD4 counts,
absolute lymphocyte count (ALC) and number of episodes of illness were
assessed before and after HAART. Adherence and barriers to adherence were
studied. RESULTS: Mean weight increased from 15.2 to 16.8 kg (P < 0.001)
while mean CD4 counts increased from 488/cmm to 765/cmm (P < 0.001). Only 2
cases of drug associated adverse event were encountered. Improvement in Center
for Disease Control (CDC) immunological classification of the subjects was
significant while that in World Health Organization (WHO) clinical staging was
not statistically significant. Follow up visits were 95% of the expected 175 visits.
The average distance traveled by the patient for every visit was 72 km (one way).
CONCLUSIONS: Use of FDC in weight specific dosages is feasible and effective
for treatment of Pediatric HIV in resource scarce setting. These preliminary
results need to be tested in a different setting.
396: Biochem Cell Biol. 2007 Apr;85(2):157-63.
Cardiovascular diseases in China.
Liu L.
Clinical Trials and Research Centre, Chinese Hypertension League,

Cardiovascular Institute and Fu Wai Hospital (CAMS & PUMC), Beijing, China.
llschl@yahoo.com.cn
Statistics from the National Population Census of China revealed a significant

increase in the Chinese population, from 590 million in 1953 to 1.26 billion in
2000. The average life expectancy increased to 71.4 years in 2000 compared with
the expectancy of 68.6 years a decade before. World Health Organization
statistics on the death rate for total cardiovascular disease, coronary heart disease,
and stroke in men and women aged 35-74 years revealed discrepancies between
rural and urban parts of China. The China Multicenter Collaborative Study of
Cardiovascular Epidemiology indicated that cardiovascular disease was the major
cause of death for both men and women, with stroke accounting for over 40% of
deaths. Ischemia was shown to be the most common subtype of stroke in both
sexes. Smoking was an independent risk factor for cardiovascular disease. The
World Health Organization reported that the death rate attributable to tobacco was
6.0% worldwide and 9.2% in China in 1990. The latter is projected to reach
16.6% by 2020. In China, the prevalence of hypertension and diabetes mellitus,
the two key risk factors of cardiovascular disease, have also increased
significantly in the past 20 years. In addition, elevated blood pressure and plasma
cholesterol were two important determinants of increased cardiovascular disease
in eastern Asia. These studies indicate that an integrated management of
comprehensive risk is urgently required to address China's increasing
cardiovascular disease burden.
Publication Types:
• Review
397: Pediatr Int. 2007 Jun;49(3):380-6.
Clinical characteristics and survival of trisomy 13 in a medical

center in Taiwan, 1985-2004.
Lin HY, Lin SP, Chen YJ, Hsu CH, Kao HA, Chen MR, Hung HY, Ho CS,
Chang JH, Huang FY, Tsai TC, Lin DS, Chan WT.
Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medicine,

Nursing and Management College, Taipei, Taiwan.
BACKGROUND: This study investigated the survival and natural history of

trisomy 13 in a series of patients, comparing the management and outcome before
and after the implementation of Taiwan's National Health Insurance program
(NHI). METHODS: A total of 28 cases of trisomy 13 seen at Mackay Memorial
Hospital, Taipei, Taiwan, from 1985 to 2004 were retrospectively reviewed.
Survival and management before (12 cases) and after (16 cases) the
implementation of National Health Insurance were compared, and structural
defects, imaging findings, and cytogenetic results were analyzed. The cases that
were diagnosed prenatally, and finally terminated, were excluded from this study.
The diagnosis of trisomy 13 was based on the postnatal chromosome analysis.
RESULTS: All patients except one with trisomy 13 translocation died in their first
year because of severe malformations of the cardiovascular or central nervous
system. The median survival was 9 days. After implementation of National Health
Insurance, survival with trisomy 13 was significantly longer than before (P <
0.05). The three most common structural defects were abnormal auricular helices
or low-set ears (89%), cryptorchidism and abnormal scrotum of male (73%) and
cleft lip and/or palate (71%). Using echocardiography, the most commonly
detected heart defects were patent ductus arteriosus (68%), ventricular septal
defect (50%) and atrial septal defect (50%), and eight cases (36%) had complex
congenital heart defects. The most common brain lesion was lenticulostriate
vasculopathy (22%), followed by holoprosencephaly (17%), brain edema (13%)
and subependymal cyst (13%). CONCLUSIONS: Early diagnosis and the survival
patterns from the data collected should be used to inform parents and health-care
professionals to assist in decision making. Although most patients with trisomy 13
die within the first weeks after birth, it is important to recognize that a few may
survive the first year. When counseling families, the long-term survival prospects
of trisomy 13 patients should be included.
Publication Types:
398: J Altern Complement Med. 2007 May;13(4):461-9.
Promoting lifestyle self-awareness among the medical team by the

use of an integrated teaching approach: a primary care experience.
Ben-Arye E, Lear A, Hermoni D, Margalit RS.
The Complementary and Traditional Medicine Unit, Department of Family

Medicine, Clalit Health Services, Haifa and Western Galilee District, Technion-
Israel Institute of Technology, Haifa, Israel. eranben@netvision.net.il
OBJECTIVES: Healthy lifestyle is recommended in clinical guidelines for the

prevention and treatment of chronic diseases such as cardiovascular disease and
diabetes. Research previously identified a gap between lifestyle recommendations
and their implementation in clinical practice. In this paper, we describe a pilot
educational program aimed to promote providers' awareness of their own
lifestyles, and to explore whether increased personal awareness enhances
providers' willingness to engage in lifestyle-change discussion with patients.
METHODS: Two primary-care urban clinics in Northern Israel participated in the
program, which consisted of a series of six biweekly educational sessions, each
lasting 2-4 hours. Each session included both knowledge-based and experiential
learning based on complementary medicine modalities. Surveys at the end of the
program and a year later provided the program evaluation. RESULTS: Thirty-five
personnel participated in the program. Thirteen (13) of the 20 participants (65%)
reported an attitude change regarding eating habits after the program. At 1-year
follow up, 24 of the 27 respondents (89%) stated that they were more aware of
their eating habits and of their physical activity compared with precourse status.
Twenty-three (23) of 27 respondents (85%) stated that after the program they
were better prepared to initiate a conversation with their patients about lifestyle
change. CONCLUSIONS: An integrated educational approach based on
knowledge-based and complementary and alternative medicine experiential
modalities, aimed to facilitate self-awareness, may enhance learners' attitude
change. The findings demonstrate readiness of learners to reexamine their
lifestyles. Increased self-awareness helped participants to make a positive attitude
change regarding eating habits and physical activity and was associated with
participants' increased engagement in lifestyle-change discussions with patients.
The teaching approach had longstanding effect, noted in the one-year follow-up.
399: Soc Work Health Care. 2007;44(1-2):73-90.
An investigation of the practice of unsafe sex yet repeated HIV

testing.
Patinkin N, Werner B, Yust I, Yagil Y, Drory M, Burke M.
Kobler Crusade Center, Clinical Immunology Unit, Tel-Aviv Souransky Medical

Center, Tel-Aviv University Sackler Faculty of Medicine, Department of Social
Sciences, Israel. patinkin@netvision.net.il
RATIONALE: A purportedly heterogeneous group of people, who come to take

tests at the Human Immunodeficiency Virus (HIV) Test-ing Clinic, includes
young males and females who lead a normative lifestyle with no unique
characteristics. Within this population, we have observed one distinct subgroup of
predominantly male individuals, who return from time to time to take the HIV
tests. They tend to partake in many occasional sexual encounters with numerous
partners, and despite their obvious knowledge of the risks involved, they attest to
not using condoms during sexual intercourse. The aim of this preliminary study
was to investigate the patterns of their risky behavior in conjunction with their test
taking conduct. METHODS: Ten self-referred volunteering subjects were
recruited. Exclusion criteria: HIV-positive, drug and/or alcohol abusers, mentally
ill, men who have sex with men (MSM) and minors. The study was carried-out
using semi-structured interviews (40-90 min each). The interviews were recorded,
transcribed and content analyzed. FINDINGS: Data analysis showed several
possible explanations for risky sexual behavior, such as applying of a variety of
risk management mechanisms, refraining from impulse control behaviors, and
self-destruction motives. The reasons for undergoing HIV testing were most
frequently related to specific events, high-risk in nature, and not part of a routine
behavioral practice. CONCLUSIONS: Our findings might suggest that within this
population group, the prevailing primary preventive interventions would not
satisfy the purpose of decreasing levels and frequency of risk-taking behaviors. In
the opinion of the authors, there are two strategies that could be employed,
simultaneously or separately. An indirect approach entails the increase and
enhancement in utilizing widely spread media, e.g., feature films and television
programs, to convey issues related to curbing risk-behavior. Direct emphasis
should be put on secondary preventive measures, by encouraging frequent test-
taking conduct, preferably accompanied by counseling, in order to decrease the
risk of further transmitting the virus.
400: Allergol Int. 2007 Sep;56(3):249-55. Epub 2007 Jun 1.
Analysis of perimenstrual asthma based on questionnaire surveys in

Japan.
Suzuki K, Hasegawa T, Sakagami T, Koya T, Toyabe S, Akazawa K,

Arakawa M, Gejyo F, Suzuki E; Niigata Asthma Treatment Study Group.
Division of Respiratory Medicine, Niigata University Graduate School of Medical

and Dental Sciences, Niigata, Japan.
BACKGROUND: Perimenstrual asthma (PMA) has been documented in 30% to

40% of asthmatic women; the characteristics of PMA have also been well
described. However, there have been few epidemiological investigations of PMA
in practice. In this study, we analyzed PMA based on a questionnaire survey
carried out in Japan and compared the results with those of studies reported
previously. METHODS: For 8 weeks from September through October 2004, a
questionnaire survey was administered to patients with bronchial asthma and their
attending physicians. The questionnaire surveyed asthma control, asthma-related
emergencies and satisfaction in daily life. The attending physicians were
questioned about patient profiles and medications. All female patients who were
menstruating during the survey period and who were known to have asthma
exacerbation related to menstruation were allocated to the PMA group; those who
were not were allocated to the non-PMA group. RESULTS: The rate of PMA in
female patients who were menstruating during the survey period was 11.3% in
this study. Characteristic features of the PMA group (n = 54) included more
severe disease, worsened disease control and more aggressive patient
management, including increased oral corticosteroid use compared with the non-
PMA group. The rates of emergency episodes in the PMA group were higher than
in the non-PMA group. There was a significant increase in aspirin intolerant
asthma (AIA, 25.5%) in the PMA group compared with the non-PMA group
(8.4%). CONCLUSIONS: Attention should be paid to the lack of knowledge
regarding PMA in patients with asthma in actual clinical settings. The low rate of
PMA reported in this study may be due to the study method using self-reports of
PMA by patients without sufficient knowledge, and may not be an accurate
representation of the actual incidence of the disease. The clinical similarity of
PMA to AIA in this study may also provide a new insight into the mechanism of
PMA.
401: J Telemed Telecare. 2007;13(3):148-53.
Qualitative and quantitative assessment of video transmitted by

DVTS (digital video transport system) in surgical telemedicine.
Shima Y, Suwa A, Gomi Y, Nogawa H, Nagata H, Tanaka H.
Information Center for Medical Sciences, Tokyo Medical and Dental University,
Japan. yoichiro@fg7.so-net.ne.jp
Real-time video pictures can be transmitted inexpensively via a broadband

connection using the DVTS (digital video transport system). However, the
degradation of video pictures transmitted by DVTS has not been sufficiently
evaluated. We examined the application of DVTS to remote consultation by using
images of laparoscopic and endoscopic surgeries. A subjective assessment by the
double stimulus continuous quality scale (DSCQS) method of the transmitted
video pictures was carried out by eight doctors. Three of the four video recordings
were assessed as being transmitted with no degradation in quality. None of the
doctors noticed any degradation in the images due to encryption by the VPN
(virtual private network) system. We also used an automatic picture quality
assessment system to make an objective assessment of the same images. The
objective DSCQS values were similar to the subjective ones. We conclude that
although the quality of video pictures transmitted by the DVTS was slightly
reduced, they were useful for clinical purposes. Encryption with a VPN did not
degrade image quality.
Publication Types:
402: J Clin Nurs. 2007 Jun;16(6):1191-3.
Comment on:
• J Clin Nurs. 2006 Feb;15(2):188-96.
Commentary on Liu JE, Mok E & Wong T (2006). Caring in

nursing: investigating the meaning of caring from the perspective of
cancer patients in Beijing, China. Journal of Clinical Nursing, 15,
188-196.
Chan CL, Leung PP.
Department of Social Work and Social Administration and Director, Center on

Behavioral Health, The University of Hong Kong, Hong Kong SAR, China.
cecichan@hku.hk
Publication Types:
• Comment
403: J Clin Nurs. 2007 Jun;16(6):1173-9.
Effectiveness of hand-washing teaching programs for families of

children in paediatric intensive care units.
Chen YC, Chiang LC.
Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
AIMS: The authors developed a video-centred teaching program based on social

learning principles to demonstrate hand-washing technique. A comparison was
made between families who viewed the video and families who were taught the
same techniques with the aid of an illustrated poster in terms of compliance and
improvement in hand-washing skills. BACKGROUND: Nosocomial infections
are a significant cause of morbidity and mortality in paediatric intensive care unit
patients. Hand hygiene is considered the most important preventive action against
hospital-acquired infections. A number of studies have shown that increased
compliance with hand-washing guidelines for health-care workers leads to
decreases in nosocomial infection rates. Furthermore, recommendations have
been made to ensure that parents who visit their children in intensive care units
wash their hands first. STUDY DESIGN: Quasi-experimental time series.
Compliance and accuracy measurements were collected during one to five visits
following the initial teaching intervention. METHODS: A total of 123 families,
who visited paediatric intensive care units, were recruited and assigned to two
groups - one experimental (61 families) and the other a comparison group (62).
Participants in the comparison group were taught hand-washing skills using
simple illustrations. A 20-item hand-washing checklist was used to examine hand-
washing compliance and accuracy. RESULTS: No significant differences were
noted in terms of demographics between the two groups. Results from a general
estimated equation analysis showed that families in the experimental group had
higher compliance and accuracy scores at statistically significant levels.
CONCLUSION: The video-based teaching program was effective in increasing
compliance and accuracy with a hand-washing policy among families with
children in intensive care units. RELEVANCE TO CLINICAL PRACTICE: The
education program is a simple, low-cost, low technology intervention for
substantially reducing the incidence of nosocomial infection.
Publication Types:
404: J Clin Nurs. 2007 Jun;16(6):1141-50.

The comparison of effectiveness of two modalities of mental health
nurse follow-up programmes for female outpatients with depression
in Taipei, Taiwan.
Hsiao FH, Yang TT, Chen CC, Tsai SY, Wang KC, Lai YM, Tsai CJ, Chang
WY.
College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei,
Taiwan. hsiaofei@tmu.edu.tw
AIMS AND OBJECTIVES: This study compares the effectiveness of two

modalities of mental health nurse three-month follow-up programmes: telephone
counselling programme and group therapy programme for female outpatients with
depression. BACKGROUND: The lifetime prevalence of major depression is
15% and is about twice as common in women as in men. Outpatients with
depression often discontinue their treatment after the initial visits to their
physicians. METHODS: This study used a quasi-experimental, pre-post-test
comparison group design. Twenty-six female outpatients with depression were
assigned to one of follow-up programmes: telephone counselling programme or
group therapy programme. To qualify for group therapy programme, potential
participants were required to come to group sessions weekly. To be accepted into
telephone counselling programme, potential participants had to be able to be
contacted by phone regularly. Mental health nurse three-month follow-up
programmes included care management and structured psychotherapy. Patients in
telephone counselling programme received 10 regular telephone calls of 30-60
minutes each. Patients in group therapy programme received 12 sessions of
weekly group meetings of 90-120 minutes each. RESULTS: Wilcoxon signed
ranks tests provided evidence that the group therapy programme (S = -52.5, p <
0.001; S = 31.5, p = 0.046) and telephone counselling programme (S = -36, p =
0.002; S = 25, p = 0.050) follow-up programmes were effective in terms of
relieving depressed symptoms and improving quality of life. According to
Quade's analysis of covariance, telephone counselling programme and group
therapy programme appeared to have similar effects of relieving depressed
symptoms (F(1,24) = 0.06, p = 0.813) and increasing quality of life (F(1,24) =
0.07, p = 0.792). While there was no significant difference in using emergency
services ( chi(2)(1)= 0.89, p = 0.539) between telephone counselling programme
and group therapy programme, the rate of adherence to scheduled outpatient
appointments with psychiatrists was higher among patients in group therapy
programme than patients in telephone counselling programme (chi(2)(3) = 8.67, p
= 0.034). CONCLUSIONS: Establishing two modalities of mental health nurse
follow-up programmes in Taiwan could benefit patients with different needs.
RELEVANCE TO CLINICAL PRACTICE: Mental health nurses specialized in
management of depression could provide not only care management but also
structured psychotherapy.
Publication Types:
• Clinical Trial, Phase I

405: J Clin Nurs. 2007 Jun;16(6):1118-24.
Patients' experiences at home after day case cystoscopy.
Erkal S.
Ankara University, Cebeci School of Health, Ankara, Turkey.

serkal@ankara.edu.tr
AIM: To determine patients' problems with day case cystoscopy and their
problem solving ways and patients' self-care at home. BACKGROUND: Day
surgery has become increasingly common in the last 20 years. Cystoscopic
procedures are increasingly being carried out as a diagnostic and therapeutic
procedures. DESIGN AND METHOD: This descriptive/prospective study
comprised 50 patients undergoing day case cystoscopic procedures in the
university hospital of Turkey. The data were collected using telephone interview
three days after the procedure. The two questionnaire used were Symptom
Measurement Questionnaire and Symptom Management Questionnaire.
Discharge information and written instruction was given to all patients.
RESULTS: It was found in the investigation that the most common problems
experienced by the patients were tiredness, haematuria, dysuria, pain over bladder
and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary
elimination problems were experienced by majority of the patients. At second
day, these problems were also common. The mean score for all problems
decreased after three days. The patients stated that they were able to deal with
their symptoms either independently or to a lesser extent with assistance of a
carer. But they were unable to deal with problems such as especially haematuria.
CONCLUSION: Problems experiences by the patients at home after cystoscopy
influenced some daily living activities. The problems related to voiding are more
frequently observed after cystoscopy. Although some these problems are related
to the procedures, some were present previously. RELEVANCE TO CLINICAL
PRACTICE: This findings indicate that patient-centred care should be
strengthened at home in urological day surgery.
406: Lepr Rev. 2007 Mar;78(1):38-9.
Leprosy free India: clinical perspectives and challenges ahead.
Kar HK.
Department of Dermatology, Leprosy and STD, Dr R. M. L. Hospital, New Delhi

110001, India. hkkar_2000@yahoo.com
Publication Types:
• Letter
407: Disaster Manag Response. 2007 Apr-Jun;5(2):36-44.
Comment in:
• Disaster Manag Response. 2007 Apr-Jun;5(2):25-6.
Emergency department staff preparedness for mass casualty events

involving children.
Rassin M, Avraham M, Nasi-Bashari A, Idelman S, Peretz Y, Morag S,

Silner D, Weiss G.
Nursing Research Unit, Assaf Harofeh Medical Center, Zrifine, Bear Yaakov
70300, Israel. rasinm@asaf.health.gov.il
BACKGROUND: In recent years, the World Health Organization in general, and

Israel in particular, have dealt with mass casualty events (MCEs) resulting from
terrorism. Children are the casualties in many of these events-a reality that forces
hospitals to prepare to deal with such a scenario. A literature review designed to
identify unique recommendations regarding pediatric MCEs highlights both a lack
of existing training programs and uncertainty on the part of health care staff when
dealing with these events. OBJECTIVES: The purpose of the study was to
examine the preparedness level of emergency department staff to deal with MCEs
involving pediatric casualties. The study included 104 physicians and nurses
working in, or responding to, the emergency department at a hospital in Israel.
METHOD: The study included a 41-item questionnaire examining perception,
approaches, and staff knowledge regarding dealing with pediatric MCEs versus
those involving adults. The reliability of all sections of the questionnaire ranged
between Chronbach's alpha coefficient 0.6 alpha-0.94. RESULTS: The
preparedness levels for MCEs involving children were found to be low. Study
participants ranked the likelihood of a pediatric MCE lower than one involving
adults, while ranking significantly higher (P = .000) their ability to cope mentally
and the knowledge and skills required when treating adults involved in MCEs.
While nurses ranked higher than physicians regarding their knowledge and skills
in dealing with pediatric MCE casualties, the level of knowledge for MCEs
involving children was low in all subjects. Staff agreement for the parent of an
MCE victim to be present during treatment was medium-low. IMPLICATIONS:
On the basis of these findings, additional research involving a larger number of
individuals and hospitals is indicated to determine if these results are consistent
throughout the region.
Publication Types:
408: J Healthc Qual. 2005 Sep-Oct;27(5):28-33.
A computerized surveillance system for the quality of care in

childhood asthma.
Peled R, Tal A, Pliskin JS, Reuveni H.
Department of Health Policy and Management, Ben-Gurion University of the

Negev, Beer Sheva, Israel. ronitpeled@yahoo.com
This article describes the development of a novel model for quality assurance of
pediatric asthma using administrative data and clinical guidelines. Children for
whom drugs for asthma were dispensed during 1998 were recruited from the
drug-dispensing registry of the largest health maintenance organization in the
southern region of Israel. The Israeli clinical guidelines were translated into a list
of six markers for inadequate treatment. This list was used for a computerized
search in the drug registry, and cases with markers were noted as cases in which
inappropriate treatment was provided. The model was validated by proving that
there was an association between inappropriate treatment (markers) and bad
outcomes (emergency room visits, hospitalizations, and healthcare utilization).
This model creates an interface between administrative and clinical information
and provides an easy-to-use tool for quality assurance.
Publication Types:
409: Anadolu Kardiyol Derg. 2007 Jun;7(2):124-7.
Comparison of traditional risk factors, natural history and

angiographic findings between coronary heart disease patients with
age <40 and >or=40 years old.
Yildirim N, Arat N, Doğan MS, Sökmen Y, Ozcan F.
Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas

University, Zonguldak, Turkey. nesligul2004@hotmail.com
OBJECTIVE: In this study we aimed to examine the angiographic findings,

traditional risk factors and natural history of Turkish patients <40 and >or=40
years old with coronary heart disease (CHD). METHODS: The records of 491
patients with stable angina pectoris or acute coronary syndrome (ACS), who had
undergone coronary angiography (CAG) were reviewed. The patients <40 years
(group 1) and >or=40 years (group 2) were compared. RESULTS: The study
population was classified as group 1 with 240 patients (mean age 35.7+/-3.4
years) and group 2 with 251 patients (mean age 61.0+/-9.7 years). Smoking,
family history, hypercholesterolemia, hypertriglyceridemia and low levels of
high-density lipoprotein cholesterol were more prevalent in group 1 while
diabetes mellitus, hypertension was higher in group 2. The common presentation
among <40 years patients was ACS whereas stable angina was the most common
presentation in patients >or=40 years old. Patients in group 1 showed a
preponderance of single-vessel disease whereas patients of group 2 showed
dominance of multivessel disease. Early clinical course of patients with ACS in
group 1 was better than in group 2. CONCLUSION: Our study shows a
significantly different clinical, angiographic and biochemical profile in <40 years
patients with CHD compared with >or=40 years patients. Dominance of smoking
and dyslipidemias that are the preventable risk factors in premature CHD patients
is an important threat for our community health. Healthy life styles should be
encouraged beginning from young ages and new precautions about smoking must
be taken.
Publication Types:
410: Nurse Educ Today. 2008 Jan;28(1):48-54. Epub 2007 May 18.
Understanding the persona of clinical instructors: the use of

students' doodles in nursing research.
de Guzman A, Pablo LA, Prieto RJ, Purificacion VN, Que JJ, Quia P.
College of Nursing, University of Santo Tomas, Manila 1015, Philippines.

doc_allan@yahoo.com
BACKGROUND: While it is true that understanding the attributes and unique

distinction of the nursing faculty has been the subject of most of the studies, little
is known about how the use of doodles can help surface the persona of the clinical
instructors. OBJECTIVE: This study aims to capture the essence or the lebenswelt
of the concept of "clinical instructor" from the lens of students' doodles which
have been considered as a powerful qualitative tool in articulating individual
experiences. METHOD: A total of 195 senior nursing students recruited from a
comprehensive university in the Philippines were the subjects in this qualitative
study. Data were gathered from self-generated illustrations and written
explanations made by the subjects to identify their concept of effective and
ineffective clinical instructors. Phenomenological reduction was observed through
a repertory grid, where doodles drawn were listed, categorized and thematised to
reveal the qualities of the clinical instructor. CONCLUSIONS: The subjective
nature of the findings, though not generalizable, has surfaced how doodling can
be a potent tool in identifying collective interpretation of the essence of health
professions construct such as the one under study. The doodles revealed that an
effective clinical instructor (enlightening, engaging and embracing) is one who is
able to facilitate the learning of the students as well as being able to establish a
harmonious learning atmosphere for and with the students. On the other hand, an
ineffective clinical instructor (detrimental, dangling, and disturbing) impedes
students' development in the clinical practice by causing conflict through their
personal attitudes and their teaching strategies. This can have benefits for clinical
instructors, to improve themselves and realize the impact of their attributes to the
clinical learning of students.
411: J Infect. 2007 Jul;55(1):41-8. Epub 2007 May 18.
Short-term effect of antibiotic control policy on the usage patterns

and cost of antimicrobials, mortality, nosocomial infection rates and
antibacterial resistance.
Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke

C, Ulusoy S.
Ege University Faculty of Medicine, Department of Infectious Diseases and

Clinical Microbiology, Bornova, Izmir, Turkey.
OBJECTIVES: In 2003 Turkish government released a new budget application

instruction for regulating the usage of parenteral antibiotics inside and outside of
the hospitals. In this study it was aimed to evaluate the effect of this instruction on
the overall usage of restricted antibiotics, their cost, overall mortality, bacterial
resistance patterns and nosocomial infection rates in intensive care units (ICUs) of
our setting for March-October 2002 and March-October 2003 periods.
METHODS AND RESULTS: Overall daily defined dose/1000 patients/day of
restricted drugs decreased, whereas unrestricted drugs increased significantly after
the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-
19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased
significantly (p<0.05). When all microbiologically confirmed nosocomial
bacteremia cases during the study period were analysed,
amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime,
piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae
decreased significantly (p<0.05). Amikacin resistance in Escherichia coli and
Acinetobacter baumannii increased significantly (p<0.05). CONCLUSION:
Antibiotic control is one of the most important and significant ways to save
money, and to prevent antibacterial resistance.

412: Int J Nurs Stud. 2008 Jan;45(1):14-23. Epub 2007 May 18.
Effects of a breastfeeding empowerment programme on Korean

breastfeeding mothers: a quasi-experimental study.
Kang JS, Choi SY, Ryu EJ.
Department of Nursing, Gyeong-Sang Hosipital, 92, Chilam-dong, Chinju 660-

751, Republic of Korea.
OBJECTIVES: This quasi-experimental study examined the effects of a new

breastfeeding empowerment programme provided to post-partum mothers within
3 days of entering post-partum care centres on their breastfeeding empowerment,
problems and practice rate. METHOD: The study employed a non-equivalent
control group non-synchronized design. Participants who conformed with the
selection criteria were selected from two post-partum care centres affiliated with
hospitals in a city in South Korea. Each of the two study groups included 30
participants. The breastfeeding empowerment programme comprised four 60-
minute sessions, and was applied for 4 weeks to mothers in the experimental
group. RESULTS: The breastfeeding empowerment scores were higher in the
experimental group than in the control group (p=0.007), and there were fewer
breastfeeding problems in the former group (p=0.012) and the breastfeeding rates
were higher in the former group (p=0.017, 0.002 and 0.002 at 4, 8 and 12 weeks
post-partum, respectively). CONCLUSIONS: These results indicate that the
provision of breastfeeding empowerment programmes to help mothers to identify
and solve problems by themselves can improve breastfeeding empowerment,
problem and practice rates, and hence should be considered useful as a post-
partum nursing intervention in clinical settings. The effectiveness of the various
components of the breastfeeding empowerment programme developed in this
study should be verified in field trials.
Publication Types:

413: Reprod Health Matters. 2007 May;15(29):172-82.

Situation analysis of quality of abortion care in the main maternity

hospital in Hai Phòng, Viet Nam.
Nguyen MH, Gammeltoft T, Rasch V.
Scientific Institute for Population, Family and Children, Viet Nam Commission of
Population, Family and Children, Hanoi, Viet Nam.
Six months after a Comprehensive Abortion Care project was implemented in

Phu-San Hospital, the main maternity hospital in Hai Phòng, northern Viet Nam,
a study of quality of abortion services was carried out. The study explored the
interaction between providers and women seeking abortion and how cultural
values influenced quality of care. A quantitative and qualitative approach was
employed: a three-part structured survey with 748 women before and after they
had an abortion, 20 in-depth interviews with women just after abortion, seven
informal interviews with health care staff and 100 participant observations. Both
the women and the staff equated quality of care mainly with improved technical
performance of abortion. Insufficient knowledge and skills had a negative impact
on provision of information and good quality counselling in relation to
understanding and uptake of contraception, treating reproductive tract infection
and preventing post-abortion infection. To further improve abortion care in
hospitals such as Phu-San, training programmes are needed that integrate
counselling and clinical skills and address the cultural factors that hinder health
staff and women from interacting in an equitable manner. A supportive
supervisory system that holds health staff accountable for conducting high quality
information and counselling sessions should also be established.
414: BMC Public Health. 2007 May 18;7(147):84.
Costs of a successful public-private partnership for TB control in an

urban setting in Nepal.
Karki DK, Mirzoev TN, Green AT, Newell JN, Baral SC.
Nuffield Centre for International Health and Development, Leeds Institute of

Health Sciences and Public Health Research, University of Leeds, Leeds, UK.
dekarki@wlink.com.np <dekarki@wlink.com.np>
BACKGROUND: In South Asia a large number of patients seek treatment for TB
from private practitioners (PPs), and there is increasing international interest in
involving PPs in TB control. To evaluate the feasibility, effectiveness and costs of
public-private partnerships (PPPs) for TB control, a PPP was developed in
Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB
are managed in the private sector. From the clinical perspective the PPP was
shown to be effective. The aim of this paper is to assess and report on the costs
involved in the PPP scheme. METHODS: The approach to costing took a
comprehensive view, with inclusion of costs not only incurred by health facilities
but also social costs borne by patients and their escorts. Semi-structured
questionnaires and guided interviews were used to collect start-up and recurrent
costs for the scheme. RESULTS: Overall costs for treating a TB patient under the
PPP scheme averaged US$89.60. Start-up costs per patient represented 12% of
the total budget. Half of recurrent costs were incurred by patients and their
escorts, with institutional costs representing most of the rest. Female patients
tended to spend more and patients referred from the private sector had the highest
reported costs. CONCLUSION: Treating TB patients in the PPP scheme had a
low additional cost, while doubling the case notification rate and maintaining a
high success rate. Costs incurred by patients and their escorts were the largest
contributors to the overall total. This suggests a focus for follow-up studies and
for cost-minimisation strategies.
Publication Types:
PMCID: PMC1888703
415: Quintessence Int. 2007 Mar;38(3):e143-50.
Satisfaction with oral status among adult school-attending Saudi

women with and without posterior fixed partial dentures.
Omar R, Al-Boaijan E, Al-Twaijri S, Akeel R.
Department of Restorative Sciences, Faculty of Dentistry, Kuwait University,

Safat, Kuwait. romar.k@hsc.edu.kw
To conduct a preliminary investigation of the relationship between patient
satisfaction with oral status and the presence of posterior fixed partial dentures
(FPD). METHOD AND MATERIALS: A total of 150 women with intact anterior
dental segments, randomly drawn from women's schools for adult education,
participated (mean age, 33.8 years; SD, 10.4; range, 20 to 63 years). Each woman
was assisted in completing a questionnaire on aspects of her oral health beliefs
and satisfaction with oral function, and underwent an on-site clinical examination.
Subjects were categorized according to general prosthodontic status: those with
missing posterior teeth and no FPDs (MN), those with FPDs (PR), and those who
were fully dentate (FD). Their responses to the questionnaire were compared.
RESULTS: Value placed on oral health did not differ among the groups.
Satisfaction with overall oral status, chewing function, and appearance did not
differ between MN and PR, although overall satisfaction and appearance were
each significantly greater in FD than in MN (P <.001 and P <.05, respectively).
Overall satisfaction was negatively correlated with the mean number of missing
teeth (P <.01), although perception of chewing ability did not differ among the
groups, nor did it differ in relation to the number of posterior occluding pairs of
teeth. CONCLUSIONS: The hypothesis that individuals with fixed prosthodontic
replacements of their missing posterior teeth are more satisfied with their oral
status than those without such replacements was not confirmed, while the
question of the importance of patient satisfaction as a positive outcome of oral
health care is raised.
416: Ann Emerg Med. 2007 Dec;50(6):635-42. Epub 2007 May 23.
Comment in:
• Ann Emerg Med. 2007 Dec;50(6):643-4.
Survival outcomes with the introduction of intravenous epinephrine

in the management of out-of-hospital cardiac arrest.
Ong ME, Tan EH, Ng FS, Panchalingham A, Lim SH, Manning PG, Ong
VY, Lim SH, Yap S, Tham LP, Ng KS, Venkataraman A; Cardiac Arrest
and Resuscitation Epidemiology Study Group.
Department of Emergency Medicine, Singapore General Hospital, Singapore

City, Singapore. marcus.ong.e.h@sgh.com.sg
STUDY OBJECTIVE: The benefit of epinephrine in cardiac arrest is

controversial and has not been conclusively shown in any human clinical study.
We seek to assess the effect of introducing intravenous epinephrine on the
survival outcomes of out-of-hospital cardiac arrest patients in an emergency
medical services (EMS) system that previously did not use intravenous
medications. METHODS: This observational, prospective, before-after clinical
study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology
project. Included were all patients who are older than 8 years, with nontraumatic
out-of-hospital cardiac arrest conveyed by the national emergency ambulance
service. The comparison between the 2 intervention groups for survival to
discharge was made with logistic regression and expressed in terms of the odds
ratio (OR) and the corresponding 95% confidence interval (CI). RESULTS: From
October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into the study,
with 615 in the pre-epinephrine and 681 in the epinephrine phase. Demographic
and EMS characteristics were similar in both groups. Forty-four percent of
patients received intravenous epinephrine in the epinephrine phase. There was no
significant difference in survival to discharge (pre-epinephrine 1.0%; epinephrine
1.6%; OR 1.7 [95% CI 0.6 to 4.5]; adjusted for rhythm OR 2.0 [95% CI 0.7 to
5.5]); return of circulation (pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9
[95% CI 0.6 to 1.2]), or survival to admission (pre-epinephrine 7.5%; epinephrine
7.5%; OR 1.0 [95% CI 0.7 to 1.5]). There was a minimal increase in scene time in
the epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference
0.02 to 0.94 minutes). CONCLUSION: We were unable to establish a significant
survival benefit with the introduction of intravenous epinephrine to an EMS
system. More research is needed to determine the effectiveness of drugs such as
epinephrine in resuscitation.
Publication Types:
• Clinical Trial, Phase II

417: Lancet Neurol. 2007 Jun;6(6):533-43.
Erratum in:
• Lancet Neurol. 2007 Dec;6(12):1037.
Epidemiology, aetiology, and clinical management of epilepsy in

Asia: a systematic review.
Mac TL, Tran DS, Quet F, Odermatt P, Preux PM, Tan CT.
Institute of Neurological Epidemiology and Tropical Neurology, Limoges,

France.
Epilepsy is a significant, but often underappreciated, health problem in Asia.

Here, we systematically review the literature on epidemiology, aetiology, and
management of epilepsy in 23 Asian countries. Prevalence estimates are available
for only 11 countries from door-to-door surveys and are generally low. Figures
for annual incidence in China and India are similar to those in the USA and
Europe but lower than those reported from Africa and Latin America. There is a
peak in incidence and prevalence in childhood, but a second peak in elderly
people, as seen in developed countries, has not been documented. The main
causes are head injuries, cerebrovascular disease, CNS infections, and birth
trauma. Availability of epilepsy care depends largely on economic factors.
Imaging and neurophysiological facilities are available in most countries, but
often only in urban centres. Costly drugs, a large treatment gap, limited epilepsy
surgery, and negative public attitude to epilepsy are other notable features of
management in Asia. An understanding of the psychosocial, cultural, economic,
organisational, and political factors influencing epilepsy causation, management,
and outcome should be of high priority for future investigations.
Publication Types:

• Review
418: Aust N Z J Psychiatry. 2007 Jun;41(6):495-500.
Diagnostic stability 2 years after treatment initiation in the early

psychosis intervention programme in Singapore.
Subramaniam M, Pek E, Verma S, Chan YH, Chong SA.
Institute of Mental Health, 10 Buangkok View, Singapore.
OBJECTIVE: To evaluate the diagnostic stability of psychotic disorders over a 2

year period in patients presenting with first-episode psychosis. METHODS: One
hundred and fifty-four patients were recruited from an early psychosis
intervention programme (EPIP). They were diagnosed by the attending
psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first
contact (baseline) and after 24 months. The diagnoses were classified into the
following categories: schizophrenia spectrum disorders (schizophrenia,
schizophreniform disorder and schizoaffective disorder), affective psychosis
(bipolar and major depressive disorders with psychotic symptoms), and other non-
affective psychosis (delusional disorder, psychosis not otherwise specified and
brief psychotic disorder). Two measures of stability, the prospective and the
retrospective consistency were determined for each diagnosis. RESULTS: The
diagnoses with the best prospective consistency were schizophrenia (87.0%) and
affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was
the most frequent diagnostic change. Duration of untreated psychosis was found
to be the only significant predictor of shift. CONCLUSION: It is difficult to make
a definitive diagnosis at first contact. The clinical need to review the diagnosis
throughout the period of follow up is emphasized.
Publication Types:
419: Sex Transm Dis. 2007 Oct;34(10):791-5.
Reproductive tract infections among women attending a gynecology

outpatient department in Vientiane, Lao PDR.
Sihavong A, Phouthavane T, Lundborg CS, Sayabounthavong K, Syhakhang

L, Wahlström R.
Division of International Health (IHCAR), Department of Public Health Sciences,

Karolinska Institutet, Stockholm, Sweden. amphoy@yahoo.com
OBJECTIVES AND GOAL: To clinically and microbiologically identify

reproductive tract infections (RTI), including sexually transmitted infections
(STI), and to monitor the antibiotic susceptibility of Neisseria gonorrhoeae among
women attending a gynecology outpatient department in Vientiane, Laos. STUDY
DESIGN: Clinical and laboratory-based cross-sectional study. Women aged 15 to
49 years underwent a pelvic examination, and specimens were taken for
laboratory testing. RESULTS: Of 1125 study participants, 82% clinically
presented with an RTI syndrome. However, only 64% had an etiologically
diagnosed RTI, including 11% with an STI. Endogenous infections were most
prevalent (candidiasis 40%; bacterial vaginosis 25%), followed by STI
[Chlamydia trachomatis 4.1%; N. gonorrhoeae (NG) and Trichomonas vaginalis,
both 3.7%]. The 41 NG isolates showed 20% resistance to ciprofloxacin, 98% to
penicillin, and complete to tetracycline. CONCLUSIONS: High RTI/STI level
combined with high NG resistance emphasizes that concurrent with syndromic
case management, periodic evaluations of etiological diagnosis should be
available to ensure adequacy of treatment algorithms and prescribed medications.
Publication Types:
420: J Clin Virol. 2007 Jun;39(2):76-81. Epub 2007 May 15.
The differences of clinical manifestations and laboratory findings in

children and adults with dengue virus infection.
Kittigul L, Pitakarnjanakul P, Sujirarat D, Siripanichgon K.
Department of Microbiology, Faculty of Public Health, Mahidol University,

Bangkok, Thailand. phlkt@mahidol.ac.th
BACKGROUND: Dengue haemorrhagic fever is an important public health

problem and mainly occurs in children less than 15 years of age. Recently, the
incidence of the disease have increased in adults but data on clinical and
laboratory presentations of those affected are limited. OBJECTIVES: To assess
and compare clinical manifestations and laboratory findings of dengue virus
infected children and adults in Thailand. STUDY DESIGN: A 1-year study was
conducted from September 2003 to August 2004 for dengue virus infected
patients admitted to Phetchabun Provincial Hospital, Thailand. Physical signs,
symptoms, and laboratory features were recorded. All dengue patients were
confirmed using immunochromatographic test on convalescent sera. RESULTS:
Based on serology-confirmed dengue virus infection, there was 286 dengue
patients including 15 (5.3%) dengue fever and 271 (94.7%) dengue haemorrhagic
fever (DHF). Among DHF cases, clinical classifications were DHF I, 40.9%;
DHF II, 43%; and DHF III or dengue shock syndrome (DSS), 10.8%. Of all
dengue patients, 231 cases (80.8%) were children aged less than 15 years and 55
cases (19.2%) were adults. The highest proportion of child cases was DHF I
(42.9%), whereas that of adults was DHF II (51%). Some clinical manifestations
were more common in adult patients, such as petechiae, melena, headache, retro-
orbital pain, joint pain, myalgia, nausea and vomiting (p-value<0.05). Signs found
commonly in children were epistaxis, oliguria, and liver enlargement (p-
value<0.05). Haemoconcentration, thrombocytopenia, increased alanine
aminotransferase, and longer prothrombin time were found to be significantly
higher in adults than in children (p-value<0.05). CONCLUSIONS: Some clinical
presentations of dengue disease and laboratory findings in adults are different
from those in children. Therefore, adults as well as pediatric cases of DHF need
appropriate and prompt case management to reduce the mortality rate of DHF.
Publication Types:
421: Medicine (Baltimore). 2007 May;86(3):138-44.
Comparison of clinical manifestations and outcome of community-

acquired bloodstream infections among the oldest old, elderly, and
adult patients.
Lee CC, Chen SY, Chang IJ, Chen SC, Wu SC.
Department of Emergency Medicine, National Taiwan University Hospital Yun-

Lin Branch, Douliou, Taiwan. chnchnglee@yahoo.com
Valid studies comparing the clinical characteristics among adult, elderly, and the
oldest old bacteremic patients are lacking. We conducted a prospective,
observational study in the emergency department (ED) of a university medical
center between June 2001 and June 2002. All patients >18 years of age who
registered in the ED with a clinically significant, culture-positive, bloodstream
infection (BSI) were enrolled. Patients were divided into 3 groups based on age:
1) oldest old (> or =85 yr), 2) elderly (65-84 yr), and 3) adult (18-64 yr). The
clinical and laboratory manifestations and 30-day mortality were recorded. Group
comparisons were performed using the chi-square test or analysis of variance
(ANOVA) test, as indicated. Survival was analyzed using the Kaplan-Meier
method and the Cox-regression model, adjusted for potential confounders.A total
of 890 cases of community-acquired BSI were eligible for analysis. Compared to
the adult group, both the elderly and the oldest old patients had more atypical
clinical manifestations, a higher propensity to develop organ failure, and a worse
prognosis. Elderly patients had significantly less tachycardia (p = 0.001), but
more acute respiratory (p = 0.007) and renal failure (p = 0.037); the oldest old
patients had more afebrile episodes (p = 0.006), leukocytosis (p = 0.012), and
more patients developed respiratory failure (p = 0.009), acute renal failure (p =
0.011), septic shock (p = 0.022), and altered mental status (p = 0.013). Urinary
tract infections were the main source of BSI for both the elderly and oldest old,
while the oldest old patients had significantly more pneumonia than the elderly or
adults.As a group, older patients had fewer signs and symptoms of BSI, but a
higher risk of organ failure and a worse prognosis than younger patients.
Publication Types:
422: Br J Gen Pract. 2007 May;57(538):377-82.
Comment in:
• Br J Gen Pract. 2007 May;57(538):350-1.
Effect of the characteristics of family physicians on their utilisation

of laboratory tests.
Vinker S, Kvint I, Erez R, Elhayany A, Kahan E.
Department of Family Medicine, Tel Aviv University, Israel.

vinker01@zahav.net.il
BACKGROUND: The use of laboratory tests by family physicians has increased

in recent years. AIMS: To evaluate the relationship between family physicians'
characteristics and the number and type of laboratory tests requested, taking into
account chronic diseases. DESIGN OF STUDY: Retrospective, cross-sectional
study. SETTING: One hundred and sixty-two physicians treating 230 123 patients
in one district of a health management organisation in Israel. METHOD:
Physicians' use of 16 common types of laboratory tests was assessed in relation to
physicians' demographic, professional, and clinic characteristics. The utilisation
rate over 1 year was divided into quintiles for each laboratory test, and each
physician was given a global laboratory score (for each test the physician got a
score from 1 (utilisation in the lower quintile) to 5 (higher quintile). The global
score was the sum of scores of the individual tests. RESULTS: On logistic
regression analysis, four background characteristics were associated with the
global score for the utilisation of laboratory tests. The highest hazard ratios were
for being a female doctor (3.2, 95% confidence interval [CI] = 1.5 to 6.5),
working in an urban clinic (3.2, 95% CI = 1.1 to 9.8), and having a greater
workload than doctors in rural clinics (1.4, 95% CI = 1.1 to 1.8). Being a graduate
of a Western country or Israel had a negative association with the global score
(0.4, 95% CI = 0.1 to 0.99). CONCLUSION: Female sex and working in a urban
clinic were major factors in the use of laboratory tests in clinical practice. As
more women enter the medical profession, an improved understanding of the sex
differences in ordering medical tests is important.
Publication Types:
PMCID: PMC2047012
423: J Am Med Dir Assoc. 2007 May;8(4):233-42.
Predictors of rehabilitation outcomes: a comparison of Israeli and

Italian geriatric post-acute care (PAC) facilities using the minimum
data set (MDS).
Gindin J, Walter-Ginzburg A, Geitzen M, Epstein S, Levi S, Landi F,

Bernabei R.
Geriatric Institute for Education and Research, Kaplan Medical Center, Rehovot,
Israel.
OBJECTIVES: To understand the relative contribution of sociodemographic,

clinical, and health care features to rehabilitation outcomes in Israel and in Italy in
post-acute care (PAC) facilities. DESIGN: Prospective cross-national study
SETTING: Two hospital geriatric PAC departments: Harzfeld Geriatric Hospital,
Gedera, Israel, and Catholic University of Sacred Heart Geriatric Hospital, Rome,
Italy. PARTICIPANTS: Post-acute care patients aged 65 and older admitted
consecutively for stabilization, improvement, or rehabilitation to 3 departments in
Harzfeld Geriatric Hospital, Gedera, Israel from April, 1999 through February,
2002 (N = 364), and to the post-acute Geriatric Rehabilitation Unit of the "A.
Gemelli" Hospital, Catholic University of Sacred Heart, Rome, Italy, between
February, 1999, and April, 2002 (N = 351), for whom there were complete
assessments at admission and discharge (the total number admitted in Israel was
505, and in Italy, 409). MEASUREMENTS: Minimum Data Set for Post-Acute
Care (MDS-PAC) assessments conducted within 4 days of admission and at
discharge; data collected identically in both sites. Predictors of functional
recovery> were identified using multivariate binary logistic regression. The
dependent variable: improvement of 1 or more points in the ADL scale.
RESULTS: The staffing pattern of the PAC department in Italy had about double
the physicians and physio- and occupational therapists than in Israel, but about the
same number of nurses and somewhat fewer aides than in Israel. Multivariate
binary logistic regression that includes country, age, sex, and marital status, found
that the patients in Italy had about triple the probability of improvement in ADL
function (OR 3.3, CI 2.4-4.6) (P < .001) than PAC patients in Israel. Even after
health system characteristics were added to the model, ADL improvement was
most significantly associated with higher cognitive ability and a diagnosis of hip
fracture, as well as longer length of stay and being admitted to PAC directly from
an acute hospital. For each additional point (worse cognition) in a cognitive scale,
there was a 30% decrease in the probability of ADL improvement (OR 0.7, CI
0.6-0.8, P < .001). Those who had a stroke were about half as likely to show ADL
improvement (OR 0.5, CI 0.3-0.7) than those without stroke, but those with a hip
fracture had more than double the probability of ADL improvement (OR 2.7, CI
1.7-4.2) than those without hip fracture. Those who stayed in the PAC ward an
additional block of time had a 30% higher probability of ADL improvement (P <
.1), and those who were admitted directly to PAC from an acute hospital had more
than 4 times the probability of ADL improvement (OR 4.1, CI 2.3-7.0, P < .001)
than those who were admitted from a private home. CONCLUSIONS: We found
support for the hypothesis that differences in sociodemographic and clinical
factors cannot account for all differences in ADL improvement, and that the
organization of care and constraints of the health system also influence functional
outcomes. Policymakers should examine the policy-amenable features of the
Italian and Israeli systems so that optimal ADL recovery can be encouraged. Any
reduction in disability will help both patients and the health care system; slightly
higher short-term PAC treatment costs may have large long-term future benefits,
if they result in the reduction of ADL disability. This study is one of the first to
examine outcomes of PAC in 2 countries, and can provide an initial assessment of
how rehabilitation can be enhanced or limited by health policies and staffing
patterns.
Publication Types:
424: Nurs Res. 2007 May-Jun;56(3):202-9.
Evaluation of an integrated communication skills training program

for nurses in cancer care in Beijing, China.
Liu JE, Mok E, Wong T, Xue L, Xu B.
School of Nursing, Capital Medical University, Beijing, China.

liujune66@yahoo.com.cn
BACKGROUND: Nurses have considerable needs for communication skills

training in cancer care because of the general lack of education and training on
oncology-specific communication skills in Mainland China. OBJECTIVES: To
evaluate the effectiveness of an integrated communication skills training program,
in which an intensive learning session was combined with practice in the clinical
unit to create a supportive ward atmosphere where nurses could practice skills in
the workplace and obtain support of head nurses. METHODS: To implement the
communication skills training for 129 nurses, a quasi-experimental research
design with a nonequivalent control group was used. Measures, including basic
communication skills, self-efficacy in oncology-specific communication skills,
communication outcome expectancies, and self-perceived support for
communication, were administered at pretraining evaluation, formative evaluation
(1 month after training), and summative evaluation (6 months after training) in the
training group. Formative evaluation was not administered in the control group.
RESULTS: There was continued significant improvement in the overall basic
communication skills, self-efficacy, outcome expectancy beliefs, and perceived
support in the training group. No significant improvement was found in the
control group over the same period. DISCUSSION: Nurses' communication skills
could be developed and consolidated under the integrated communication skills
training model. Development of effective interventions to change nurses' negative
outcome expectancies in communication with cancer patients is needed in further
study.
Publication Types:


425: Avian Dis. 2007 Mar;51(1 Suppl):501-3.
EFSA scientific risk assessment on animal health and welfare

aspects of avian influenza (EFSA-Q-2004-075).
Serratosa J, Ribó O, Correia S, Pittman M.
Animal Health and Animal Welfare Unit, European Food Safety Authority, Largo
Palli Natale S/A, 43100 Parma, Italy.
Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in

50 million EU birds culled or dead. The circulation of H5N1 in Asia could
represent the origin of a human pandemic. Questions have been raised to combat
the ongoing AI crisis. HPAI H5N1 has spilled over to resident and migratory wild
bird populations which could represent a means of the virus reaching the EU, but
lack of data make any forecast imprudent. Poultry holdings located close to
migratory bird breeding and resting sites are considered at greater risk of exposure
and methods to prevent exposure should be implemented. Legal safeguards for
importation of poultry commodities currently only apply to HPAI and rely on
detection of clinical signs that may not be observable during incubation period.
Illegal imports represent an additional risk. Insufficient data on the effectiveness
of commodity processing are available and few indications can be deducted.
Biosecurity is the primary tool to prevent AI introduction and secondary spread.
Massive spread was observed in densely populated poultry areas resulting in
vaccination programs. Vaccination should be used to support eradication together
with enhanced biosecurity and restriction measures, which shall also be
implemented in case of prophylactic vaccination. Animal welfare aspects of AI
include use of appropriate culling methods, correct vaccine application, and
availability of trained staff. EFSA has recently set up a new scientific work group
to further assess the risk of HPAI introduction and spread posed in particular by
wild, migratory birds, as well as further follow-up of recent AI developments.
426: Nurse Res. 2007;14(3):46-59.
Lost in translation? Undertaking transcultural qualitative research.
Irvine FE, Lloyd D, Jones PR, Allsup DM, Kakehashi C, Ogi A, Okuyama
M.
School of Nursing, Midwifery and Health Studies, University of Wales, Bangor.
If nurses are to undertake rigorous transcultural research, they must take account
of the cultural and linguistic diversity of the countries in which they propose to
complete their work. Fiona Elizabeth Irvine and colleagues describe the
experiences of researchers undertaking the qualitative phase of a study of
Japanese and UK nurse educators, and consider the measures that can be taken to
enhance the rigour of transcultural research.
Publication Types:

• Review
427: Int Nurs Rev. 2007 Jun;54(2):179-82.
A nursing tool validated as an effective measure over MMSE and

FAB in dementia.
Yamashita M, Kubota T, Fuchita E, Yokoyama K, Hayashi H, Okamoto S,

Sano E, Matsuo A, Shimasue N, Watanabe T, Kawashima R, Sugimoto K.
Department of Nursing, School of Health Sciences, Saitama Prefectural

University, Saitama, Japan. yamashita-mineko@spu.ac.jp
AIM: To evaluate the clinical use of the Abilities Assessment Instrument (AAI)
when used together with Mini Mental State Examination (MMSE) and Frontal
Assessment Battery (FAB), thus examining the concurrent validity of the
instrument. Also, to evaluate the effect of a learning program administered for
elders with dementia. METHODS: Fourteen older people, who were afflicted with
Alzheimer's disease or related dementias, were invited into a learning program.
Measures were taken at baseline, at 3 months and 6 months to see the effects of
the program. Instruments used in the study were the AAI, the MMSE and the
FAB. FINDINGS: There were statistically significant differences measured by the
Japanese version of the AAI in the subjects' abilities to perform the learning tasks
between 3 and 6 months after intervention. No statistical significant differences
were noted at any points in time measured by the MMSE or the FAB.
CONCLUSION: The translated AAI promises to be a valid instrument for nurses'
use in their day-to-day assessment of Japanese elders. The AAI appears also to be
useful in learning programs with this population, and may have value as a
screening tool.
Publication Types:
• Validation Studies
428: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2007 Feb;15(1):184-7.
[Research on Zhejiang blood information network and management

system]
[Article in Chinese]
Yan LX, Xu Y, Meng ZH, Kong CH, Wang JM, Jin ZL, Wu SD, Chen CS,
Luo LF.
Blood center of Zhejiang Province, Key Laboratory of Blood Safety Ministry of

Health, Hangzhou 310006, China.
This research was aimed to develop the first level blood information centralized
database and real time communication network at a province area in China.
Multiple technology like local area network database separate operation, real time
data concentration and distribution mechanism, allopatric backup, and optical
fiber virtual private network (VPN) were used. As a result, the blood information
centralized database and management system were successfully constructed,
which covers all the Zhejiang province, and the real time exchange of blood data
was realised. In conclusion, its implementation promote volunteer blood donation
and ensure the blood safety in Zhejiang, especially strengthen the quick response
to public health emergency. This project lays the first stone of centralized test and
allotment among blood banks in Zhejiang, and can serve as a reference of
contemporary blood bank information systems in China.
Publication Types:
429: Ind Health. 2007 Apr;45(2):232-6.
The effectiveness of an education program on stages of smoking

behavior for workers at a factory in Turkey.
Gunes G, Ilgar M, Karaoglu L.
Department of Public Health, Inonu University Medical School, Malatya, Turkey.
The aim of the study was to determine the smoking behavior based on "stages of
change" model of the workers and to assess the effectiveness of a education
program at a workplace. The first step was descriptive and the second step was an
experimental study. The intervention group received an smoking cessation
education. Before intervention 36% of the intervention group were at
precontemplation stage. Six months after the intervention decline the percentage
of those at precontemplation stage was significantly lower. In the control group
there was not a significant reduction in the percentages of smokers at
precontemplation stage before and after the intervention. After the 6 months the
"maintenance" stage rates were 6% and 2% in the intervention and control groups,
respectively. The study showed that the education in factory for workers could not
be successful in quiting, however it impacted the intention and preparation of to
quit in the future.
Publication Types:
• Clinical Trial
430: Mil Med. 2007 Apr;172(4):431-5.
Effect of a computerized online grading system on patient

satisfaction in a military primary health care setting.
Levy G, Goldstein L, Barenboim E, Bar-Dayan Y.

Surgeon General Headquarters, Israel Air Force, Tel-Hashomer, Israel.
Patient satisfaction is gaining recognition as an important determinant of the

quality of medical care. We conducted an analysis to evaluate the effect of a
computerized online system that comparatively displays grades of patient
satisfaction among primary care military infirmaries. Fifteen Israel Air Force
primary care infirmaries served as the intervention group, and 130 Israel Defense
Force infirmaries were the control group. Baseline patient satisfaction was
surveyed in all infirmaries. In the intervention group only, infirmaries were
resurveyed at 3-month intervals during a 1-year period. Satisfaction scores were
continuously displayed on an intranet site in a comparative graphical manner by
using the computerized system, available only to the intervention group. At the
endpoint, patient satisfaction improved in both groups. However, the magnitude
of improvement in the intervention group was significantly greater, in comparison
with the control group. The most pronounced improvement was noted in
availability of service (intervention group, 57.9% at baseline vs. 66.0% at
endpoint, p < 0.001; control group, 67.5% vs. 69.6%, p < 0.025). We conclude
that the use of this computerized system in conjunction with promotional efforts
resulted in significant improvements in patient satisfaction.
Publication Types:
• Clinical Trial
431: Ann Acad Med Singapore. 2007 Apr;36(4):233-8.
Extracranial non-vestibular head and neck schwannomas: a ten-

year experience.
Kang GC, Soo KC, Lim DT.
Department of General Surgery, Singapore General Hospital, Singapore.
INTRODUCTION: We present a series of head and neck extracranial non-

vestibular schwannomas treated during a ten-year period, assessing epidemiology,
presenting signs and symptoms, location, nerve of origin, diagnostic modalities,
treatment and clinical outcome. MATERIALS AND METHODS: Clinical records
of all patients with head and neck schwannomas treated at our department from
April 1995 to July 2005 were retrospectively reviewed. RESULTS: There was
female predominance (67%). The mean age at diagnosis was 48 years. Sixteen
(76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in
the parapharyngeal space. The most common nerves of origin were the vagus and
the cervical sympathetic chain. The tumour may masquerade as a cervical lymph
node and other myriad conditions. Treatment for all but 2 cases was complete
excision with nerve preservation. Two cases of facial schwannoma required
sacrifice of the affected nerve portion with nerve reconstruction. All facial
schwannoma patients suffered postoperative facial palsy with only partial
resolution (mean final House-Brackman grade, 3.25/6). Among non-facial
schwannoma patients, postoperative neural deficit occurred in 12 with partial to
complete resolution in 7. The median follow-up period was 24 months. No
schwannoma was malignant and none recurred. CONCLUSION: Non-vestibular
extracranial head and neck schwannomas most frequently present as an innocuous
longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be
aided by fine-needle cytology and magnetic resonance imaging or computed
tomographic imaging. The mainstay of treatment is complete intracapsular
excision preserving the nerve of origin, but for extensive tumour or facial
schwannomas, subtotal resection or nerve sacrifice with reconstruction and
rehabilitation are considerations. Surgery on intraparotid facial schwannomas
carries considerable morbidity and conservative management has a place in
treatment. Early recognition of facial schwannomas is key to optimal treatment.
432: J Pain Symptom Manage. 2007 May;33(5):628-33.
Jordan palliative care initiative: a WHO Demonstration Project.
Stjernswärd J, Ferris FD, Khleif SN, Jamous W, Treish IM, Milhem M,

Bushnaq M, Al Khateib A, Al Shtiat MN, Wheeler MS, Alwan A.
Cancer Control and Palliative Care, World Health Organization, World Health
Organization Collaborating Center for Palliative Cancer Care, Oxford, UK.
janstjernsward@hotmail.com
A model for pain relief and palliative care for the Middle East has been
established in Jordan. King Hussein Cancer Centre (KHCC) in Amman is now a
truly comprehensive cancer center as it includes palliative care for inpatients,
outpatients, and patients at home. This is especially important in a country and a
region where over 75% of the cancer patients are incurable when diagnosed. To
support effective palliative care delivery, there have been many significant
changes in Jordan between 2001 and 2006. Regulations governing opioid
prescribing have been changed to facilitate effective pain management. The
national opioid quota has been increased. Cost-effective, generic, immediate-
release morphine tablets are being produced in Jordan. Intensive, interactive
bedside training courses for doctors, nurses, and clinical pharmacologists have
started to overcome opiophobia and motivate health care professionals to take up
palliative care as a profession. "Champions" for palliative care have emerged who
are leading the development of palliative care in Jordan's health care systems and
starting to support neighboring countries to develop pain relief and palliative care.
While before 2003, fewer than 250 patients per year received palliative care, by
2006 more than 800 patients per year were receiving pain relief and palliative care
through the KHCC and Al Basheer Hospital. The achieved changes and the
unusually rapid and effective institutionalization of palliative care serve as a
model for other countries in the Middle East region as to what should be done and
how.
Publication Types:
• Review
433: J Altern Complement Med. 2007 Apr;13(3):387-91.
Educating CAM practitioners about integrative medicine: an

approach to overcoming the communication gap with conventional
health care practitioners.
Frenkel M, Ben-Arye E, Geva H, Klein A.
The Complementary and Traditional Medicine Unit, Department of Family

Medicine, The Bruce Rappaport Faculty of Medicine, The Technion, Israel
Institute of Technology, Haifa, Israel. mfrenkel@mdanderson.org
OBJECTIVE: To assess an educational initiative that teaches complementary and

alternative medicine (CAM) students how to communicate more effectively with
conventional physicians about CAM. DESIGN: We introduced an educational
initiative in integrative medicine to CAM students in their final year of study,
emphasizing evidence-based learning, patient-centered care, and communication
skills with conventional health care providers. A precourse semistructured
questionnaire and an anonymous open essay about the students' experiences at the
end of the course were used as tools for assessment. The precourse questionnaires
and the postcourse essays were evaluated, using content analysis for parallel
responses to determine whether students' views changed during the course.
RESULTS: We evaluated the experience in 62 students exposed to the initiative
during 4 academic years, 2001-2005. We found that CAM students perceive that
they need practical communication tools in order to communicate effectively with
conventional practitioners. After the educational experience, the students
confirmed that critical thinking training is important, and reported feeling more
empowered and more confident in their work as well as in communicating with
physicians. CONCLUSIONS: The results of this study suggest that CAM
practitioners feel better equipped to communicate with conventional health care
practitioners after exposure to a structured educational initiative that emphasizes
critical thinking, patient-centered care, and communication skills with
conventional practitioners.
434: Am Heart Hosp J. 2007 Spring;5(2):100-2.
Cardiac services in Sarawak, Malaysia.
Sim KH, Yip Fong AY.
Deaprtment of Cardiology & Clinical Reearch Centre, Sarawak General Hospital,

Kuching, Sarawak, Malaysia. sim.kui.hian@health.gov.my
435: Diabetes Res Clin Pract. 2007 Sep;77 Suppl 1:S82-6. Epub 2007 Apr 30.
Present state of diabetes management in the elderly, Japan.
Fujisawa T, Ikegami H, Nojima K, Kawabata Y, Noso S, Asano K, Hiromine

Y, Fukai A, Shindo N, Ogihara T.
Department of Geriatric Medicine, Osaka Graduate School of Medicine, 2-2

Yamadaoka, Suita, Osaka 565-0871, Japan. fujisawa@geriat.med.osaka-u.ac.jp
A recent dramatic increase in elderly patients with diabetes mellitus has made the
proper management of the disease in this population more important. Here, we
discuss the present status of diabetes management in the elderly in Japan. As a
characteristic feature of elderly persons, body weight reduction is difficult,
because of the profound adaptive reduction in resting energy expenditure under
calorie restriction in the elderly. However, hyperglycemia increases the risk for
diabetic complications, except proliferative retinopathy, similarly in elderly and
non-elderly. Of note, there is marked clinical heterogeneity in this generation in
the following aspects: duration, complication status (past aspect), insulin
secretion, insulin sensitivity, familial support and physical exercise/activity
(present aspect), as well as the expected lifespan (future aspect). This
heterogeneity among the elderly should render diabetes treatment diverse, and in
fact, one of the largest surveys in Japan demonstrated significant diversity in
diabetes management in the elderly. In Japan, thus, the present management of
diabetes in the elderly is considerably diverse, reflecting the clinical heterogeneity
among elderly patients with diabetes. Further clinical evidence is awaited for the
establishment of proper and safe management of diabetes in the elderly.
Publication Types:
436: Int J Gynecol Cancer. 2008 Jan-Feb;18(1):110-5. Epub 2007 Apr 26.
Silent killer of the night: a feasibility study of an outreach well-

women clinic for cervical cancer screening in female sex workers in
Hong Kong.
Wong WC, Wun YT, Chan KW, Liu Y.
Department of Community and Family Medicine, The Chinese University of

Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
cwwong@cuhk.edu.hk
The purpose of this study was to see if an outreach model could be a feasible
option for early detections of preinvasive cervical cancer in women with double
identities of female sex workers (FSW) and illegal migrant workers in Hong Kong
who most needed cervical screening but were often deprived of such a service.
High turnover rates, acceptability, and compliance for follow-ups could
potentially render such a clinical model unsuccessful. A total of 245 FSW were
screened at the outreach clinic from January 2004 to December 2005, which was
set up in a nongovernmental organization in a red light district. A questionnaire
regarding their lifestyles and demographic details was used before a
gynecological history, Papanicolaou (PAP) smear, and other health checkup were
conducted. Chi-square test and multinomial logistic regression were used to
analyze the results. Of 235 women tests, 9.8% of them had CIN I-III, and places
of origin were found to be important risk factors for abnormal PAP smears. The
nonlocal workers were significantly more likely to have abnormal PAP smears
(chi(2)= 10.55, P= 0.04). Among the women, 88.1% of them who had the tests
returned for follow-up with poorer compliance among those with an abnormal
result. We conclude that an outreach well-women clinic seems to be an acceptable
option for these women and an effective way for the early detection of cervical
cancer.
437: Regen Med. 2006 Sep;1(5):671-83.
China and the global stem cell bioeconomy: an emerging political

strategy?
Salter B, Cooper M, Dickins A.
Institute of Health, Global Biopolitics Research Group, University of East Anglia,

Norwich, UK. brian.salter@uea.ac.uk
There is a growing consensus, amongst policy analysts and scientists alike, that
China is likely to play a key role in the scientific, clinical and commercial
development of stem cell research. However, to date, there exist few detailed
analyses of China's current investment in the field. After introducing the UK's
recent political strategy on stem cell science, this article develops an in-depth
discussion of the formal organization of China's research and development in the
area, as well as its rapidly evolving commercial, regulatory and ethical
environment. From here, we go on to assess the probability of China's emergence
as a global player in the increasingly internationalized business of stem cell
biomedicine.
Publication Types:

• Review
438: Australas Psychiatry. 2007 Apr;15(2):140-3.
Six months in Aceh.
Hugo M.
Central Northern Adelaide Health Service, Mental Health Division, SA, Australia.
malcolm.hugo@nwahs.sa.gov.au
OBJECTIVE: Brief case histories are presented of people with schizophrenia

treated in the Indonesian province of Aceh, where the author worked as a clinical
psychologist for Medecines Sans Frontieres in 2005. Aceh was severely affected
by the December 2004 tsunami, with significant destruction and loss of life.
CONCLUSIONS: The case studies highlight the needs of patients and the current
opportunities to establish more effective mental health services. The role of
culture as a significant consideration and a possible barrier to accessing care is
also discussed.
Publication Types:
• Case Reports
439: Acta Paediatr. 2007 May;96(5):693-6.
Characteristics of severely malnourished under-five children

hospitalized with diarrhoea, and their policy implications.
Chisti MJ, Hossain MI, Malek MA, Faruque AS, Ahmed T, Salam MA.
Clinical Sciences Division, ICDDR,B: Centre for Health and Population

Research, GPO Box 128, Dhaka 1000, Bangladesh.
AIM: Identify clinical and nutritional features, and complications among severely
malnourished, under-five children in an urban diarrhoeal disease facility in
Bangladesh. METHODS: For this case-control design, children of both sexes,
aged 0-59 months were studied. Severely (< -3 z-score) underweight, stunted or
wasted constituted cases and those with better nutritional status (z-score > or = -3)
constituted controls. RESULTS: During 2000-2005, of the total 6881 children,
1103 (16%) were severely underweight, 705 (11%) severely stunted and 217 (3%)
severely wasted. In logistic regression analysis, severely underweight children
were more likely to be older than 11 months (OR 3.7, 95% CI 3.1-4.3, p < 0.001),
non-breastfed (OR 1.5, 95% CI 1.3-1.8, p < 0.001), have illiterate mothers (OR
2.6, 95% CI 2.2-3.0, p < 0.001), non-sanitary toilet (OR 1.4, 95% CI 1.2-1.6, p <
0.001), a history of measles in preceding 6 months (OR 1.7, 95% CI 1.3-2.4, p =
0.001), dehydrating diarrhoea (OR 1.9, 95% CI 1.6-2.2, p < 0.001), abnormal
findings in lung auscultation (OR 1.7, 95% CI 1.3-2.3, p < 0.001) and require
hospitalization > or = 48 h (OR 2.2, 95% CI 1.8-2.5, p < 0.001). CONCLUSION:
There thus is a need to incorporate appropriate, cost-effective and sustainable
preventive strategies and improved management policies in the health systems as
well as in social support systems in Bangladesh.
Publication Types:

440: J Clin Nurs. 2007 May;16(5):963-70.
A survey of Chinese nurses' current knowledge of pain in older

people.
Yu HD, Petrini MA.
Faculty of HOPE, School of Nursing, Wuhan University, Wuhan, China.

flyyhd@yahoo.com.cn
AIM: To investigate the current level of Chinese nurses' knowledge of pain and
pain management in older people. BACKGROUND: Most research about nurses'
knowledge regarding pain has taken place in developed countries; however,
limited research in this area has taken place in developing countries and
particularly in China. METHODS: Registered Nurses (n = 621) in three different
hospitals were surveyed with the questionnaire about pain and pain management
with respect to older people. RESULTS: The finding showed that a significant
knowledge deficit in this area exists. There were no significant differences among
nurses in terms of education background, position and whether or not there was
attendance in an educational session on pain management. However, there were
statistically significant differences based on age; hospital of employment and
clinical area in which employed. CONCLUSION: This survey suggested that
nurses' knowledge of pain in older people should be improved. Basic and
continuing education of nurses in this area should be enhanced and their active
participation in pain management should be encouraged. RELEVANCE TO
CLINICAL PRACTICE: The findings in this survey highlight a significant pain
management knowledge deficit among the nurses in the clinical practice. The
findings may help the nurses realize their knowledge deficit in this area and may
also suggest curriculum changes for the nurses to improve pain management
knowledge.
Publication Types:
441: J Clin Nurs. 2007 May;16(5):928-36.
Effectiveness of bran supplement in older orthopaedic patients with

constipation.
Kaçmaz Z, Kaşiçi M.
Erzurum Health School of Ataturk University Erzurum, Turkey.
AIM: The purpose of the study was to evaluate the effectiveness of planned
nursing interventions, including bran supplement, on the bowel management of
older orthopaedic patients. BACKGROUND: Constipation is prevalent among
older people. Constipation is also well-known to be a problem for a range of
orthopaedic patients. Orthopaedic diseases or conditions may, because of the
specific problems, cause this. The problem may also arise as a result of the
orthopaedic treatment options undertaken by patients. DESIGN: A
quasiexperimental design was employed. METHODS: The patients were recruited
from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey.
Descriptive statistics, independent sample test t-test, chi-square and McNemar test
were used to analyse the data. Constipation problems were identified through
interviews by using the Constipation Diagnosis Form. Interviews were performed
within the fourth postoperative day. After that, while the patients in the control
group received routine nursing care according to clinic routine, the patients in the
experimental group received bran supplement together with planned nursing
interventions. The patents in both groups were followed by using the Constipation
Follow Form. RESULTS: While patients in the experimental group showed
significant improvements in most characteristics of bowel elimination such as
time of defecation, intensity of faeces, colour of faeces and amount of faeces, the
control group showed a significant improvement in only duration of defecation.
CONCLUSIONS: The results of the study indicate planned nursing interventions
including bran supplement are more effective than routine nursing interventions
for management of constipation problems in older orthopaedic patients.
RELEVANCE TO CLINICAL PRACTICE: Nurses have an important part to
play in both prevention and management of constipation. Constipation is a
problem especially for older orthopaedic patients. Planned nursing interventions
that include bran supplements may be more effective than routine nursing
interventions for management of constipation problems in older orthopaedic
patients.
Publication Types:

442: Nurs Ethics. 2007 May;14(3):309-19.
Differences in moral judgment between nursing students and

qualified nurses.
Kim YS, Park JH, Han SS.
Ajou University, Suwon, Korea.
This longitudinal study examined how nursing students' moral judgment changes
after they become qualified nurses working in a hospital environment. The sample
used was a group of 80 nursing students attending a university in Suwon, Korea,
between 2001 and 2003. By using a Korean version of the Judgment About
Nursing Decisions questionnaire, an instrument used in nursing care research,
moral judgment scores based on Ketefian's six nursing dilemmas were
determined. The results were as follows: (1) the qualified nurses had significantly
higher idealistic moral judgment scores than the nursing students; (2) the qualified
nurses showed significantly higher realistic moral judgment scores than the
nursing students; and (3) when comparing idealistic and realistic moral judgment
scores, both the qualified nurses and the nursing students had higher scores for
idealistic moral judgment. Further study is recommended to examine changes in
moral judgment.
Publication Types:
443: Percept Mot Skills. 2007 Feb;104(1):166-70.
Attitudes of physical education majors in Turkey towards disability

are changed by adaptive physical education training.
Gürsel F.
School of Physical Education, Ankara University, Kenedi caddesi 119/14 06700,

Kavaklidere Ankara, Turkey. gursel@pharmacy.ankara.edu.tr
This study was designed to investigate the attitudes of university students who are
prospective physical education teachers toward individuals with physical
disabilities. 47 college students majoring in physical education (Study group) and
34 students from other sports-related departments, i.e., sports management and
training (Control group), participated in the study. The study group took a 14-
week course on Adapted Physical Education (APE), whereas the control group
did not. The Attitude Toward Disabled Persons scale, Form O was used to
compare the attitudes of the groups. Analyses showed no significant difference
between the groups in terms of attitude towards individuals with physical
disabilities at the beginning of the semester but a significant difference at
semester end. Results indicated that the APE course positively influenced attitude
of the prospective physical education teachers towards individuals with physical
disabilities.
Publication Types:

444: Ann Acad Med Singapore. 2007 Mar;36(3):165-8.
Demographic and clinical features of 150 pathological gamblers

referred to a community addictions programme.
Teo P, Mythily S, Anantha S, Winslow M.
Community Addiction Management Programme, Institute of Mental Health,

Singapore.
INTRODUCTION: Pathological gambling has been defined as a persistent and

recurrent maladaptive gambling behaviour that disrupts personal, family and work
life. The present study reports on the sociodemographic features, gambling
activity, comorbidity and legal problems in a sample of 150 pathological gamblers
who sought treatment from the Community Addiction Management Programme
(CAMP), Singapore over a 4-year period from 2002 to 2006. MATERIALS AND
METHODS: Data were collected on 150 consecutive subjects who sought
treatment at CAMP. Patients were administered a semi-structured interview to
elicit demographic data, age of onset, family history, onset games and types of
games ever played, largest debt incurred due to gambling, triggers, illegal
activities and suicidal attempts by their counsellor. Patients were then assessed by
the clinicians to establish the primary and comorbid diagnoses. RESULTS: The
mean age of the subjects was 42.5 [standard deviation (SD) 10.2] years. The
majority of them were males (87.3%) and of Chinese origin (97.3%). The most
common comorbid disorders were mood disorders (n = 22, 14.7%), substance
abuse (n = 11, 7.3%) and alcohol abuse or dependence (n = 7, 4.7%). Sixteen
(10.7%) subjects had a history of suicidal attempts which had been precipitated by
gambling-related issues. CONCLUSIONS: Pathological gambling in our subjects
appears to be associated with significant comorbidity and financial problems.
These are the preliminary findings and further research is needed regarding the
phenomenology, profile, course and response to treatment of pathological
gambling disorders.
445: J Korean Med Sci. 2007 Apr;22(2):270-6.

Clinical outcome of urgent coronary artery bypass grafting.
Kim DK, Yoo KJ, Hong YS, Chang BC, Kang MS.
Department of Thoracic and Cardiovascular Surgery, Severance Hospital

Cardiovascular Center, 134 Sinchon-dong, Seodaemun-gu, Seoul, Korea.
Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than
elective CABG. The purpose of this study was to evaluate the clinical outcome of
urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent
CABG. All patients required an urgent surgical revascularization within 24 hr of
diagnostic coronary angiography. In-hospital mortality after urgent CABG was
17.3% (18/104). We compared preoperative characteristics and postoperative
clinical outcomes between the survival group (n=86) and the mortality group
(n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of
mortality was low cardiac output. The independent preoperative risk factors of
mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative
shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492,
p=0.034). Other risk factors of mortality included prolonged cardiopulmonary
bypass time, prolonged ventilator use, and extended intensive care unit stay. The
10-yr actuarial survival rate was 61%. Although the operative mortality rate was
high after urgent CABG, a favorable long-term clinical outcome can be expected
if the patients survive.
Publication Types:
446: Pediatr Diabetes. 2007 Apr;8(2):60-6.
Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel

population, 1997-2003.
Koton S; Israel IDDM Registry Study Group - IIRSG.
The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.
koton@post.tau.ac.il
BACKGROUND: Recent reports from different countries have shown an
increased incidence of type 1 diabetes mellitus (T1DM). A national juvenile
diabetes register was established by the Israel Pediatric Endocrine Society and the
Israel Center for Disease Control (ICDC) in 1997. OBJECTIVE: This article
reports the epidemiology of T1DM in children in the age-group 0-17 yr in Israel
during 1997-2003. METHODS: The Israel juvenile diabetes register is a
population-based anonymous registry. Newly diagnosed cases of all types of
diabetes in children and adolescents are reported to the ICDC by all the
endocrinologists in all the pediatric diabetes centers. Overall incidence rates and
rates by sex, age, and population group are presented. Comparisons are made by
year, sex, age, and population group. RESULTS: During 1997-2003, 1485
children and adolescents with T1DM were reported in the age-group 0-17 yr. The
annual incidence rate of T1DM increased by 34% during 1997-2003, from 8.0 per
100 000 [95% confidence interval (CI) 6.8-9.3] to 10.7 per 100 000 (95% CI 9.4-
12.1). Incidence rates were higher for Jews than for Arabs. Among Jews, children
of Yemenite origin had the highest incidence rate (26.1 per 100 000; 95% CI
13.3-38.9). Incidence peaked at an earlier age in girls. A first-degree family
history of T1DM was found in 9.1% of the cases. CONCLUSIONS: The
incidence of T1DM is increasing in the Israeli population, particularly in the Arab
population. The culturally varied composition of the Israeli population provides
important areas for future studies based on data collected in this national register.
Publication Types:
• Clinical Trial
447: Wilderness Environ Med. 2007 Spring;18(1):2-9.
Snakes of medical importance in India: is the concept of the "Big 4"

still relevant and useful?
Simpson ID, Norris RL.
WHO Snakebite Treatment Group. iandsimpson@gmail.com
Snakebites continue to be a major medical concern in India. However, there is

very little hard evidence of a numerical nature to enable us to understand which
species are responsible for mortality and morbidity. For many decades, the
concept of the "Big 4" Snakes of Medical Importance has reflected the view that 4
species are responsible for Indian snakebite mortality--the Indian cobra (Naja
naja), the common krait (Bungarus caeruleus), the Russell's viper (Daboia
russelii) and the saw-scaled viper (Echis carinatus). However, a recent discovery
that another species, the hump-nosed pit viper (Hypnale hypnale), is capable of
causing lethal envenomation, and that this problem was being concealed by
systematic misidentification of this species as the saw-scaled viper, has
necessitated a review of the concept of the "Big 4." The concept of the "Big 4"
snakes is reviewed to demonstrate its failure to include all currently known snakes
of medical significance in India, and its negative effects related to clinical
management of snakebite. The emergence of the hump-nosed pit viper (Hypnale
hypnale) as a snake of medical significance has rendered the "Big 4" obsolete in
terms of completeness. The concept of the "Big 4" is restricting sound
epidemiological work and the development of effective snake antivenoms. It
should be replaced by the model introduced in the 1980s by the World Health
Organization, which has not received adequate circulation and implementation.
448: Midwifery Today Int Midwife. 2007 Spring;(81):48-51.
My midwifery practice in Israel.
Shemesh I.
449: Trop Med Int Health. 2007 Apr;12(4):540-6.
Diagnosis and management of malaria by rural community health

providers in the Lao People's Democratic Republic (Laos).
Mayxay M, Pongvongsa T, Phompida S, Phetsouvanh R, White NJ, Newton

PN.
Wellcome Trust - Mahosot Hospital - Oxford Tropical Medicine Research

Collaboration, Mahosot Hospital, Vientiane, Lao PDR.
We assessed the knowledge of malaria diagnosis and management by community

health providers in rural Vientiane and Savannakhet Provinces, Lao PDR. Sixty
health providers (17 pharmacy owners/drug sellers and 43 village health
volunteers) were interviewed. All diagnosed malaria using symptoms and signs
only; 14% were aware of >2 criteria for the diagnosis of severe malaria. Although
chloroquine and quinine, the then recommended Lao national policy for
uncomplicated malaria treatment, were the most common antimalarials prescribed
- 65% gave incorrect doses and 70% did not know the side effects. Although not
recommended by the then national policy, 27% of the health providers used
combinations of antimalarials as they considered monotherapy ineffective. This
study strongly suggests that further training of Lao rural health providers in
malaria diagnosis and management is needed to improve the quality of health
services in areas remote from district hospitals.
Publication Types:
450: Kekkaku. 2007 Mar;82(3):201-16.
[Preventive measures against tuberculosis in working facilities and

companies]
Suzuki K, Satou K.
Chiba Foundation for Health Promotion and Disease Prevention, 32-14,

Shinminato, Mihama-ku, Chiba-shi, Chiba 261-0002, Japan.
kimi.suzuki@nifty.com
The health care program in working facilities and companies have played a
significant part in prevention of tuberculosis. However, the ordinary national
tuberculosis survey policy was abolished in April, 2005 and the tuberculosis
survey for salary-earners is on the brink of drastic change. In this symposium the
current status of the prevailing survey of tuberculosis in working facilities and
companies was reviewed and the future direction of the tuberculosis survey in
comparison to that in lung cancer survey was discussed. 1. Epidemiological trends
of tuberculosis from the tuberculosis surveillance data: Masako OHMORI
(Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association). The
estimated rate of tuberculosis case discovery by periodical mass screening in the
working facilities was 0.033% and it was higher than that in general adult
population. The detection rate of tuberculosis in nurses who suffered from
tuberculosis reached 40.4% by an aid of mass X-ray screening and 8.7% by
contact tracing. The risk of onset of the disease was 4.3 times higher nurses than
in general at the same years of age. The importance of infection control measures
in the medical facilities was emphasized. 2. Current status and problems in
tuberculosis control in a large-sized company: Yusuke NAKAOKA (Department
of Occupational Health, Osaka Railway Hospital, West Japan Railway Company).
Some preventive modalities against TB such as periodical medical check-up and
awareness programs have been done for the purpose of prevention in our
company. The prevalence of the disease has significantly reduced in number. The
specific circumstances in large-sized company should be taken into consideration,
and it is important for company workers and health professionals to recognize
their roles in preventing the infectious disease. 3. Are there any differences
between clinical cases and control people working for small-sized companies in
the onset of tuberculosis?: Osamu NAKASHIMA, Kohei IMOTO (Taito Health
Center, Tokyo) and Toru MORI (Research Institute of Tuberculosis, JATA). We
surveyed environmental conditions in working places and domestic conditions of
employees who were working for small-sized companies located in Taito ward,
based on written questionnaires. The companies were selected as those which had
the patients of tuberculosis in the past one-year period, and the number of
employees was less than ten. Compared with control people, TB patients had
more frequent smoking habit (p < 0.05), and tended to have been less exposed to
the sunshine at their residency and to have nutritionally poor meals and deficits of
their meals. These results suggest that these factors alone or in combination may
contribute to accelerated onset of tuberculosis. 4. Current status and problems in
tuberculosis management among high prevalence population and in health check-
up for personnel with unspecified and high occupational contact with tuberculosis
patients: Hidetoshi IGARI (Division of Control and Treatment of Infectious
Diseases, Chiba University Hospital), Kiminori SUZUKI (Chiba Foundation for
Health Promotion and Disease Prevention). Tuberculosis prevalence is as high as
500-1500 per 100,000 peoples among the homeless and construction workers
living in "Hanba", a bunkhouse. We surveyed their medical conditions through
periodical or extraperiodical health check-up. We retrospectively analyzed some
medical factors contributing to successful treatment of the disease. Hospital
admission and enhancement of counseling opportunities were two factors leading
to the success of the treatment. The ambulance attendants have a significant
possibility to contact patients with TB and are high at risk of acquiring the
infection. As there are often limited information on TB in patients in an
emergency condition, it is difficult to protect themselves from its contagion
properly. Periodical and extraperiodical health check-up is important for these
personnel and application of QuantiFERON-TB 2nd generation to the personnel is
new and useful for diagnosis of the latent tuberculosis infection. 5. A role of chest
X-ray examination for lung cancer detection among company workers: Takeo
TESHIMA (Koseikan Clinic, Miyagi Branch, Japan Anti-Tuberculosis
Association). Detection rates of lung cancer in company workers and in general
population under the age of 60 years were compared. Chest X-ray survey was
done using 10 cm x 10 cm indirect chest X-ray films of the chest. The detection
rates of lung cancer in patients with definite or suspicious diagnosis in 265,620
company workers were 2.3 and 2.6 per 100,000, respectively. On the other hand
the rates were 9.9 and 8.8 per 100,000 in a general population of 811,391.
Twenty-four percent of patients with suspicious diagnosis were eventually made a
definite diagnosis. The corrected detection rate reached to 21.0 for male patients
and 8.3 for female patients and 12.1 totally. The detection rates of lung cancer in
company workers and in general population under the age of 60 years exceeded
the rate of pulmonary tuberculosis. Chest X-ray examination for the detection of
lung cancer and pulmonary tuberculosis is still recommended under various
working and social circumstances.
Publication Types:
451: Int J Dermatol. 2007 Apr;46(4):388-92.
Mycotic cysts: report of 21 cases including eight pheomycotic cysts

from Saudi Arabia.
Sheikh SS, Amr SS.
Pathology Services Division, Dhahran Health Center, Dhahran, Saudi Arabia.

sheikhss@aramco.com.sa
BACKGROUND: Mycotic cysts are subcutaneous cystic granulomas caused by

either dematiaceous (pigmented) fungi (pheomycotic cysts) or eumycotic
(nonpigmented fungi) present in soil, wood, and decaying plant material. These
fungi gain access to the tissues via a wooden splinter or thorn. No deep tissue
involvement or extension to bone is known to occur. METHODS: We reviewed
our surgical pathology files for the last 32 years. All cases with the diagnosis of
cysts with fungi, thorns, or splinters and associated granulomatous and acute
inflammation were reviewed. Gomori's silver and periodic acid-Schiff stains were
performed in all cases. RESULTS: Twenty-one cases of mycotic cyst were found,
including eight pheomycotic cysts (one with a recurrent lesion seen 11 months
after the initial excision of the cyst). Thirteen cysts had nonpigmented fungal
hyphae. There were 14 males and seven females, with an age range of 5-76 years.
The dorsum of the foot was the most frequently affected site (12 cases). Four
cases involved the fingers, two involved the knee area, two involved the big toe,
and one each involved the leg, ankle, and forearm. The cysts measured 0.6-4.5 cm
in diameter. Histologically, there was granulomatous inflammation with a
variable degree of neutrophilic infiltrate giving central abscess formation. Twelve
cases showed a wooden splinter. All cases were positive for fungal organisms,
mostly septate hyphae and spores that were highlighted by special stains. Fungal
pigment, ranging from yellow-brown to light brown to black, was observed in
eight cases. No extension to deep tissues was noted. The clinical impression
varied widely including ganglion, sebaceous cyst, giant cell tumor of the tendon
sheath, and lipoma. One patient was immunosuppressed following renal
transplantation. All patients were treated by simple excision. No antifungal
chemotherapy was needed or administered in any of the patients. One patient had
a recurrence of his lesion within 1 year as a result of inadequate initial excision. A
second re-excision was curative. CONCLUSION: Mycotic cysts are uncommonly
encountered lesions that can be easily missed, especially in cases with scant
fungal elements, thus requiring special stains to detect the organisms. We reported
21 cases of mycotic cyst, including eight pheomycotic cysts, with emphasis on the
histopathologic recognition of this unusual entity.
452: Dig Dis Sci. 2007 Nov;52(11):3043-8. Epub 2007 Apr 10.
Noncardiac chest pain--an Asia-Pacific survey on the views of

primary care physicians.
Cheung TK, Lim PW, Wong BC.
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong

Kong.
Noncardiac chest pain (NCCP) is common and has a significant impact on health
care. Primary care physicians (PCPs)' attitudes, clinical approach, preference of
diagnostic tests, referral patterns, and comfort in managing patients with NCCP in
the Asia-Pacific region are not known. Consequently, we performed this survey in
the Asia-Pacific region. The self-completed questionnaire was sent to PCPs in the
Asia-Pacific region. A 28-item questionnaire contained questions on demographic
information, characteristics of practice, preferences of diagnostic tests, referral
patterns, treatment plans, and opinion on Helicobacter pylori and NCCP. A total
of 108 (74%) PCPs returned the questionnaire. A mean of 18% of the patients
were diagnosed with NCCP by PCPs in the past 6 months. Ninety-four percent of
PCPs had treated NCCP patients in the last 6 months. Only 38% of the PCPs were
comfortable in diagnosing NCCP but 85.2% believed that they should manage
NCCP patients. PCPs in Malaysia and Philippines were more likely to refer
patients to subspecialists. Fifty-seven and four-tenths percent of PCPs believed
that H. pylori infection plays a role in the development of NCCP. The study
demonstrates clearly that the understanding, diagnostic strategies, and treatment
strategies of NCCP in the Asia-Pacific region are suboptimal and thus highlights
the importance of educational and training programs tailored for PCPs in NCCP.
Publication Types:
453: Taehan Kanho Hakhoe Chi. 2007 Mar;37(2):185-91.
The effectiveness of the error reporting promoting program on the

nursing error incidence rate in Korean operating rooms.
Kim MS, Kim JS, Jung IS, Kim YH, Kim HJ.
Department of Nursing, Ulsan College, Ulsan, Korea. kanosa@hanmail.net
PURPOSE: The purpose of this study was to develop and evaluate an error
reporting promoting program(ERPP) to systematically reduce the incidence rate
of nursing errors in operating room. METHODS: A non-equivalent control group
non-synchronized design was used. Twenty-six operating room nurses who were
in one university hospital in Busan participated in this study. They were stratified
into four groups according to their operating room experience and were allocated
to the experimental and control groups using a matching method. Mann-Whitney
U Test was used to analyze the differences pre and post incidence rates of nursing
errors between the two groups. RESULTS: The incidence rate of nursing errors
decreased significantly in the experimental group compared to the pre-test score
from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in
the 3 domains-"compliance of aseptic technique", "management of document",
"environmental management" in the experimental group while it decreased in the
control group which was applied ordinary error-reporting method.
CONCLUSION: Error-reporting system can make possible to hold the errors in
common and to learn from them. ERPP was effective to reduce the errors of
recognition-related nursing activities. For the wake of more effective error-
prevention, we will be better to apply effort of risk management along the whole
health care system with this program.
Publication Types:
454: Health Policy Plan. 2007 May;22(3):156-66. Epub 2007 Apr 12.
Social franchising of TB care through private GPs in Myanmar: an

assessment of treatment results, access, equity and financial
protection.
Lönnroth K, Aung T, Maung W, Kluge H, Uplekar M.
TB Strategy and Health Systems, Stop TB Department, World Health

Organization, 20 Avenue Appia, CH-1211 Geneva, 27, Switzerland.
lonnrothk@who.int
This article assesses whether social franchising of tuberculosis (TB) services in

Myanmar has succeeded in providing quality treatment while ensuring equity in
access and financial protection for poor patients. Newly diagnosed TB patients
receiving treatment from private general practitioners (GPs) belonging to the
franchise were identified. They were interviewed about social conditions, health
seeking and health care costs at the time of starting treatment and again after 6
months follow-up. Routine data were used to ascertain clinical outcomes as well
as to monitor trends in case notification. The franchisees contributed 2097 (21%)
of the total 9951 total new sputum smear-positive pulmonary cases notified to the
national TB programme in the study townships. The treatment success rate for
new smear-positive cases was 84%, close to the World Health Organization target
of 85% and similar to the treatment success of 81% in the national TB programme
in Myanmar. People from the lower socio-economic groups represented 68% of
the TB patients who access care in the franchise. Financial burden related to direct
and indirect health care costs for tuberculosis was high, especially among the
poor. Patients belonging to lower socio-economic groups incurred on average
costs equivalent to 68% of annual per capita household income, with a median of
28%. However, 83% of all costs were incurred before starting treatment in the
franchise, while 'shopping' for care. During treatment in the franchise, the cost of
care was relatively low, corresponding to a median proportion of annual per
capita income of 3% for people from lower socio-economic groups. This study
shows that highly subsidized TB care delivered through a social franchise scheme
in the private sector in Myanmar helped reach the poor with quality services,
while partly protecting them from high health care expenditure. Extended
outreach to others parts of the private sector may reduce diagnostic delay and
patient costs further.
Publication Types:
455: Contemp Clin Trials. 2007 Nov;28(6):677-83. Epub 2007 Mar 23.
Industry-sponsored research in developing countries.
Abbas EE.
Saif Bin Gobash and Ibrahim Bin Hamad Obaidullah Hospitals, Ras Alkhaima,
United Arab Emirates. eeabbas@emirates.net.ae
BACKGROUND: Industry has become an important source of funding for

clinical research; guidelines governing the relationship between industry and
medical institutions are not clear in developing countries and hence we wanted to
test attitudes and practices in those countries and compare them to developed
countries. We conducted a survey amongst medical practitioners in developed and
Arab countries representing developing countries, in order to document their
views towards industry-sponsored research and their actual practice in this regard.
METHODS: A structured questionnaire was distributed by email, mail and
through personal contacts. The questionnaire included information on
characteristics of the practitioners involved, their attitudes towards industry-
sponsored research and their actual practices. The questionnaire was distributed to
510 medical practitioners of countries in both groups. Practitioners representing
developed countries were from the United States, United Kingdom, Australia and
New Zealand. Those representing developing countries included Arab countries
from Asia and Africa. RESULTS: We found that there were contrasting views
and practices between the two groups although more than 80% in both groups
agreed that industry-sponsored research is necessary. 69.7% of respondents in
developed countries participated in industry-sponsored research while only 30.1%
did so in developing countries. Guidelines governing such research were better
adhered to in developed countries than in developing countries. Where there were
no authors who were not part of investigators in developed countries, 16.3% of
industry-sponsored research in developing countries included authors who were
not part of the investigators. Research ethics committees were present in 94% and
58% of institutions in developed and developing countries respectively. Review
bodies were available in 57% and 41% in developed and developing countries.
CONCLUSIONS: Industry-sponsored research is necessary; it is much more
common in developed countries. Clear guidelines governing industry-sponsored
research should be adopted in developing countries, including the establishment
of research ethics committees and review bodies to monitor such research.
456: Int Psychogeriatr. 2007 Aug;19(4):669-78. Epub 2007 Apr 16.
The diagnosis of dementia in the community.
Jacob KS, Kumar PS, Gayathri K, Abraham S, Prince MJ.
Department of Psychiatry, Christian Medical College, Vellore, India.

ksjacob@cmcvellore.ac.in
BACKGROUND: Different interview schedules and diagnostic criteria for

dementia have contributed to differing incidence and prevalence rates. AIM: This
study aimed to examine the effect of different diagnostic criteria on the
prevalence of dementia in the community. METHODS: Some 1000 subjects (>65
years) were recruited in Kaniyambadi Block, Vellore, India, using a one-stage
assessment procedure. RESULTS: The prevalence of dementia by Diagnostic and
Statistical Manual IV standard, the Community Screening instrument for
Dementia DF Score, the education adjusted 10/66 Dementia Research Group
criteria, and the Geriatric Mental State was 0.8%, 6.2%, 10.6%, 63.2%
respectively. CONCLUSION: Differences in information, interview schedules,
diagnostic criteria and settings contribute to variation in identification of people
with dementia. Minor variations in criteria have a significant impact on diagnosis.
The assessment of the clinical state is influenced by education, level of baseline
function, impairment in current functioning, life style and demands on the person,
tolerance of impairment and expectation by relatives and by differences between
patients attending hospitals and those living in the community. The variation in
rates demands a debate on the criteria for dementia in the community in general
and for less literate populations in particular.
457: Minn Med. 2007 Mar;90(3):26-30.

Erratum in:
• Minn Med. 2007 May;90(5):6.
Global health hot zone.
Hequet M.
458: Rinsho Shinkeigaku. 2006 Nov;46(11):955-7.
[Japanese guidelines for the management of herpes simplex

encephalitis; comparison with those from the International
Management Herpes Forum]
Shoji H.
The School of Rehabilitation Sciences, International University of Health and

Welfare.
Herpes simplex encephalitis (HSE) is still recognized as a severe sporadic

encephalitis, although the mortality and morbidity rates have been decreased to
10% and 30%, respectively. This disease is diagnosed using clinical symptoms,
CSF, EEG, CT, MRI, and virologic tests such as polymerase chain reaction (PCR)
or enzyme immunosorbent assay (EIA). Early diagnosis and treatment are
essential for HSE. However, the early symptoms of this disease are various, and
the laboratory diagnostic criteria are unclear to the non-specialist. In 2005,
Japanese guidelines for the management of HSE have been issued via two sets of
Workshops at the Japanese Neuroinfectious Disease Congress. The diagnostic and
therapeutic criteria were discussed in comparison with those from the
International Management Herpes Forum (IMHF) in 2004. For a definitive
diagnosis, CSF PCR for herpes simplex virus (HSV) is recommended, and the
detection rate has been reported to be 60 to 80% within the 7th day of the illness.
In the IMHF, the PCR method has also been the primary method for early
diagnosis and for monitoring the therapy. Further, quantitative real-time PCR has
become available for measuring the effectiveness of aciclovir therapy. To
measure HSV antibody levels, complement antibody (CF), neutralizing antibody
(NT), or enzyme-linked immunosorbent assay (ELISA or EIA) are available.
Significant elevation of EIA IgG or intrathecal HSV antibody production should
be shown, although these antibody responses often appear two weeks after the
onset of HSE. Regarding anti-herpesvirus drugs, in both Japanese and IMHF
guidelines aciclovir is consistent with the first choice, and it is recommended that
its administration would be started as soon as HSE is suspected on the basis of
clinical pictures, CT * MRI, EEG, or CSF findings. However, antiviral therapy
may be discontinued if a negative CSF HSV PCR is obtained at > 72 hours after
onset. A recent Japanese study shows the efficacy of a combination therapy of
aciclovir and corticosteroid for this disease. Further prospective investigation is
expected.
Publication Types:
459: J Psychiatr Ment Health Nurs. 2007 May;14(3):239-42.
The Bali bombings and the evolving mental health response to

disaster in Australia: lessons from Darwin.
Guscott WM, Guscott AJ, Malingambi G, Parker R.
Top End Mental Health Service, Parap, NT, Australia. anthony.guscott@nt.gov.au
The Bali bombing in 2002 initiated a new phase of trauma response for public
health services in Australia, and the Royal Darwin Hospital in particular. The
mental health response to the initial disaster was limited to a debriefing of Royal
Darwin Hospital staff some time after the disaster. Following this initial episode,
a number of important developments occurred within the Royal Darwin Hospital
and nationally to further develop mental health resources. A mental health
consultation liaison nursing position was established within the hospital. The
Director of Mental Health for the Northern Territory, along with the Director of
Psychiatry, was involved with an evolving national mental health response to
mass trauma through the National Planning Group of Mental Health Response to
Trauma. The improved recognition of mental health in disaster response, along
with increased recognition and confidence in the consultation liaison nursing
staff, considerably improved the mental health services available to patients and
Royal Darwin Hospital staff following the second Bali blast in October 2005.
460: Semin Thromb Hemost. 2007 Apr;33(3):265-72.
External quality assessment scheme for hemostasis in India.
Mammen J, Nair SC, Srivastava A.
Department of Clinical Pathology and Blood Bank, Christian Medical College,

Vellore, India.
Regular participation in an external quality assessment scheme (EQAS) is critical

for ensuring acceptable laboratory performance. However, participation in such
programs is uncommon for laboratories performing tests of hemostasis in
developing countries. There are several reasons, including lack of awareness of its
significance, absence of locally administered and easily accessible programs, and
costs associated with some of the international schemes. To address this problem,
we initiated an EQAS for hemostasis in India in the year 2000. This initially was
limited to approximately 25 laboratories associated with the chapters of the
Hemophilia Federation (India), with samples and analysis of results supported by
United Kingdom National External Quality Assessment Scheme. This was
converted to a national program in 2003, in association with the Indian Society of
Haematology and Transfusion Medicine. Local manufacture of survey samples
began in 2004, along with analysis of results. Currently, more than 100
laboratories are registered in the program. They receive samples three times a
year for the following tests: prothrombin time, activated partial thromboplastin
time, and factor assays. Some surveys also include samples for fibrinogen and von
Willebrand factor assays. In recent surveys, 60 to 95% of laboratories had their
clotting times and 57 to 77% of laboratories had their factor assays within
consensus. The program has helped identify causes of unacceptable performance.
The challenges ahead are to increase participation, improve reporting of results,
and provide individualized support to laboratories to improve performance when
necessary.
461: J Trauma. 2007 Apr;62(4):940-5.

Comment in:
• J Trauma. 2007 Aug;63(2):451-2; author reply 452.
Predictive model for estimating risk of crush syndrome: a data

mining approach.
Aoki N, Demsar J, Zupan B, Mozina M, Pretto EA, Oda J, Tanaka H,

Sugimoto K, Yoshioka T, Fukui T.
School of Health Information Sciences, University of Texas Health Science

Center, Houston, Texas 77030, USA. noriaki.aoki@uth.tmc.edu
BACKGROUND: There is no standard triage method for earthquake victims with

crush injuries because of a scarcity of epidemiologic and quantitative data. We
conducted a retrospective cohort study to develop predictive models based on
clinical data for crush injury in the Kobe earthquake. METHODS: The medical
records of 372 patients with crush injuries from the Kobe earthquake were
retrospectively analyzed. Twenty-one risk factors were assessed with logistic
regression analysis for three outcomes relating to crush syndrome. Two types of
predictive triage models--initial evaluation in the field and secondary assessment
at the hospital--were developed using logistic regression analysis. Classification
accuracy, Brier score and area under the receiver operating characteristic curve
(AUC) were used to evaluate the model. RESULTS: The initial triage model,
which includes pulse rate, delayed rescue, and abnormal urine color, has an AUC
of 0.73. The secondary model, which includes WBC, tachycardia, abnormal urine
color, and hyperkalemia, shows an AUC of 0.76. CONCLUSIONS: These triage
models may be especially useful to nondisaster experts for distinguishing
earthquake victims at high risk of severe crush syndrome from those at lower risk.
Application of the model may allow relief workers to better utilize limited
medical and transportation resources in the aftermath of a disaster.
462: J Prev Med Pub Health. 2007 Mar;40(2):150-4.
[The determinants of purchasing private health insurance in Korean

cancer patients]
[Article in Korean]
Lim JH, Kim SG, Lee EM, Bae SY, Park JH, Choi KS, Hahm MI, Park EC.
Division of Cancer Policy and Management, National Cancer Control Research

Institute, National Cancer Center, Korea.
OBJECTIVES: The aim of this study is to identify factors determining the

purchase of private health insurance under the mandatory National Health
Insurance(NHI) system in Korea. METHODS: The data were collected by the
National Cancer Center in Korea. It includes cancer patients who were newly
diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal
cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital
Order Communication System (OCS), medical records, and face-to-face
interviews, using a structured questionnaire. Clinical, socio-demographic and
private health insurance related factors were also gathered. RESULTS: Overall,
43.9% of patients had purchased one or more private health insurance schemes
related to cancer, with an average monthly premium of won 65,311 and an
average benefit amount of won 19 million. Females, younger aged, high income
earners, national health insurers and metropolitan citizens were more likely to
purchase private health insurance than their counterparts. CONCLUSIONS:
About half of Korean people have supplementary private health insurance and
their benefits are sufficient to cover the out-of-pocket fees required for cancer
treatment, but inequality remains in the purchase of private health insurance.
Further studies are needed to investigate the impacts of private health insurance
on NHI, and the relationship between cancer patients' burden and benefits.
Publication Types:
463: Nurs Ethics. 2007 Mar;14(2):203-14.
Professional ethics as an important factor in clinical competency in

nursing.
Memarian R, Salsali M, Vanaki Z, Ahmadi F, Hajizadeh E.
Tarbiat Modares University, Faculty of Medical Sciences, Tehran, P.O. Box

14115-331, IR Iran. memarian_2004@hotmail.com
It is imperative to understand the factors that influence clinical competency.
Consequently, it is essential to study those that have an impact on the process of
attaining clinical competency. A grounded theory approach was adopted for this
study. Professional competency empowers nurses and enables them to fulfill their
duties effectively. Internal and external factors were identified as affecting
clinical competency. A total of 36 clinical nurses, nurse educators, hospital
managers and members of the Nursing Council in Tehran participated in this
research. Data were obtained by semistructured interviews. Personal factors and
useful work experience were considered to be significant, based on knowledge
and skills, ethical conduct, professional commitment, self-respect and respect for
others, as well as from effective relationships, interest, responsibility and
accountability. Effective management, education systems and technology were
named as influential environmental factors. Personal and environmental factors
affect clinical competency. Ethical persons are responsible and committed to their
work, acquiring relevant work experience. A suitable work environment that is
structured and ordered also encourages an ethical approach by nurses.
Publication Types:
464: Nurs Ethics. 2007 Mar;14(2):194-202.
Whistleblowing in Japan.
Davis AJ, Konishi E.
University of California, San Francisco, USA.
This article, written from research data, focuses on the possible meaning of the
data rather than on detailed statistical reporting. It defines whistleblowing as an
act of the international nursing ethical ideal of advocacy, and places it in the
larger context of professional responsibility. The experiences, actions, and ethical
positions of 24 Japanese nurses regarding whistleblowing or reporting a colleague
for wrongdoing provide the data. Of these respondents, similar in age, educational
level and clinical experience, 10 had previously reported another nurse and 12 had
reported a physician for a wrongful act. These data raise questions about overt
actions to expose a colleague in a culture that values group loyalty and saving
face. Additional research is needed for an in-depth understanding of
whistleblowing, patient advocacy and professional responsibility across cultures,
especially those that value group loyalty, saving face and similar concepts to the
Japanese Ishin Denshin, where the value is on implicit understanding requiring
indirect communication. Usually, being direct and openly discussing sensitive
topics is not valued in Japan because such behavior disrupts the most fundamental
value, harmony (wa).
465: J Clin Nurs. 2008 Jan;17(1):135-43. Epub 2007 Apr 5.
Sleep patterns and insomnia management in Korean-American

older adult immigrants.
Sok SR.
College of Nursing Science, Kyung Hee University, Seoul, Korea.

5977sok@khu.ac.kr
AIMS: This study aimed to describe sleep patterns and insomnia management in
first generation Korean-American older adult immigrants. Specifically, this
research examined differences in sleep interruption factors, use of sleep
promotion aids, sleep characteristics and insomnia management between men and
women who are first generation Korean-American older adult immigrants.
BACKGROUND: Older adults feel that their sleep is shallow, interrupted
frequently and is insufficient. If sleep changes are severe, it is difficult for older
adults to maintain an awakened state during the day. DESIGN: This was a
descriptive survey study. METHODS: The survey included a set of four
questionnaires. All measures were self-administered. In the data analysis,
descriptive statistics was used to analyse demographic characteristics. The chi-
squared test and t-test were used to examine the differences between men and
women. RESULTS: Most subjects experienced sleep interruption (n = 43, 82.6%)
and were not satisfied with their sleep (n = 42, 80.8%). A quarter of the subjects
had experience with complementary/alternative therapies to manage insomnia,
although 40 subjects (76.9%) wanted to use complementary/alternative therapies
to manage their insomnia. CONCLUSIONS: The study shows that first generation
Korean-American older adult immigrant men and women report sleep
interruptions and dissatisfaction with the quality of their sleep. Women were more
likely in want of using complementary/alternative therapies for insomnia
management than men. Women may have longed more for their traditional
healthcare practices. The high degree of sleep disruption in this sample may relate
to living in a different culture. RELEVANCE TO CLINICAL PRACTICE:
Health professionals need to assess sleep patterns and consider an array of
methods including complementary/alternative therapies to manage insomnia.
466: Cancer Detect Prev. 2007;31(2):173-83. Epub 2007 Apr 6.
"Health is strength": a community health education program to

improve breast and cervical cancer screening among Korean
American Women in Alameda County, California.
Moskowitz JM, Kazinets G, Wong JM, Tager IB.
140 Warren Hall, Center for Family and Community Health, School of Public
Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA.
jmm@berkeley.edu
BACKGROUND: A 48-month community intervention was conducted to

improve breast and cervical cancer (BCC) screening among Korean American
(KA) women in Alameda County (AL), California. KA women in Santa Clara
(SC) County, California served as a comparison group. METHODS: Random
samples of KA women from each county were surveyed by telephone in 1994
(n=818) and 2002 (n=1084). Propensity score analyses were used to estimate the
difference between counties in changes over time in screening (Pap tests, breast
self-examinations, clinical breast examinations, and mammography), and to
estimate differences in screening between participants and non-participants in an
educational workshop among women in AL in 2002. RESULTS: Mammography
screening and clinical breast examinations increased over time in both counties.
Pap tests increased in AL but not SC, and breast self-examinations did not change
significantly in either county. None of the intervention-comparison group
differences over time were significant. In 2002, compared to non-participants,
women who attended a workshop were more likely to report a recent Pap test
(P<.08). CONCLUSIONS: Although our overall intervention did not appear to
enhance screening practices at the community-level, attendance at a women's
health workshop appears to have increased cervical cancer screening.
Publication Types:

• Research Support, U.S. Gov't, P.H.S.
467: J Clin Gastroenterol. 2007 Apr;41(4):394-9.
Diagnostic yield and safety of colonoscopy in Israeli patients in an

open access referral system.
Rainis T, Keren D, Goldstein O, Stermer E, Lavy A.
Gastroenterology Unit, Bnai-Zion Medical Center, Haifa, Israel. tova@4utv.co.il
BACKGROUND: Open access endoscopy allows reference of patients for

endoscopic procedures without prior gastrointestinal consultation, allowing the
procedure to be more accessible. This practice is becoming increasingly
widespread in the United States and other countries and has become
commonplace in clinical practice in Israel. The objective of our study is to bring
forward our experience with an open access referral system for colonoscopy and
to measure the yield and safety of colonoscopy in this system. METHODS:
Between January 2001 and September 2003, 10,866 colonoscopies were
performed. Patient's charts were reviewed for the following data: demographics,
indication for endoscopy, endoscopic and histopathologic findings, and
complications. The practice guidelines of the American Society for
Gastrointestinal Endoscopy were used to assess appropriateness of colonoscopy.
RESULTS: 3533 pathologic findings were found, in 2978 colonoscopies. 2336
polyps were removed, including 18% hyperplastic, 26% tubular adenomata, 13%
villous adenomata, 11% tubulovillous adenomata. Advanced disease was found in
41% of pathologic findings, 11% were invasive cancer. Rate of colonoscopies
"generally indicated" according to American Society for Gastrointestinal
Endoscopy guidelines was 78% with a rate of colonoscopies "generally not
indicated" of 22%. Colonoscopy was completed successfully to the cecum in 93%
of patients. 0.08% had serious complications during or immediately after
colonoscopy. CONCLUSIONS: Our results suggest that open access colonoscopy
is a reliable and safe method for screening average risk population. As
colonoscopy is becoming the recommended screening model for colorectal cancer
this attitude of performing screening in an open access system could both cut
costs in the future and improve availability, in an aim to become common
practice.
468: AIDS. 2007 Apr;21 Suppl 2:S99-102.

Role of the data safety and monitoring board in an international

trial.
NIMH Collaborative HIV/STD Prevention Trial.
OBJECTIVE: To describe the composition and role of the data safety and
monitoring board (DSMB) for the National Institute of Mental Health (NIMH)
Collaborative HIV/STD Prevention Trial. DESIGN: NIMH appointed to the
DSMB nine members representing the following areas of expertise: prevention
science, ethnography, infectious diseases (especially HIV and sexually
transmitted diseases), laboratory diagnostics, clinical practice, methodology,
international trial experience, statistics, and ethics. METHODS: The DSMB
assessed the overall study for any concern about plans or implementation and
reviewed cumulative study data to evaluate the safety of study participants, the
ongoing conduct of the study, and the scientific validity and integrity of the Trial.
Because of the Trial's international scope, the DSMB examined the effects of
cultural differences on study implementation and fidelity. RESULTS: Among the
DSMB recommendations that strengthened the Trial was one to conduct initial
epidemiological studies of the venues selected for the intervention to verify risk
and to establish intraclass correlation coefficients that could be used to calculate
appropriate sample sizes. CONCLUSIONS: The DSMB played a critical role in
this Trial. Because members have the expertise required to monitor the Trial, are
not involved in the daily management of the Trial, and can review interim
analyses and adverse event reports, they are in an excellent position to provide
expert advice to ensure that the Trial's goals are achieved and that NIH funds are
well invested.
469: Eur J Public Health. 2007 Oct;17(5):419-23. Epub 2007 Apr 4.
Comment in:
• Eur J Public Health. 2007 Oct;17(5):409.
Barriers in accessing to tuberculosis care among non-residents in

Shanghai: a descriptive study of delays in diagnosis.
Wang W, Jiang Q, Abdullah AS, Xu B.
Department of Epidemiology, School of Public Health, Fudan University, China.
OBJECTIVES: To describe accessibility to tuberculosis (TB) diagnosis in non-

resident TB patients in Shanghai, China, and to identify factors associated with
delay in diagnosis. METHODS: A face-to-face interview of 222 newly diagnosed,
non-resident TB patients registered in two districts of Shanghai: Changning
District and Putuo District, was conducted using a structured questionnaire.
RESULTS: Among the 222 non-resident TB patients, median patient's delay was
21 days and median doctor's delay was 8 days. The duration of doctor's delay was
significantly longer in Changning District than Putuo District (13 vs. 5 days, P <
0.001). One-fourth of the subjects had a patient's delay longer than 42 days and a
doctor's delay longer than 15 days. Logistic regression model shows that patients
at lower income level, and who did not have haemoptysis symptom were more
likely to have longer patient's delay. Patients who registered in Changning were
more likely to have a longer doctor's delay. The proportion of diagnosis or
consideration as suspected TB for referral was significantly higher in hospitals
than non-hospitals. CONCLUSION: The results of this study indicate that patient-
and doctor-related factors contribute significantly to delays in the diagnosis of
non-resident TB patients in Chinese cities. Non-resident's poor economic status,
clinical status, complexities in referral and diagnostic procedure at different
districts accounted for delayed TB care-seeking and diagnosis.
Publication Types:
470: BMC Health Serv Res. 2007 Apr 5;7:49.
Graduates of Lebanese medical schools in the United States: an

observational study of international migration of physicians.
Akl EA, Maroun N, Major S, Chahoud B, Schünemann HJ.
Department of Medicine, University at Buffalo, NY, USA. elieakl@buffalo.edu
BACKGROUND: As healthcare systems around the world are facing increasing

physician shortages, more physicians are migrating from low to high income
countries. As an illustrative case of international migration of physicians, we
evaluated the current number and historical trends of Lebanese medical graduates
(LMG) in the US, and compared their characteristics to those of US medical
graduates (USMG) and other international medical graduates (IMG). METHODS:
We evaluated the number of LMG using the 2004 the American Medical
Association Physicians' Professional Data (AMA-PPD) and then compared it to
the number of graduates of other countries. We evaluated the historical trends
using the 1978-2004 historical files of the AMA-PPD. We analyzed the
characteristics of all LMG and compared them to a random sample of 1000
USMG and a random sample of 1000 IMG using the 2004 AMA-PPD.
RESULTS: In 2004, there were 2,796 LMG in the US, constituting 1.3% of all
IMG. Compared to other foreign countries contributing to the US physician
workforce, Lebanon ranked 2nd after adjusting for country population size (about
4 million) and 21st overall. About 40% of those who graduated from Lebanese
medical schools in the last 25 years are currently active physicians in the US.
Since 1978, the number of LMG in the US showed a consistent upward trend at a
rate of approximately 71 additional graduates per year. Compared with USMG
and IMG, LMG were more likely to work in medical research (OR = 2.31; 95%
Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01,
respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR =
2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice
(OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26,
respectively). CONCLUSION: Given the magnitude and historical trends of
migration of LMG to the US, further exploration of its causes and impact is
warranted. High income countries should consider the consequences of their
human resources policies on both low income countries' and their own healthcare
systems.
Publication Types:
PMCID: PMC1854889
471: J Thorac Oncol. 2006 Nov;1(9):965-71.
The role of gefitinib treatment for Korean never-smokers with

advanced or metastatic adenocarcinoma of the lung: a prospective
study.
Lee DH, Han JY, Yu SY, Kim HY, Nam BH, Hong EK, Kim HT, Lee JS.
Research Institute and Hospital, Research Institute for National Cancer Control
and Evaluation, Gyeonggi, Korea.
PURPOSE: This prospective trial was conducted to evaluate the role of gefitinib
in never-smokers with advanced or metastatic adenocarcinoma of the lung.
PATIENTS AND METHODS: The main inclusion criteria were stage IIIB/IV
adenocarcinoma of the lung and status as a lifetime never-smoker. Patients
received a 250-mg single oral daily dose of gefitinib until disease progression,
unacceptable toxicity, or patient's refusal. Tumor response was assessed after
every two 4-week cycles according to the World Health Organization response
criteria. Additional analyses were performed to identify predictors of response
and survival. RESULTS: Between August 2003 and March 2005, 72 Korean
patients were enrolled; 55 chemotherapy naive, 17 previously treated; 6 male, 66
female; and ECOG PS 0/1/2, 24/42/4. All patients were assessed for response,
toxicity, quality of life, and survival. Overall objective tumor response rate was
55.6% (95% confidence interval [CI], 43.4-67.3%). With a median follow-up of
23 months, the median survival time was 19.7 months (95% CI, 18.5-21.0
months) with a 1-year survival rate of 76.3%. The median duration of response
was 6.8 months (95% CI, 4.7-9.0 months). Therapy-related improvement of
symptoms and quality of life was observed within 2 to 4 weeks after the
commencement of therapy in the responders. In a multivariate Cox proportional
hazard model, good performance status and no prior history of chemotherapy
were the two significant predictors of better survival (p = 0.005 and 0.042).
CONCLUSION: Gefitinib showed very promising antitumor activity and survival
outcome in Korean never-smokers with adenocarcinoma of the lung. It seems to
be a good alternative to standard chemotherapy as a first-line therapy for this
subgroup.
Publication Types:
• Clinical Trial
472: Hong Kong Med J. 2007 Apr;13(2):100-5.
Determinants of preference for elective caesarean section in Hong

Kong Chinese pregnant women.
Pang SM, Leung DT, Leung TY, Lai CY, Lau TK, Chung TK.
Department of Obstetrics and Gynaecology, The Chinese University of Hong

Kong, Prince of Wales Hospital, Shatin, Hong Kong. selina.pang@gmail.com
OBJECTIVE: To find the clinical and socio-demographic determinants for Hong

Kong Chinese women who preferred elective caesarean section. DESIGN: Cross-
sectional interview survey. SETTING: University teaching hospital, Hong Kong.
PARTICIPANTS: A cohort of consecutive Hong Kong Chinese pregnant women
(n=660) attending a government-funded obstetric unit catering deliveries in the
New Territories in Hong Kong in 2002. MAIN OUTCOME MEASURES: The
clinical and socio-demographic determinants of preference for elective caesarean
section, in women who could have a trial of vaginal delivery. RESULTS: The
overall prevalence for maternal preference for elective caesarean section was
16.7% (95% confidence interval, 13.8-19.6). The factors associated with
preferring elective caesarean section were: previous elective caesarean section
(odds ratio=7.6; 95% confidence interval, 2.0-28.7) and previous emergency
caesarean section (3.8; 1.8-8.2). Among nulliparous women, the prevalence of
preference for elective caesarean section was 16.8% (95% confidence interval,
13.0-20.6). Conception by in-vitro fertilisation was found to be significantly
associated with preferring elective caesarean section in nulliparous women (odds
ratio=5.2; 95% confidence interval, 1.0-26.4). CONCLUSION: Previous
caesarean section and conception by in-vitro fertilisation were determinants for
women preferring elective caesarean section.
473: Gesundheitswesen. 2007 Feb;69(2):105-9.
[Dental health in German and Turkish school children--a 10-year

comparison]
[Article in German]
Heinrich-Weltzien R, Kühnisch J, Goddon I, Senkel H, Stösser L.
Poliklinik für Präventive Zahnheilkunde, Zentrum für Zahn-, Mund- und

Kieferheilkunde, Friedrich-Schiller-Universität Jena, Jena, Germany.
Roswitha.Heinrich-Wetzien@med.uni-jena.de
The purpose of this cross-sectional study was to assess the changes in dental
health in 12- and 15-year-old Turkish immigrants and German students who were
included in a school-based caries-preventive programme for ten years (1993-
2003). In 1993 352 and 402 12- and 15-year-olds and in 2003 352 and 402 12-
and 15-year-olds were investigated, respectively. 23.6% of the 12-year-olds and
21.5% of the 15-year-olds were of Turkish origin. The clinical examination was
performed with support of artificial light at school. Caries was diagnosed
according to the WHO standard using the DMFT Index for permanent dentition.
Within the ten-year period the highest increment of caries-free dentitions was
found in 12- and 15-year old Germans attending grammar schools with 41,5% and
27% and secondary modern schools with 22,3% and 17%, respectively. The
proportion of caries-free Turkish students attending secondary modern schools,
only increased imperceptible in both age groups (1.2%). A significant caries
decline of 1.5 DMFT was observed in 12-year old Germans at grammar schools,
only. In 15-year olds caries declined in German students at secondary modern
schools (2.5 DMFT), and at Grammar schools (2.2 DMFT), significantly,
however caries experience in Turkish students remained nearly unchanged (0.3
DMFT). A strong polarisation of dental caries was found in 2003. Among the 12-
year-olds 23% of those at secondary modern school accumulated 70% of the total
caries experience (>3 DMFT) and at grammar school 9% of students accumulated
76% of the whole amount of caries (>1 DMFT). Among the 15-year-olds 73% of
the total caries experience (>3 DMFT) was concentrated in 32% of the students at
secondary modern schools, while 25% of the students at grammar schools
exhibited 84% of the whole amount of caries (>1 DMFT). Intended concepts in
caries prevention in the future should aim to improve dental health especially in
Turkish students at secondary modern schools while taking social inequality of
this risk group into account.
Publication Types:
474: J Clin Nurs. 2007 Apr;16(4):786-93.
Application of a virtual reality prototype for pain relief of pediatric

burn in Taiwan.
Chan EA, Chung JW, Wong TK, Lien AS, Yang JY.
School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong
Kong. hseachan@inet.polyu.edu.hk
AIM: This study examines the usability and effectiveness of virtual reality in
reducing pain in wound-care procedures for pediatric burn patients in Taiwan.
BACKGROUND: Virtual reality has continuously gained prominence in the
medical arena, for instance, the telepresence for surgery, the management of
mental health disorders and pain control of the paediatric burn. Notwithstanding
an increased application of virtual reality in the medical arena in North America,
there have been no studies investigating its use for paediatric burn patients in
Asia. METHODS: This descriptive study has two phases: Phase I: the
development of a virtual reality prototype. Phase II: the implementation of the
prototype to discern its usability and efficacy with paediatric burn patients at a
local hospital. RESULTS: The findings suggest that a significant difference is
found in the children's reported pain, with or without the virtual reality
intervention, over the three phases: before, during and after the dressing change.
However, less pain was noted in the intervention group during and after the
dressing change. CONCLUSION: Adding to the existing clinical value of virtual
reality identifies the nature of and different children's responses to pain with the
use of virtual reality. RELEVANCE TO CLINICAL PRACTICE: This study is
significant since it demonstrates a difference in the child's response to pain based
on the nature of presence and distraction. Moreover, given the evidence that a
decrease in anxiety was experienced after the dressing change with virtual reality
intervention, timing of using the virtual reality intervention before the child
develops conditioning anxiety and anticipated pain for the procedure would be of
importance.
Publication Types:
475: J Clin Nurs. 2007 Apr;16(4):646-53.
The Turkish version of the Newcastle Satisfaction with Nursing

Care Scale used on medical and surgical patients.
Akin S, Erdogan S.
Istanbul University Florence Nightingale School of Nursing, Istanbul, Turkey.

semihaakin@yahoo.com
AIM AND OBJECTIVES: The aim of this study is to test the validity and
reliability of the modified version of the Newcastle Satisfaction with Nursing
Care Scale on medical and surgical patients. BACKGROUND: Measuring patient
satisfaction with nursing care is important in evaluating the extent to which
patients' needs are met and for determining the appropriate nursing care. In recent
years there has been increasing interest in patient satisfaction with nursing care in
Turkey, but there are no validated scales available to measure this. DESIGN: It is
an evaluative study. METHODS: The data were collected using the Newcastle
Satisfaction with Nursing Care Scale and by a demographic information
questionnaire. After translinguistic study, the content validity of the scale was
confirmed and tested on 200 patients who were recruited at Istanbul University
Hospital on the day of discharge. Internal consistency of the scale was tested by
Cronbach's alpha. Demographic variables related to the satisfaction scores were
analysed using the Spearmen correlation, the Mann-Whitney U- and Kruskal-
Wallis tests. RESULTS: The Turkish version of the Satisfaction with Nursing
Care Scale, with a total of 19 items, was determined to be suitable for measuring
patient satisfaction with nursing care. Patients were generally satisfied with the
nursing care received. The items with the most positive rating were respectively:
the amount of freedom they were given on the ward, the amount of privacy they
were given by nurses and how quickly nurses responded to their requests. The
study found that female patients, older patients and those who had health
insurance were the most satisfied. CONCLUSION: The Turkish version of the
Satisfaction with Nursing Care Scale showed an adequate reliability and validity
for its use on adult Turkish patients. RELEVANCE TO CLINICAL PRACTICE:
Nurses can use the Satisfaction with Nursing Care Scale of Newcastle Satisfaction
with Nursing Scales in evaluating and improving the nursing care in clinical
practice.
Publication Types:
• Validation Studies
476: Int J Nurs Educ Scholarsh. 2007;4:Article2. Epub 2007 Jan 23.
Comparing teaching practices about humor among nursing faculty:

an international collaborative study.
Adamle KN, Chiang-Hanisko L, Ludwick R, Zeller RA, Brown R.

Kent State University, USA. kadamle@kent.edu
Humor has been recognized by nurse researchers as a therapeutic intervention

known to have positive psychological and physiological outcomes for patients.
There is, however, no research that examines how nurses learn about humor. The
purpose of this preliminary study was to examine nursing faculty members'
teaching practices about humor education in the classroom and in clinical settings.
Nursing faculty members from four nursing programs, two in the United States,
one in Northern Ireland, and one in Taiwan, were surveyed about the inclusion of
humor in the nursing curriculum. Findings revealed that substantially more humor
education was included in clinical settings in the USA and Northern Ireland than
in the classroom. In Taiwan, however, humor education was included more in the
classroom than in clinical settings. Older and more experienced nurses with
higher levels of education reported using less humor in teaching practices.
Publication Types:
477: Aust Health Rev. 2007 Apr;31 Suppl 1:S116-21.
Anaesthesia underpins acute patient care in hospitals.
Thompson WR, Phillips GD, Cousins MJ.
Australian and New Zealand College of Anaesthetists, Melbourne, VIC.

ceoanzca@anzca.edu.au
The Australian and New Zealand College of Anaesthetists (ANZCA) carried out a
review of the roles of anaesthetists in providing acute care services in both public
and private hospitals in Europe, North America and South-East Asia. As a result,
ANZCA revised its education and training program and its processes relating to
overseas-trained specialists. The new training program, introduced in 2004,
formed the basis for submissions to the Australian Medical Council, and the
Australian Competition and Consumer Commission/Australian Health Workforce
Officials' Committee review of medical colleges. A revised continuing
professional development program will be in place in 2007. Anaesthetists in
Australia and New Zealand play a pivotal role in providing services in both public
and private hospitals, as well as supporting intensive care medicine, pain
medicine and hyperbaric medicine. Anaesthesia allows surgery, obstetrics,
procedural medicine and interventional medical imaging to function optimally, by
ensuring that the patient journey is safe and has high quality care. Specialist
anaesthetists in Australia now exceed Australian Medical Workforce Advisory
Committee recommendations.
478: Bull Soc Pathol Exot. 2007 Feb;100(1):32-5.
[The management of stroke in Phnom Penh, Cambodia]
[Article in French]
Chan S, Ros S, You KY, Nhem S, Salle JY, Dudognon P, Daviet JC.
Service de médecine A, Hôpital Calmette, Phnom Penh, Cambodge.
Stroke ranks first among nervous pathologies in Kampuchea. It's a main cause of
disability and mortality in our country. We conducted a prospective study
including 100 patients hospitalized in the service of general medicine at the
Calmette hospital in Phnom Penh. We analyzed the principal risk factors, clinical
signs, nature of stroke, complications and markers of the vital and functional
prognosis. This work shows the difficulties encountered in the initial care of
stroke: delay or absence of hospitalization, cost of complementary examinations
to be carried out to determine the nature and the aetiology of stroke and very low
level of follow-up to ensure secondary prevention and functional rehabilitation. It
can be explained in part by the socioeconomic and cultural level. Research like
this one which assesses local needs for stroke prevention, treatment and
rehabilitation should be conducted in developing countries to inform the planning
and allocation of health care resources in order to reduce the burden of illness
associated with stroke. The progressive improvement of the medical structures,
and of the socioeconomic and cultural level will facilitate stroke care
management.
Publication Types:

479: Tuberk Toraks. 2007;55(1):59-63.
[Does tumor type and sex distribution of primary lung cancer

change? The comparison of the results of 2004 and previous years]
[Article in Turkish]
Sulu E, Damadoğlu E, Nergiz S, Ertuğrul M, Saltürk C, Oğütçü Karabay E,

Yilmaz A.
Department of Chest Diseases, Süreyyapaşa Thoracic and Cardiovascular

Diseases Training and Investigation Hospital, Istanbul, Turkey.
suluebru@yahoo.com
The aim of the present study was to evaluate the tumor cell type and sex
distribution of patients diagnosed with primary lung cancer during 2004. Patients
with primary lung cancer were detected from pathology records. Clinical files of
patients were analyzed retrospectively. 1403 patients with primary lung cancer
were included in the study. 1238 (88.2%) patients were male and 165 (11.8%)
were female and female to male ratio was 1/7.5. When the ratio was compared
with 1/10.9 in 1998, the ratio of female patients was determined to increase.
Tumor cell type was squamous cell carcinoma in 577 (41.1%) patients,
adenocarcinoma in 359 (25.6%), small cell carcinoma in 184 (13.1%), nonsmall
cell carcinoma in 115 (8.2%) and other malign tumors in 21 (1.5%) patients.
Tumor cell type was not detected in 147 (10.5%) patients. When 147 patients
were excluded from the study, the frequency of squamous cell carcinoma was
45.9%, adenocarcinoma was 28.6% and small cell carcinoma was 14.6%. The
results of our study show that squamous cell carcinoma is the most frequent tumor
cell type in our center and the ratio of female patients is increasing.
Publication Types:
480: Chest. 2007 Aug;132(2):373-9. Epub 2007 Mar 30.

Comment in:
• Chest. 2007 Aug;132(2):365-7.
Registry and survival study in chinese patients with idiopathic and

familial pulmonary arterial hypertension.
Jing ZC, Xu XQ, Han ZY, Wu Y, Deng KW, Wang H, Wang ZW, Cheng XS,
Xu B, Hu SS, Hui RT, Yang YJ.
Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and
Chinese Academy of Medical Sciences, 167 Beilishi Rd, Beijing 100037, People's
Republic of China. jingzhicheng@medmail.com.cn
BACKGROUND: To evaluate the clinical features and survival data of patients

with idiopathic pulmonary arterial hypertension (PAH) and familial PAH in
Chinese patients. METHODS: Seventy-two patients with idiopathic PAH and
familial PAH were enrolled in the study from 1999 to 2004 and were classified
into two groups according to World Health Organization (WHO) functional class
(I/II and III/IV). Clinical and hemodynamic data were recorded. RESULTS: The
mean age of the 72 patients was 35.9 years with female patient/male patient ratio
of 2.4:1. A significant difference was identified in the clinical presentation
between two WHO functional class groups at baseline. Echocardiography showed
a mean pulmonary systolic pressure of 98 mm Hg. Left ventricular end-diastolic
diameter was significantly smaller in the group of patients in WHO functional
class III/IV than in those in class I/II group. After follow-up for a mean (+/- SD)
duration of 40.1 +/- 20.0 months, the survival rates at 1, 2, 3, and 5 years were
68.0%, 56.9%, 38.9%, and 20.8%, respectively. A significant difference was
identified in survival rate between the class I/II and class III/IV groups (p = 0.02
[log rank test]). CONCLUSIONS: The baseline characteristics and survival rates
of our cohort study are close to those of the National Institutes of Health Registry
in the 1980s, and the 1-year survival rate is obviously lower for patients in this
registry than for those in the French registry between 2002 to 2003. Lack of
effective treatment was the main cause of poor survival in this study. Our results
support the need of an appropriate treatment strategy for this devastating disease
in China.
Publication Types:

481: Seishin Shinkeigaku Zasshi. 2007;109(2):110-27.
[Maternal filicide in Japan: analyses of 96 cases and future

directions for prevention]
Taguchi H.
Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Ph.D.

Course of Graduate School of Tokyo Medical and Dental University.
OBJECTIVE: Maternal filicide is not an isolated phenomenon. When a mother

kills her child, she may be affected by many factors and confronted with different
problems based on the child's developmental stage. In this study in Japan, a
judicial sample of 96 adult women, convicted in their first trial for the murder or
attempted murder of their children, was divided into four groups of mothers
according to the age of the victim (25 women killed neonates, 22 women infants,
27 women preschool children, and 22 women schoolchildren and/or teenagers) in
order to identify the factors that have a major impact on filicide in each group.
METHODS: The socio-demographic, clinical, forensic, circumstantial, and
offense characteristics, and legal disposition of 96 cases drawn from judicial
records were compared among the four groups using the Kruskal-Wallis test;
comparison of two groups was conducted using the Mann-Whitney test.
RESULTS: Neonaticide cases were distinguished from the other three groups by
marked differences: a significantly higher rate of unmarried mothers, financial
difficulties, absence of mental illness, and admission of not wanting an
illegitimate child. In the other groups, mental disorders were frequent; in
particular, post-partum depression was the primary cause of infanticide. For the
two groups of cases involving a child older than one year, filicidal mothers were
more affected by circumstantial factors such as health problems of the child or
severe marital discord. These problems may then have caused a reactive mental
disorder among these mothers. The risk of fatal abuse or neglect was higher for
handicapped preschool children. Filicide-suicide was most frequently seen among
school-aged children and/or teenagers who had serious behavioral problems, and
these children often had a mental disorder. CONCLUSIONS: The classification of
maternal filicide by age of the child demonstrated that there are specific issues for
each group. Based on these findings, future directions for prevention include:
appropriate sex education for youths to avoid unwanted pregnancy; organization
of specialized mental health services for mothers with post-partum mental
disorder; careful psychiatric risk assessment of mentally ill mothers; and
development of diversified social support measures for child-bearing parents,
especially those with identifiable financial or social difficulties.
Publication Types:
482: Stroke. 2007 May;38(5):1430-5. Epub 2007 Mar 29.
Comment in:
• Stroke. 2007 Nov;38(11):e151.
Radiological findings, clinical course, and outcome in asymptomatic

moyamoya disease: results of multicenter survey in Japan.
Kuroda S, Hashimoto N, Yoshimoto T, Iwasaki Y; Research Committee on

Moyamoya Disease in Japan.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine,

Kita-ku, Sapporo, Japan. skuroda@med.hokudai.ac.jp
BACKGROUND AND PURPOSE: Although the development of a noninvasive

MR examination has increased the opportunity to identify asymptomatic patients
with moyamoya disease who have experienced no stroke episodes, their clinical
features are still unclear. This was the first multicenter, nation-wide survey
focused on asymptomatic moyamoya disease in Japan and was designed to clarify
their clinical features. METHODS: A clinical database of asymptomatic patients
with moyamoya disease was collected from 12 participating hospitals in Japan
between 2003 and 2006. In total, 40 patients were enrolled in this historical
prospective cohort study. Of these, 6 underwent surgical revascularization,
including superficial temporal artery to middle cerebral artery anastomosis and/or
pial synangiosis. Their demographic and radiological findings as well as outcome
were evaluated. RESULTS: On initial evaluation, cerebral infarction and
disturbed cerebral hemodynamics were detected in approximately 20% and 40%
of the involved hemispheres, respectively. Angiographical stage was more
advanced in more elderly patients. Of 34 nonsurgically treated patients, 7
experienced transient ischemic attack (n=3), ischemic stroke (n=1), or intracranial
bleeding (n=3) during follow-up periods (mean, 43.7 months). The annual risk for
any stroke was 3.2%. Disease progression was associated with ischemic events or
silent infarction in 4 of 5 patients. No cerebrovascular event occurred in the 6
patients who underwent surgical revascularization. CONCLUSIONS: The
findings revealed that asymptomatic moyamoya disease is not a silent disorder
and may potentially cause ischemic or hemorrhagic stroke. Asymptomatic
patients with moyamoya disease should be carefully followed-up to further clarify
their outcome and to establish the management guideline for them.
Publication Types:
483: BMC Fam Pract. 2007 Mar 29;8:14.
Does Family Medicine training in Thailand affect patient

satisfaction with primary care doctors?
Jaturapatporn D, Dellow A.
Department of Family Medicine, Ramathibodi Hospital, Mahidol University,

Bangkok, Thailand. dr_darinj@yahoo.com
BACKGROUND: Recent national healthcare reforms in Thailand aim to transfer

primary care to family physicians, away from more expensive specialists. As
Family Medicine has yet to be established as a separate discipline in Thailand,
newly trained family physicians work alongside untrained general doctors in
primary care. While it has been shown that Family Medicine training programs in
Thailand can increase the quality of referrals from primary care doctors to
specialists, information is lacking about whether such training affects the quality
of patient care. In the Department of Family Medicine at Ramathibodi Hospital,
trained family physicians work with residents and general doctors. Although this
situation is not typical within Thailand, it offers us the opportunity to look for
variations in the levels of satisfaction reported by patients treated by different
types of primary care doctor. METHODS: During a two-week period in
December 2005, 2,600 questionnaires (GPAQ) were given to patients visiting the
Department of Family Medicine at Ramathibodi Hospital. Patients were given the
choice of whether or not they wanted to participate in the study. A cross-sectional
analysis was performed on the completed questionnaires. Mean GPAQ scores
were calculated for each dimension and scored out of 100. Student t-tests,
ANOVA with F-test statistic and multiple comparisons by Scheffe were used to
compare the perceived characteristics of the different groups of doctors. Five
dimensions were measured ranging from access to care, continuity of care,
communication skills, enablement (the patient's knowledge of a self-care plan
after the consultation) and overall satisfaction. RESULTS: The response rate was
70%. There were significant differences in mean GPAQ scores among faculty
family physicians, residents and general doctors. For continuity of care, patients
gave higher scores for faculty family physicians (67.87) compared to residents
(64.57) and general doctors (62.51). For communication skills, patients gave the
highest GPAQ scores to faculty family physicians (69.77) and family medicine
residents (69.79). For enablement, faculty family physicians received the highest
score (82.44) followed by family medicine residents (80.75) and general doctors
(76.29). CONCLUSION: Faculty family physicians scored higher for continuity
of care when compared with general doctors and residents. General doctors had
lower GPAQ scores for communication skills and enablement when compared to
faculty family physicians and residents. Faculty family physicians had the highest
GPAQ scores in many dimensions of family practice skills, followed by residents
and general doctors.
Publication Types:
PMCID: PMC1852109
484: J Clin Nurs. 2007 Jun;16(6):1061-7.
The relationship between personal traits and job satisfaction among

Taiwanese community health volunteers.
Lin MC, Li IC, Lin KC.
Purchase & Maintenance, Dong Guang Junior High School, Yilan County,
Taiwan.
AIM: The purpose of the study was to understand the relationship between job
satisfaction and personal traits in health volunteers in one community in Taiwan.
BACKGROUND: Among different kinds of community resources, the human
resource is most essential for the process of developing healthy communities and
cities. However, it is not easy to keep voluntary workers as part of health
programmes even though they have been trained. Previous research has shown
that to increase the job satisfaction of such a person, the volunteer needs to
improve effectively his/her need to achieve. The need to achieve is an important
part of a person's personal traits. METHODS: A cross-sectional survey design
was used to interview 317 health volunteers in various community health centres
in I-lan county, northern Taiwan. The research instruments of this study included
the 'locus of control orientation scale' for personality measurement, the
'achievement orientation scale' and the 'job satisfaction scale'. RESULTS: Most of
the sample volunteers were female with an average age of 49.55 years; the
majority was married and living with their spouses. In terms of the volunteers'
personal traits, most of them are internal control orientation. The job satisfaction
of the volunteers who took part in this research was extremely high. Significant
variables correlating with job satisfaction in this study were gender, educational
level, religious preference, participation in training, working to promote
community health, the willingness to work, the frequency of participating in job
training, and cooperation with other volunteer partners. The explainable variance
for the prediction of job satisfaction from a combination of achievement
orientation and the frequency of collaboration with other people was 9.1%.
RELEVANCE TO CLINICAL PRACTICE: The results suggest that there is a
need to strengthen cooperative relationships among volunteer by initiating well-
planned volunteer training programmes and growth groups with the aim of
enhancing their interpersonal relationships.
485: J Nurs Scholarsh. 2007;39(1):46-53.
Nurses' tobacco-related knowledge, attitudes, and practice in four

major cities in China.
Chan SS, Sarna L, Wong DC, Lam TH.
Department of Nursing Studies, L.K.S. Faculty of Medicine, University of Hong

Kong, Hong Kong SAR, China. nssophia@hkucc.hku.hk
PURPOSE: To (a) identify Chinese nurses' tobacco-related knowledge, attitude,

and practice (KAP), including perception of competency in smoking-cessation
interventions; (b) identify barriers and facilitators to smoking cessation
interventions to patients; and (c) assess the learning needs and smoking status of
nurses. Design: A cross-sectional survey was conducted in four major cities
(Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to
December 2003. METHODS: 2,888 registered nurses working in hospitals
affiliated with five university schools of nursing in these cities were invited to
complete a questionnaire. An instrument used to assess tobacco-related KAP in
Hong Kong was translated into Chinese and pilot tested to ensure reliability and
validity. FINDINGS: 2,179 questionnaires were returned and after exclusion of
the grossly incomplete questionnaires, 1,690 were included in the present
analysis. Only 2% of participants were current and 1% were former smokers;
most had not received training for smoking-cessation interventions as part of their
nursing education program. Two-thirds recognized smoking as a leading cause of
preventable death and that smoking cessation was the most cost effective
intervention, but only a third routinely assisted patients' quit attempts. Nurses who
received training reported greater competence in providing smoking-cessation
intervention, and more frequent practice of cessation interventions.
CONCLUSIONS: Chinese nurses had some knowledge about the health effects of
tobacco use, but seldom practiced smoking-cessation interventions. Those who
had prior training had greater competence and more practice. Including tobacco
control, especially smoking cessation, in nursing curricula in China has the
potential to save millions of lives.
Publication Types:
486: J Vasc Access. 2007 Jan-Mar;8(1):21-7.
Increased use of catheters as vascular access: is it justified by

patients' clinical conditions?
Di Benedetto A, Basci A, Cesare S, Marcelli D, Ponce P, Richards N.
NephroCare-Italy, Naples, Italy. attilio.dibenedetto@fmc-ag.com
BACKGROUND: Over the last years many technical improvements have been
made in hemodialysis treatment. Vascular access (VA) still remains an important
problem. Although the use of indwelling vascular catheters is discouraged, in
Europe there is an increasing use of them. The K/DOQI Guidelines recommend a
native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there
is considerable geographic variation in the distribution of type of VA used
amongst hemodialysis patients. The aim of this study was to evaluate the time
patients in four European countries have to wait before undergoing their first
surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD
clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics
network between October 1, 2002 and September 30, 2004 were considered. Data
were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients
(males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy
and Portugal had a higher proportion of elderly patients. At time of admission, the
proportion of patients starting dialysis with AVF ranged between 23% and 60%
from Turkey to Italy respectively. Patients with an indwelling catheter at
admission are expected to undergo VA surgery as soon as possible. After 3
months of follow-up, about 75% of all patients had undergone surgery, however
in the UK less than 50% of the patients had had a VA procedure. Overall, males
have significantly higher probability of undergoing surgery, whilst elderly
patients have a lower probability (27% and 14% respectively). CONCLUSION:
Significant differences exist between countries in the time interval from referral to
creation of VA. Health care system related problems seem to be the major reason
to explain such differences. Patients in the UK have longer waiting times than the
other countries studied.
Publication Types:
487: Diabetes Care. 2007 Apr;30(4):989-92.
Erratum in:
• Diabetes Care. 2007 Aug;30(8):2175-6.
Microalbuminuria is common in Japanese type 2 diabetic patients: a

nationwide survey from the Japan Diabetes Clinical Data
Management Study Group (JDDM 10).
Yokoyama H, Kawai K, Kobayashi M; Japan Diabetes Clinical Data

Management Study Group.
Department of Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan.

hiroki@m2.octv.ne.jp
Publication Types:
488: Asia Pac J Clin Nutr. 2007;16 Suppl 1:329-38.
Health economics of weight management: evidence and cost.
Kouris-Blazos A, Wahlqvist ML.
Asia Pacific Health and Nutrition Centre, Monash Asia Institute, 8th Floor
Menzies Building, Monash University, Victoria 3800, Australia.
akouris@optusnet.com.au
The World Health Organization estimates that around one billion people
throughout the world are overweight and that over 300 million of these are obese
and if current trends continue, the number of overweight persons will increase to
1.5 billion by 2015. The number of obese adults in Australia is estimated to have
risen from 2.0 million in 1992/93 to 3.1 million in 2005. The prevalence of
obesity has been increasing due to a convergence of factors--the rise of TV
viewing, our preference for takeaway and pre-prepared foods, the trend towards
more computer-bound sedentary jobs, and fewer opportunities for sport and
physical exercise. Obesity is not only linked to lack of self esteem, social and
work discrimination, but also to illnesses such as the metabolic syndrome and
hyperinsulinaemia (which increases the risk of developing heart disease, diabetes,
hypertension, fatty liver), cancer, asthma, dementia, arthritis and kidney disease.
It has been estimated that the cost of obesity in Australia in 2005 was $1,721
million. Of this amount, $1,084 million were direct health costs, and $637 million
indirect health costs (due to lost work productivity, absenteeism and
unemployment). The prevalence cost per year for each obese adult has been
estimated at $554 and the value of an obesity cure is about $6,903 per obese
person. Government efforts at reducing the burden remain inadequate and a more
radical approach is needed. The Australian government, for example, has made
changes to Medicare so that GPs can refer people with chronic illness due to
obesity to an exercise physiologist and dietitian and receive a Medicare rebate,
but so far these measures are having no perceptible effect on obesity levels. There
is a growing recognition that both Public Health and Clinical approaches, and
Private and Public resources, need to be brought to this growing problem.
Australian health economist, Paul Gross, from the Institute of Health Economics
and Technology Assessment claims there is too much reliance on health workers
to treat the problem, especially doctors, who have not been given additional
resources to manage obesity outside a typical doctor's consultation. Gross has
recommended that further changes should be made to Medicare, private health
insurance, and workplace and tax legislation to give people financial incentives to
change their behaviour because obesity should not just be treated by governments
as a public health problem but also as a barrier to productivity and a drain on
resources. A Special Report of the WMCACA (Weight Management Code
Administration Council of Australia) (www.weightcouncil.org) on the "Health
Economics of Weight Management" has been published in the Asia Pacific
Journal of Clinical Nutrition in September 2006. This report explores the cost
benefit analysis of weight management in greater detail.
Publication Types:
• Review
489: Asia Pac J Clin Nutr. 2007;16 Suppl 1:22-6.
Sucrose consumption in Thai undergraduate students.
Promdee L, Trakulthong J, Kangwantrakul W.
Department of Clinical Chemistry, Faculty of Associated Medical Sciences, Khon

Kaen University, Khon Kaen, Thailand 40002. lpromdee@yahoo.com
Highly added sugar diets have been associated with various health problems such
as dental caries, dyslipidemia, obesity and poor quality of life. Unfortunately,
sugar consumption, especially sucrose, has increased continuously worldwide.
The purpose of the study was to examine sources of sugar consumption and
amount of added sucrose consumed in Thai undergraduate students. This study
was carried out at Khon Kaen University, Thailand, between the years 2004-2005.
A complete 3-day record of items and amounts of sweet consumption were
obtained from 202 individuals--38 male and 164 female students. Added sucrose
content of each sweetened food and drinks referred to in the record was
determined by an enzymatic method. Mean intakes of sucrose were calculated
from the sucrose content. The average of sucrose consumption in all subjects was
69+/-38 g/day, ranged from 4 to 182 g/day or 17 teaspoons of added sucrose per
day. This amount accounted for 13.8% of total daily energy intake. There was a
record of 337 kinds of sweetened foods and drinks found. The major source of
added sucrose consumption was sweetened beverage, which was consumed 118
g/day averagely, or 60% of daily sugar consumption. Intake of sucrose per day in
both male and female was not statistically difference, neither among different
BMI groups. Intake of added sugar in the students was higher than the
recommendation of the World Health Organization. These data would be helpful
in a health promotion campaign aimed at a reduction of sugar consumption in
Thai undergraduate students.
Publication Types:
490: Urol Nurs. 2007 Feb;27(1):25-33.
Effectiveness of nursing care after surgery for stress urinary

incontinence.
Cayir G, Beji NK, Yalcin O.
Istanbul Education and Research Hospital, Istanbul, Turkey.
This study was conducted in two stages with 32 Turkish women undergoing
surgery for correction of stress urinary incontinence. In Stage 1, 13 subjects
(Group 1) were recruited for interviews and observations of their nursing care
needs. Stage I also involved the development of a patient education pamphlet,
nursing care protocol, and a standard nursing care plan. In Stage II, a new group
of 19 subjects (Group 2) were recruited. Preoperative education and the patient
education pamphlet developed during Stage I were provided to Group 2 subjects.
A standard nursing care plan and nursing care protocol were also applied in the
postoperative period for Group 2 subjects. The study protocol implemented by
Turkish nurses and physicians is detailed. Study results are also described and
discussed.
Publication Types:

491: Health Aff (Millwood). 2007 May-Jun;26(3):w296-309. Epub 2007 Mar 27.
Variations in practice quality in five low-income countries: a

conceptual overview.
Das J, Gertler PJ.
Development Research Group, World Bank, Washington, DC, USA.

jdas1@worldbank.org
Country studies from Indonesia, Tanzania, India, Paraguay, and Mexico

document the quality of medical advice and variation in practice quality across a
number of dimensions. This overview paper serves three purposes. First, the
studies use several different measures; we contextualize these measures and
discuss how they relate to each other. Second, we propose a three-way
decomposition to analyze variations in the quality of care. These variations can
arise from inequalities in access, inequalities in choices, or inequalities arising
from discrimination. We discuss common elements across the studies and draw
policy implications for future research and advocacy.
Publication Types:
492: Health Aff (Millwood). 2007 May-Jun;26(3):w352-66. Epub 2007 Mar 27.
Differences in access to high-quality outpatient care in Indonesia.
Barber SL, Gertler PJ, Harimurti P.
Institute of Business and Economic Research, University of California, Berkeley,

USA. barber@haas.berkeley.edu
Using a representative cross-section of health care providers in Indonesia, we

describe variations in prenatal, child, and adult care quality. Quality is measured
as knowledge about clinical guidelines. Public health centers offer above-average-
quality prenatal care, and private physicians provide high-quality curative care.
Private nurses offer below-average care, as do most providers in the more remote
regions of Outer Java-Bali. The poor and wealthy have access to the same levels
of quality; however, the poorest women report receiving fewer prenatal
procedures. Recommendations include improving the professional development
of nurses in private settings, testing quality improvements in Outer Java-Bali, and
investigating wealth disparities in quality received.
Publication Types:
493: World J Surg. 2007 May;31(5):1031-40.
Spectrum of breast cancer in Asian women.
Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS.
Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate

Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh,
India. gaurav@sgpgi.ac.in
INTRODUCTION: Breast cancer is the leading cause of cancer-related deaths in

Asia, and in recent years is emerging as the commonest female malignancy in the
developing Asian countries, overtaking cancer of the uterine cervix. There have
been no studies objectively comparing data and facts relating to breast cancer in
the developed, newly developed, and developing Asian countries thus far.
MATERIAL AND METHODS: This multi-national collaborative study
retrospectively compared the demographic, clinical, pathological and outcomes
data in breast cancer patients managed at participating breast cancer centers in
India, Malaysia and Hong Kong. Data, including those on the availability of
breast screening, treatment facilities and outcomes from other major cancer
centers and cancer registries of these countries and from other Asian countries
were also reviewed. RESULTS: Despite an increasing trend, the incidence of
breast cancer is lower, yet the cause-specific mortality is significantly higher in
developing Asian countries compared with developed countries in Asia and the
rest of the world. Patients are about one decade younger in developing countries
than their counterparts in developed nations. The proportions of young patients (<
35 years) vary from about 10% in developed to up to 25% in developing Asian
countries, which carry a poorer prognosis. In the developing countries, the
majority of breast cancer patients continue to be diagnosed at a relatively late
stage, and locally advanced cancers constitute over 50% of all patients managed.
The stage-wise distribution of the disease is comparatively favorable in developed
Asian countries. Pathology of breast cancers in young Asian women and the
clinical picture are different from those of average patients managed elsewhere in
the world. Owing to lack of awareness, lack of funding, lack of infrastructure, and
low priority in public health schemes, breast cancer screening and early detection
have not caught up in these under-privileged societies. CONCLUSIONS: The
inadequacies of health care infrastructures and standards, sociocultural barriers,
economic realities, illiteracy, and the differences in the clinical and pathological
attributes of this disease in Asian women compared with the rest of the world
together result in a different spectrum of the disease. Better socioeconomic
conditions, health awareness, and availability of breast cancer screening in
developed Asian countries seem to be the major causes of a favorable clinical
picture and outcomes in these countries.
Publication Types:
494: Environ Geochem Health. 2007 Oct;29(5):413-28. Epub 2007 Mar 24.
Improving human micronutrient nutrition through biofortification

in the soil-plant system: China as a case study.
Yang XE, Chen WR, Feng Y.
MOE Key Lab, Environmental Remediation and Ecosystem Health, Zhejiang

University, 310029, Hanghzou, China. xyang@zju.edu.cn
Micronutrient malnutrition is a major health problem in China. According to a

national nutritional survey, approximately 24% of all Chinese children suffer
from a serious deficiency of iron (Fe) (anemia), while over 50% show a sub-
clinical level of zinc (Zn) deficiency. More than 374 million people in China
suffer from goiter disease, which is related to iodine (I) deficiency, and
approximately 20% of the Chinese population are affected by selenium (Se)
deficiency. Micronutrient malnutrition in humans is derived from deficiencies of
these elements in soils and foods. In China, approximately 40% of the total land
area is deficient in Fe and Zn. Keshan and Kaschin-Beck diseases always appear
in regions where the soil content of Se in low. The soil-plant system is
instrumental to human nutrition and forms the basis of the "food chain" in which
there is micronutrient cycling, resulting in an ecologically sound and sustainable
flow of micronutrients. Soil-plant system strategies that have been adopted to
improve human micronutrient nutrition mainly include: (1) exploiting
micronutrient-dense crop genotypes by studying the physiology and genetics of
micronutrient flow from soils to the edible parts of crops; (2) improving
micronutrient bioavailability through a better knowledge of the mechanisms of the
enhancers' production and accumulation in edible parts and its regulation through
soil-plant system; (3) improving our knowledge of the relationship between the
content and bioavailability of micronutrients in soils and those in edible crop
products for better human nutrition; (4) developing special micronutrient
fertilizers and integrated nutrient management technologies for increasing both
the density of the micronutrients in the edible parts of plants and their
bioavailability to humans.
Publication Types:
• Case Reports
495: Int J Cardiol. 2008 Jan 24;123(3):298-301. Epub 2007 Mar 23.
Pneumococcal endocarditis in children: a nationwide survey in

Japan.
Ishiwada N, Niwa K, Tateno S, Yoshinaga M, Terai M, Nakazawa M.
Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba,

Japan. ishiwada@faculty.chiba-u.jp
BACKGROUND: Infective endocarditis (IE) due to Streptococcus pneumoniae

(S. pneumoniae) carries a high mortality rate. However, little is known about
pneumococcal IE in children and no optimal therapy has been established. Thus,
we attempted to identify the clinical features of this disorder through a Japanese
nationwide survey. METHODS: Members of the Japanese Society of Pediatrics
Cardiology and Cardiac Surgery registered 170 pediatric patients with IE
diagnosed during a 5-year period (1997-2001). Nine of these patients (5.3%) had
pneumococcal IE. The clinical course, treatment and outcome of these 9 patients,
aged 7 months to 4 years, were analyzed. RESULTS: Pneumococcal IE was
associated with congenital heart disease in 7 patients and accompanied by other
systemic infections including meningitis, pneumonia and otitis media, in 4
patients. Five of the 9 (55.6%) strains isolated by blood culture were penicillin-
resistant S. pneumoniae strains. Seven patients were treated with carbapenem.
Three underwent cardiac surgery due to cardiac failure and/or vegetation. One
died due to septic shock on the first day of hospitalization. CONCLUSIONS: In
children, pneumococcal endocarditis is often accompanied by severe systemic
infections. The majority of pediatric cases are caused by penicillin-resistant S.
pneumoniae strains. Carbapenem is an effective for IE caused by penicillin-
resistant S. pneumoniae. This survey might be helpful to establish proper
management strategies for pediatric pneumococcal IE.
Publication Types:
496: Arch Gerontol Geriatr. 2007 Nov-Dec;45(3):327-34. Epub 2007 Mar 23.
Clinical and laboratory predictors of all-cause mortality in older

population.
Lan TY, Chiu HC, Chang HY, Chang WC, Chen HY, Tai TY.
Division of Gerontology Research, National Health Research Institutes, Room

4110, 4F, No. 161, Ming-Chuan East Road, Sec. 6, Taipei 114, Taiwan.
tylan@nhri.org.tw
Although some clinical and laboratory tests have been studied on their individual
relationship with total mortality or cause-specific mortality such as cardiovascular
mortality, the overall effect of these indicators on mortality has rarely been
evaluated. The purposes of this study were to assess the relationship of clinical
and laboratory measures and all-cause mortality and to evaluate their potential
clinical importance in mortality prediction in older adults. A sample of 2086
persons aged 65 and older participating the population-based health examination
in 1995 and 1996 in Kaohsiung City, Taiwan was followed until the end of 2003.
All participants completed medical history and underwent clinical assessment and
laboratory tests. Measures selected for analysis were pulse rate, blood pressure,
height, weight, serum level of cholesterol, triglyceride, creatinine, and uric acid,
fasting blood glucose (FBG), hemoglobin (HG) and red (RBC) and white blood
cell (WBC) counts. Cox regression was used to select measures significant to total
mortality. All participants were further classified into risk groups, based on
disease history and values of measures identified from analyses, to evaluate
mortality risk. A total of 409 deaths occurred during an average of 8.2 years of
follow-up time. Among all 14 measures assessed individually, five (systolic blood
pressure=SBP, creatinine, uric acid, FBG, and HG) were statistically related to
total mortality. SBP (hazard ratio (HR)=1.22; 95% confidence interval (CI)=1.09-
1.36), FBG (HR=1.18; CI=1.08-1.29), and HG (HR=0.81; CI=0.73-0.91) were
further identified to have independent effect on total mortality in the multivariate
analysis. Age- and sex-adjusted total mortality HRs for disease risk (with disease
history but with normal biomedical values), biomedical risk (without disease
history but with abnormal biomedical values), and combined risk groups (with
disease history and with abnormal biomedical values) were 1.94 (CI=1.22-3.10),
2.08 (CI=1.57-2.76), and 2.45 (CI=1.83-3.27) compared with low risk group
(without diseases history and with normal biomedical values). Results from this
study reveal the importance of incorporating clinical and laboratory measures on
the assessment of mortality in older adults. Establishing mortality risk profile
based on both diseases conditions and inexpensive biomedical measures (for
example, SBP, FBG and HG identified in the study) may help physicians in
evaluating older persons' prognosis.
497: Nurse Educ Today. 2007 Oct;27(7):808-18. Epub 2007 Mar 26.
A descriptive study of Bruneian student nurses' perceptions of

stress.
Burnard P, Haji Abd Rahim HT, Hayes D, Edwards D.
School of Nursing and Midwifery Studies, Cardiff University, Wales, UK.

burnard@cardiff.ac.uk
While much has been written about stress in nursing in the 'West', less research
has been done on this issue in many 'Eastern' countries. This paper offers the
findings of the first study of stress in student nurses in Brunei. The paper
describes a study of 20 Brunei nursing students and their views about stress in
nursing. A modified grounded theory approach was used in collecting and
analysing data (and the 'modifications' are described). Findings were organised
around the themes: stressors, moderators and outcomes [Carson, J., and Kuipers,
E., 1998. Stress management interventions. In: Hardy, S., Carson, J., Thomas, B.
(Eds.), Occupational Stress: Personal and Professional Approaches. Stanley
Thornes, Cheltenham. pp. 157-174.]. Students often found their status as students
caused them stress in the clinical setting: with other nurses, with doctors and even
with patients. Academic related stressors included having to complete
assignments and having to study in English. Various ways of moderating stress
were reported including talking to 'trusted friends', engaging in sports or simply
being quiet. Positive and negative outcomes of stress were identified: stress could
lead to mental illness but, also, it could be motivating. This report concludes with
a Weberian 'ideal type': a composite word-picture of the findings.

498: Eur J Gynaecol Oncol. 2007;28(1):33-8.
Supraclavicular lymph node metastases in cervical cancer.
Qiu JT, Ho KC, Lai CH, Yen TC, Huang YT, Chao A, Chang TC.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and

Chang Gung University College of Medicine, Taoyuan, Taiwan.
PURPOSE OF INVESTIGATION: To evaluate the outcome and prognostic

factors of patients with supraclavicular lymph node (SCLN) involvement at
primary diagnosis. METHODS: We reviewed the medical records of cervical
cancer patients primarily treated at Chang Gung Memorial Hospital between 1987
and 2005. Thirty-three patients with histologically confirmed SCLN metastasis at
primary diagnosis were eligible for analysis. Clinical and pathological features
were analyzed for association with outcome. RESULTS: The 3- and 5-year
survival rates of patients with SCLN metastasis were 16.5% and 16.5%,
respectively. Multivariate analysis showed the serum level of squamous cell
carcinoma antigen (SCC-Ag) < 15 ng/ml at initial diagnosis (p = 0.021) and
staging/restaging including [18F] fluoro-2-deoxy-D-glucose positron emission
tomography (FDG-PET) (p = 0.006) to be associated with a better prognosis.
CONCLUSION: Primary SCLN metastasis in cervical cancer is not incurable.
The benefit from PET findings might help in selecting appropriate patients for
curative primary and/or salvage treatment.
Publication Types:
499: J Trop Pediatr. 2007 Jun;53(3):171-8. Epub 2007 Mar 17.
Day-care management of children with severe malnutrition in an

urban health clinic in Dhaka, Bangladesh.
Ashraf H, Ahmed T, Hossain MI, Alam NH, Mahmud R, Kamal SM, Salam
MA, Fuchs GJ.
Clinical Sciences Division, ICDDR, B, Dhaka 1212, Bangladesh.
ashrafh@icddrb.org
Management of severely malnourished children with associated complications

relies on hospital-based treatment. Implementation of a standardized protocol at
the Dhaka Hospital, ICDDR,B reduced case fatality approximately 50%. We
developed and prospectively evaluated a day-care clinic approach that provided
antibiotics, micronutrients and feeding during the day with continued care by
parents at home at night as an alternative to hospitalization. Severely
malnourished children aged 6-23 months denied admission to hospital were
enrolled at Radda Clinic, Dhaka and received protocolized management with
antibiotics, micronutrients and milk-based diet from 8:00 am to 5:00 pm each day,
while mothers were educated on continuation of care at home. They were
transitioned to the day-care nutrition rehabilitation (NR) unit of Radda Clinic
following resolution of acute illness, received NR diet (Khichuri, halwa and milk-
based) daily until children attained 80% weight-for-length. From February 2001
to November 2003, 264 children were enrolled; 52% were boys and 78%, 21%
and 1% had marasmus, marasmus-kwashiorkor and kwashiorkor, respectively.
Only 13% had severe malnutrition alone while 35% had pneumonia, 35% had
diarrhea and 17% had both pneumonia and diarrhea. The mean (SD) duration of
acute and NR phases were 8 (4) and 14 (13) days, respectively. Children gained
weight [mean (SD) g/kg day] more rapidly during acute 10 (7) than NR phase 6
(5). Successful management was possible in 82% (95% CI 77-86%) children,
12% discontinued treatment and 6% referred to hospitals. Only one child died
during NR phase. Severely malnourished children can be successfully managed at
existing day-care clinics using a protocolized approach.
Publication Types:
• Clinical Trial
500: Ann Trop Med Parasitol. 2007 Apr;101(3):187-93.
Cerebral malaria in adults -- a description of 526 cases admitted to

Ispat General Hospital in Rourkela, India.
Mishra SK, Mohanty S, Satpathy SK, Mohapatra DN.
Department of Internal Medicine and Critical Care Unit, Ispat General Hospital,
Rourkela 769 005, Orissa, India. sarojrkl@gmail.com
Although the clinical picture of cerebral malaria in children has been reported
extensively, scant information is available about cerebral malaria in adults. This
report relates to one of the largest series of adult cases of cerebral malaria patients
ever described. At Rourkela, in eastern India, 526 adults (aged >12 years) who
each satisfied the World Health Organization's criteria for cerebral malaria were
admitted to Ispat General Hospital between 1995 and 2001. These cases
represented 18% of the 2994 adult patients who were admitted with Plasmodium
falciparum malaria over the same period. Most (76%) of the adult cases of
cerebral malaria were male, 48% were aged 21-40 years, and only 4% were older
than 60 years. The most common presenting symptoms were fever (97.7%),
vomiting (54.6%), headache (30.8%) and seizures (17.1%). Most (62.4%) of the
cases had associated severe complications: jaundice (47.5%), acute renal failure
(28.9%), and/or severe anaemia (9.7%). Overall, 175 (23%) of the cases were
fatal, mortality being particularly high (59%) among those with multi-organ
failure. Of the fatal cases, 107 (61%) died within the first 24 h of hospitalization,
presumably indicative of late presentation. As the management of multiple
complications may be inadequate at primary centres, early referral to higher
centres is recommended.

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301: Int J Health Care Finance Econ. 2007 Sep;7(2-3):217-31.

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