His 4

601: Med Eng Phys. 2007 Mar;29(2):199-204. Epub 2006 Apr 18.
Related Articles, Links
A remote data access architecture for home-monitoring health-care

applications.
Lin CH, Young ST, Kuo TS.
Department of Electrical Engineering, National Taiwan University, No. 1, Sec. 4,

Roosevelt Rd., Taipei 106, Taiwan, ROC.
With the aging of the population and the increasing patient preference for
receiving care in their own homes, remote home care is one of the fastest growing
areas of health care in Taiwan and many other countries. Many remote home-
monitoring applications have been developed and implemented to enable both
formal and informal caregivers to have remote access to patient data so that they
can respond instantly to any abnormalities of in-home patients. The aim of this
technology is to give both patients and relatives better control of the health care,
reduce the burden on informal caregivers and reduce visits to hospitals and thus
result in a better quality of life for both the patient and his/her family. To facilitate
their widespread adoption, remote home-monitoring systems take advantage of
the low-cost features and popularity of the Internet and PCs, but are inherently
exposed to several security risks, such as virus and denial-of-service (DoS)
attacks. These security threats exist as long as the in-home PC is directly
accessible by remote-monitoring users over the Internet. The purpose of the study
reported in this paper was to improve the security of such systems, with the
proposed architecture aimed at increasing the system availability and
confidentiality of patient information. A broker server is introduced between the
remote-monitoring devices and the in-home PCs. This topology removes direct
access to the in-home PC, and a firewall can be configured to deny all inbound
connections while the remote home-monitoring application is operating. This
architecture helps to transfer the security risks from the in-home PC to the
managed broker server, on which more advanced security measures can be
implemented. The pros and cons of this novel architecture design are also
discussed and summarized.
Publication Types:
• Research Support, Non-U.S. Gov't
PMID: 16621655 [PubMed - indexed for MEDLINE]
602: Environ Res. 2007 Jan;103(1):87-98. Epub 2006 Apr 17.

Estimating the effect of air pollution from a coal-fired power station

on the development of children's pulmonary function.
Dubnov J, Barchana M, Rishpon S, Leventhal A, Segal I, Carel R, Portnov

BA.
Haifa District Health Office, Ministry of Health, Israel.

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

Determination of zygosity by questionnaire and physical features

comparison in Chinese adult twins.
Gao W, Li L, Cao W, Zhan S, Lv J, Qin Y, Pang Z, Wang S, Chen W, Chen

R, Hu Y.
Department of Epidemiology and Biostatistics, School of Public Health, Peking

University Health Science Center, Beijing, China. gaowenjing1979@gmail.com
This study reports on the determination of zygosity in Chinese adult twins by
simple questionnaire and physical features comparison. The subjects were 511
twin pairs from two cities and their town areas, consisting of 371 monozygotic
(MZ) and 140 same-sex dizygotic (DZ) pairs, identified by ABO blood group and
multiplex polymerase chain reaction of several polymorphic short tandem repeat
markers. The twins themselves responded to 8 questionnaire items, 4 items on
twin similarity, and 4 items on the frequency of mistaking one twin for another by
parents, relatives, teachers and strangers when they were 6 to 13 years old.
Research assistants responded to 20 items regarding twins' physical features at the
moment of interview. A parsimonious model established using stepwise logistic
regression analysis of the 28 items showed that the total accuracy of zygosity
diagnosis was 90.1%. The accuracy was 89.2% when using only the items dealing
with the confusion of twins and 85.4% using only similarity. In the questionnaire,
'facial appearance', 'mistaken by teachers' and 'mistaken by strangers' had stronger
discriminating power between MZ and DZ twins. Two physical features--'eyelid'
and 'middigital hair'--were informative to some extent. There was no statistically
significant sex and area difference in the validity of such questionnaire and
physical features comparison-based classification. In conclusion, questionnaire-
based zygosity assessment in this Chinese adult twin sample could still be
regarded as a valid and valuable classification method. Physical features
comparison, however, could only provide limited information for zygosity
determination.
Publication Types:
604: Ind Health. 2006 Jan;44(1):42-7.

Networking grassroots efforts to improve safety and health in

informal economy workplaces in Asia.
Kawakami T.
ILO Subregional Office for East Asia, United Nations Building, Rajadamnern
Nok Avenue, Bangkok 10200, Thailand.
Many workers in Asia are in the informal economy. They often work in
substandard conditions, exposed to hazards in the workplace. Learning from the
recent successes of participatory training programmes to improve safety and
health in Asia, the ILO has strengthened its partnership efforts with local people
to improve safety and health of informal economy workplaces. The target groups
were: (1) home workplaces in Cambodia and Thailand, (2) salt fields and fishing
villages in Cambodia where many young workers are working, and (3) small
construction sites in Cambodia, Laos, Mongolia, Thailand and Vietnam. The
walk-through survey results showed that the workers and owners in the target
informal economy workplaces had the strong will to improve safety and health at
their own initiatives and needed practical support. In the participatory, action-
oriented training workshops carried out, the participated workers and owners were
able to identify their priority safety and health actions. Commonly identified were
clear and safe transport ways, safer handling of hazardous substances, basic
welfare needs such as drinking water and sanitary toilets, and work posture. The
follow-up visits confirmed that many of the proposed actions were actually taken
by using low-cost available materials. These positive changes were possible by
applying the participatory training tools such as illustrated checklists and
extensive use of photographs showing local good examples and placing emphasis
on facilitator roles of trainers. In conclusion, the target informal economy
workplaces in Asia made positive changes in safety and health through the
participatory, action-oriented training focusing on local initiative and low-cost
improvement measures. Local network support mechanisms to share lessons from
good practices played essential roles in encouraging the voluntary implementation
of practical improvement actions. It is important to increase our joint efforts to
reach more informal economy workplaces in industrially developing countries
and provide practical support measures focusing on local self-help initiatives.
605: J Formos Med Assoc. 2005 Dec;104(12):883-90.

Use of diagnosis-based risk adjustment models to predict individual

health care expenditure under the National Health Insurance system
in Taiwan.
Chang RE, Lai CL.
Graduate Institute of Health Care Organization Administration, College of Public

Health, National Taiwan University, Taipei, Taiwan.
BACKGROUND AND PURPOSE: Diagnostic information has been extensively

studied and employed in the prediction of risk adjusted capitation payments in
some countries. Nevertheless, few studies have been dedicated to the development
of diagnosis-based risk adjusters in Taiwan. The purposes of this study were to
develop outpatient diagnosis-based risk adjusters for a model of Taiwan's
National Health Insurance (NHI) system and to evaluate the predictability of the
risk adjustment models generated utilizing these adjusters. METHODS: Using a
2% random sample of 371,620 NHI enrollees, 5 risk adjustment models--i.e.,
demographic, inpatient diagnostic information outpatient diagnostic information,
full diagnostic information, and prior utilization models--were evaluated with
respect to predictive R2 and predictive ratios. While inpatient diagnosis-based
risk adjusters were borrowed from previous research, outpatient diagnosis-based
risk adjusters, referred to as Taiwan Ambulatory Spending Groups (TASGs), were
developed based on 1996 claims data. RESULTS: The values of predictive R2 for
the 5 risk adjustment models showed that the inclusion of outpatient diagnostic
information considerably improved the predictability of the risk adjustment
models for Taiwan's NHI system. Moreover, the predictive ratios revealed that the
full diagnostic information model would reimburse different risk subgroups more
fairly than the demographic, inpatient diagnostic information, and outpatient
diagnostic information models and also outperform the prior utilization model
with respect to disease risk groups. CONCLUSIONS: The risk adjustment model
including the TASG risk adjusters can significantly improve predictability and
can be employed to assess the NHI's current and proposed reform measures.
606: Foodborne Pathog Dis. 2006 Spring;3(1):68-73.

Effectiveness of pulsed-field gel electrophoresis for the early

detection of diffuse outbreaks due to Shiga toxin-producing
Escherichia coli in Japan.
Terajima J, Izumiya H, Iyoda S, Mitobe J, Miura M, Watanabe H.
Department of Bacteriology, National Institute of Infectious Diseases, Tokyo,

Japan.
We applied pulsed-field gel electrophoresis (PFGE) to the investigation of diffuse

outbreaks of illness due to Shiga toxin?producing Escherichia coli O157:H7
(STEC O157) in Japan and used these data to develop a database of STEC O157
PFGE patterns and associated clinical and microbiologic information to facilitate
the recognition of geographic and temporal clusters of cases based on their PFGE
profiles. This project has evolved into a subtyping network called PulseNet Japan
that is cooperatively run by National Institute of Infectious Diseases (NIID) and
the local Health Institutes and the Ministry of Health, Labor and Welfare.
Although our domestic PFGE network that utilized locally developed PFGE
protocols was effective in recognizing diffuse outbreaks of STEC O157 within
Japan, we decided to adopt the standardized PFGE protocols from PulseNet USA
and collaborate closely with the Centers for Disease Control and Prevention
(CDC) in the United States to facilitate recognition of international clusters of
STEC O157 and their investigations.
Publication Types:
607: Foodborne Pathog Dis. 2006 Spring;3(1):36-50.

Building PulseNet International: an interconnected system of

laboratory networks to facilitate timely public health recognition
and response to foodborne disease outbreaks and emerging
foodborne diseases.
Swaminathan B, Gerner-Smidt P, Ng LK, Lukinmaa S, Kam KM, Rolando

S, Gutiérrez EP, Binsztein N.
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic

Diseases, National Center for Infectious Diseases, Coordinating Center for
Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
30033, USA. bas5@cdc.gov
PulseNet USA, the national molecular subtyping network for foodborne disease
surveillance, began functioning in the United States in 1996 and soon established
itself as a critical early warning system for foodborne disease outbreaks,
particularly those in which cases may be geographically dispersed. The PulseNet
network is now being replicated in different ways in Canada, Europe, the Asia
Pacific region, and Latin America. These independent networks work together in
PulseNet International allowing public health officials and laboratorians to share
molecular epidemiologic information in real-time and enabling rapid recognition
and investigation of multi-national foodborne disease outbreaks. Routine
communication between the various international PulseNet networks will provide
early warning on foodborne disease outbreaks to participating public health
institutions and countries.
608: East Mediterr Health J. 2005 May;11(3):319-28.

Mental health publications from the Arab world cited in PubMed,

1987-2002.
Afifi MM.
Department of Research and Studies, Ministry of Health, Muscat, Oman.

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

Central system of psychosocial support to the Czech victims affected

by the tsunami in Southeast Asia.
Vymetal S.
Psychology Section, The Ministry of Interior of the Czech Republic.

vym@mvcr.cz
The tsunami disaster affected several countries in Southeast Asia in December

2004 and killed or affected many tourists, most of them from Europe. Eight Czech
citizens died, and about 500 Czechs were seriously mentally traumatized. The
psychosocial needs of tourists included: (1) protection; (2) treatment; (3) safety;
(4) relief; (5) psychological first aid; (6) connecting with family members; (7)
transportation home; (8) information about possible mental reactions to trauma;
(9) information about the normality of their reaction; (10) procedural and
environmental orientation; (11) reinforcement of personal competencies; and (12)
psycho-trauma therapy. The Ministry of Foreign Affairs of the Czech Republic
was in charge of general emergency management. General coordination of
psychosocial support was coordinated under the Ministry of Interior of the Czech
Republic, which is connected to the Central Crisis Staff of the Czech
Government. The major cooperative partners were: the Ministry of Foreign
Affairs, the Ministry of Defence, the Ministry of Health, Czech Airlines,
psychosocial intervention teams of the Czech Republic, and the Czech
Association of Clinical Psychologists. The main goals of relief workers were: (1)
to bring back home the maximum number of Czech citizens; (2) to provide
relevant information to the maximum number of affected Czech citizens; (3) to
provide relevant information to rescue workers and professionals; and (4) to
prepare working psychosocial support regional network. Major activities of the
Ministry of Interior (psychology section) included: (1) establishing a
psychological helpline; (2) running a team of psychological assistance (assistance
in the Czech airports, psychological monitoring of tourists, crisis intervention,
psychological first aid, assistance in the collection of DNA material from
relatives); (3) drafting and distributing specific information materials (brochures,
leaflets, address lists, printed and electronic instructions); (4) communicating via
the media and advertising, and (5) providing analysis and research studies.
Central coordination of psychosocial support has been found as successful in the
first phase after the disaster. The plans must be built for preferable cooperation in
the psychosocial field in the Czech Republic. Better collaborates with journalists
must exist in order to reduce secondary psycho-trauma. There is a need for
intensive international cooperation in the psychosocial field and to build the
network at the global level.
610: J Nurs Manag. 2006 Apr;14(3):222-6.

Comparison of risk management in Taiwan and the USA.
Lin LC.
School of Nursing, University of Texas at Austin, Austin, TX and RN, North

Austin Medical Center, Austin, TX 78701, USA. lycheejulie@yahoo.com
AIM: The purpose of this paper is to compare and contrast the systems of risk
management between a hospital in the USA and a hospital in Taiwan.
BACKGROUND: By comparing both systems, nurses and managers will have a
better understanding of risk management improvements and be in a better position
to protect their patients and themselves. EVALUATION: Two interviews were
conducted and literature were collected and reviewed by the author to support the
argument. The gathered information was analysed to demonstrate the strengths
and weaknesses of both hospital systems. KEY ISSUES: Although risk
management is not difficult to understand, nurses and managers usually pay
insufficient attention to it. CONCLUSION: Health care providers should work as
a team to complete risk assessment and management in their workplaces. There
are weaknesses to be improved and strengths to be continued and addressed in
Taiwan and in the USA.
Publication Types:
• Comparative Study
611: J Ayub Med Coll Abbottabad. 2005 Oct-Dec;17(4):26-30.

Assessing the effects of training on knowledge and skills of health

personnel: a case study from the family health project in Sindh,
Pakistan.
Farid-ul-Hasnain S, Israr SM, Jessani S.
Department of Community Health sciences, The Aga Khan University, Karachi,

Pakistan. farid.hasnain@aku.edu
BACKGROUND: The Family Health Project (FHP) was implemented in the

province of Sindh during 1992-99 with the assistance of the World Bank. The
project was designed to bring substantial changes in health care system for
achieving improvement in the health status by strengthening the quality and
integration of primary health care services. One of the major components of the
project was to develop the institutional capacity of Ministry of Health in Sindh.
This is a comparative analysis to assess the knowledge and skills of health care
providers in Area Focus Approach (AFA) health facilities with the ones in non-
AFA health care facilities. METHODS: In order to obtain a representative
sample, 8 districts were selected which included, Larkana, Khairpur, Nawabshah,
Dadu, Tharparkar, Thatta, Karachi South, and Karachi West. A structured
questionnaire was designed with various sections to assess the knowledge and
skills of various cadres of health facility staff. RESULTS: This comparative
assessment has come up with some interesting results; there is a difference
between the scores of knowledge and skills between AFA and non-AFA health
care providers. This assessment identified some important methodological issues
such as the use of base-line information for comparing the results and the
selection of a comparable study population for controlling the confounding
factors. CONCLUSIONS: These findings can be used as important lessons
learned for producing better results of any post training assessment intervention.
Publication Types:
612: BMC Public Health. 2006 Apr 4;6:86.

Organizational aspects and implementation of data systems in large-
scale epidemiological studies in less developed countries.
Ali M, Park JK, von Seidlein L, Acosta CJ, Deen JL, Clemens JD.
International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7 dong,
Kwanak-gu, Seoul, Korea. mali@ivi.int
BACKGROUND: In the conduct of epidemiological studies in less developed

countries, while great emphasis is placed on study design, data collection, and
analysis, often little attention is paid to data management. As a consequence,
investigators working in these countries frequently face challenges in cleaning,
analyzing and interpreting data. In most research settings, the data management
team is formed with temporary and unskilled persons. A proper working
environment and training or guidance in constructing a reliable database is rarely
available. There is little information available that describes data management
problems and solutions to those problems. Usually a line or two can be obtained
in the methods section of research papers stating that the data are doubly-entered
and that outliers and inconsistencies were removed from the data. Such
information provides little assurance that the data are reliable. There are several
issues in data management that if not properly practiced may create an unreliable
database, and outcomes of this database will be spurious. RESULTS: We have
outlined the data management practices for epidemiological studies that we have
modeled for our research sites in seven Asian countries and one African country.
CONCLUSION: Information from this model data management structure may
help others construct reliable databases for large-scale epidemiological studies in
less developed countries.
Publication Types:
PMCID: PMC1450272
613: Bull World Health Organ. 2006 Mar;84(3):239-45. Epub 2006 Mar 22.
Verbal autopsy: current practices and challenges.

Soleman N, Chandramohan D, Shibuya K.
Department of Infectious and Tropical Diseases, London School of Hygiene and

Tropical Medicine, England. nadia.soleman@lshtm.ac.uk
Cause-of-death data derived from verbal autopsy (VA) are increasingly used for
health planning, priority setting, monitoring and evaluation in countries with
incomplete or no vital registration systems. In some regions of the world it is the
only method available to obtain estimates on the distribution of causes of death.
Currently, the VA method is routinely used at over 35 sites, mainly in Africa and
Asia. In this paper, we present an overview of the VA process and the results of a
review of VA tools and operating procedures used at demographic surveillance
sites and sample vital registration systems. We asked for information from 36
field sites about field-operating procedures and reviewed 18 verbal autopsy
questionnaires and 10 cause-of-death lists used in 13 countries. The format and
content of VA questionnaires, field-operating procedures, cause-of-death lists and
the procedures to derive causes of death from VA process varied substantially
among sites. We discuss the consequences of using varied methods and conclude
that the VA tools and procedures must be standardized and reliable in order to
make accurate national and international comparisons of VA data. We also
highlight further steps needed in the development of a standard VA process.
Publication Types:
614: Bull World Health Organ. 2006 Mar;84(3):233-8. Epub 2006 Mar 22.
A critical assessment of mortality statistics in Thailand: potential for

improvements.
Tangcharoensathien V, Faramnuayphol P, Teokul W, Bundhamcharoen K,

Wibulpholprasert S.
Ministry of Public Health, International Health Policy Program, Nonthaburi,

Thailand. viroj@ihpp.thaigov.net
This study evaluates the collection and flow of mortality and cause-of-death
(COD) data in Thailand, identifying areas of weakness and presenting potential
approaches to improve these statistics. Methods include systems analysis,
literature review, and the application of the Health Metrics Network (HMN) self-
assessment tool by key stakeholders. We identified two weaknesses underlying
incompleteness of death registration and inaccuracy of COD attribution: problems
in recording events or certifying deaths, and problems in transferring information
from death certificates to death registers. Deaths occurring outside health
facilities, representing 65% of all deaths in Thailand, contribute to the inaccuracy
of cause-of-death data because they must be certified by village heads with
limited knowledge and expertise in cause-of-death attribution. However, problems
also exist with in-hospital cause-of-death certification by physicians. Priority
should be given to training medical personnel in death certification, review of
medical records by health personnel in district hospitals, and use of verbal
autopsy techniques for assessing internal consistency. This should be coupled
with stronger collaboration with district registrars for the 65% of deaths that occur
outside hospitals. Training of physicians and data coders and harmonization of
death certificates and registries would improve COD data for the 35% of deaths
that take place in hospital. Public awareness of the importance of registering all
deaths and the application of registration requirements prior to funerals would
also improve coverage, though enforcement would be difficult.
615: Lancet. 2006 Apr 1;367(9516):1066-74.

WHO analysis of causes of maternal death: a systematic review.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF.
Academic Department of Obstetrics and Gynaecology, University of

Birmingham, Birmingham, UK.
BACKGROUND: The reduction of maternal deaths is a key international

development goal. Evidence-based health policies and programmes aiming to
reduce maternal deaths need reliable and valid information. We undertook a
systematic review to determine the distribution of causes of maternal deaths.
METHODS: We selected datasets using prespecified criteria, and recorded dataset
characteristics, methodological features, and causes of maternal deaths. All
analyses were restricted to datasets representative of populations. We analysed
joint causes of maternal deaths from datasets reporting at least four major causes
(haemorrhage, hypertensive disorders, sepsis, abortion, obstructed labour, ectopic
pregnancy, embolism). We examined datasets reporting individual causes of death
to investigate the heterogeneity due to methodological features and geographical
region and the contribution of haemorrhage, hypertensive disorders, abortion, and
sepsis as causes of maternal death at the country level. FINDINGS: 34 datasets
(35,197 maternal deaths) were included in the primary analysis. We recorded
wide regional variation in the causes of maternal deaths. Haemorrhage was the
leading cause of death in Africa (point estimate 33.9%, range 13.3-43.6; eight
datasets, 4508 deaths) and in Asia (30.8%, 5.9-48.5; 11,16 089). In Latin America
and the Caribbean, hypertensive disorders were responsible for the most deaths
(25.7%, 7.9-52.4; ten, 11,777). Abortion deaths were the highest in Latin America
and the Caribbean (12%), which can be as high as 30% of all deaths in some
countries in this region. Deaths due to sepsis were higher in Africa (odds ratio
2.71), Asia (1.91), and Latin America and the Caribbean (2.06) than in developed
countries. INTERPRETATION: Haemorrhage and hypertensive disorders are
major contributors to maternal deaths in developing countries. These data should
inform evidence-based reproductive health-care policies and programmes at
regional and national levels. Capacity-strengthening efforts to improve the quality
of burden-of-disease studies will further validate future estimates.
Publication Types:

• Review
616: N Engl J Med. 2006 Mar 30;354(13):1426-9; author reply 1426-9.

Comment on:
• N Engl J Med. 2005 Dec 29;353(26):2779-87.
Clinical trials report card.
Tamir O, Lipschitz Y, Shemer J.
Publication Types:
• Comment
• Letter
617: Med J Malaysia. 2005 Oct;60(4):432-40.

Perceived skill and utilisation of information technology in medical

education among final year medical students, Universiti Putra
Malaysia.
Lim TA, Wong WH, Lim KY.
Anaesthesiology Unit, Faculty of Medicine and Health Sciences, Universiti Putra

Malaysia, Hospital Kuala Lumpur, Jalan Masjid, 50586 Kuala Lumpur.
The objective of this survey was to obtain a self-reported assessment of the use of
information technology (IT) by final year medical students. Two hundred and
sixty five students responded to a questionnaire survey. 81.5% of students
considered their computer skills adequate, while 87.9% had access to computers
outside the campus. Most students reported adequate skills at word processing, e-
mailing and surfing the Internet. Fifty three percent of students spent three hours
or more each week on the computer. While students indicated a general
willingness to access Internet-based materials, further steps need to be taken to
increase the use of this method of instruction.
618: Natl Med J India. 2006 Jan-Feb;19(1):14-7.

Usefulness of an observational database to assess antiretroviral

treatment trends in India.
Cecelia AJ, Christybai P, Anand S, Jayakumar K, Gurunathan T, Vidya P,

Solomon S, Kumarasamy N.
YR Gaitonde Cente for AIDS Research and Education, Chennai, Tamil Nadu,
India.
BACKGROUND: Human immunodeficiency virus (HIV) observational cohorts,

which are established worldwide, support comparative studies across different
regions. They have played an important role in developing international and
country-specific HIV treatment and care guidelines. We describe the YRG CARE
Chennai HIV observation database (YCHOD) and highlight its utility in
monitoring trends in antiretroviral treatment use and HIV disease outcomes in
India. METHODS: The baseline characteristics, time trends in antiretroviral
treatment, trends in incidence of acquired immune deficiency syndrome (AIDS)-
defining illness and mortality following the introduction of highly active
antiretroviral therapy (HAART) in India were assessed using YCHOD.
RESULTS: Till January 2005, 7647 HIV-positive patients had registered in
YCHOD. A majority of the patients were men (69%) and had a mean age of 32
years. At baseline, 14% had an existing AIDS-defining illness. Among patients
who required therapy by the WHO criteria, 14% initiated antiretroviral therapy
(ART) in 1996 and 35% in 2000. Since the dramatic cost reduction of generic
HAART in 2001, there has been an increase in the proportion of patients
receiving ART to 57% in 2004. In patients who were started on HAART, the
incidence of at least one AIDS-defining illness was 2% in 2001, and this
decreased to 0.48% in 2004. CONCLUSION: We feel observational cohorts are
useful as a surveillance tool for monitoring trends in treatment and disease
progression. Standardized observational data collected systematically on HIV-
infected individuals will help to assess the cost-effectiveness of ART and in
planning ART strategies for India.
619: Lancet. 2006 Mar 25;367(9515):1000-6.

Comment in:
• Lancet. 2006 Mar 25;367(9515):968-9.
Prevalence and treatment of mental disorders in Lebanon: a

national epidemiological survey.
Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S,
Kessler RC.
Department of Psychiatry and Clinical Psychology, St George Hospital University

Medical Center, Beirut, Lebanon. idrac@idrac.org.lb
BACKGROUND: Mental disorders are believed to account for a large portion of

disease burden worldwide. However, no national studies have been undertaken to
assess this assumption in the Arab world. METHODS: As part of the WHO
World Mental Health (WMH) Survey Initiative, a nationally representative
psychiatric epidemiological survey of 2857 adults (aged 18 years) was done in
Lebanon between September, 2002, and September, 2003, through a study called
LEBANON (Lebanese Evaluation of the Burden of Ailments and Needs Of the
Nation). 12-month prevalence and severity of DSM-IV (Diagnostic and Statistical
Manual of Mental Disorders, fourth edition) disorders, and treatment were
assessed with the WHO Composite International Diagnostic Interview (CIDI,
version 3.0). Information was also obtained for sociodemographics and exposure
to traumatic events in the Lebanon wars. FINDINGS: 308 (17.0%) of respondents
met criteria for at least one 12-month DSM-IV/CIDI disorder, 108 (27.0%) of
whom were classified serious and an additional 112 (36.0%) moderate. Nearly
half of respondents had a history of exposure to war-related traumatic events.
Significantly elevated odds ratios (OR) of mood, anxiety, and impulse-control
disorders were associated with two (OR 2.0-3.6) or more (2.2-9.1) war-related
traumatic events, resulting in substantially higher proportions of moderate and
severe 12-month mental disorders in respondents exposed to multiple war-related
traumata (16.8-20.4%) compared with other respondents (3.3-3.5%). Only 47
(10.9%) respondents with 12-month disorders obtained treatment. 85% of people
were treated in the general medical sector and the mental-health-care system, and
the rest by religious or spiritual advisers, counsellors, herbalists, or fortune-tellers.
INTERPRETATION: Mental disorders are common in Lebanon, with a
prevalence equivalent to that in Western Europe. However, the number of
individuals with mental disorders who are not receiving treatment is considerably
higher in Lebanon than in Western countries.
Publication Types:
• Research Support, N.I.H., Extramural

PMCID: PMC2030488
620: BMC Public Health. 2006 Mar 26;6:76.

Life time suicidal thoughts in an urban community in Hanoi,

Vietnam.
Tran Thi Thanh H, Tran TN, Jiang GX, Leenaars A, Wasserman D.
Hanoi Medical University, Hanoi, Vietnam. tranhuong73@hotmail.com
BACKGROUND: Suicidal thought is a risk factor and a stage in the suicidal

process from planning to attempting and dying by suicide. To date, studies on
suicidal thought in the general population, especially in Asian communities, have
been limited. METHOD: The WHO SUPRE-MISS (the multisite intervention
study on suicidal behaviours) community survey questionnaire was filled in for
2,280 randomly selected residents of the DongDa district of Hanoi, Vietnam by
means of face-to-face interviews. This multi-factor questionnaire includes such
variables as sociodemographic information, suicidal thought and history of
suicide attempts, physical health, alcohol consumption and medication.
RESULTS: Prevalence rates for life time suicidal thoughts, suicide plans and
suicide attempts were 8.9%, 1.1% and 0.4% respectively. Suicidal thoughts are
associated with multiple characteristics, such as female gender,
single/widowed/separated/divorced marital status, low income, lifestyle (use of
alcohol, sedatives and pain relief medication), but not with low education or
employment status. Having no religion and being a Buddhist appear to be
protective factors for suicidal thought. The ratio of suicidal thoughts, suicide
plans and suicide attempts on a lifetime basis is 22.3:2.8:1. CONCLUSION: In
Vietnam, as in Western and other Asian countries, suicidal thoughts are
associated with similar negative psychosocial risk factors, lifestyle and emotional
problems, which implies that suicide preventive measure developed elsewhere can
be adjusted to Vietnamese condition. Understanding the unique and common risks
in a culture may assist in prediction and control.
Publication Types:
PMCID: PMC1444928
621: Immunohematology. 2006;22(1):1-5.

External quality assessment scheme in red blood cell serology: a 5-

year experience in Thailand.
Bejrachandra S, Saipin J, Nathalang O, Siriboonrit U, Rungroung E, Udee S.
Department of Transfusion Medicine, Faculty of Medicine, Siriraj Hospital,

Mahidol University, Bangkok 10700, Thailand.
From 2000 to 2004, 36, 58, 72, 78, and 86 laboratories participated in an external
quality assessment scheme (EQAS) organized by the Department of Transfusion
Medicine, Faculty of Medicine Siriraj Hospital. Each year the staff was requested
to perform ABO grouping, D typing, antibody screening, antibody identification,
and DATs on eight blood samples. Each participant received information on the
correct test results and a coded summary. Regarding ABO grouping, the error rate
ranged from 0.3 to 1.3 percent, mostly due to human errors. Error rates in D
typing ranged from 0.7 to 5.7 percent, the most problematic being weak D
phenotype interpretation. Although every sample was negative by the DAT, error
rates due to false positive test results were determined to be 0.4 to 2.1 percent.
Antibody screening errors were also found; however, errors steadily decreased
from 4.2 percent in 2000 to 0.3 percent in 2004. Only 69.4 to 87.2 percent of
laboratories performed antibody identification; however, correct results increased
from 78.4 to 91.0 percent. In conclusion, an EQAS in RBC serology should be
used to compare results from different laboratories and to identify those
laboratories that need improvement in testing procedures.
622: J Adv Nurs. 2006 Apr;54(1):120-31.

Dimensions of hospital nurses' quality of working life.
Hsu MY, Kernohan G.
Institute of Nursing Research, University of Ulster, Newtownabbey, County

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

The Harvard case of Xu Xiping: exploitation of the people, scientific
advance, or genetic theft?
Sleeboom M.
Amsterdam School of Social Science Research, University of Amsterdam, The

Netherlands. m.sleeboom@wanadoo.nl
A unique history and make-up of a population may make it an attractive research

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

The utilization of pediatric computed tomography in a large Israeli

Health Maintenance Organization.
Chodick G, Ronckers C, Ron E, Shalev V.
Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, Israel.

chodickg@mail.nih.gov
BACKGROUND: Concern has been raised about the potential risks related to
radiation exposure from CT scans, particularly among children. However, to date,
there are few data available describing the magnitude of pediatric CT utilization.
OBJECTIVE: The aim of the study was to explore patterns of CT use in pediatric
patients, with respect to time, use of multiple scans, body regions imaged, and
medical diagnoses. MATERIALS AND METHODS: Records of 22,223 scans
performed on 18,075 people aged < or =18 years over the period 1999-2003,
including diagnoses recorded within 21 days after the examination, were obtained
from a large Israeli Health Maintenance Organization (1,600,000 members).
RESULTS: The highest annual CT examination rate (per 1,000) was recorded in
2001 (10.1) compared to 7.0 and 6.3 in 1999 and 2003, respectively. The lowest
rate (three scans per 1,000) was found for 3-year-old children, with increasing
rates with age. The head was the most frequently scanned region, both in young
children (78%) and adolescents (39%). Symptoms of ill-defined conditions and
injuries were documented in 22% and 10% of all scans, respectively.
CONCLUSIONS: Although the results suggest that children comprise only 3% of
all patients undergoing CT, this important modality must be carefully used
because of their increased radiosensitivity, higher effective radiation doses, and
longer life expectancy.
Publication Types:
• Research Support, N.I.H., Intramural
625: Eur J Gynaecol Oncol. 2006;27(1):81-5.

The use of complementary and alternative medicine (CAM)

therapies by Turkish women with gynecological cancer.
Yildirim Y, Tinar S, Yorgun S, Toz E, Kaya B, Sonmez S, Balsak D.
Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital,

Department of Gynecologic Oncology, Yenisehir, Izmir, Turkey.
PURPOSE: To evaluate the prevalence and patterns of complementary and

alternative medicine (CAM) utilization among Turkish women with
gynecological cancer METHODS: In this cross-sectional study, a total of 156
patients treated between December 2002 and March 2005 at the Ministry of
Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of
Gynecologic Oncology were evaluated. Data regarding CAM use were obtained
from patients by means of face-to-face interviews. RESULTS: Sixty women
(38.5%) had used CAM having been diagnosed with cancer; herbal medicine was
the most common. The age, income, educational level, cancer site, FIGO stage,
previous CAM usage, and time since patients were diagnosed with cancer were
associated with CAM usage. The most (40%) commonly cited reason for CAM
use was to boost the immune system. Although only 8.3% of CAM users received
CAM information from health care professionals or CAM practitioners, this group
of patients was more likely to discuss their CAM use with physicians.
CONCLUSION: Our data suggest that physicians should increase their
knowledge of CAM therapies and ask cancer patients about previous CAM
history.
Publication Types:
626: J Environ Manage. 2006 Dec;81(4):434-40. Epub 2006 Mar 23.

Discovering meaningful information from large amounts of

environment and health data to reduce uncertainties in formulating
environmental policies.
Lee IN, Chang WC, Hong YJ, Liao SC.
Faculty of Medical Information Management, Kaohsiung Medical University,

Kaohsiung City, 807, Taiwan, ROC.
This study uses knowledge discovery concepts to analyze large amounts of data
step by step for the purpose of assisting in the formulation of environmental
policy. We performed data cleansing and extracting from existing nation-wide
databases, and used regression and classification techniques to analyze the data.
The current water hardness in Kaohsiung, Taiwan contributes to the prevention of
cardiovascular disease (CVD) but exacerbates the development of renal stones
(RS). However, to focus on water hardness alone to control RS would not be cost
effective at all, because the existing database parameters do not adequately allow
for a clear understanding of RS. Analysis of huge amounts of data can most often
turn up the most reliable and convincing results and the use of existing databases
can be cost-effective.
627: J Med Syst. 2006 Feb;30(1):17-22.

Use of electronic medical records in Oman and physician
satisfaction.
Al Farsi M, West DJ Jr.
MHA Program, University of Scranton, Pennsylvania, USA.
The Electronic Medical Record (EMR) is a computerized record of clinical,

demographic and management information. EMR is an enabling technology that
allows physicians to utilize quality improvement processes in the practice of
medicine. Oman is one of the Middle Eastern Countries that has implemented an
integrated electronic hospital information system at government health care
institutions. The system was first applied in primary health care centers and then
implemented in hospitals. Survey research highlights factors that affect physician
satisfaction and utilizing of this new technology in a hospital setting. Outcome
survey data suggests areas for improvement. Specific concerns about patient
confidentiality are discussed as well as quality improvement in patient care.
628: Rinsho Byori. 2006 Feb;54(2):145-52.

[Summary of an electronic chart system in Anjo Kosei hospital and

clinical laboratory system]
[Article in Japanese]
Ishikawa K.
Department of Clinical Laboratory, Anjo Kosei Hospital, Anjo 446-8602.
Many companies are introducing PC systems, and management administration

can be done more effectively. Management administration was previously paper-
based was, but, with improved PC information systems, their adoption is
inevitable. This is the situation facing the Mayor of Ministry of Health and
Welfare Health Policy Bureau, the medical and pharmaceutical safety chief of the
bureau, the guidelines about "saving medical examination and treatment records
on electronic media" by the insurance chief of the bureau joint signature
notification on April 22, 1999, the spread of the electronic chart system which
changes a patient's paper record, aiming at patient's record disclosure,
standardization of data, and equalization of medical quality to no longer be an
exception in medical care. At this symposium, I presented a summary of the
electronic chart system and the inspection system that this House introduced
concentrating on the particularly special functions.
Publication Types:
• English Abstract
629: J Nurs Res. 2006 Mar;14(1):75-81.

Bibliometric analysis of nursing research in Taiwan 1991-2004.
Huang YL, Ho YS, Chuang KY.
Department of Public Health, Taipei Medical University, Taiwan.

adinma@tmu.edu.tw
This study examined nursing research performance in Taiwan from 1991 to 2004
by conducting bibliometric analysis of papers published by researchers affiliated
with nursing institutes in Taiwan. Bibliometric information of papers that were
published between 1991 and 2004 and had contact address including the words
"Taiwan", and "nursing" were downloaded from the ISI Web of Knowledge
website. The information used for this research included number of papers,
number of authors, number of references listed, impact factors of publishing
journals, times cited, and whether the paper was written through international or
domestic collaboration. The information was coded and tabulated. Bibliometric
characteristics were compared between 1995- 1999 and 2000-2004. Furthermore,
an exponential model was fitted to show the past growth trend in research outputs.
The results showed that there was a significant growth in quantity of papers from
1991 to 2004. In general, recent papers had averaged more authors, more
domestic collaboration, more international collaboration, higher impact factors,
and more references listed than earlier papers. Papers written with collaboration
tended to have a higher average number of authors and more references listed, and
tended to be published in journals with higher impact factors. The exponential
model proved to be in good fit with the past growth pattern. The authors speculate
that the recent increase in research collaboration, both internationally and
domestically, may have contributed to the significant increase in output. It is not
clear whether the growth in quantity of papers will continue or for how long.
Based on past data, however, no sign of leveling off has been observed. More
research is needed to understand what societal and individual level factors were
involved in fueling such a dramatic increase in quantity in the last decade.
Furthermore, as the quantity of papers has increased steadily, more focus can be
placed on improving the quality of research papers.
Publication Types:
• Review
630: Eur J Epidemiol. 2006;21(3):191-5.

Incidence of acute myocardial infarction during Islamic holiday

seasons.
Zubaid M, Thalib L, Suresh CG.
Department of Medicine, Faculty of Medicine, Kuwait University, PO Box

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

Quality of hospital care for children in Kazakhstan, Republic of

Moldova, and Russia: systematic observational assessment.
Duke T, Keshishiyan E, Kuttumuratova A, Ostergren M, Ryumina I, Stasii
E, Weber MW, Tamburlini G.
Centre for International Child Health, Department of Paediatrics, University of

Melbourne, Royal Children's Hospital, Parkville, Victoria, 3052, Australia.
trevor.duke@rch.org.au
BACKGROUND: Major concerns about the quality of basic hospital care for
children have been raised in developing countries, but no formal assessment
applying international standards has been done in the Commonwealth of
Independent States. METHODS: We assessed 17 hospitals in Kazakhstan, the
Republic of Moldova, and the Russian Federation with a generic WHO hospital
assessment framework adapted for use in the WHO European region. WHO
management guidelines for paediatric care in peripheral hospitals were used as
standards. FINDINGS: Hospital access for children was generally good. Good
health networks existed, and skilled and committed doctors cared for children.
Case-fatality rates were low. However, unnecessary and lengthy hospital stays
were common, and most children received excessive and ineffective treatment (in
one country median number of drugs prescribed concurrently was 5, IQR 2-6).
Several conditions were systematically overdiagnosed, especially neurological
disease, or overinvestigated, such as acute diarrhoea. Reasons for these practices
included absence of clear evidence-based clinical guidelines, regulations tying
duration of admission to financial reimbursement, generalisation of disease-
control methods from rare problems to common illnesses, and regulations
maintaining financial and professional status of some subspecialties. Many
disincentives to efficient practice existed. INTERPRETATION: To improve
quality of hospital care for children in the Commonwealth of Independent States,
several issues must be addressed, including: adoption of international guidelines
for inpatient management; complementary guidelines for outpatient management;
reforms to health regulations governing admission and discharge criteria;
improvement of quality of training, availability of medical information, and
systems to promote and certify quality of care.
Publication Types:
632: J Cancer Res Clin Oncol. 2006 Jul;132(7):439-43. Epub 2006 Mar 15.
Clinical features of American versus non-American gynecologic

cancer patients requesting information from a proprietary web-
based decision-support program.
Markman M, Markman M, Petersen J, Belland A.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

mmarkman@mdanderson.org
PURPOSE: As the Internet can potentially substantially reduce geographic

barriers to the dissemination of health-related information, it would be interesting
to know if non-American women with gynecologic malignancies accessing
United States (US)-based cancer Web sites differ from American patients with the
same illness. PATIENTS AND METHODS: Aggregate data from individuals
providing personal clinical information into one of four proprietary gynecologic
cancer (cervix, endometrial, newly diagnosed and recurrent ovarian cancers)
decision-support programs (NexProfiler Treatment Option Tools for Cancer;
NexCura Inc., Seattle WA, USA) currently embedded within approximately 100
established cancer-related Web sites were examined for differences between
American versus non-American patient populations. RESULTS: In this analysis,
which included >15,000 patients, American and non-American gynecologic
cancer patients were remarkably similar in most clinical characteristics, including
age, stage of disease at presentation, overall health, and desire to receive
information regarding clinical trials. Notable differences included features
suggestive of a more aggressive surgical philosophy in the US (e.g., higher
percentage of American recurrent ovarian cancer patients reported they had
undergone a secondary surgical procedure; greater use of radiotherapy in non-
American cervical cancer patients). CONCLUSION: Despite differences in
geographic location and health care delivery systems, American and non-
American patients with gynecologic malignancies and with access to Internet-
based cancer information exhibit few, but notable, differences in self-reported
clinical characteristics.
Publication Types:
633: J Epidemiol. 2006 Mar;16(2):57-63.

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

Factors associated with exclusive breast-feeding in Japan: for
activities to support child-rearing with breast-feeding.
Kaneko A, Kaneita Y, Yokoyama E, Miyake T, Harano S, Suzuki K, Ibuka

E, Tsutsui T, YukoYamamoto , Ohida T.
Department of Public Health, School of Medicine, Nihon University, Tokyo,

Japan.
BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and

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

Electronic medical record use and physician-patient

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

University of Nebraska Medical Center, 986075 Nebraska Medical Center,
Omaha, 68198-6075, USA. rmargalit@unmc.edu
OBJECTIVES: Within the context of medical care there is no greater reflection of

the information revolution than the electronic medical record (EMR). Current
estimates suggest that EMR use by Israeli physicians is now so high as to
represent an almost fully immersed environment. This study examines the
relationships between the extent of electronic medical record use and physician-
patient communication within the context of Israeli primary care. METHODS:
Based on videotapes of 3 Israeli primary care physicians and 30 of their patients,
the extent of computer use was measured as number of seconds gazing at the
computer screen and 3 levels of active keyboarding. Communication dynamics
were analyzed through the application of a new Hebrew translation and adaptation
of the Roter Interaction Analysis System (RIAS). RESULTS: Physicians spent
close to one-quarter of visit time gazing at the computer screen, and in some cases
as much as 42%; heavy keyboarding throughout the visit was evident in 24% of
studied visits. Screen gaze and levels of keyboarding were both positively
correlated with length of visit (r = .51, p < .001 and F(2,27) = 2.83, p < .08,
respectively); however, keyboarding was inversely related to the amount of visit
dialogue contributed by the physician (F(2,27) = 4.22, p < .02) or the patient
(F(2,27) = 3.85, p < .05). Specific effects of screen gaze were inhibition of
physician engagement in psychosocial question asking (r = -.39, p < .02) and
emotional responsiveness (r = -.30, p < .10), while keyboarding increased
biomedical exchange, including more questions about therapeutic regimen
(F(2,27) = 4.78, p < .02) and more patient education and counseling (F(2,27) =
10.38, p < .001), as well as increased patient disclosure of medical information to
the physician (F(2,27) =3.40, p < .05). A summary score reflecting overall
patient-centered communication during the visit was negatively correlated with
both screen gaze and keyboarding (r = -.33, p < .08 and F(2,27) = 3.19, p < .06,
respectively). DISCUSSION: The computer has become a 'party' in the visit that
demanded a significant portion of visit time. Gazing at the monitor was inversely
related to physician engagement in psychosocial questioning and emotional
responsiveness and to patient limited socio-emotional and psychosocial exchange
during the visit. Keyboarding activity was inversely related to both physician and
patient contribution to the medical dialogue. Patients may regard physicians'
engrossment in the tasks of computing as disinterested or disengaged. Increase in
visit length associated with EMR use may be attributed to keyboarding and
computer gazing. CONCLUSIONS: This study suggests that the way in which
physicians use computers in the examination room can negatively affect patient-
centered practice by diminishing dialogue, particularly in the psychosocial and
emotional realm. Screen gaze appears particularly disruptive to psychosocial
inquiry and emotional responsiveness, suggesting that visual attentiveness to the
monitor rather than eye contact with the patient may inhibit sensitive or full
patient disclosure. PRACTICAL IMPLICATIONS: We believe that training can
help physicians optimize interpersonal and educationally effective use of the
EMR. This training can assist physicians in overcoming the interpersonal
distancing, both verbally and non-verbally, with which computer use is
associated. Collaborative reading of the EMR can contribute to improved quality
of care, enhance the decision-making process, and empower patients to participate
in their own care.
635: East Mediterr Health J. 2005 Jan-Mar;11(1-2):192-8.

Health management information system: a tool to gauge patient

satisfaction and quality of care.
Shaikh BT, Rabbani F.
Health Systems Division, Department of Community Health Sciences, Aga Khan

University, Karachi, Pakistan. babar.shaik@aku.ed
The health management information system (HMIS) is an instrument which could

be used to improve patient satisfaction with health services by tracking certain
dimensions of service quality. Quality can be checked by comparing perceptions
of services delivered with the expected standards. The objective of the HMIS
would be to record information on health events and check the quality of services
at different levels of health care. The importance of patient assessment is a part of
the concept of giving importance to patient's views in improving the quality of
health services. Expected benefits include enhancing patient satisfaction through
improved communication; greater provider sensitivity towards patients; enhanced
community awareness about the quality of services; and overall better use of
services in the health system.
Publication Types:
• Review
636: Health Place. 2007 Mar;13(1):238-48. Epub 2006 Mar 10.

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

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

• Research Support, U.S. Gov't, Non-P.H.S.
637: J Pers. 2006 Apr;74(2):457-78.

Monitoring: a dual-function coping style.
Shiloh S, Orgler-Shoob M.
Department of Psychology, Tel Aviv University, Israel. shoshi@freud.tau.ac.il
Monitoring (Miller, 1991) is defined as a cognitive coping style characterized by

the tendency to seek information about threats. This study found that information
seeking in stressful situations is perceived by individuals as related to the
emotion-focused more than the problem-focused function of coping and that there
is considerable variance among individuals in the perceived functions of
information seeking and the relationships among information-seeking reactions
and their perceived functions. Information-seeking preferences in a natural
stressful situation (a final course examination) were predicted by individual
differences in perceived functions of information seeking rather than by
generalized behavioral coping styles (monitoring). The results were interpreted in
relation to the cognitive-affective system theory (Mischel & Shoda, 1995), and
implications for the measurement of coping dispositions were discussed.

638: Kekkaku. 2006 Feb;81(2):71-7.
[Tuberculosis control in health care facilities for the elderly, from

the viewpoint of risk management]
Ohmori M, Wada M, Mitarai S, Yanai H, Ito K, Yamauchi Y, Shishido S.
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24,

Matsuyama, Kiyose-shi, Tokyo 204-8533, Japan. ohmori@jata.or.jp
OBJECTIVES: To discuss the optimal TB control system in health care facilities

for the elderly where the periodic TB screening is currently not obligatory.
METHODS: A study was conducted in three health care facilities for the elderly
in Tokyo during the period from 2002 to 2004, and 212 admitted elderly persons
were enrolled in this study. Medical charts were analyzed to identify informations
about mental and physical conditions and TB risk factors. Questionnaire-based
interviews were conducted in 58 residents who had no dementia or no serious
conditions. TB mass screening was carried out with a mobile vehicle equipped
with computed radiography, financially supported by the Tokyo Metropolitan
Government. Since this mobile vehicle is equipped with a special wheelchair for
chest X-ray examination, most elderly persons were able to receive chest X-ray
examination. Medical chart review and interview were conducted at around the
time of TB mass screening. The screening results of 183 elderly residents who
received X-ray examination were reviewed. RESULTS: Of the 212 persons
admitted to the facilities, 73.1% were women. The mean ages of men and women
were 80.7 and 84.2 years, respectively. Mental disorders were observed in 42.9%
and dysfunction of extremities in 54.7%. At the time of admission, chest X-ray
records were submitted by the attending doctors in 73.1% of the residents, but this
proportion differed among facilities. From these records, old TB was found in
12.3%; however this proportion was 20.8% according to the TB mass screening
results. A history of TB was more prevalent in the group interviewed than in the
non-interview group (24.1% vs. 6.5%; p < 0.001). Two facilities had conducted
TB screening for three consecutive years and comparative reading of chest X-ray
films could be done in 35.8%. The remaining facility conducted TB screening for
the first time, and comparative reading was not possible. The proportion of cases
requiring further investigations was higher in the facility where TB screening was
conducted for the first time (2.8% vs. 13.0%; p = 0.008). No active TB patient
was detected in this study. CONCLUSION: From the viewpoint of risk
management for tuberculosis, it is important to establish a system of early case
finding for the aged persons admitted to health care facilities for the elderly.
Therefore, the information on risk factors should be collected properly at the time
of admission, and careful attention should be paid to the residents with risk
factors, for the possible development to active disease. X-ray records submitted
by the attending doctors or by screening would provide useful informations for
early diagnosis, when abnormal shadows are found on chest X-ray films.
Publication Types:
639: Am J Med Genet A. 2006 May 1;140(9):945-51.

Comment in:
• Am J Med Genet A. 2006 Nov 15;140(22):2510.
Clinical characteristics and survival of trisomy 18 in a medical

center in Taipei, 1988-2004.
Lin HY, Lin SP, Chen YJ, Hung HY, Kao HA, Hsu CH, Chen MR, Chang
JH, Ho CS, Huang FY, Shyur SD, Lin DS, Lee HC.
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Trisomy 18 is the second most common autosomal trisomy in newborns. The

birth prevalence of this disorder is approximately 1 in 3,000 to 1 in 8,000, and the
life span of the majority of patients is less than 1 year. As information regarding
outcome in trisomy 18 is rather fragmentary in the literature, this study is aimed at
investigating the survival and natural history of trisomy 18. We also evaluated the
survival age and management of trisomy 18 in two different periods, before and
after the implementation of National Health Insurance (NHI) program. Thirty-
nine cases of trisomy 18 were collected in Mackay Memorial Hospital in a 17-
year period, from 1988 to 2004. Delivery data, survival age, management before
and after the implementation of NHI program, structural defects, image findings
and cytogenetic results were analyzed by medical and nurse's records. The
diagnosis of trisomy 18 was based on the prenatal amniocentesis or postnatal
chromosome analysis. Three patients had trisomy 18 mosaicism. Since
cardiovascular and central nervous systems are the most common organ systems
involved in this disorder, 31 patients received brain ultrasonography and heart
ultrasonography for evaluation of their multiple anomalies after admission. All
patients except one died in their first year due to severe malformations of the
cardiovascular or central nervous systems. The median survival age was 6 days.
We found a longer survival with female patients than with male patients (P <
0.05). Implementation of NHI program in the more recent decade of this study
period was associated with longer survival of trisomy 18 (P < 0.05). The three
most common structural defects were clenched hands (95%), rocker bottom feet
(90%), and low set or malformed ears (90%). Low birth weight was present in
90%. By cardiac ultrasonography, the top four heart defects were ventricular
septal defect (94%), patent ductus arteriosus (77%) and atrial septal defect (68%).
However, ten cases (32%) had complex congenital heart defects. By brain
ultrasonography, the most common brain lesion was cerebellar hypoplasia (32%),
followed by brain edema (29%), enlarged cisterna magna (26%) and choroid
plexus cysts (19%). Although most patients with trisomy 18 die within the first
few weeks after birth, it is important to recognize that a small but notable
percentage of these patients will survive the first year. When prenatal or postnatal
decisions need to be made, the possibility of long-term survival should be
included in any discussion to enable families to make the most appropriate
decision. 2006 Wiley-Liss, Inc.
Publication Types:
640: Drug Saf. 2006;29(3):261-72.

Cardiovascular events associated with long-term use of celecoxib,

rofecoxib and meloxicam in Taiwan: an observational study.
Huang WF, Hsiao FY, Tsai YW, Wen YW, Shih YT.
Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei,

Taiwan. huang@ym.edu.tw
BACKGROUND: Using national data (2001-2003), this study explored the risk
of acute myocardial infarction (AMI), angina, stroke and transient ischaemic
attack (TIA) in long-term users of rofecoxib and celecoxib in Taiwan and
compared this data with that for those using meloxicam. METHODS: Patients
included in the study had used celecoxib, rofecoxib or meloxicam for at least 180
days. Data were taken from National Health Insurance database for the period
from 2001 to 2003. Main outcome measurements were the occurrence of AMI,
angina, stroke or TIA after the initiation of long-term continuous use of these
drugs. Person-time exposures and hazard ratios (HRs) were calculated based on
data from 9602 eligible patients. RESULTS: In patients without a history of a
cardiovascular event within the year before drug treatment began, the overall rates
of AMI, angina, stroke and TIA were 1.1%, 0.6%, 2.0% and 0.6%, respectively.
In those with cardiovascular events in the year before treatment began, the overall
rates of AMI, angina, stroke and TIA were 5.0%, 4.8%, 6.6% and 5.8%,
respectively. Compared with meloxicam users, celecoxib users had lower HRs for
the development of AMI (HR 0.78, 95% CI 0.63, 0.96) and stroke (HR 0.81, 95%
CI 0.70, 0.93). Rofecoxib users were at no higher risk of cardiovascular events
than those receiving meloxicam. Regardless of treatment, having had a
cardiovascular event in the year before treatment began played a significant role
in the development of the same cardiovascular event during the prescription
period; the HRs associated with having had the same cardiovascular event in the
past year, versus not having had such an event, were 3.02 (95% CI 1.44, 6.32) for
AMI, 5.82 (95% CI 3.19, 10.63) for angina, 2.44 (95% CI 1.79, 3.33) for stroke
and 7.16 (95% CI 3.70, 13.87) for TIA. CONCLUSIONS: Patients taking
celecoxib had a lower risk of cardiovascular events than those taking meloxicam.
Patients taking rofecoxib were not found to be at higher cardiovascular risk than
those taking meloxicam. The most significant determinant of cardiovascular risk
was a history of such cardiovascular disease in the year preceding treatment
initiation. Patients with a history of other medical conditions also appeared to be
at higher risk of adverse cardiovascular events.
Publication Types:
641: Health Policy. 2006 Dec;79(2-3):325-36. Epub 2006 Mar 6.

Advanced Asia's health systems in comparison.
Gauld R, Ikegami N, Barr MD, Chiang TL, Gould D, Kwon S.
Department of Preventive and Social Medicine, University of Otago, PO Box 913,

Dunedin, New Zealand. robin.gauld@otago.ac.nz
There is growing interest in comparing patterns of social and health service

development in advanced Asian economies. Most publications concentrate
broadly on a range of core social services such as education, housing, social
security and health care. In terms of those solely focused on health, most discuss
arrangements in specific countries and territories. Some take a comparative
approach, but are focused on presentation and discussion of expenditure,
resourcing and service utilization data. This article extends the comparative
analysis of advanced Asian health systems, considering the cases of Japan, South
Korea, Taiwan, Hong Kong and Singapore. The article provides basic background
information, and delves into common concerns among the world's health systems
today including primary care organization, rationing and cost containment,
service quality, and system integration. Conclusions include that problems exist in
'classifying' the five diverse systems; that the systems face common pressures;
and that there are considerable opportunities to enhance primary care, service
quality and system integration.
Publication Types:
642: J Manag Care Pharm. 2006 Mar;12(2):152-7.

Suboptimal pneumococcal pneumonia vaccination rates among

patients at risk in a managed care organization in Israel.
Kahan NR, Waitman DA, Blackman S, Chinitz DP.
Leumit Health Fund, 23 Schprintsak St., Tel Aviv 64738, Israel.

nkahan@leumit.co.il
OBJECTIVE: Pneumococcal pneumonia is a vaccine-preventable disease that

poses a significant threat to immunocompromised patients. Vaccination rates tend
to be low despite recommendations for vaccination in several groups of high-risk
patients including any person aged 65 years or older. The purpose of this study
was to (a) evaluate the vaccination rates among high-risk patients in a managed
care setting in Israel and (b) gain a better understanding of the factors associated
with suboptimal use of this vaccine. METHODS: Data were extracted from the
electronic medical records of the managed care organization for patients with
dates of service from January 2000 to December 2004 for whom the vaccine is
recommended. Patients were identified via diagnosis codes according to the
International Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM). Vaccination rates were calculated for patients in each disease
category. These high-risk patients were contacted to participate in a telephone
survey to evaluate the variance in knowledge and awareness levels of the disease
between the vaccinated and unvaccinated patients. RESULTS: A total of 672
patients were identified by the ICD-9-CM codes; 140 (20.8%) had been
vaccinated and 532 (79.2%) were unvaccinated. Vaccination rates were highest
among patients with solid organ transplants (33.3%), followed by nephrotic
syndrome (29.4%), bone marrow transplants (10.2%), and human
immunodeficiency virus (HIV, 9%), for an overall rate of 20.8%. Of these
patients, survey responses were obtained from 364 (54.2%). Respondents who
were unvaccinated tended to be less well informed about which patient
populations are at risk for the disease and the availability of the vaccine.
CONCLUSION: The pneumococcal vaccination rate among
immunocompromised patients in this managed care organization was found to be
inadequate, at just 20.8% of the target population. Approaches based on direct
contact with the patient, such as by a case manager, may be more successful in the
future.
Publication Types:
643: Acta Cytol. 2006 Jan-Feb;50(1):41-7.

Cervical smear abnormalities in the United Arab Emirates: a pilot

study in the Arabian Gulf.
Ghazal-Aswad S, Gargash H, Badrinath P, Al-Sharhan MA, Sidky I, Osman

N, Chan NH.
Department of Obstetrics and Gynecology, Faculty of Medicine and Health

Sciences, United Arab Emirates University, P.O. Box 17666, Al-Ain, United Arab
Emirates. saad.ghazal_aswad@uaeu.ac.ae
OBJECTIVE: To gather epidemiologic data on cervical abnormalities and make

recommendations pertaining to a national cervical screening policy in the United
Arab Emirates (UAE). STUDY DESIGN: A cross-sectional survey of patients
and physicians in the UAE with regard to cervical cytology was carried out.
Knowledge, attitudes and practices (KAP) of a group of female primary care
physicians on cervical cytology were assessed by a self-administered
questionnaire. Pap smears and Chlamydia testing were offered to women
attending selected primary care centers and secondary health care facilities.
RESULTS: Results of Chlamydia prevalence and KAP were published elsewhere;
this report addresses the cytologic aspects of this study. There were 2,013 smears
collected from primary health centers and 2,042 from secondary care. The overall
rate of cervical screening among women in this survey was 85.5% in primary care
and 77% in secondary care. The proportion of unsatisfactory smears was < 5%.
The prevalence of cervical abnormalities according to the Bethesda System 2001
was 3.6%. There were 9 (primary care) and 21 (secondary care) cases of low
grade squamous intraepithelial lesion (LSILs), for a prevalence of 0.77%. There
were 4 primary care and 17 secondary care cases of high grade squamous
intraepithelial lesion (HSIL), for a prevalence of 0.54%. The combined
prevalence for LSIL and HSIL is 1.32%. There were 3 cases of glandular
abnormalities. The atypical squamous cells of undetermined significance/SIL
ratio was 1.71. No cases of squamous cell carcinoma were detected. No tissue
follow-up information is available. The prevalence of cervical abnormalities is
low in the UAE. We first recommend the institution of a more organized approach
to opportunistic screening in the UAE with appropriate clinical follow-up rather
than the immediate launch of a cervical mass screening program.
Publication Types:
644: Health Policy. 2006 Dec;79(2-3):296-305. Epub 2006 Feb 28.

Differences in practice income between solo and group practice

physicians.
Lin HC, Chen CS, Liu TC, Lee HC.
School of Health Care Administration, Taipei Medical University, and Taipei

Municipal Wan Fang Hospital, Taiwan.
An examination of the distribution of physician incomes between different types

of practices could help policymakers and researchers alike to gain an
understanding of the effects of different organizational characteristics of practices
on the practice of medicine as a whole. This study uses a national database to
explore the relationships that exist between practice incomes and practice types
vis-à-vis the overall size of practices. The primary data source for this study,
which includes 7757 office-based physicians, was provided by the Taiwan
Department of Health (DOH), with the dependent variable of interest to this study
being the annual gross income of physician practices, while the independent
variables are physician practice types and the number of physicians within a
clinic. Multiple regression analyses were used to model the logarithm of annual
physician practice incomes as a linear function of a set of independent variables.
Kruskal-Wallis test results revealed the existence of significant relationships
between practice incomes and practice types (p<0.001) and the number of
physicians within a clinic (p<0.001). Multiple regression analysis also showed
that after adjusting for socio-demographic and professional characteristics, the
annual incomes of physicians in both single-specialty or multi-specialty group
practices (p<0.001) were higher than those of their solo practice counterparts.
This study concludes that after adjusting for other factors, higher practice incomes
are enjoyed by physicians in single-specialty or multi-specialty group practices as
compared to their solo practice counterparts. The finding of higher incomes for
those physicians organized into groups supports the policy call from the DOH in
Taiwan for the widespread formation of group practices.
645: BMC Health Serv Res. 2006 Feb 17;6:11.

Referral from secondary care and to aftercare in a tertiary care

university hospital in Japan.
Toyabe S, Kouhei A.
Department of Medical Informatics, Niigata University Medical and Dental

Hospital, Asahimachi-dori 1-754, Niigata 951-8520, Japan. toyabe@med.niigata-
u.ac.jp
BACKGROUND: In Japan, all citizens are covered by the national insurance

system in which universal free access to healthcare services is promised to
everybody. There are no general physicians or gatekeepers in the Japanese
healthcare system. METHODS: We studied the pattern of referral of inpatients
from secondary care hospitals to a tertiary care university hospital and the reverse
referral under the situations using a geographic information system (GIS), taking
paediatric inpatients as an example. RESULTS: The results showed that 61.2% of
the patients were directly admitted to the hospital without referral from other
hospitals or clinics and that 82.8% of the inpatients were referred to the outpatient
department of the hospital to which they had been admitted. GIS analysis for the
inpatients service area showed the hospital functions as both a secondary care
hospital and tertiary care hospital. Patients who lived near the hospital tended to
be admitted directly to the hospital, and patients who lived far from the hospital
tended to utilize the hospital as a tertiary care provider. There were territorial
disputes with other secondary care hospitals. To estimate spatial differences in
referral to aftercare, we analyzed the spatial distribution of inpatients with focus
on their length of hospital stay (LOS). GIS analysis revealed apparent foci of
patients with long LOS and those with low LOS. CONCLUSION: These results
suggest that the function of university hospital in Japan is unspecialized and that
the referral route from the university hospital to aftercare is also unequipped.
PMCID: PMC1388212
646: Nutrition. 2006 Mar;22(3):283-7.
New Quantitative Index for Dietary Diversity (QUANTIDD) and its

annual changes in the Japanese.
Katanoda K, Kim HS, Matsumura Y.
Division of Health Informatics and Education, National Institute of Health and

Nutrition, Tokyo, Japan. katanoda-tky@umin.ac.jp
OBJECTIVE: A diverse diet is recommended in many dietary guidelines.

However, because there are no unified standards for measurement methods,
objective comparisons across different populations or time points is difficult. This
report proposes a new dietary diversity index based on quantitative distribution of
consumed foods to allow objective measurement of dietary diversity. METHODS:
A Quantitative Index for Dietary Diversity (QUANTIDD) is proposed:
QUANTIDD=(1-summation operatorjn prop[j]2)/(1-1/n), where prop(j) is the
proportion of food group(s) j that contributes to total energy or nutrient intake, n
is the number of food groups, and j = 1,2,...,n. The numerator is the probability
that the two foods taken out of an aggregation of consumed foods belong to
different food groups. The denominator is its maximum value. The index ranges
from 0 to 1. By using the officially released average data from the National
Nutrition Survey in Japan from 1957 to 2000, we investigated annual changes in
the QUANTIDD. We also investigated the distribution of the index by using
individual data from the National Nutrition Survey in Japan in 1996. RESULTS:
The QUANTIDD increased from the 1960s to the 1970s. This was the era of rapid
economic growth in Japan, during which the dietary habits of the Japanese
underwent rapid changes. The distribution of the QUANTIDD was skewed to the
left, but logit-transformation decreased this asymmetry and made it similar to a
normal distribution. CONCLUSION: Because this index can measure dietary
diversity objectively and is suitable for statistical handling, it is useful as a
method to compare dietary patterns across different populations or time points.
Publication Types:
647: Hong Kong Med J. 2006 Feb;12(1):47-55.

Domestic health expenditure in Hong Kong: 1989/90 to 2001/02.
Leung GM, Tin KY, Yeung RY, Rannan-Eliya R, Leung ES, Lam DW, Lo
SV.
Department of Community Medicine and School of Public Health, The University

of Hong Kong, Pokfulam Road, Hong Kong. gmleung@hku.hk
OBJECTIVE: To estimate the total domestic health expenditure in Hong Kong

between fiscal years 1989/90 and 2001/02, with breakdown by financing source,
provider, and function over time. METHODS: The standard health accounting
methods as per the Organisation for Economic Co-operation and Development
System of Health Accounts guidelines of 2000 were adopted. RESULTS: Total
domestic health expenditure was $68,620 million in the fiscal year 2001/02. In
real terms, expenditure grew at an average rate of 7% while gross domestic
product increased by 4% during the same period. This indicates a growing share
of health spending relative to gross domestic product, from 3.8% in 1989/90 to
5.5% in 2001/02. This upward trend was largely driven by increased public
spending that rose 208% in real terms over the period, compared with 76% for
private spending. Out-of-pocket payments by households accounted for about
70% of private spending while employers and insurance accounted for 28%.
Private insurance plays an increasingly important role in financing private
spending whereas household expenditure has shown a corresponding decrease
during the period. Expenditure incurred at providers of ambulatory services and
hospitals accounted for more than 70% of total health expenditure during the
observed period. Hospitals' share of total spending increased by 18%, reaching
45% of total expenditure in 2001/02, whilst the share of providers of ambulatory
services reduced to 30% in 2001/02. The two largest functional components of
total health expenditure were ambulatory care (35-41%) and in-patient curative
care (20-27%). Public spending generally financed in-patient curative care and
ambulatory services; private spending was concentrated on ambulatory services
and medical goods outside the patient care setting. CONCLUSION: These data
provide important information for the public, policymakers, and researchers to
assess the performance of the health care system longitudinally, and to evaluate
health expenditure-related policies.
648: Comput Biol Med. 2007 Feb;37(2):206-13. Epub 2006 Feb 21.
Using Healthcare IC Cards to manage the drug doses of chronic

disease patients.
Lai JT, Hou TW, Yeh CL, Chao CM.
National Cheng Kung University, Engineering Science, No. 1 Ta-Hsueh Road,

Tainan 701, Taiwan. jjlia@mail2000.com.tw
In Taiwan's medical system, the Healthcare IC Card is used as form of secure data
storage. This research applies the Healthcare IC Card to record the chronic
disease patient's recent drug doses, diagnoses and prescriptions. With the Hospital
Information System, this research combines the diagnosis records stored in the
Healthcare IC Card to establish a platform which could simulate the procedures of
a doctor in examining a patient and checking the circumstances of the patient's
repetitive drug doses and drugs interactions. The experiment is based on a data
log of about 22,000 items of drug prescribed to 43 diabetes patients and about
88,200 items to 192 high blood pressure patients. The results show that the
proposed approach would have reduced the waste of medical resources,
strengthened Taiwan's medical system and increased the public's health.
Publication Types:
649: Health Care Manage Rev. 2006 Jan-Mar;31(1):11-7.

Negotiating time scripts during implementation of an electronic

medical record.
Bar-Lev S, Harrison MI.
Department of Sociology and Anthropology, Bar-Ilan University, Ramat Gan,

Israel. shirley.barley@gmail.com
Practitioners renegotiated time use requirements in an electronic medical record

(EMR), thereby improving fit between health information technology (HIT) and
clinical practices. The study contains important implications for managing HIT
implementation.
650: J Occup Health. 2006 Jan;48(1):62-4.

Relationships between effort-reward imbalance, over-commitment,

and fatigue in Japanese information-technology workers.
Takaki J, Nakao M, Karita K, Nishikitani M, Yano E.
Department of Hygiene and Public Health, Teikyo University School of

Medicine, Kaga, Tokyo, Japan. jirosinryounaika-tky@umin.ac.jp
651: Int J Med Inform. 2006 Oct-Nov;75(10-11):764-70. Epub 2006 Feb 17.
Electronic healthcare communications in Vietnam in 2004.
Trân VA, Seldon HL, Hoàng DC, Nguyên KP.
Biomedical Electronics Center, Hanoi University Technology, 1 Dai Co Viet

Road, Hanoi, Vietnam.
BACKGROUND: There is a lack of literature about health information systems

(HIS) in "developing" countries, including Vietnam. However, computerization
and network development are proceeding in these places, although not in a
systematic, transparent way. OBJECTIVE: This is a preliminary overview of
HIS's and healthcare communications in Vietnam's four-tiered public healthcare
system. It is to indicate the direction that nation might take in order to establish a
modern, standards-compliant, national HIS. METHODS: We conducted site visits
and interviews in Hanoi and nearby provinces. Additional information was
derived from publications of the Vietnamese government and the United Nations.
RESULTS: Many of the top-level "central" hospitals have HIS's, although their
quality and daily usage varies. Fewer provincial hospitals have networks; district
hospitals have a few stand-alone computers, and commune health centers have no
computers. Patients often go directly to higher-level providers, due to a widely
held perception of better care at such sites. Communications among healthcare
units are largely on paper, consisting mostly of administrative matters and some
hand-written patient referrals. Telephones are used for discussions of specific
matters. Internet connections are almost all dial-up and often belong to individual
staff members rather than the healthcare units. Lower-level units derive much of
their general medical information from television and newspapers. However,
there is considerable interest in computerization among healthcare workers at all
levels. CONCLUSION: Familiarization with computerized communications, i.e.,
training and hardware at all healthcare levels, must be the first step towards a
modern healthcare communications network in Vietnam. The skills to do this
already exist. The aim of such a network must be to raise the level of information
and quality of care at the lower levels. Adherence to international standards, such
as HL7, from the beginning would enable the country to bypass many years of
haphazard development.
652: J Clin Pharm Ther. 2006 Feb;31(1):73-82.

Trends in the use of oral antidiabetic drugs by outpatients in

Taiwan: 1997-2003.
Chiang CW, Chiu HF, Chen CY, Wu HL, Yang CY.
Graduate Institute of Pharmaceutical Science, Kaohsiung Medical University, 100

Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
OBJECTIVE: To define the prescribing patterns of oral antidiabetic drugs

(OADs) in Taiwan over a 7-year period (1997-2003) and to critically comment on
changes observed. METHODS: A cross-sectional study design was implemented
using data from Taiwan's National Health Insurance Research Database between
January 1997 and December 2003. Outpatients who were 18 years or older and
had at least an OAD claim during the study period were identified. The unit of
analysis was each OAD prescription for diabetic outpatient visits. The prescribing
trends were described in terms of annual changes in prescribing rates and patterns.
RESULTS: The numbers of OAD prescriptions rose 1.23-fold. The sulfonylurea
(SU) class was the most commonly used OAD, but the prescribing rates for this
class declined over time. The biguanide (BG) class was the second most
frequently prescribed OAD class and its prescribing rate initially increased,
peaked in 2000, and then substantially decreased. The largest increase in
prescribing was for acarbose use. The prescribing rates of two new classes of
OAD, meglitinide (MG) and thiazolidinedione (TZD), also significantly increased
within a short period of time. A trend towards combination therapy was observed
away from monotherapy. The SU class was the most commonly prescribed as
monotherapy. SU plus BG was the most commonly prescribed dual therapy.
Triple oral therapy showed a significant ninefold increase. CONCLUSION: The
prescribing rates of OADs are shifting from the older OADs (i.e. SUs) to newer
OADs [i.e. alpha-glucosidase inhibitor (AGI), MGs, and TZDs]. The prescribing
patterns of OADs are moving toward combination therapy, especially triple oral
therapy.
Publication Types:
653: Int J Tuberc Lung Dis. 2005 Dec;9(12):1398-402.

Bovine tuberculosis in Burdur, southern Turkey: epidemiological,

pathological and economic study.
Ozmen O, Kurşun O, Ozcelik M.
Department of Pathology, Faculty of Veterinary Medicine, University of Akdeniz,

Burdur, Turkey. oozmen@akdeniz.edu.tr
SETTINGS: Burdur is the most important dairy cattle breeding and milk
production area of Turkey, and Burdur slaughterhouse is one of the biggest
slaughterhouses in the southern part of the country. No scientific information is
available on the prevalence of tuberculosis (TB) in cattle in Burdur. A survey was
therefore undertaken to determine the prevalence of disseminated TB infection in
cattle in this district. OBJECTIVES: To implement a disease monitoring system
in Burdur slaughterhouse to estimate the annual prevalence of disseminated TB in
cattle slaughtered and inspected in 2003-2004. DESIGN: Epidemiological survey.
RESULTS: Prevalence of bovine TB was investigated in Burdur slaughterhouse
from January 2003 to December 2004. All of the affected animals were Holstein
breed. The prevalence of disseminated TB in all slaughtered cattle was 0.38% in
this period. The value of the condemned meat and organs was calculated to
establish economic loss. CONCLUSION: Despite a strict eradication programme,
bovine TB is still an important health issue among cattle and remains one of the
greatest threats to cattle and human health in southern Turkey. Veterinarians and
cattle producers in this region are encouraged to develop and work on herd plans
aimed at controlling and eradicating TB.
Publication Types:
654: J Hepatobiliary Pancreat Surg. 2006;13(1):2-6.

JPN Guidelines for the management of acute pancreatitis: cutting-
edge information.
Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M,

Hirota M, Kimura Y, Takeda K, Isaji S, Koizumi M, Otsuki M, Matsuno S;
JPN.
Department of Surgery, Teikyo University School of Medicine, Itabashi-Ku,

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

655: Bull World Health Organ. 2005 Dec;83(12):928-34. Epub 2006 Jan 30.
Global surveillance for chemical incidents of international public

health concern.
Olowokure B, Pooransingh S, Tempowski J, Palmer S, Meredith T.
Health Protection Agency Regional Surveillance Unit (West Midlands), Regional

Epidemiology Unit, Heartlands Hospital, Birmingham, England.
babatunde.olowokure@hpa.org.uk
OBJECTIVE: In December 2001, an expert consultation convened by WHO

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

656: Bull World Health Organ. 2005 Dec;83(12):913-9. Epub 2006 Jan 30.
Mapping the global distribution of trachoma.
Polack S, Brooker S, Kuper H, Mariotti S, Mabey D, Foster A.
Clinical Research Unit, London School of Hygiene and Tropical Medicine,

London, England. sarah.polack@1shtm.ac.uk
OBJECTIVE: We aimed to summarize and map the existing global population-

based data on active trachoma and trichiasis. Detailed distribution maps of various
infectious diseases have proved a valuable tool in their control. Such maps play an
important role in assessing the magnitude of the problem, defining priority areas
for control, monitoring changes, and advocacy. Until now, information on
trachoma prevalence at within country levels has not been systematically collated,
analysed and reported. METHODS: We gathered the last 18 years' worth of
reported data on active trachoma in children aged less than 10 years, and the last
25 years of reported trichiasis in adults aged 15 years and over from 139
population-based surveys in 33 countries. We collated these data into one
database using the "district" (second administrative level) as the standard unit of
reporting. We used Geographical Information Systems as a database and
cartographic tool to generate a global map of the prevalence of trachoma and
trichiasis. FINDINGS: We obtained data on active trachoma and trichiasis from
18 countries in the WHO African Region, 6 in the Eastern Mediterranean Region,
3 in the South-East Asia Region, 3 in the Western Pacific Region and 2 in the
Region of the Americas. In 23 countries suspected of having endemic trachoma
no reliable district-level population-based data were available. In China and India,
data were limited to a few districts. The data highlighted important regional
differences and marked national variations in prevalence of active trachoma and
trichiasis. CONCLUSION: This is the first attempt to summarize and map the
existing population-based data on active trachoma and trichiasis. The lack of data
in many countries remains an important obstacle to trachoma control efforts.
Publication Types:
657: Nippon Koshu Eisei Zasshi. 2005 Dec;52(12):1009-20.

[Chronological analysis of individually linked data for patients with
intractable disease receiving public financial aid for treatment]
Shibazaki S, Nagai M, Fuchigami H, Nishina M, Ohta A, Kawamura T,

Ohno Y.
Department of Public Health, Saitama Medical School.
PURPOSE: Nationwide surveys of intractable disease patients receiving public

financial aid for treatment were performed by Research Committee for
Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) 4
times in the past, in 1984, 1988, 1992 and 1997. The purpose of the present study
was to clarify the features of continuance with intractable disease patients
receiving public financial aid for treatment. METHODS: Individual information
collected by each nationwide survey was linked using the disease, the residence,
the sex, and the birth date. The proportion of intractable disease patients
according to receipt duration, kind of medical insurance, sex and age was
calculated with reference to the disease and an estimation of the receipt
persistence rate was calculated for every year. Moreover, in consideration of
variation in the data, average receipt persistence rates over years were also
calculated. RESULTS: According to observation on individual patient's follow
up, the proportion for which financial aid was discontinued within four years was
25%, while 70% continued receiving aid for at least four years and some 55% for
eight or nine years. The proportion of those who continue receiving support long-
term is high about the so-called autoimmune diseases, such as systemic lupus
erythematosus, Behçet's disease, and the aortic syndrome. In contrast, with
diseases having a poor prognosis, such as fulminant hepatitis, amyloidosis, and
amyotrophic lateral sclerosis, periods of continuance are short. The proportion
needing long-term continuation is higher in women than in men, especially with
diseases which have long been eligible for support. However, with diseases for
which receipt was started recently, there is a tendency for persistence to be higher
in men than in women. CONCLUSION: With reform of insurance systems,
including the medical system for intractable diseases, it is predicted that receipt
continuation will change with alteration of social factors, and it is necessary to
monitor receipt continuation carefully from now on.
Publication Types:

658: J Pak Med Assoc. 2006 Jan;56(1):13-6.
Morbidity pattern and utilization of a primary health care center in

a low socioeconomic area of Karachi.
Anjum Q, Alam E, Rizvi R, Usman J, Shaikh S, Ahmed Y.
Department of Family Medicine, Ziauddin Medical University, Karachi.
OBJECTIVE: To identify the morbidity pattern according to age, gender and

seasonal variation using the ICD coding and the utilization of Primary Health
Care (PHC) center services in a demographically defined community.
METHODS: The data collected from 2001-2003 was analyzed using the
International Classification of Diseases-10 (ICD-10) coding for identifying the
morbidity patterns presenting at the PHC Center. The age and gender distribution
of the patients and the seasonal variation of few diseases were noted. Only the
residents of the area visiting the center for preventive or curative services were
included. A structured performa was designed to enter the age, gender, disease
and ICD codes. The faculty was trained for using the coding system. RESULTS:
A total of 13,519 patients visited the PHC during three-year period. On an
average, 376 patients were seen during a month with male to female ratio of 1:2.
The most common diseases presented belong to the respiratory system, followed
by infections or parasitic infestations and diseases of the reproductive system. The
women presented for first visit of antenatal check up were 960 out of 4614
women of reproductive age group. Among the adult population, 391 (6%)
presented with hypertension, 64 (1%) were Type 2 diabetics and 86 (1.3%) were
asthmatics. The paediatric population analysis showed that 918 (13%) had upper
respiratory infections and 1339 (19%) had diarrhoea. CONCLUSION: Problem
oriented medical records from health centers, computerized in a uniform
standardized way, can give extensive information about the content and burden of
health problems in family practice and presumably public health.
Publication Types:
659: Int J Dent Hyg. 2003 May;1(2):89-97.

Dental hygienists in Korea.

Kim SH.
Hanseo University, Department of Dental Hygiene 360 Daegok-Ri, Haemi-Myun,

Seosan-Si, Chungnam, Republic of Korea 356-706. Sookim@hanseo.ac.kr
The purpose of this paper is to give basic information about the status of dental
hygienists in Korea. This paper examines the changing process of the dental
hygiene education system in Korea, from its start in 1965 until the present, 2003,
the composition of dental personnel in Korea, the specialised areas and roles of
dental hygienists after they receive their licenses, employment of dental
hygienists, dental hygiene-related organisations, and the status and direction of
dental hygienists in Korea. This paper shows the organisational, educational,
governmental and individual efforts to increase the level of professionalism,
education and quality of care delivered to Korean citizens nationwide.
660: Int J Dent Hyg. 2004 Nov;2(4):179-84.

Dental hygiene education in Japan: present status and future

directions.
Yoshida N, Endo K, Komaki M.
School of Oral Health Care Science, Faculty of Dentistry, Tokyo Medical and
Dental University, Tokyo, Japan. minny.sdh@tmd.ac.jp
The aim of this report is to provide basic information about the historical
development, current status and future needs of education and training of dental
hygienists in Japan. The first formal training of dental hygienists in Japan started
at Tokyo in 1949. Restructure and modification of the dental hygiene education
system has been reiterated over the years in order to satisfy the needs of the
constantly changing society. Although previously only vocational training was
provided for dental hygienists, higher-level education has been conducted. The
present legislation of dental hygiene has gone through a complicated process. The
student should take the dental hygienist licensing examination which is held once
a year by the National Board organized by the Ministry of Health, Labour and
Welfare. Currently there are 136 dental hygiene schools and the total enrolment is
about 7000. The duration of dental hygiene education course has been prolonged
from 2 to 3 years since 2001. In 2004, the 4-year course started. The 2-year dental
hygiene education program is expected to be replaced with the 3- and 4-year
courses by 2010. The dental hygiene education system in Japan will be improved
in many ways as dental hygienists are expected to participate in health promotion
and preventive care, and to gain knowledge of the economics and organization of
health care in relation to oral hygiene.
661: East Mediterr Health J. 2003 Sep-Nov;9(5-6):1019-25.

Erratum in:
• East Mediterr Health J. 2005 Sep-Nov;11(5-6):887.
Knowledge of and attitudes towards family planning by male

teachers in the Islamic Republic of Iran.
Tavakoli R, Rashidi-Jahan H.
Health Education Department, Faculty of Health, Baghyatallah University of

Medical Sciences, Tehran, Islamic Republic of Iran.
A cross-sectional study was carried out on knowledge of and attitudes to family

planning in male teachers working in the education system in Teheran. We found
that 65% of the study population had acceptable knowledge regarding the issue.
More than 95% of respondents reported having a favourable attitude towards the
implementation of family planning programmes and about 90% believed that
decision-making regarding use of contraceptives should be a joint process. To
improve the planning and administration of family planning programmes, the
main variables identified in this study should be further investigated in different
population groups. Addressing men in family planning programmes may improve
their success and lead to increased contraceptive use.
662: Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(4):380-3.

Effectiveness of structured teaching program in improving

knowledge and attitude of school going adolescents on reproductive
health.
Dhital AD, Badhu BP, Paudel RK, Uprety DK.
Department of Community Health Nursing, College of Nursing, BP Koirala

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

[Present conditions and future prospects of the at-home examination

system]
Uedai M, Kasugai T, Miyake C, Tsuki S.
Japan Medical Institute of Studies, Minato-ku, Tokyo 108-0023.
It became say the preventive times than a treatment now. We did "the remoteness
examination" that it was at home possible for from 1986 while the making of
consciousness to "follow one's health by oneself' was demanded. I begin colon
cancer examination, and now an examination item menu extends to 58 kinds.
Remoteness examination is inspection and a support system of the making of
health to assume medical call center a nucleus of 24 hours. Such a system
described the times setting which became necessary and gathered up a role of the
at-home examination system which aimed at cancer and a lifestyle-related disease
and early discovery and a review of a habit and significance, the future prospects
about a problem.
Publication Types:
• Review
664: Shokuhin Eiseigaku Zasshi. 2005 Dec;46(6):305-18.

[Study of pesticide residues in agricultural products for the

"Positive List" system]
Akiyama Y, Yoshioka N, Ichihashi K.
Hyogo Prefectural Institute of Public Health and Environmental Sciences, 2-1-29,

Arata-cho, Hyogo-ku, Kobe 652-0032, Japan.
During a 3-year monitoring survey (April 2002-March 2005) of pesticide residues

in agricultural products, 592 samples (324 domestic; 268 imported) collected in
Hyogo prefecture, Japan were analyzed. The number of pesticides tested
increased from 232 in FY 2002 to 323 in FY 2004. The purpose of the study was
to clarify the residue status by accumulating information about pesticides detected
frequently, to allow effective and efficient regulation under the new "Positive
List" legislation to be implemented in FY 2006. Overall, 47% of domestic and
61% of imported samples contained detectable residues and ca. 60% of positive
samples contained multiple residues. The limit of quantitation was set at 0.01
microg/g and the limit of detection was 0.001-0.003 microg/ g. Most of the
residues were present at low concentrations: 80% of the detections in samples
excluding imported citrus fruits were < 0.05 microg/g. More than 5 different
pesticides (> 0.01 microg/g) were detected simultaneously in 13 samples. The
sum of the ratios of residues to MRLs was calculated as one of the indexes to
represent the risk of multiple residues, and they exceeded 100% in 3 imported
frozen vegetables; baby kidney bean, spinach, Welsh onion. Samples in violation
of the Food Sanitation Law were not found in our survey, but 1.9% of the samples
might be in conflict with the new "Positive List" legislation.
Publication Types:
665: Mil Med. 2005 Oct;170(10):836-40.

Linkage between the Israeli Defense Forces primary care physician

demographics and usage of secondary medical services and
laboratory tests.
Levy I, Goldberg A, Vinker S, Shvarts S.
Healthcare Management, Ben-Gurion University of the Negev, Bear Sheva,

Israel.
BACKGROUND: The primary care physicians in the Israeli Defense Forces, as in

the Israeli civilian health system, have two major subpopulations. Graduates of
Israeli schools of medicine, and graduates of foreign medical schools, most of
them in Eastern Europe. OBJECTIVE: To evaluate differences in the referral
patterns of primary care physicians according to their graduation institution and
demographic characteristics. METHODS: The study took place in one primary
care practice in central Israel. The referrals to consultations and laboratory tests
over a period of 1 year were evaluated. Physicians that had less than 37
encounters were excluded from the study. Data were extracted from the central
computerized databases of the Medical Corps and Israeli Defense Forces.
RESULTS: Sixty-eight physicians had a total of 18,402 encounters that resulted
in 23,845 outcomes. There were no associations between demographic and
training backgrounds of the physicians and their actual referral rates to
consultations and laboratory tests. CONCLUSION: The background data of the
primary care physicians does not predict their referral patterns and their role as
"gate keepers".
666: Natl Med J India. 2005 Sep-Oct;18(5):259-62.

Methodological issues in setting up a surveillance system for birth

defects in India.
Suresh S, Thangavel G, Sujatha J, Indrani S.
Fetal Care Research Foundation, 203, Avvai Shanmugam Salai, Royapettah,

Chennai 600014, Tamil Nadu.
India is undergoing an epidemiological transition--communicable diseases are on

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

A sociodental approach to assessing dental needs of children:

concept and models.
Gherunpong S, Tsakos G, Sheiham A.
Department of Epidemiology and Public Health, Royal Free and University

College London Medical School, London, UK.
OBJECTIVES: Traditional normative methods of assessing dental needs do not

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

association with health services utilization.
Toren O, Kerzman H, Koren N, Baron-Epel O.
Chaim Sheba Medical Center, Nursing Division, Tel Hashomer, 52621 Tel
Hashomer, Israel. orly@sheba.health.gov.il
BACKGROUND: Upon discharge from the hospital, patients are significantly

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

Web GIS in practice IV: publishing your health maps and

connecting to remote WMS sources using the Open Source UMN
MapServer and DM Solutions MapLab.
Boulos MN, Honda K.
Open Source Web GIS software systems have reached a stage of maturity,
sophistication, robustness and stability, and usability and user friendliness
rivalling that of commercial, proprietary GIS and Web GIS server products. The
Open Source Web GIS community is also actively embracing OGC (Open
Geospatial Consortium) standards, including WMS (Web Map Service). WMS
enables the creation of Web maps that have layers coming from multiple different
remote servers/sources. In this article we present one easy to implement Web GIS
server solution that is based on the Open Source University of Minnesota (UMN)
MapServer. By following the accompanying step-by-step tutorial instructions,
interested readers running mainstream Microsoft(R) Windows machines and with
no prior technical experience in Web GIS or Internet map servers will be able to
publish their own health maps on the Web and add to those maps additional layers
retrieved from remote WMS servers. The 'digital Asia' and 2004 Indian Ocean
tsunami experiences in using free Open Source Web GIS software are also briefly
described.
Publication Types:
• Editorial
PMCID: PMC1352347

Defining localities of inadequate treatment for childhood asthma: a

GIS approach.
Peled R, Reuveni H, Pliskin JS, Benenson I, Hatna E, Tal A.
Department of Health Systems Management, Ben-Gurion University of the

Negev, Beer-Sheva, Israel. ronitpeled@yahoo.com
BACKGROUND: The use of Geographic Information Systems (GIS) has great

potential for the management of chronic disease and the analysis of clinical and
administrative health care data. Asthma is a chronic disease associated with
substantial morbidity, mortality, and health care use. Epidemiologic data from all
over the world show an increasing prevalence of asthma morbidity and mortality
despite the availability of effective treatment. These facts led to the emergence of
strategies developed to improve the quality of asthma care. THE OBJECTIVE: To
develop an efficient tool for quality assurance and chronic disease management
using a Geographic Information System (GIS). GEOGRAPHIC LOCATION: The
southern region of Israel. January 1998 - October 2000. DATABASES:
Administrative claims data of the largest HMO in Israel: drug dispensing registry,
demographic data, Emergency Room visits, and hospitalization data bases.
METHODS: We created a list of six markers for inadequate pharmaceutical
treatment of childhood asthma from the Israeli clinical guidelines. We used this
list to search the drug dispensing registry to identify asthmatic children who
received inadequate treatment and to assess their health care utilization and bad
outcomes: emergency room visits and hospitalizations. Using GIS we created
thematic maps on which we located the clinics with a high percentage of children
for whom the treatment provided was not in adherence with the clinical
guidelines. RESULTS: 81% of the children were found to have at least one
marker for inadequate treatment; 17.5% were found to have more than one
marker. Children with markers were found to have statistically significant higher
rates of Emergency Room visits, hospitalizations and longer length of stay in
hospital compared with children without markers. The maps show in a robust way
which clinics provided treatment not in accord with the clinical guidelines. Those
clinics have high rates of Emergency Room visits, hospitalizations and length of
stay. CONCLUSION: Integration of clinical guidelines, administrative data and
GIS can create an efficient interface between administrative and clinical
information. This tool can be used for allocating sites for quality assurance
interventions.
Publication Types:
PMCID: PMC1363718
671: Nippon Koshu Eisei Zasshi. 2005 Nov;52(11):943-56.

Competence necessary for Japanese public health center directors in

responding to public health emergencies.
Tachibanai T, Takemura S, Sone T, Segami K, Kato N.
Department of Public Health Administration and Policy, National Institute of

Public Health, Saitama, Japan. ttomoko@niph.go.jp
OBJECTIVE: To clarify the "competencies" required of public health center

directors in "public health emergency responses." METHODS: We selected as our
subjects six major public health emergencies in Japan that accorded with a
definition of a "health crisis." Their types were: (1) natural disaster; (2) exposure
to toxic substances caused by individuals; (3) food poisoning; and (4) accidental
hospital infection. Item analysis was conducted using the Incident Analysis
Method, based on the "Medical SAFER Technique." RESULTS: The
competencies of public health center directors required the following actions: (1)
to estimate the impact on local health from the "first notification" of the
occurrence and the "initial investigation"; (2) to manage a thorough investigation
of causes; (3) to manage organizations undertaking countermeasures; (4) to
promptly provide precise information on countermeasures, etc.; and (5) to create
systems enabling effective application of countermeasures against recurrence of
incidents, and to achieve social consensus. CONCLUSION: For public health
preparedness, public health center directors should have the following
competencies: (1) the ability to estimate the "impact" of public health
emergencies that have occurred or may occur; (2) be able to establish and carry
out proactive policies; (3) be persuasive; and (4) have organizational management
skills.
672: Health Place. 2007 Mar;13(1):164-72. Epub 2006 Jan 9.

Responses of 6500 households to arsenic mitigation in Araihazar,

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

673: J Med Assoc Thai. 2005 Aug;88(8):1083-91.

Extra charge and extra length of postoperative stay attributable to

surgical site infection in six selected operations.
Kasatpibal N, Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S.
Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand.

nongyaok2003@yahoo.com
BACKGROUND: Information concerning the economic impact of surgical site
infection (SSI) is very rare in Thailand. As the national health care financial
system has been changing, the need for such data is critical. OBJECTIVE: The
purpose of this study is to estimate the extra charge and excess postoperative
hospitalization attributable to SSI in six surgical operative procedures comprising
appendectomy, herniorrhaphy, mastectomy, cholecystectomy, colectomy, and
craniotomy. MATERIAL AND METHOD: The study population consisted of
patients undergoing major operations admitted to Songklanagarind Hospital from
January, 1998 to December, 2003. Data were prospectively collected to identify
demographic data, surgical operations, development of SSI, and outcomes of SSI.
The study used one-to-one matched-pair strategy to compare case (patient with
SSI) and controls (patient without SSI). The matching criteria were same final
diagnosis, same operative procedure, and same American Society of
Anesthesiologists (ASA) score. Data were calculated for mean difference, median
difference, and 95% confidence intervals (95% C.I) of hospital charge and
postoperative stay. RESULTS: The study could identify 140 matched-pairs of
case and control. When compared to matched controls, cases had higher hospital
charge and greater postoperative length of stay. Mean of extra hospital charge
attributable to SSI was 43,658 (95% C.I; 30,228-57,088) baht and mean of excess
postoperative stay was 21.3 (95% C.I; 16.6-26.0) days. Median of extra
expenditure was 31,140 (95% CI; 17,327-49,081) baht and median of
prolongation of postoperative stay was 14 (95% C.I, 12-18) days.
CONCLUSION: This study supports the findings of the previous published
reports that patients who have SSI incur enormous excess cost and hospital stay.
674: BMC Bioinformatics. 2006 Jan 11;7:13.

Construction of a nasopharyngeal carcinoma 2D/MS repository with

Open Source XML database--Xindice.
Li F, Li M, Xiao Z, Zhang P, Li J, Chen Z.
Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya

Hospital, Central South University, Changsha, China. fengl@xysm.net
BACKGROUND: Many proteomics initiatives require integration of all

information with uniformcriteria from collection of samples and data display to
publication of experimental results. The integration and exchanging of these data
of different formats and structure imposes a great challenge to us. The XML
technology presents a promise in handling this task due to its simplicity and
flexibility. Nasopharyngeal carcinoma (NPC) is one of the most common cancers
in southern China and Southeast Asia, which has marked geographic and racial
differences in incidence. Although there are some cancer proteome databases
now, there is still no NPC proteome database. RESULTS: The raw NPC proteome
experiment data were captured into one XML document with Human Proteome
Markup Language (HUP-ML) editor and imported into native XML database
Xindice. The 2D/MS repository of NPC proteome was constructed with Apache,
PHP and Xindice to provide access to the database via Internet. On our website,
two methods, keyword query and click query, were provided at the same time to
access the entries of the NPC proteome database. CONCLUSION: Our 2D/MS
repository can be used to share the raw NPC proteomics data that are generated
from gel-based proteomics experiments. The database, as well as the PHP source
codes for constructing users' own proteome repository, can be accessed at
http://www.xyproteomics.org/.
Publication Types:
PMCID: PMC1351203
675: Harefuah. 2005 Dec;144(12):848-51, 910.

["Wise be aware of your sayings"--about gaps between

epidemiological data base, experimental results and decision making
in health administration]
[Article in Hebrew]
Hefer E.
When scientific researches are being published one should consider carefully the
different possible influences which may change the results. These influences may
be of two kinds: Non-Causal explanations, and Casual explanations. Researchers
may arrive at their results and not have considered all the causative explanations.
Occams's Razor is the basic rule by which most reasonable explanations are
chosen. A statistical result and an appropriate simple theory to explain it, is not
sufficient to prove causative effect. In many cases though, the media and public
tend to accept a statistically significant result as if it was a proven cause and effect
relation. There are several conditional demands called Bradford Hill criteria of
which epidemiological data and results are only one, the more results arrived by
using the Bradford Hill criteria, the better chances exist that the examined
variable is the cause for the effect. Finally, there is a gap between a proven causal
factor for disease or the harmful effects of treatment and a "clear cut" health
policy. There are several intermediate powerful influences which are involved in
the process of stating a new health policy. These influences include among others,
the involvement of decision makers, political influences and civil service
professionals. As an example three different issues of a well proven clinical
research will be presented. The research of Rofecoxib = "Vioxx" cardiac effects,
the research of Hormonal Replacement Treatment health effects on post
menopausal women and the last of Health risks presented by mobile phone use.
Although the results of those researches were proven to be statistically significant,
Health Policy in each case is different and less clear. Health Policy is not based
solely on figures and statistical results, but rather on a far wider and more
complex influences and judgment.
Publication Types:
• Editorial
676: Indian J Dermatol Venereol Leprol. 2005 Jan-Feb;71(1):14-9.

Comparison of two systems of classification of leprosy based on

number of skin lesions and number of body areas involved--a
clinicopathological concordance study.
Rao PN, Sujai S, Srinivas D, Lakshmi TS.
Department of Dermatology, Osmania Medical College, Hyderabad, India.

dermarao@hotmail.com
BACKGROUND AND AIMS: WHO guidelines classify leprosy patients for

therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy
based on the number of skin lesions. An alternative system of classification has
been in practice in Nepal from 1985 onwards, based on the number of body areas
involved in patients of leprosy. We attempted a clinicopathological approach for
comparison of these two systems of classification in leprosy patients for their
ability to demarcate patients into groups of PB and MB leprosy. MATERIALS
AND METHODS: The study included 108 leprosy patients (80 males and 28
females). Complete clinical examination and body charting was carried out in
each patient noting the count of skin lesions and the number of body areas
involved. Slit skin smears and skin biopsies were taken from an active skin lesion
in all patients. RESULTS: On analysis, it was observed that there was good
clinicopathological correlation between patients with 5 or < 5 skin lesions and 2
or < 2 body areas involved. (Clinical 95% and histological 96%) A similar
correlation was also observed in the other group of patients with > 5 skin lesions
and > 2 body areas involved, (Clinical 94% and histological 96%). There were
almost identical numbers of patients represented in these two groups of
classification. CONCLUSIONS: Our findings suggest that patients with
involvement of 2 or less body areas can be classified as PB leprosy and those with
more than 2 body areas involved can be classified as MB leprosy for the purposes
of therapy. The study of areas of involvement in leprosy patients not only
provides additional patient information but also adds another parameter as a basis
for the study of leprosy patients.
Publication Types:
677: Indian J Pediatr. 2005 Nov;72(11):919-23.

The 2001 dengue epidemic in Chennai.
Kabilan L, Balasubramanian S, Keshava SM, Satyanarayana K.
Centre for Research in Medical Entomology, Indian Council of Medical Research,

Chennai, India. d1crme@sify.com
Dengue is emerging as a serious public health problem in Tamil Nadu. The

present surveillance system is unlikely to generate proper information on the
epidemiology of the disease, which is essential for planning and development of
relevant control/preventive measures against dengue. OBJECTIVE: Between
November 2001 and January 2002, a descriptive study was undertaken on
children with clinical dengue attending Kanchi Kamakoti Child Trust Hospital
(KKCTH, a major private referral pediatric hospital in Tamil Nadu, India) to
define the magnitude of dengue burden, the natural history of this disease in terms
of clinical presentation, and outcome of the infections in hospitalized children (<
15) with clinical dengue. METHODS: The sera collected from patients analyzed
for dengue specific IgM and IgG antibodies by IgM, IgG antibody capture
enzyme linked immunosorbent assay (ELISA) using alternatively two commercial
kits. World Health Organization clinical case definition was adopted to categorize
the dengue confirmed children. RESULTS: Dengue was diagnosed in 74.5%
(143) of the 192 hospitalized children with clinical dengue. A considerable
proportion (20%) of the total dengue infections were constituted by infants less
than 1 yr of age. DF [dengue fever], DHF [dengue hemorrhagic fever] and DSS
[dengue shock syndrome] were diagnosed in 65%, 11.2% and 23.8% of 143
dengue confirmed patients respectively. Though severe dengue (DSS + DHF) was
present in 35% of the patients, the mortality rate was low during the study period
due to timely diagnosis and clinical management of the patients. CONCLUSION:
In developing countries like India, building of laboratory capacity for diagnosis
and combat-mode ready preparedness for the management of dengue cases in
emergency situation may reduce dengue-related mortality. This can be achieved
in a wider scale through an integrated approach through the community,
professionals and the public health departments.

Epidemiological geomatics in evaluation of mine risk education in

Afghanistan: introducing population weighted raster maps.
Andersson N, Mitchell S.
Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de

Guerrero, Acapulco, Mexico. neil@ciet.org
Evaluation of mine risk education in Afghanistan used population weighted raster

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

PMCID: PMC1352365
679: Am J Prev Med. 2005 Dec;29(5 Suppl 1):102-6.

Integrated population-based surveillance of noncommunicable

diseases: the Pakistan model.
Nishtar S, Bile KM, Ahmed A, Amjad S, Iqbal A.
Heartfile, Islamabad, Pakistan. sania@heartfile.org
The escalating burden of noncommunicable diseases (NCDs) worldwide warrants

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

Health resources and Internet with reference to HealthNet Nepal.
Pradhan MR.
HealthNet, Nepal. pradhan@healthnet.org.np

Technologies with the ability to send information in a fast, efficient and cheap
fashion, such as the Internet--can provide dramatic improvements in access to
information, advice and care. This article discusses importance of Internet,
applications of Internet in providing information services in the health field. The
Internet was developed in western countries and the information flow is from
North to South. But for decision making within a country, information generated
within a country is needed. For this, an organization like HealthNet Nepal is
developed. The article discusses the various services of HealthNet Nepal and
discusses about its unique features as compared to commercial ISPs.
Publication Types:
• Review
681: J Postgrad Med. 2005 Oct-Dec;51(4):312-5.

Telemedicine: experience at SGPGIMS, Lucknow.
Kapoor L, Mishra SK, Singh K.
Telemedicine Centre and Department of Endocrine Surgery, Sanjay Gandhi

Postgraduate Institute of Medical Sciences, Lucknow-226 014, India.
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in

Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level
referral academic medical center involved in teaching and training of super
specialist medical professionals with 22 academic departments. It is the first
tertiary care hospital in public healthcare sector in India to adopt Information
Technology (IT) for healthcare delivery. The Hospital Information System (HIS)
was implemented in 1998 to record, store, process and retrieve health data of all
the patients. This software was developed in-house in collaboration with Center
for Development of Advanced Computing (C- DAC), Pune. Later in the year
1999, telemedicine activities were initiated in the form of testing the concept and
technology. The first research grant was availed of in the year 2001, which helped
in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-
educational services were introduced for the postgraduate students of medical
colleges of Orissa. These services have now been extended to educate the doctors
of other medical colleges and community centers in other states. Besides, the
Institute is associated with organizational activities and in policy initiatives of the
government. All the activities are in project mode and are being financially
supported by government agencies such as Indian Space Research Organisation
(ISRO) and Department of Information Technology. Looking at the need of
skilled manpower in the field of telemedicine and e-health, a school of
telemedicine is coming up in the campus, which will also provide core
infrastructure for research and development.
682: IEEE Trans Inf Technol Biomed. 2005 Dec;9(4):502-7.

Prediction of care class by local additive reference to prototypical

examples.
Miyano T, Tsutsui T, Seki Y, Higashino S, Taniguchi H.
Department of Micro System Technology, Ritsumeikan University, Shiga, Japan.

tmiyano@se.ritsumei.ac.jp
The public long-term care insurance program for the elderly in Japan set out in
2000 toward establishing a new system whereby citizens can be assured that they
will receive care and be supported by the society as a whole. The insurance
program includes computer-aided certification processes to estimate the needs for
nursing care for clients. In this work, we show the applicability of an adaptive
local nonlinear approximation method associated with the Japanese national
database for automatic inference of the care class.
Publication Types:
683: Jpn J Clin Oncol. 2005 Dec;35(12):758-9.

Comparison of breast cancer mortality in five countries: France,

Italy, Japan, the UK and the USA from the WHO mortality
database (1960-2000).
Kawamura T, Sobue T.
Statistics and Cancer Control Division, Research Center for Cancer Prevention
and Screening, National Cancer Center.
Publication Types:
684: J Telemed Telecare. 2005;11 Suppl 2:S64-6.

Transmission of online digital documents for the health assessment

component of e-visa applications.
MacDermott A, Crowe B.
Department of Immigration and Multicultural and Indigenous Affairs, Canberra,

Australia.
Up to 350,000 health assessments are conducted annually for persons seeking a

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

scheme: lessons learnt from SEWA Insurance, Gujarat.
Sinha T, Ranson MK, Chatterjee M, Acharya A, Mills AJ.
Research Coordinator, Vimo SEWA, SEWA Reception Centre, Opposite Victoria

Garden, Bhadra, Ahmedabad 380 001, India. taragsinha@yahoo.co.in
This paper seeks to examine barriers faced by members of a community-based

insurance (CBI) scheme, which is targeted at poor women and their families, in
accessing scheme benefits. CBI schemes have been developed and promoted as
mechanisms to offer protection to poor families from the risks of ill-health, death
and loss of assets. However, having voluntarily enrolled in a CBI scheme, poor
households may find it difficult or impossible to access scheme benefits. The
paper describes the results of qualitative research carried out to assess the barriers
faced in accessing scheme benefits by members of the CBI scheme run by the
Self-Employed Women's Association (SEWA) in Gujarat, India. The study finds
that the members face a variety of different barriers, particularly in seeking
hospitalization and in submitting insurance claims. Some of the barriers are rooted
in factors outside the scheme's control, such as illiteracy and financial poverty
amongst members, and inadequacies of the transportation and health care
infrastructure. But other barriers relate to the scheme's design and management,
for example, lack of clarity among scheme staff regarding the scheme's rules and
processes, and requirements that claimants submit documents to prove the validity
of their claims. The paper makes recommendations as to how SEWA Insurance
can address some of the identified barriers and discusses the relevance of these
findings to other CBI schemes in India and elsewhere.
Publication Types:
686: Huan Jing Ke Xue. 2005 Sep;26(5):28-33.

[Assessment on ecological security spatial differences of west areas

of Liaohe River based on GIS]
[Article in Chinese]
Wang G, Wu W.
College of Environment and Life in Dalian University of Technology, Dalian

116024, China. wanggeng2003@sohu.com
Ecological security assessment and early warning research have spatiality; non-
linearity; randomicity, it is needed to deal with much spatial information. Spatial
analysis and data management are advantages of GIS, it can define distribution
trend and spatial relations of environmental factors, and show ecological security
pattern graphically. The paper discusses the method of ecological security spatial
differences of west areas of Liaohe River based on GIS and ecosystem non-
health. First, studying on pressure-state-response (P-S-R) assessment indicators
system, investigating in person and gathering information; Second, digitizing the
river, applying fuzzy AHP to put weight, quantizing and calculating by fuzzy
comparing; Last, establishing grid data-base; expounding spatial differences of
ecological security by GIS Interpolate and Assembly.
Publication Types:
687: Cell Res. 2005 Nov-Dec;15(11-12):908-13.

United Nations system efforts to support the response to AIDS in

China.
He JL, Rehnstrom J.
UNAIDS China, 1-162, Tayuan Diplomatic Office Building, 14 Liangmahe

Nanlu, Beijing 100600, China. hejinglin@public.un.org.cn
In the last two years, we have seen a remarkable intensification in the response to
AIDS in China. A number of organizations have joined and contributed to the
efforts of the Chinese government in responding the AIDS epidemic in China.
This article specifically describes the role of the United Nations (UN) in
supporting and strengthening those responses. Achievements of the United
Nations highlighted in the article include: strengthened leadership and political
commitment to respond to AIDS; improved HIV/AIDS surveillance and
information; expanded prevention efforts; improved treatment, care and support to
people living with HIV and increased resources for AIDS programs. Additional
roles of the United Nations system in the near future include strengthening
national leadership by supporting the 'three ones', i.e., one national plan on AIDS;
one national coordinating authority for AIDS; and one monitoring and evaluation
system for AIDS. In addition, the UN system is expected to strengthen alignment
and harmonization of activities of all international organizations and improved
accountability and oversight. Remaining challenges identified include increasing
awareness of AIDS and reducing stigma and discrimination; reducing
vulnerability and risk behaviour among specific groups; providing improved
treatment, care and support for people living with HIV; promoting stronger
engagement by civil society, and; addressing the gender dimensions of AIDS.
688: Cell Res. 2005 Nov-Dec;15(11-12):825-32.

The HIV epidemic in China: history, response, and challenge.
He N, Detels R.
Department of Epidemiology, School of Public Health, Fudan University,

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

• Review

689: Ren Fail. 2005;27(6):663-9.
Prognostic value of acute physiology and chronic health evaluation

II and organ system failure in patients with acute renal failure
requiring dialysis.
Wang IK, Wang ST, Chang HY, Lin CL, Kuo HL, Chen TC, Lee CH,
Chuang FR.
Division of Nephrology, Chang Gung Memorial Hospital at Chiayi, Taiwan.

ikwang@seed.net.tw
BACKGROUND: Despite advances in modern technology of dialysis, prognosis

of patients with acute renal failure (ARF) remains poor. To give the clinicians the
most useful information, a model that accurately predicts outcome early in the
course of ARF is required. However, because ARF is a heterogeneous syndrome
and occurs in patients with diverse etiologies and some coexisting diseases,
predicting outcome early is hard. The aim of this study is to evaluate
prospectively the Acute Physiology and Chronic Health Evaluation (APACHE II)
and organ system failure (OSF) models, evaluated prior to dialysis, in predicting
hospital mortality. METHODS: From June 2002 to March 2004, ARF patients
requiring dialysis at Chang Gung Memorial Hospital, Chiayi, were prospectively
recruited for this study. The worst clinical and laboratory data in the 24 hours
before initiation of dialysis were prospectively evaluated, and the patients'
APACHE II score and OSF number were assessed. RESULTS: A total of 61
patients (40 male and 21 female) were enrolled, of whom 38 (62.3%) died before
discharge. By multivariate logistic regression, the APACHE II score (odds ratio
1.3 per increase in one score; P<0.001), or OSF number (odds ratio 1.9 per
increase in one OSF; P<0.01) and oliguria (odds ratio 4.2; P=0.04), were found to
be statistically significant prognostic factors for hospital mortality. Mortality
increased progressively and significantly as OSF number (chi-square for trend;
P=0.001) or the APACHE II score (chi-square for trend; P < 0.001) increased. By
using Youden's index, the best cut-off value for APACHE II was 24, with 63%
sensitivity and 96% specificity. The best cut-off value for OSF number was 2,
with a sensitivity of 81.6% and a specificity of 60.9%. The areas under the
receiver operating characteristic curves for APACHE II and OSF number were
0.847 (95% confidence interval (CI)=0.752-0.942; P<0.01) and 0.769 (95%
CI=0.646-892; P<0.001), respectively, indicating good model discrimination.
CONCLUSIONS: This study concludes that APACHE II and OSF number
measured prior to initiation of dialysis reliably predict outcomes of ARF patients
requiring dialysis. The mortality rates increase as the APACHE II score or OSF
number increases. For predicting mortality, the APACHE II score > or = 24 was
found to have 63% sensitivity and 96% specificity, and OSF number> or = 2 had
81.6% sensitivity and 60.9% specificity.
Publication Types:
690: Seishin Shinkeigaku Zasshi. 2005;107(8):870-6.

[Community psychiatric care as viewed by young psychiatrists in

Japan]
Hashimoto N.
691: J Infect. 2006 Sep;53(3):206-10. Epub 2005 Dec 15.

TLR4 polymorphism in Iranian patients with brucellosis.
Rezazadeh M, Hajilooi M, Rafiei A, Haidari M, Nikoopour E, Kerammat F,

Mamani M, Ranjbar M, Hashemi H.
Department of Internal Medicine, Sina Hospital, Hamedan University of Medical

Sciences, Hamedan, Iran.
OBJECTIVE: Brucellosis is a zoonosis of both public health and economic

significance in most developing countries. Polymorphisms in Toll-like receptor-4
(TLR4) have been reported to be associated with a blunted immune response to
microbial pathogens. Information regarding any association between genetic
variation of TLR4 and susceptibility to brucellosis is not available in the
literatures. The main purpose of this research is to evaluate the role of
polymorphic alleles of TLR4 gene in susceptibility to brucellosis. MATERIALS
AND METHODS: In this case-control study, 198 patients with brucellosis and
111 healthy volunteers matched for sex, age and geographic area were evaluated
by genotyping for polymorphism in TLR4 gene (Asp299Gly) using amplification
refractory mutation system (ARMS)-PCR method. RESULTS: Allele 896G was
more prevalent in patients with brucellosis compared to healthy controls (33.6%
vs. 20.7%, P=0.000003). Also the frequency of G allele of TLR4 gene was
significantly higher in male patients with brucellosis compared to the same sex in
control group (36% vs. 21.7%, P=0.00005). Multiple logistic regression analysis
demonstrated that male patients heterozygous at allele G gene had a significantly
higher risk for brucellosis with an odds ratio of OR 2.89, 95% CI: 1.79-4.69,
P<0.0001). CONCLUSION: This study is the first to show an association between
genetic polymorphism in TLR4 gene and susceptibility to brucellosis.
692: J Neurol Sci. 2006 Feb 15;241(1-2):83-90. Epub 2005 Dec 15.
Neurology in Operation Iraqi Freedom: risk factors for referral,

clinical presentations and incidence of disease.
Hartmann JE.
Neurology Service, Tripler Army Medical Center, 1 Jarrett White Road,

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

693: Am J Epidemiol. 2006 Feb 1;163(3):211-6. Epub 2005 Dec 7.
Refined estimate of the incubation period of severe acute respiratory

syndrome and related influencing factors.
Cai QC, Xu QF, Xu JM, Guo Q, Cheng X, Zhao GM, Sun QW, Lu J, Jiang
QW.
Department of Epidemiology, School of Public Health, Fudan University,

Shanghai, China.
Many epidemiologists have agreed that a refined estimate of the incubation period
of severe acute respiratory syndrome (SARS) would need a sample size of about
200 cases and appropriate statistical methods enabling the inclusion of cases with
defined periods of exposure. However, no such studies have been reported so far.
Besides, determinants of the SARS incubation period remain unclear. In this
study, 209 probable SARS cases with documented episodes of exposure between
March 1 and May 31, 2003, in mainland China were included. A nonparametric
method was used to analyze these data with defined periods of exposure to obtain
the refined estimate of the SARS incubation period. Furthermore, the authors also
explored the influence of various factors on the SARS incubation period by
analysis of variance, linear regression analysis, and analysis of covariance. The
estimates of mean and variance of the SARS incubation period were 5.29 days
and 12.33 days(2), respectively; 90% of patients would have an incubation period
of less than 11.58 days with a probability of 0.8, and 99% of patients would have
an incubation of less than 22.22 days with a probability of 0.9. The affected area
showed a highly significant effect on the incubation period (p < 0.001), but the
contact pattern, occupation, gender, and age did not.
Publication Types:
694: Sex Health. 2005;2(3):193-202.

Female sex work in Yangon, Myanmar.
Talikowski L, Gillieatt S.
Centre for International Health, Curtin University of Technology, Perth,
Australia.
BACKGROUND: Myanmar (Burma), with an upper estimate of 400,000 people

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

Traffic law enforcement in Hyderabad, India.
Dandona R, Kumar GA, Dandona L.
Health Studies Area, Centre for Human Development, Administrative Staff

College of India, Raj Bhavan Road, Hyderabad-500 082, India. rakhi@asci.org.in
The aim of the study was to understand traffic law enforcement (TLE) carried out
by the police to reduce non-compliance with traffic laws on the roads of
Hyderabad city in India for 2001-2003. The Traffic Police database of citations
issued to drivers who violated traffic laws in Hyderabad was analysed for the
years 2001-2003 to describe the TLE activities of the police, to describe and
compare the TLE activities for the different types of vehicles and to compare the
TLE activities for the 3 years. The violations were classified in five categories -
those related to driving, parking, vehicle, document and others; and TLE into
safety and other TLE. A total of 646 161 traffic-law violations were registered in
2001, 904 447 in 2002 and 964 275 in 2003 for Hyderabad. Driving and parking
violations were the most common violations registered in all 3 years, with parking
violations slightly higher in 2001 (43.5%) and driving violations slightly higher in
2002 (35%) and 2003 (36.4%). Auto-rickshaws (three-wheel commercial
passenger vehicles) accounted for the highest violations registered in 2001
(41.4%) whereas motorized two-wheelers had the highest registered violations in
2002 (35.5%) and 2003 (33.2%). Safety TLE activity (detecting and registering
driving violations) was only one-third of all the TLE activity performed by the
police in the 3 years, and disobeying traffic signals was the most common
violation registered under safety TLE. Indian rupees 50 (US$1.1) were collected
by way of a fine in 87% of the cases registered. Age and gender of the violators
were not recorded in the database. These data can be used for planning,
monitoring and evaluating TLE in Hyderabad. These can help identify traffic
control and human factors that could lead to traffic noncompliance, and help
identify priorities for improving road safety. These data indicate a need to
enhance the safety TLE activity of the police, to make TLE more visible in
Hyderabad, and to assess the effectiveness of the current legal action as
deterrence to improve road safety. Recommendations to enhance TLE within the
given resources of the police are made. More effort is needed towards systematic
collection and analysis of data on TLE in India to facilitate long-term
improvements in TLE for safer roads.
Publication Types:
696: Int Arch Occup Environ Health. 2006 May;79(5):441-4. Epub 2005 Dec 7.
Autonomic nervous activity changes in relation to the reporting of

subjective symptoms among male workers in an information service
company.
Karita K, Nakao M, Nishikitani M, Nomura K, Yano E.

Medicine, 2-11-1 Kaga, 173-8605, Tokyo, Japan. kanae@med.teiyo-u.ac.jp.
OBJECTIVES: The objective of the study was to clarify the relationship between
major subjective symptoms and autonomic nervous system function by power
spectral analysis of heart rate variability (HRV). METHODS: Short-term HRV
was examined for 413 male workers in a Japanese information service company
aged 19-45 years, and questionnaire survey on subjective symptoms and
biochemical measurements were conducted at annual health checkup. RESULTS:
The most prevalent subjective symptom (> or =10%) was dullness, followed by
fatigue, backache, diarrhea, sleep disorder, and irritation. HRV in high frequency
(HF 0.15-0.40 Hz) bands and the coefficient of variance in the
electrocardiographic R-R interval (CVrr) were lower in the subjects with any of
these six symptoms than in those without the symptoms. Both parameters were
negatively associated with the reporting of any of the six symptoms by multiple
regression analyses, controlling for the significant effects of age (HF and CVrr)
and plasma cortisol levels (HF). CONCLUSION: It was suggested that the
reporting of the subjective symptoms is one of good predictors for reduced
parasympathetic tones.
Publication Types:
697: Pharmacoepidemiol Drug Saf. 2006 Jun;15(6):421-7.

Trends in new drug interactions for pharmaceutical products in

Japan.
Yoshida N, Yamada A, Mimura Y, Kawakami J, Adachi I.
Department of Pharmacy, Toyama University Hospital, University of Toyama,

Toyama, Japan.
PURPOSE: The aim of the present study was to elucidate the trends in drug
interactions for pharmaceutical products in Japan by examining safety profile
updates. METHODS: All 12 422 prescription drugs currently on the Japanese
market were included in the study. Revisions to their product information (or
package insert: PI) were investigated from January 2000 to December 2003. The
publication 'Drug Safety Update,' which is a summary of the revisions made to the
precautions in PIs and is issued by The Society of Japanese Pharmacopoeia and
The Federation of Pharmaceutical Manufacturers' Associations of Japan under the
supervision of the Ministry of Health, Labour and Welfare (MHLW), was used as
a data source. The revised drug interactions were categorized according to
measures, mechanisms, and evidence from published references. RESULTS AND
CONCLUSIONS: The results revealed 426 new interactions, including 75
contraindicative combinations, during the survey period. About 45% and 27% of
the new interactions involved metabolic and pharmacological processes,
respectively, with metabolic interactions involving cytochrome P450 3A4 being
the dominant reason for the revision of PIs. Only 37% of the new interactions
cited scientific journals and/or books, and 58% of these references cited were
published more than 5 years prior to the date of revision. In conclusion, metabolic
interactions were the major reasons for the update of safety information after
2000. Published references should be provided in order to assist with clinical
management and avoid the undesirable effects of new drug interactions.
Publication Types:
698: Eur J Epidemiol. 2005;20(12):1023-9.

Relationship between distance of schools from the nearest municipal

waste incineration plant and child health in Japan.
Miyake Y, Yura A, Misaki H, Ikeda Y, Usui T, Iki M, Shimizu T.
Department of Public Health, Kinki University School of Medicine, Osaka-

Sayama, Japan. miyake-y@fukuoka-u.ac.jp
In Japan, the main source of dioxins is incinerators. This study examined the
relationship between the distance of schools from municipal waste incineration
plants and the prevalence of allergic disorders and general symptoms in Japanese
children. Study subjects were 450,807 elementary school children aged 6-12 years
who attended 996 public elementary schools in Osaka Prefecture in Japan. Parents
of school children completed a questionnaire that included items about illnesses
and symptoms in the study child. Distance of each of the public elementary
schools from all of the 37 municipal waste incineration plants in Osaka Prefecture
was measured using geographical information systems packages. Adjustment was
made for grade, socioeconomic status and access to health care per municipality.
Decreases in the distance of schools from the nearest municipal waste incineration
plant were independently associated with an increased prevalence of wheeze,
headache, stomach ache, and fatigue (adjusted odds ratios [95% confidence
intervals] for shortest vs. longest distance categories =1.08 [1.01-1.15], 1.05
[1.00-1.11], 1.06 [1.01-1.11], and 1.12 [1.08-1.17], respectively). A positive
association with fatigue was pronounced in schools within 4 km of the second
nearest municipal waste incineration plant. There was no evident relationship
between the distance of schools from such a plant and the prevalence of atopic
dermatitis or allergic rhinitis. The findings suggest that proximity of schools to
municipal waste incineration plants may be associated with an increased
prevalence of wheeze, headache, stomach ache, and fatigue in Japanese children.
Publication Types:
699: Int J Epidemiol. 2006 Apr;35(2):323-9. Epub 2005 Dec 2.

Extreme weather events and environmental contamination are

associated with case-clusters of melioidosis in the Northern
Territory of Australia.
Cheng AC, Jacups SP, Gal D, Mayo M, Currie BJ.
Tropical and Emerging Infectious Diseases Division, Menzies School of Health

Research, Charles Darwin University, Australia. allenc@menzies.edu.au
BACKGROUND: Melioidosis, the infection due to the environmental organism

Burkholderia pseudomallei, is endemic to northern Australia and South East Asia.
It is associated with exposure to mud and pooled surface water, but environmental
determinants of this disease are poorly understood. We defined case-clusters in
northern Australia, determined their contribution to the observed rate of
melioidosis, and explored clinical features and associated environmental factors.
METHODS: Using geographical information systems data, we examined
clustering of melioidosis cases in time and geographical space in the Top End of
the Northern Territory of Australia between 1990 and 2002 using a scan statistic.
DNA macrorestriction analysis, resolved by pulsed field gel electrophoresis, was
performed on isolates from patients. RESULTS: We defined five case-clusters
involving 27 patients that occurred within 7-28 days and/or a radius of 100-300
km. Clustered cases were associated with extreme weather events or
environmental contamination; no difference in the clinical pattern of disease was
noted from other patients not involved in clusters. Isolates from patients linked to
environmental contamination were caused by isolates with similar DNA
macrorestriction patterns, but isolates from patients linked to severe weather
events had more diverse DNA macrorestriction patterns. CONCLUSION: Case-
clusters of melioidosis where isolates exhibit diverse DNA macrorestriction
patterns in our region are linked to extreme weather events and outbreaks where
isolates are predominantly of the same DNA macrorestriction pattern are linked
with contamination of an environmental source.
Publication Types:
700: Arch Med Res. 2006 Jan;37(1):175-7.

•
Japanese guidelines-based management of lipid levels in a
hypercholesterolemia education class.
Kotani K, Katase H, Saiga K, Sakane N.
Division of Clinical Laboratory Medicine and Division of Health

Administration and Promotion, Faculty of Medicine, Tottori University,
Yonago, Japan. kakotani@grape.med.tottori-u.ac.jp
The "Japan Atherosclerosis Society (JAS) Guidelines for Diagnosis and

Treatment of Atherosclerotic Cardiovascular Diseases" proposed the
recommended lipoprotein levels in each patient according to some
categories classified by the risk factor numbers. Because the
categorization is somewhat complex for some patients, we redeveloped the
JAS guidelines-based survey into a simple form to easily assess each
lipoprotein target level. Forty participants in the hypercholesterolemia
education classes were divided into the ordinary approach group (n = 20;
mean age 59 years) and the intervention group using the survey (age 58
years). When participants assessed the class by 100-point scales, the
intervention group had significantly more understanding levels than the
ordinary approach group (86.7 vs. 75.1 points). Our results suggested that
the simplified JAS guidelines-based survey system was effectively
applicable to transmitting information about lipoprotein target levels
among hypercholesterolemic subjects as an educational tool.

701: Jpn J Clin Oncol. 2005 Nov;35(11):690-1.
Comparison of prostate cancer mortality in five countries: France,

Italy, Japan, UK and USA from the WHO mortality database (1960-
2000).
Marugame T, Mizuno S.
Statistics and Cancer Control Division, National Cancer Center.
Publication Types:
702: Soc Sci Med. 2006 May;62(10):2551-64. Epub 2005 Nov 21.
Non-attendance and effective equity of access at four public

specialist outpatient centers in Hong Kong.
Johnston JM, Leung G, Saing H, Kwok KO, Ho LM, Wong IO, Tin KY.
Department of Community Medicine, University of Hong Kong, Hong Kong.
This study tests whether socio-economic status (SES), at either the individual or
ecologic levels, exerts a direct impact on non-attendance or an indirect impact on
attendance through longer waiting time for appointments and/or doctor-shopping
behavior at four public specialist outpatient centers in Hong Kong. We collected
information through three main sources, namely patients' referral letters,
telephone interviews with both open- and closed-ended questions (e.g. doctor-
shopping data) and hospital administrative databases from a total of 6495
attenders and non-attenders enrolled from July 2000 through October 2001.
Individual-level SES was measured by education, occupation and monthly
household income. Tertiary planning unit (TPU)-level SES data consisted of
proportion unemployed, proportion with tertiary education, median income and
Gini coefficient. Direct effects of SES on non-attendance were examined by
logistic regression. Indirect contributions mediated through waiting time and
doctor-shopping were analyzed by structural equation modeling. We found that
SES, at the individual or ecologic level, did not exert a direct effect on non-
attendance. Instead, TPU-level SES contributed positively to waiting time
(beta=0.06+/-0.03, p=0.048), i.e. worse-off neighborhoods (and those with greater
income inequality) had a shorter waiting time. Individual-level SES was also
directly associated with the likelihood of doctor-shopping (beta=0.16+/-0.02,
p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time
(beta=0.12+/-0.02, p<0.001) and doctor-shopping (beta=0.37+/-0.02, p<0.001)
were significantly related to non-attendance. Our findings suggest a highly
equitable specialist ambulatory care public system in Hong Kong. Health care
resources are appropriately targeted at the socially indigent, and the poor are not
discriminated against and pushed to seek alternative sources of care by the
system. These results should be confirmed using a prospective design.
703: Maturitas. 2006 Jun 20;54(3):205-12. Epub 2005 Nov 21.

Factors associated with treatment options among menopausal

women in Taiwan.
Chiou YW, Tai CJ, Chien LY.
Institute of Community Health Nursing, National Yang Ming University and

Department of Nursing, Taipei Veterans General Hospital, Taiwan.
OBJECTIVES: Taiwan has a two-tiered medical system that includes modern

medicine and traditional Chinese medicine (TCM). The objectives of this study
were to compare the characteristics of menopausal women who did not use any
treatment, who used hormone replacement therapy (HRT), and who used TCM to
treat their climacteric symptoms. METHODS: The study subjects were 182
women aged 46-55 years (non-treatment: 61, HRT: 60, TCM: 61). Variables used
included socio-demographics, climacteric symptoms, other physical symptoms,
experiences with the treatment, and attitude toward menopause. Multivariate
analyses were performed using multinomial logistic regression. RESULTS:
Compared with women in the non-treatment group, employed women were more
likely to have received HRT or TCM. Women in the TCM group were more
likely to have comorbid non-climacteric physical symptoms and were less likely
to have family support for the use of HRT. Women in the TCM group were more
likely to have an attitude regarding menopause as a natural phenomenon and as
having little impact on attractiveness and sexual life. Severity of current
climacteric symptoms was lower in the HRT group, while it was higher in the
TCM group. These factors accounted for 66.1% of the model variances.
CONCLUSIONS: Women in different treatment groups had different
characteristics. Health professionals should be aware of the differences and
provide information on treatment options in order to help and support women in
making treatment decisions.
704: Prehosp Disaster Med. 2005 Sep-Oct;20(5):290-300.

Recommended modifications and applications of the Hospital

Emergency Incident Command System for hospital emergency
management.
Arnold JL, Dembry LM, Tsai MC, Dainiak N, Rodoplu U, Schonfeld DJ,
Paturas J, Cannon C, Selig S.
Yale University School of Medicine, New Haven, Connecticut, USA.

Jeffrey.arnold@ynhh.org
The Hospital Emergency Incident Command System (HEICS), now in its third
edition, has emerged as a popular incident command system model for hospital
emergency response in the United States and other countries. Since the inception
of the HEICS in 1991, several events have transformed the requirements of
hospital emergency management, including the 1995 Tokyo Subway sarin attack,
the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory
Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several
modifications of the HEICS are suggested to match the needs of hospital
emergency management today, including: (1) an Incident Consultant in the
Administrative Section of the HEICS to provide expert advice directly to the
Incident Commander in chemical, biological, radiological, nuclear (CBRN)
emergencies as needed, as well as consultation on mental health needs; (2) new
unit leaders in the Operations Section to coordinate the management of
contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in
the Operations Section to coordinate mental health support for patients, guests,
healthcare workers, volunteers, and dependents in terrorism-related emergencies
or events that produce significant mental health needs; (4) a new
Decedent/Expectant Unit Leader in the Operations Section to coordinate the
management of both types of patients together; and (5) a new Information
Technology Unit Leader in the Logistics Section to coordinate the management of
information technology and systems. New uses of the HEICS in hospital
emergency management also are recommended, including: (1) the adoption of the
HEICS as the conceptual framework for organizing all phases of hospital
emergency management, including mitigation, preparedness, response, and
recovery; and (2) the application of the HEICS not only to healthcare facilities,
but also to healthcare systems. Finally, three levels of healthcare worker
competencies in the HEICS are suggested: (1) basic understanding of the HEICS
for all hospital healthcare workers; (2) advanced understanding and proficiency in
the HEICS for hospital healthcare workers likely to assume leadership roles in
hospital emergency response; and (3) special proficiency in constituting the
HEICS ad hoc from existing healthcare workers in resource-deficient settings.
The HEICS should be viewed as a work in progress that will mature as additional
challenges arise and as hospitals gain further experience with its use.
705: Ind Health. 2005 Oct;43(4):623-9.

Influence of overtime work, sleep duration, and perceived job

characteristics on the physical and mental status of software
engineers.
Nishikitani M, Nakao M, Karita K, Nomura K, Yano E.

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

706: Health Policy. 2006 Oct;78(2-3):224-34. Epub 2005 Nov 15.
The landscape of community health insurance in India: an overview

based on 10 case studies.
Devadasan N, Ranson K, Van Damme W, Acharya A, Criel B.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.

deva@devadasan.com
The Indian health system is mainly funded by out-of-pocket payments. More than
80% of health care expenditure is borne by individual households. Only about 3%
of the population, mostly those in the formal sector, benefit from some form of
health insurance. Several Indian Non-Governmental Organisations (NGOs) have
initiated Community Health Insurance (CHI) schemes within their existing
development programmes. This article describes the principal features of the
design and functioning of a selection of 10 CHI schemes and presents a brief
overview of the current landscape of CHI in India. The schemes explicitly target
the poorest and most vulnerable households in Indian society-scheduled tribes,
scheduled castes and poor women. Three CHI management models can be
distinguished. The first model consists of local NGOs acting as both insurer and
provider. In the second model, the NGO is the insurer but does not itself provide
care, which is then purchased from a private provider. In the third model, the
NGO neither does provide health care nor acts as an insurer: the NGO, on behalf
of a community, links with an insurer and purchases health care from a provider.
The benefit packages generally include both primary and secondary care and most
of the providers are in the private sector. Most of the schemes require external
resources for financial sustainability. There is currently little information on the
impact of CHI schemes on the performance of local health systems and more
research is warranted in that respect.
Publication Types:
707: Reprod Health Matters. 2005 Nov;13(26):54-64.

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

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

The Automated Classification of Medical Entities (ACME) system

objectively assessed the appropriateness of underlying cause-of-
death certification and assignment.
Lu TH, Tsau SM, Wu TC.
Institute of Public Health, College of Medicine, National Cheng Kung University,

Tainan, Taiwan.
BACKGROUND AND OBJECTIVES: To assess the feasibility of using the

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

• Validation Studies
709: J Clin Forensic Med. 2006 Jan;13(1):21-5. Epub 2005 Nov 10.
Review of forensic assessments of female referrals to the branch of

legal medicine, Malatya region, Turkey--1996-2000.
Celbiş O, Gökdoğan MR, Kaya M, Günes G.
Inönü University, Faculty of Medicine, Department of Legal Medicine, Malatya,

Turkey.
It is well recognized that the most pervasive form in gender violence is violence
against women by their intimate male partners. Domestic violence (DV) crosses
all cultures, races, and socioeconomic levels, affecting people of all ages and both
sexes, but particularly women and children. DV refers to the chronic physical,
sexual and psychological maltreatment of one family member against another in
order to control. DV represents a significant health threat to women. It may also
be an important precipitating factor of female suicide. As the literature has begun
to document the extent of interfamilial violence, attention has focused on forensic
documentation. The aim of this study is to review female victims presented at the
Branch of Legal Medicine of Malatya, Turkey, regarding gender-based violence
and DV in relation towards sexual offenses and suicide attempts. Accordingly,
recommendations were presented to increase the awareness of DV by setting
policies and in response legislative recommendations. The legal reports of women
(n=2245) were reviewed. In respect of the Turkish Penal Code (TPC), paragraph
456/1, 2, 3 and 4, which covers the act of assault and battery, the severity of the
injuries have been categorized into three groups according to the Turkish Injury
Scale (TIS) covered by TPC 456/1, 2 and 4, into the issues of functional
incapacitation according to TPC 456/2 and 3, and with regard to the presence of a
mark of an injury on the face according to TPC 456/2 tables. Because of
incomplete data, not all results be categorized as positive for DV. Despite the
large number of blunt force injuries (699 cases out of 2245) and the high
percentage of external lesions, 76% of 1796 files, found, recognition of DV was
uncommon. According to TPC 456/4, in cases of small trauma-related injuries,
legal proceedings are dependent upon a victim's making a complaint. The
percentage of 80.4% (n=2245) represents the need for information regarding legal
requirements. The frequency of sexual assault cases, 144 victims out of 162, and
in suicide attempts, 95 women out of 145, in the 15-24 year age span may also
reflect a society's accusative approach towards women based on moral values.
Unless prosecuting DV cases purely on the evidence in regard to victim's safety,
withdrawal of complaints will continue. It is essential to identify to 'name' DV
when it occurs. Recognizing the serious immediate and future long-term
implications for health, multifaceted intervention is important. DV has to undergo
some fundamental and far-reaching reformation in Turkey regarding how the
legal system deals with it appropriately.
710: Childs Nerv Syst. 2006 Apr;22(4):346-51. Epub 2005 Nov 10.
Childhood brain tumour information on the Internet in the Chinese

language.
Lau L, Hargrave DR, Bartels U, Esquembre C, Bouffet E.
Paediatric Brain Tumour Programme, Division of Haematology/Oncology, The

Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8,
Canada.
BACKGROUND: Internet information, now available in many different

languages, can become a major source of information for patients and families in
their own mother tongue. Chinese represent one of most frequently spoken
language in the world. The aims of this study were to critically appraise the
quantity and quality of Internet health information in childhood brain tumour in
the Chinese language and to identify sufficient quality websites that can
potentially be recommended to Chinese-speaking parents. METHODS: Internet
information on six common paediatric brain tumours was searched using six
commonly used Chinese search engines. Websites were assessed systematically
using two rating tools: DISCERN instrument and Checklist Rating System
Instrument. RESULTS: Out of 946 sites accessed, only 13 assessable Chinese
websites, displaying Traditional Chinese characters and providing information on
brain tumour, were identified. Only four sites included specific discussion on
brain tumours in children. Ten websites failed to provide satisfactory information
on brain tumour as rated by DISCERN instrument. Overall only 41% of the 13
specific items relevant to brain tumours were mentioned (Checklist Rating System
Instrument). CONCLUSION: Only a few satisfactory websites can be
recommended to Chinese-speaking families for general information on brain
tumour with caution from health care providers that such information may not
apply to the child's individual condition.
Publication Types:
• Evaluation Studies
711: BMJ. 2005 Nov 12;331(7525):1107.

Cost effectiveness analysis of strategies for maternal and neonatal

health in developing countries.
Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, Zupan J,

Darmstadt GL.
Health Systems Financing, Evidence and Information for Policy, World Health
Organization, Switzerland.
OBJECTIVE: To determine the costs and benefits of interventions for maternal

and newborn health to assess the appropriateness of current strategies and guide
future plans to attain the millennium development goals. DESIGN: Cost
effectiveness analysis. SETTING: Two regions classified by the World Health
Organization according to their epidemiological grouping: Afr-E, those countries
in sub-Saharan Africa with very high adult and high child mortality, and Sear-D,
comprising countries in South East Asia with high adult and high child mortality.
DATA SOURCES: Effectiveness data from several sources, including trials,
observational studies, and expert opinion. For resource inputs, quantities came
from WHO guidelines, literature, and expert opinion, and prices from the WHO
choosing interventions that are cost effective database. MAIN OUTCOME
MEASURES: Cost per disability adjusted life year (DALY) averted in year 2000
international dollars. RESULTS: The most cost effective mix of interventions was
similar in Afr-E and Sear-D. These were the community based newborn care
package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia,
screening and treatment of asymptomatic bacteriuria and syphilis); skilled
attendance at birth, offering first level maternal and neonatal care around
childbirth; and emergency obstetric and neonatal care around and after birth.
Screening and treatment of maternal syphilis, community based management of
neonatal pneumonia, and steroids given during the antenatal period were
relatively less cost effective in Sear-D. Scaling up all of the included interventions
to 95% coverage would halve neonatal and maternal deaths. CONCLUSION:
Preventive interventions at the community level for newborn babies and at the
primary care level for mothers and newborn babies are extremely cost effective,
but the millennium development goals for maternal and child health will not be
achieved without universal access to clinical services as well.
Publication Types:
PMCID: PMC1283271
712: J Epidemiol. 2005 Nov;15(6):199-202.

A framework for cancer surveillance in Japan.
Kaneko S.
and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
stkaneko@ncc.go.jp
The World Health Organization (WHO) has recommended that countries develop
national cancer control programs in order to reduce the number of deaths due to
preventable cancers. The national cancer control program should be
comprehensive and systematic with evidence-based priority-setting and the
efficient use of limited resources. In order to provide evidence-based information,
cancer surveillance systems must be established with registration as a focus.
Cancer registration monitors the incidence, mortality, survival, and prevalence of
cancers. In Japan, however, cancer registration systems have not been either well
developed or standardized until recently. In 2003, the Ministry of Health, Labour
and Welfare of Japan launched the Third Term Comprehensive 10-Year Strategy
Program for Cancer Control, which gave grants to several projects to enhance the
dissemination and standardization of cancer registries. However, the
establishment of a cancer registration system is merely the first step in the process
to provide a comprehensive surveillance system that leads to a national cancer
control program, as proposed by the WHO. To provide the best cancer care
services equitably in Japan, cancer surveillance systems should be established
without delay.
713: Eubios J Asian Int Bioeth. 2000 Jul;10(4):119-25.

Attitudes and practices of patients and physicians towards patient

autonomy: a survey conducted prior to the enactment of the
Patients' Rights Bill in Israel.
Sadan B, Chejk-Saul T.
Division of Information Systems, Hadassah Medical Organization, Jerusalem

91120, Israel. batami@hadassah.org.il
On the surface, it would appear that patients would welcome the opportunity to
relinquish their traditional subordination to doctors in therapeutic decision
making, and that doctors would be pleased to have partners with whom to share
the burden involved in making such fateful decisions. We investigated the
attitudes and practices of patients and physicians towards "patient autonomy" in
an outpatient clinic of an internal medicine department prior to the enactment of
the Patient's Rights Bill in Israel. There were 81 patients randomly chosen from
those attending the study clinic and 21 physicians randomly selected from among
the physicians treating them. They were all administered the Krantz, the
Abramson Health Index, and the Christie Ethical Decision Making pre-tested
questionnaires. They were also queried on demographic and background material.
The results indicated that the patient sample was neither particularly interested in
participating in medical decision making (average score of 3 out of 9 in the
Krantz behavioral involvement sub-scale) nor in receiving medical information
(average score of 4 out of 7 in the Krantz preference of information sub-scale).
The physicians exhibited a willingness to establish equal relations with their
patients, and claimed to prefer their taking an active role in decision making.
However, when presented with ethical dilemmas, the physicians were not
consistent in their attitude in terms of respecting "patient autonomy." The findings
of an Israeli survey conducted three years after the bill's passage showed that only
one-third of the studied physicians had read the Israel Medical Association
booklet's explaining the new law and most of them claimed that the new law had
no affect on their daily encounter with patients, meaning that the law did not
affect any change in these physicians' pattern of behavior. We concluded that if
the Patient's Rights Bill is to achieve its goals, it will have to be accompanied by a
widespread educational campaign to encourage the public to appreciate the value
and the importance of the autonomy granted to them, and to guide them in
exercising this autonomy to its best advantage. In parallel, the medical profession
will need to be aware of the importance of achieving the therapeutic goals while
upholding ethical and moral values in health care.
714: Int Heart J. 2005 Sep;46(5):855-66.

Impact of the Japanese Diagnosis Procedure Combination-based

Payment System on cardiovascular medicine-related costs.
Yasunaga H, Ide H, Imamura T, Ohe K.
Department of Planning, Information & Management, University of Tokyo

Hospital, Hongo, Japan.
In 2003, a lump-sum payment system based on Diagnosis Procedure

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

715: J Adv Nurs. 2005 Dec;52(5):498-507.
Responses to advanced cancer: Chinese-Australians.
Chui YY, Donoghue J, Chenoweth L.
Department of Nursing Studies, The University of Hong Kong, Pokfulam, Hong

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

716: Nippon Koshu Eisei Zasshi. 2005 Sep;52(9):817-23.
[Establishment of Healthy Japan 21 Regional plans according to

local community type]
Katanoda K, Hirota K, Matsumura Y.
Division of Health Informatics and Education, National Institute of Health and

Nutrition, Japan.
OBJECTIVE: To examine the establishment of Health Japan 21 regional plans

according to the local community type. METHODS: We sent all the Japanese
local governments a questionnaire regarding the establishment of health Japan 21
regional plans with a request to provide a hardcopy of established regional plans.
RESULTS: Of the respondent 1954 local communities, the proportions regarding
establishment of plans (including "Completed" and "In the course of") according
to the community type were: major, middle sized cities and Tokyo metropolitan
wards, 100%; other cities, 64.9%; towns, 40.7%; and villages, 38.8%. Of the 500
local communities which answered "Completed establishment", the proportions
with release onto the internet (including "Completed" and "In the course of")
were: major cities, 100%; middle sized cities, 67.7%; Tokyo metropolitan wards,
85.7%; other cities, 38.8%; towns, 13.5%; and villages, 14.3%. We examined
whether each of the 462 collected regional plans included each of the national
Health Japan 21's target themes and items, and found a tendency for smaller
community' regional plans to be less likely to give comprehensive coverage.
CONCLUSION: More support for smaller local governments is necessary to
achieve establishment and effective implementation of Health Japan 21 regional
plans.
Publication Types:
717: Int Fam Plan Perspect. 2005 Sep;31(3):115-23.

Use of family planning services in the transition to a static clinic

system in Bangladesh: 1998-2002.
Mercer A, Ashraf A, Huq NL, Haseen F, Uddin AH, Reza M.
Health Systems and Infectious Diseases Division, International Centre for

Diarrhoeal Disease Research, Bangladesh. amercer@icddrb.org
CONTEXT: In rural Bangladesh, family planning services--previously provided

through household visits and satellite clinics--were transferred to static
community clinics under the government's sectoral program for 1998-2003, but
the next sectoral program reversed the change without a formal evaluation. It is
important to assess changes in utilization and coverage to inform further
development of the service delivery system. METHODS: Longitudinal data on
use of family planning services and contraceptive methods were collected
quarterly in 1998-2002 from married women in about 11,000 households in two
rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were
conducted among women and service providers in 2003 to gather detailed
information about the transition to static clinics and women's response to the
changes. Quarterly time series graphs of selected indicators were plotted for areas
served by community clinics. RESULTS: In a time of considerable change in
service delivery and sources of contraceptive supply, contraceptive prevalence
remained constant in Abhoynagar and increased in Mirsarai. Community clinics
quickly became the source of supplies for one-third of contraceptive users in
Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became
operational (mostly in 2001-2002), three-quarters of women had used one at some
time. CONCLUSIONS: Despite cultural constraints on mobility, women do not
appear to have become dependent on home delivery of contraceptives.
Publication Types:
718: J Health Popul Nutr. 2005 Sep;23(3):215-21.

Acceptability of and adherence to dispersible zinc tablet in the

treatment of acute childhood diarrhoea.
Nasrin D, Larson CP, Sultana S, Khan TU.
Health Systems and Infectious Diseases Division, ICDDR,B: Centre for Health
and Population Research, GPO Box 128, Dhaka 1000, Bangladesh.
dnasrin@icddrb.org
Zinc treatment is now recommended by the World Health Organization as part of

the routine management of acute childhood diarrhoea. A dispersible zinc tablet
formulation was developed taking into account the taste, cost, and feasibility to
distribute and store. Only limited information is available on the acceptability of
and adherence to dispersible zinc tablet. No study has formally assessed whether
the formulation is acceptable to children and if caretakers can adhere to the
instructions regarding preparation, dosage, and duration of treatment. This
community-based study aimed at determining the acceptability of and adherence
to a dispersible zinc tablet formulation in a cohort of children (n=320) aged less
than five years. Caretakers of children with acute childhood diarrhoea were
prescribed zinc tablet treatment and followed up after 2-3 weeks. The formulation
was acceptable to children; 90.1% of 303 caretakers perceived that the tablets
were equally or even more acceptable to their children compared to other
medicines. Ninety-eight percent of the children received the standard dose of one
tablet per day, and 55.8% completed the full 10-day course of zinc treatment.
Adherence rates did not vary by age or gender of the child. These findings
indicate that the tablet formulation is acceptable, but further efforts are required to
enhance adherence.
Publication Types:
719: Ned Tijdschr Geneeskd. 2005 Oct 15;149(42):2339-43.

[Participation in the Dutch national screening programme for

uterine cervic cancer higher after invitation by a general
practitioner, especially in groups with a traditional low level of
attendance]
[Article in Dutch]
de Nooijer DP, de Waart FG, van Leeuwen AW, Spijker WW.
Stichting Bevolkingsonderzoek Baarmoederhalskanker Zuidwest-Nederland

(SBKZ), Postbus 3051, 3130 CB Vlaardingen.
OBJECTIVE: To gain insight into the differences in participation in the screening

programme for uterine cervix cancer between women invited by a general
practitioner (GP) and women invited by the local health authority (GGD).
Specific attention was given to those groups whose participation is generally
below average. DESIGN: Descriptive epidemiological study. METHOD: In the
period 2000-2003, 237,719 women (30-60 years of age) were invited to
participate in the national uterine cervix cancer screening programme in the
Southwest of the Netherlands; 37.1% of the women were invited by the GP and
62.9% by the GGD. Data were obtained from the Cervix Information System of
the GGDs. Differences in attendance between those invited by the GP and those
invited by the GGD were tested by linear regression. Participation was defined as
the number of women for whom the result of a cervical smear was known,
divided by the number invited. RESULTS: Invitation by a GP led to a 7.9% (95%
CI: 7.5-8.3) higher attendance rate than invitation by a GGD. This difference in
attendance was higher for women born in Morocco, Turkey, Surinam and the
Netherlands Antilles/Aruba (17.2%; 95% CI: 15.2-I9.2), young women (11.9%;
95% CI: 10.8-13.0), women with a low socio-economic status (11.6%; 95% CI:
10.4-12.7), and women who lived in highly urban areas (13.0%; 95% CI: 12.3-
13.6). The differences were the greatest among non-western women who were
also part of another low-attendance group: 19.0% (95% CI: 16.7-21.2) for women
who lived in highly urban areas and 20.8% (95% CI: 16.8-24.9) for those in the
youngest age group.
Publication Types:
720: J Bone Miner Metab. 2005;23(6):488-94.

Serum 25-hydroxyvitamin D levels and activities of daily living in

noninstitutionalized elderly Japanese requiring care.
Nakamura K, Nishiwaki T, Ueno K, Yamamoto M.
Department of Community Preventive Medicine, Niigata University Graduate

School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-
8510, Japan. kazun@med.niigata-u.ac.jp
To date, no study has investigated the nutritional status of vitamin D in frail

elderly people living at home. The purposes of this study were to assess serum 25-
hydroxyvitamin D (25[OH]D) levels and associated factors in noninstitutionalized
elderly people who had various levels of physical disability, and to propose an
adequate vitamin D nutritional status for the elderly by interpreting the serum
25(OH)D levels in relation to serum parathyroid hormone (PTH) levels in this
population. Health examinations were conducted in the winter and summer of
2003. The subjects were 143 elderly people in the winter, and 120 elderly people
in the summer, who all used the long-term care insurance system at home. Serum
25(OH)D concentrations were determined with a chemiluminescence protein-
binding assay, and serum intact PTH concentrations were determined with an
immunoradiometric assay. The subjects' disease histories and lifestyle information
were obtained through an interview. Activities of daily living (ADL) levels were
evaluated using the Barthel index, and grip strength was measured with a digital
hand dynamometer. Average serum 25(OH)D levels in the winter and summer
were 54.2 nmol/l (SD 29.0) and 53.3 nmol/l (SD 32.3), respectively, and intact
PTH concentrations in the winter and summer were 4.2 pmol/l (SD 1.8) and 4.3
pmol/l (SD 1.8), respectively. The proportion of people who had a low 25(OH)D
(<30 nmol/l) and high intact PTH levels (>6.9 pmol/l) were 15%-20% and 8%,
respectively. Significant predictors of low serum 25(OH)D concentrations were
low ADL levels, female sex, and low fish consumption in both seasons. Serum
25(OH)D concentrations of less than 50 nmol/l were associated with elevated
serum intact PTH concentrations. In conclusion, elderly people requiring care at
home are at high risk of hypovitaminosis D, and their low serum 25(OH)D levels
are mainly associated with low ADL levels. In addition, maintenance of serum
25(OH)D concentrations above 50 nmol/l may prevent hypovitaminosis D-
induced hyperparathyroidism.
Publication Types:
721: Jpn J Clin Oncol. 2005 Oct;35(10):626-9.

Comparison of laryngeal cancer mortality in five countries: France,

Italy, Japan, UK and USA from the WHO mortality database (1960-
2000).
Sano H, Hamashima C.
and Screening, National Cancer Center, Tokyo, Japan.
Publication Types:

722: Prog Transplant. 2005 Sep;15(3):286-90.
Promoting organ donation and transplantation among South Asians

in the United Kingdom: the role of social networks in the South
Asian community.
Randhawa G.
Institute for Health Research, University of Luton, United Kingdom.
The percentage of South Asians on the kidney transplant waiting list in the United
Kingdom is 3 times their percentage in the general population. Obviously, organ
donation and transplantation among South Asians in the United Kingdom needs
improvement. In recent years, ethnically targeted campaigns in the mass media
have specifically attempted to attract donors from the South Asian communities.
A number of pilot studies have been done to evaluate the effectiveness of these
initiatives in providing information about organ donation to South Asians. Results
indicate that detailed information related to transplantation was learned mainly by
people within the community receiving transplants and was transmitted through
various informal community networks rather than through the resources provided
by the Department of Health. This article provides an overview of who South
Asians are and how these community networks were established. Transplant
professionals must devise effective strategies to access these community
networks, thereby raising the consciousness of transplantation among South
Asians in the United Kingdom.
Publication Types:
• Review
723: AJR Am J Roentgenol. 2005 Nov;185(5):1361-5.

The application of the Six Sigma program for the quality

management of the PACS.
Kang JO, Kim MH, Hong SE, Jung JH, Song MJ.
Department of Radiation Oncology, Kyunghee University Medical College,

Kyunghee University Hospital, Hoikidong, Dongdaemungu, Seoul, South Korea.
kangjino@khmc.or.kr
OBJECTIVE: We implemented a Six Sigma-based quality management program

for the PACS to improve the quality of and lessen the necessary resources for its
management. CONCLUSION: With the Six Sigma-based PACS quality
management program, we were able to reduce resource requirements while
maintaining quality.
724: Turk J Gastroenterol. 2005 Sep;16(3):147-9.

Can we rely on public data as a source of information for cancer

registry in developing countries?
Semnani S, Kabir MJ, Besharat S, Abdolahi N, Danesh A, Roshandel D.
Department of Gastroenterology, Golestan University of Medical Sciences, Iran.

sh_semnani@yahoo.com
BACKGROUND/AIMS: Although a "hospital-based cancer registry" is important

in improving patient care, a "population-based cancer registry" with emphasis on
epidemiology is important in allocating health care resources and prioritizing
public health programs. Because of its reliance on retrieved clinical and para-
clinical documents, there is some limitation in registering all cancer incidents in
this system, especially in developing countries. In this study we examined the
possibility of using public data as a complementary source of information for
recording cancers in a population-based cancer registry. METHODS: Along with
the annual census in rural areas, a survey was performed in Golestan province in
March 2004 to identify public awareness about cancer incidents in the
community. Individuals were questioned about history of cancer in their close
relatives during the last two years. Those who reported cancer in their relatives
were also asked to name the main organ of involvement. A similar list was
retrieved from the cancer registry at the Ministry of Health in Gorgan, and cases
with upper GI (esophagus and gastric) cancer diagnosis from 21 March 2002
through 20 March 2004 were selected for this study. Finally, these two lists were
compared for examining accuracy of the collected data. RESULTS: We included
137 cases in our study with rural residence and known addresses. Only 35
(25.5%) cases were reported by the relatives and among them only 20 (57.1%)
relatives correctly reported the tumor location. Although we found a difference in
accurate reporting of cancer incidents by year of diagnosis (more correct cases
reported during the second versus the first year), the difference was not
statistically significant between the two years. CONCLUSION: In this study, we
examined the possibility of using public awareness about cancer incidents as a
complementary source of information for a population-based cancer registry. We
found that this approach is not ideal for reducing limitations. Therefore, we
recommend a nationwide cancer registry to record all cancer-related information
at the time of diagnosis. This strategy will reduce the need for performing
retrospective surveys in collecting cancer-related information.
725: Public Health Nutr. 2005 Sep;8(6A):766-72.

Comment in:
• Public Health Nutr. 2006 Apr;9(2):275.
The new nutrition science: sustainability and development.
Wahlqvist ML.
International Union of Nutritional Sciences, Monash University, Melbourne,

Victoria, Australia. mark.wahlqvist@adm.monash.edu.au
OBJECTIVE: To show that nutrition science is anchored in food systems and is

influenced by the social, through the environmental to the cosmological, life's
connections and rhythms. To indicate that an integrative approach is now
becoming possible with advances in food technology, in the understanding of
food choice and of human behaviour, and in a preparedness to recognise
nutritional inputs in the full sweep of life-long well-being and health outcomes.
METHOD: An analysis of the much broader understanding of nutritionally related
diseases from an ecological perspective, with attention to economic development,
beginning with poverty alleviation. Recognition that the biological dimension of
nutrition science is undergoing a profound reappraisal; that technologies will
allow us to change the course of nutritionally related diseases for the better; and
that nutrition science will find partners in information technology and
telecommunications, food technology and energy technology. CONCLUSION: A
new generation of nutrition scientists can help build a new economy that supports
development amongst communities, whether close or distant from each other. The
opportunities for this kind of development to be realised between Asia, Latin
America and Africa are considerable. At all times, however, nutrition scientists
must uphold the paramount importance of good governance, conflict resolution
and maternal literacy if their work is to achieve its growing potential.
Publication Types:
• Review
726: Eur Urol. 2005 Nov;48(5):712-22; discussion 722-3. Epub 2005 Apr 1.
Reversible, non-barrier male contraception: status and prospects.
Hoesl CE, Saad F, Pöppel M, Altwein JE.
Department of Urology, Hospital Barmherzige Brüder, Technical University

Munich, Romanstr. 93, 80639 Munich, Germany. cornelia_hoesl@yahoo.de
OBJECTIVE: Male, non-barrier, contraceptive options are limited to vasectomy

and inadequate methods such as withdrawal and periodic abstinence. Herein we
give an overview of current research on male contraception by pharmacological
means. METHODS: Literature search of PubMed documented publications and
abstracts from meetings. RESULTS: Cross-cultural surveys show men's
willingness to carry contraceptive responsibility. Clinical trials substantiate that
hormonal contraception involving suppression of gonadotropins holds the best
promise to provide a male pharmacological contraceptive. Androgens have been
demonstrated to induce reversible infertility particularly in combination with
certain progestins and GnRH antagonists. Advances in non-endocrine
contraception include intervention with triptolide derivatives, alkylated imino
sugars, and immunization by eppin. CONCLUSION: The prospect of a
pharmacological, male contraceptive has been considerably advanced in recent
years. Long-term studies involving a greater number of subjects may result in a
safe, reversible and effective means. Asia is likely to be the first market for male,
hormonal contraceptive methods. The clinical evaluation of non-endocrine
approaches may ultimately lead to an alternative to hormone-based male
contraception.
Publication Types:
• Review
727: Public Health Nurs. 2005 Sep-Oct;22(5):407-13.

Evaluation of a community-based exercise program for elderly
Korean immigrants.
Sin MK, Belza B, Logerfo J, Cunningham S.
College of Nursing, Seattle University, 901 12th Ave, P.O. Box 222000, Seattle,
WA 98122-1090, USA. sinm@seattleu.edu
OBJECTIVE: To evaluate feasibility and effectiveness of a modified exercise

program for elderly Korean immigrants (EKIs). Design and sample: Intervention
study with EKI residents of a senior house (n = 13, age range 67-86 years, mean
age 77 years), recruited through posted fliers and with help from a Korean social
worker. INTERVENTION: A Korean-American instructor taught a modified
version of an evidence-based exercise program 3 times weekly, 50 min per
session, for 12 weeks. Program was evaluated with the Quality Health Outcomes
Model. System and client characteristics were taken into consideration because
elderly Koreans have their own values and beliefs, which influence their health
management behaviors. Evaluation measures included exercise adherence,
preintervention and postintervention health outcomes, and satisfaction with the
exercise program. Group discussion was used to evaluate satisfaction with the
exercise program. RESULTS: Participants showed improved health outcomes on
muscle strength, agility/balance, and blood pressure after the exercise program.
All participants were satisfied with the exercise program, and participation rates
were good (nine participants attended > or = 80% of classes). CONCLUSIONS:
The exercise program was feasible for this sample and should be evaluated in a
larger population of EKIs and in populations of other ethnic minorities.
Publication Types:
• Research Support, U.S. Gov't, P.H.S.
728: Health Policy. 2005 Nov;74(3):247-60.

Arsenic poisoning in Bangladesh: spatial mitigation planning with

GIS and public participation.
Hassan MM.
Jahangirnagar University, Department of Geography and Environment, Savar,

Dhaka 1342, Bangladesh. manzurulh@yahoo.com
A PPGIS (Public Participatory Geographical Information System) has recently

been developed in combination with PRA (Participatory Rural Appraisal) and GIS
(Geographical Information Systems) methodologies to utilise GIS in the context
of the needs of communities that are involved with, and affected by development
programmes. The impact of arsenic poisoning in Bangladesh is 'tragic and painful'
on patients' health and their social life what was described as the 'worse mass
poisoning in human history' in a WHO report. Deep tubewell is said to be a
source of arsenic-free safe drinking water and people are mainly interested in
deep tubewell water rather than rainwater harvesting, dug-wells, and pond-sand-
filters (PSF) approved by the BAMWSP (Bangladesh Arsenic Mitigation Water
Supply Project). This paper mainly explores the application and suitability of GIS
with local community participation in deep tubewell planning for arsenic
mitigation. The relevant data for this study were collected from the field survey.
The PRA methods were used to obtain social and resource information; while a
GIS was used to organise, analyse, and display the information. Participants from
three different focus-groups were asked to determine their 'own priorities' for
spatial planning of deep tubewell for arsenic-free water. The study results
valuable community perspectives on deep tubewell planning and reveals the
suitability of PPGIS in spatial planning for arsenic mitigation with local
community mapping overlay. The process of dialogue and preparation of mental
mapping within each focus-group participants lead to enhance information about
community needs of deep tubewell in the study area.
Publication Types:
729: J Forensic Odontostomatol. 2005 Jun;23(1):1-18.

Thai tsunami victim identification overview to date.
James H.
Forensic Odontology Unit, University of Adelaide, Australia.

helen.james@adelaide.edu.au
The boxing day tsunami of 26 December 2004 caused devastation and loss of life
around the Indian ocean. International disaster victim identification efforts were
centred in Thailand, with many odontologists from over 20 countries contributing
to the examination of deceased, collection of antemortem information,
comparison and reconciliation of data. The contribution of forensic odontology to
the identification process conducted in Thailand in response to the tsunami
devastation is presented in a composite of short reports focused on the five phases
associated with disaster victim identification. To date 1,474 deceased have been
identified. Dental comparison has been the primary identifier in 79% of cases and
a contributor in another 8%, a total of 87%.
730: J Forensic Odontostomatol. 2005 Jun;23(1):19-25.

DVI System International: software assisting in the Thai tsunami

victim identification process.
Andersen Torpet L.
Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and

Anatomy, School of Dentistry, Faculty of Health Sciences, University of
Copenhagen, Denmark. la@odont.ku.dk
DVI System International is software that operates on the PC-Windows platform.

It is capable of managing aspects of identification in day-to-day cases and major
disasters, where it has particular advantages when victims of several nationalities
are involved. The system uses Interpol forms as standard protocols for input and
transfer of antemortem and postmortem information. Following the Thai Tsunami
Disaster of 26 December 2004, Interpol recommended that its member country
Thailand use DVI System International software, as it is one of the few
internationally approved systems. This paper focuses on the concepts upon which
the dental forms, F1 and F2, of the DVI System International are designed,
describes how it works and some of the adjustments implemented during the
ongoing Thai Tsunami Victim Identification process.
731: Food Nutr Bull. 2005 Sep;26(3):255-8.

Thirty years of a ban on the sale of noniodized salt: impact on iodine

nutrition in children in Himachal Pradesh, India.
Kapil U, Sharma TD, Singh P, Dwivedi SN, Kaur S.

Department of Human Nutrition, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi 1-110029, India. kapilumesh@hotmail.com
BACKGROUND: A survey conducted by the central iodine-deficiency disorders

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

Erratum in:
• Ann Pharmacother. 2005 Dec;39(12):2143. Yeom, Jong Hum [corrected

to Yeom, Jong Hun].
Identification of inappropriate drug prescribing by computerized,

retrospective DUR screening in Korea.
Yeom JH, Park JS, Oh OH, Shin HT, Oh JM.

College of Medicine, Han Yang University, Seoul, Korea.
BACKGROUND: In Korea, the drug use process has changed significantly since
the new pharmacy law was implemented in 2000, separating the prescribing and
dispensing functions between physicians and pharmacists and mandating
prospective drug use review (DUR) practice by pharmacists immediately before
dispensing medications. However, a high prevalence of inappropriate prescribing
has been suspected by the public, pharmacists, and health insurance managers,
possibly due to suboptimal DUR practice by pharmacists. OBJECTIVE: To assess
overall patterns of drug usage and potential problems of inappropriate use in
outpatient settings by analyzing prescription data that were electronically
submitted to the national health insurance manager with a computerized DUR
system and develop a computerized adjudication system model for drug claims.
METHODS: The national prescription drug claims data that were submitted
electronically by pharmacies located in the northern part of Korea during 15 days
in 2002 were retrospectively screened against the predetermined DUR standards
of the selected criteria on drug dosage, duration of therapy, and drug interaction
using the DUR screening system. The results of all the DUR conflicts were
further validated manually by an expert panel and statistically analyzed to
determine drug use patterns. RESULTS: Of 31,994,260 drugs prescribed,
3,325,760 (10.4%) items showed a conflict with at least one of the DUR
standards. The average number of drugs prescribed on each prescription was 4.07,
and even more troubling was the high incidence of under-dosing, over-dosing,
and contraindicated drug prescribing. CONCLUSIONS: It is evident that
inappropriate drug prescribing is very common in Korea; thus, a great deal of
attention is urgently needed in the country with respect to proper prescribing and
supportive interventions.
Publication Types:
733: Acta Crystallogr D Biol Crystallogr. 2005 Oct;61(Pt 10):1364-72. Epub 2005
Sep 28.
Three-dimensional structure determination of proteins related to

human health in their functional context at The Israel Structural
Proteomics Center (ISPC). This paper was presented at ICCBM10.
Albeck S, Burstein Y, Dym O, Jacobovitch Y, Levi N, Meged R, Michael Y,

Peleg Y, Prilusky J, Schreiber G, Silman I, Unger T, Sussman JL.
Department of Structural Biology, Weizmann Institute of Science, Rehovot
76100, Israel.
The principal goal of the Israel Structural Proteomics Center (ISPC) is to

determine the structures of proteins related to human health in their functional
context. Emphasis is on the solution of structures of proteins complexed with their
natural partner proteins and/or with DNA. To date, the ISPC has solved the
structures of 14 proteins, including two protein complexes. It has adopted
automated high-throughput (HTP) cloning and expression techniques and is now
expressing in Escherichia coli, Pichia pastoris and baculovirus, and in a cell-free
E. coli system. Protein expression in E. coli is the primary system of choice in
which different parameters are tested in parallel. Much effort is being devoted to
development of automated refolding of proteins expressed as inclusion bodies in
E. coli. The current procedure utilizes tagged proteins from which the tag can
subsequently be removed by TEV protease, thus permitting streamlined
purification of a large number of samples. Robotic protein crystallization screens
and optimization utilize both the batch method under oil and vapour diffusion. In
order to record and organize the data accumulated by the ISPC, a laboratory
information-management system (LIMS) has been developed which facilitates
data monitoring and analysis. This permits optimization of conditions at all stages
of protein production and structure determination. A set of bioinformatics tools,
which are implemented in our LIMS, is utilized to analyze each target.
Publication Types:
734: East Mediterr Health J. 2004 Jan-Mar;10(1-2):56-63.

Capture-recapture methods for estimation of fertility and mortality

in a rural district of Turkey.
Aslan D, Ozcebe H, Bertan M, Karaağaoğlu E.
Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara,

Turkey.
The study used capture-recapture methods to determine if information on births,

deaths and family planning use obtained from two data sources provides the same
or more complete information than that available from a single source. Five
different data sources used were: village heads (mukhtars), community health
volunteers, primary health care centres, maternal and child care units and local
administrative units (health group presidencies) in 10 selected villages in a rural
area of Turkey from May to October 1999. Although the numbers of deaths and
births were estimated, no estimation of the number of women using any family
planning method could be made. The study highlights some data collection
problems of the surveillance system in Turkey and recommends that the routine
surveillance systems be strengthened.
Publication Types:
735: Environ Sci Technol. 2005 Sep 15;39(18):7318-28.

Site-dependent life-cycle analysis by the SAME approach: its

concept usefulness, and application to the calculation of embodied
impact intensity by means of an input-output analysis.
Nansai K, Moriguchi Y, Suzuki N.
Research Center for Material Cycles and Waste Management, and Endocrine
Disruptors and Dioxin Research Project, National Institute for Environmental
Studies, Tsukuba, Ibaraki, Japan. nansai.keisuke@nies.go.jp
This paper describes a practical approach to site-dependent life-cycle analysis

(SDLCA) that differentiates site-dependent environmental impacts from a
system's processes by considering the geographical conditions of each process.
This approach converts an environmental output into its impacts by using site-
dependent characterization factors (SDCFs). This approach defines an area-the
Spatial Area of iMpact Equivalency (SAME)-within the boundaries of the
geographical system during site-dependent life-cycle inventory (SDLCI) analysis
and calculates an environmental output from a process for the SAMEs. Each
SAME represents a collection of geographical areas with internally homogeneous
environmental impacts and can be mapped using a geographic information
system. Preparing a SDLCI and SDCFs based on SAMEs facilitates the
implementation of SDLCA by permitting the use of fewer regions during SDLCI.
To demonstrate application of the SAME approach, an embodied impact intensity
was formulated; it quantifies the impact directly and indirectly on the basis of the
unit activity of a sector by means of input-output analysis with SDCFs. The
validity of using SAMEs for SDLCA is demonstrated through two case studies:
one studying suspended particulate matter, and one studying benzene. In both
cases, the impact intensities are calculated using the SAME approach and the
results are compared with those of site-generic LCI.
736: Ambio. 2005 Aug;34(6):445-9.

Toward modeling regionally specific human security using GIS: case

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

The impact of computerization of the nutrition support process on

the nutrition support program in a tertiary care hospital in the
Philippines: report for the years 2000-2003.
Llido LO.
Room 315-316, MAB, Nutrition Support Services, St. Luke's Medical Center, E.
Rodriguez Sr. Avenue, Quezon City, Metro-Manila, Philippines.
llido2001@yahoo.com
BACKGROUND & AIMS: To improve hospital health care delivery by
identifying malnutrition in all admitted patients and following up those identified
to be malnourished and "at risk of developing malnutrition" a hospital nutrition
support program based on the JCAHO system was initiated in 1999. Two major
problems were encountered: first, the inability to perform a nutrition surveillance
process due to failure by the staff to implement existing nutrition screening tools
and second, the lack of awareness and support from the medical staff in this
initiative. Two solutions were implemented in 2000: computerization of the
nutrition screening and nutrition support process and synchronizing this with the
whole nutrition support program. METHODS: A computer program was
developed which performs BMI-based nutrition screening, produces lists of all
malnourished patients, and computes the different formulas for either nutritional
requirement or parenteral and/or enteral formulation. It also generates patient
status reports based on encoded data from the nutrition support team, which
prioritized these patients for management based on the data output. RESULTS:
From 2000 to 2003, improvement was seen in these areas: entry of height and
weight in the patient record increased from 30% to 90%; nutrition surveillance
shows nutritional status distribution to be: normal (58%), underweight (9%),
overweight (25%), and obese (8%), referrals to the nutrition support team based
on the screen notification increased from 37% to 100%, patient coverage by
nutrition support services increased from 7374 (38.8%) in 2000 to 11,369 (83%)
in 2003, and critical care patients seen increased from 10% in 2000 to 99% in
2003. More improvement is needed in physician response to nutrition support
recommendations, which still remains low (11.2-24%). CONCLUSIONS:
Computerization helps to improve nutrition support delivery in the hospital, but
more cooperation and support from the medical staff is still needed for better
results.
738: Science. 2005 Sep 30;309(5744):2156-9.

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

739: Bull World Health Organ. 2005 Aug;83(8):604-10.
The use of a computerized database to monitor vaccine safety in Viet

Nam.
Ali M, Canh GD, Clemens JD, Park JK, von Seidlein L, Minh TT, Thiem
DV, Tho HL, Trach DD; The Vaccine Safety Datalink Group.
International Vaccine Institute, SNU Campus, Seoul, Republic of Korea.
Health information systems to monitor vaccine safety are used in industrialized

countries to detect adverse medical events related to vaccinations or to prove the
safety of vaccines. There are no such information systems in the developing
world, but they are urgently needed. A large linked database for the monitoring of
vaccine-related adverse events has been established in Khanh Hoa province, Viet
Nam. Data collected during the first 2 years of surveillance, a period which
included a mass measles vaccination campaign, were used to evaluate the system.
For this purpose the discharge diagnoses of individuals admitted to polyclinics
and hospitals were coded according to the International Classification of Diseases
(ICD)-10 guidelines and linked in a dynamic population database with
vaccination histories. A case-series analysis was applied to the cohort of children
vaccinated during the mass measles vaccination campaign. The study recorded
107,022 immunizations in a catchment area with a population of 357,458 and
confirmed vaccine coverage of 87% or higher for completed routine childhood
vaccinations. The measles vaccination campaign immunized at least 86% of the
targeted children aged 9 months to 10 years. No medical event was detected
significantly more frequently during the 14 days after measles vaccination than
before it. The experience in Viet Nam confirmed the safety of a measles
vaccination campaign and shows that it is feasible to establish health information
systems such as a large linked database which can provide reliable data in a
developing country for a modest increase in use of resources.
Publication Types:
740: Death Stud. 2005 Jul-Aug;29(6):559-72.

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

Hadi A.
Research and Evaluation Division, Bangladesh Rural Advancement Committee,

BRAC, 75 Mohakhali, Dhaka 1212, Bangladesh. hadi.a@brac.net
This study attempts to improve our understanding of the prevalence and

determinants of violent death in rural Bangladesh. Data came from a demographic
surveillance system covering a population of nearly 62,000 in 10 districts of the
country. Findings reveal that drowning and homicide were the leading causes of
death followed by traffic accident and suicide. Significant sociodemographic
differentials in violent death existed. The probability to become the victim of
violent death was 61.2 per 100,000 if the person was very young, male, poor,
illiterate and Muslim. The author concludes that the public health program should
consider the appropriate mechanisms to prevent many avoidable events of death
in rural Bangladesh.
741: Int Arch Occup Environ Health. 2006 Feb;79(2):115-22. Epub 2005 Sep 27.
Negative association between serum dioxin level and oxidative DNA

damage markers in municipal waste incinerator workers.
Yoshida J, Kumagai S, Tabuchi T, Kosaka H, Akasaka S, Kasai H, Oda H.
Department of Environmental Health, Osaka Prefectural Institute of Public

Health, Osaka, 1-3-69, Nakamichi, Higashinari-ku, 537-0025, Japan.
jnyosida@iph.pref.osaka.jp
OBJECTIVES: To investigate the effect of dioxin on the formation of oxidative

DNA damage and urinary mutagenicity, we measured the concentrations of serum
dioxins and lymphocytic 8-hydroxydeoxyguanosine (8-OH-dG) in 57 male waste
incinerator workers, urinary 8-OH-dG and urinary mutagenicity in 29 male waste
incinerator workers. METHODS: Information about the subjects was obtained
from a questionnaire. Concentrations of polychlorinated dibenzo-p-dioxin
(PCDD), polychlorinated dibenzofuran (PCDF), and coplanar-polychlorinated-
biphenyl (Co-PCB) in serum samples from the workers were measured with a
high-resolution gas chromatograph /high-resolution mass spectrometer.
Lymphocytic and urinary 8-OH-dG levels were measured with a high-
performance liquid chromatography-electrochemical detector system. The urinary
mutagenicity was measured with umu assay. RESULTS: The lymphocytic 8-OH-
dG level showed a negative association with the serum dioxin level (total value of
TEQ-PCDD, PCDF, and Co-PCB). Urinary 8-OH-dG did not show correlation
with serum dioxin level, but showed positive correlation with the smoking index.
CONCLUSIONS: With respect to the subjects' serum dioxin level, dioxin did not
increase the urinary 8-OH-dG level by oxidative DNA damage, but upregulation
of the primary defenses with oxidative damage and/or DNA repair system activity
might have occurred.
742: Diabetes Care. 2005 Oct;28(10):2514-8.

High plasma level of remnant-like particle cholesterol in the

metabolic syndrome.
Satoh A, Adachi H, Tsuruta M, Hirai Y, Hiratsuka A, Enomoto M, Furuki

K, Hino A, Takeuchi T, Imaizumi T.
The Third Department of Internal Medicine and The Cardiovascular Institute,

Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-
0011, Japan.
OBJECTIVE: The metabolic syndrome is associated with a high incidence of

cardiovascular disease even when the abnormalities present in the syndrome are
mild. The underlying mechanism of the metabolic syndrome has not been
elucidated. We investigated whether a strong atherogenic lipoprotein, remnant-
like particle (RLP) lipoprotein cholesterol, is elevated in the metabolic syndrome.
RESEARCH DESIGN AND METHODS: We performed a health examination
among the residents of a rural community in Japan. Complete datasets, including
fasting RLP cholesterol levels, were obtained in 1,261 subjects (509 men and 752
women) without diabetes and who were not taking lipid-lowering drugs. The
subjects' medical history, use of alcohol, and smoking habits were ascertained by
a questionnaire. RESULTS: All of the components of the metabolic syndrome
were significantly related to RLP cholesterol by univariate analysis. Total
cholesterol and smoking habits were also positively associated with RLP
cholesterol. The subjects with the metabolic syndrome showed only mild
abnormalities of each component. When RLP cholesterol levels were stratified by
the number of the components of the metabolic syndrome, there was a strong
association between RLP cholesterol levels and the number of components (P <
0.001 and F = 72.7). CONCLUSIONS: RLP cholesterol levels are elevated in the
metabolic syndrome, and this elevation may underlie the high incidence of
cardiovascular disease in the metabolic syndrome.
Publication Types:

743: Bull World Health Organ. 2005 Aug;83(8):618-25. Epub 2005 Sep 22.
Evaluating national cause-of-death statistics: principles and

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

744: Bull World Health Organ. 2005 Aug;83(8):611-7. Epub 2005 Sep 22.
Sample registration of vital events with verbal autopsy: a renewed

commitment to measuring and monitoring vital statistics.
Setel PW, Sankoh O, Rao C, Velkoff VA, Mathers C, Gonghuan Y, Hemed

Y, Jha P, Lopez AD.
Department of Epidemiology and MEASURE Evaluation, Carolina Population

Center, University of North Carolina, Chapel Hill, NC 27516, USA.
psetel@unc.edu
Registration of births, recording deaths by age, sex and cause, and calculating
mortality levels and differentials are fundamental to evidence-based health policy,
monitoring and evaluation. Yet few of the countries with the greatest need for
these data have functioning systems to produce them despite legislation providing
for the establishment and maintenance of vital registration. Sample vital
registration (SVR), when applied in conjunction with validated verbal autopsy
procedures and implemented in a nationally representative sample of population
clusters represents an affordable, cost-effective, and sustainable short- and
medium-term solution to this problem. SVR complements other information
sources by producing age-, sex-, and cause-specific mortality data that are more
complete and continuous than those currently available. The tools and methods
employed in an SVR system, however, are imperfect and require rigorous
validation and continuous quality assurance; sampling strategies for SVR are also
still evolving. Nonetheless, interest in establishing SVR is rapidly growing in
Africa and Asia. Better systems for reporting and recording data on vital events
will be sustainable only if developed hand-in-hand with existing health
information strategies at the national and district levels; governance structures;
and agendas for social research and development monitoring. If the global
community wishes to have mortality measurements 5 or 10 years hence, the
foundation stones of SVR must be laid today.
Publication Types:


745: Altern Lab Anim. 2005 Apr;33(2):111-8.
The use of live apes in research in the twenty-first century.
Hagelin J.
joakim.hagelin@hsl.gov.uk
A literature-based survey was conducted on the use of live apes in research

between 2000 and 2003. The 599 studies identified and considered were grouped
according to area of research, taxonomy and geographic location of the work. The
results suggested that behaviour/cognition, conservation and various applications
related to virology (most notably, hepatitis and HIV) were the most frequent areas
of research. Of the studies, 73% were classified as non-invasive, whereas 27%
were classified as invasive. Among the invasive studies, 39% were scored as of
mild severity, and 61% were scored as of moderate/substantial severity. Pan
species were involved in 65% of the studies, Gorilla species in 15%, Pongo
species in 12%, and Hylobates species in 8%. Most of the invasive research was
conducted in the USA (60%). The majority of the non-invasive research was
conducted in the USA (31%), Japan (13%), or in the animals natural habitats in
Africa (35%) and Asia (8%).
Publication Types:
• Historical Article
746: J UOEH. 2005 Sep 1;27(3):279-93.

[Actual condition survey on inclusive child day-care--a

questionnaire survey of child day-care facilities in K city]
Kawachi S, Hamada Y, Fukuzawa Y.
Department of Nursing Science and Arts, School of Health Sciences, University

of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-
8555, Japan.
The purpose of this questionnaire survey is to gather information on actual

conditions of inclusive child day-care in K City in order to qualify what support
we can provide as part of the community. The questionnaire was sent to 148
child-care facilities (day nurseries) in date, of which 116 provided sufficient data
for analysis. Of these 116 facilities, 104 (89.7%) accepted children with
disabilities, while 12 (10.3%) did not. The number of disabled children accepted
by the 104 facilities over a 2.5-year period was 275. Mental retardation (including
children with multiple disabilities) was the most common type of disability;
autism, physical disability and cerebral palsy were also seen. Thus, nursery staff,
whose training is largely geared toward education and child development, is faced
with a particularly difficult task. What we envisage as one of our future roles is to
train and provide nursing experts with a specialized knowledge of medical
rehabilitation, day-to-day medical care, training and support of children with
various types of disabilities. Such nurses could then be introduced to child day-
care facilities to provide individualized child-care services, which would take into
account all factors relating to the child's condition and developmental stage. The
results of our survey also suggest that close coordination and partnership with
specialized/related agencies and institutions should be pursued in order to both
enrich the support systems of child day-care facilities and to enhance their
inclusiveness.
Publication Types:
747: J Med Syst. 2005 Aug;29(4):391-400.

Dolphin project--cooperative regional clinical system centered on

clinical information center.
Takada A, Guo J, Tanaka K, Sato J, Suzuki M, Suenaga T, Kikuchi K, Araki

K, Yoshihara H.
Medical Information Technology, Kumamoto University Hospital, Honjo 1-1-1,

Kumamoto, Japan. takada@fc.kuh.kumamoto-u.ac.jp
In 2001, a system was created to improve patient service, improve the quality of
medical care, and achieve efficient medical care. A Data Center was established
to accumulate and manage clinical information in the regions and share clinical
information safely and appropriately. The system has already been in operation
for 3 years. Even though a patient may have been examined at multiple hospitals,
his medical record information will be integrated at the Center. This ensures
medical care continuity and enables the patient to view his own medical records at
home. Its usefulness in obtaining informed consent has been demonstrated as
well. XML instances established in the MML standards (MML (Medical Markup
Language): http.//www.medxml.net/E_mml30/mmlv3_E_index.htm Accessed
July 2004; Jpn. J. Med. Informatics (JJMI) 17(3):203-207, 1997; J. Med. Syst.
24(3):195-211, 2000; J. Med. Syst. 27(4):357-366, 2003; J. Med. Syst. 28(6):523-
533, 2004) are used for Electronic Medical Record System data exchange
between the Data Center and each medical institution. The openness provided by
XML makes it possible to connect diverse electronic medical records to the
Center. As of the year 2004, over 10 types of electronic medical records have an
MML interface, enabling connection to the Center.
748: Indian J Med Res. 2005 Aug;122(2):137-42.

Utilization of indigenous systems of medicine & homoeopathy in

India.
Singh P, Yadav RJ, Pandey A.
Institute for Research in Medical Statistics (ICMR), Ansari Nagar, New Delhi
110-029, India.
BACKGROUND & OBJECTIVE: Very little information is available on the

utilization of Indian systems of medicine and homoeopathy (ISM&H) in India. A
study was undertaken on the usage and acceptability of indigenous systems of
medicine to provide estimate of utilization of different indigenous systems of
medicine in the country along with the reasons for preferences as well as the cost
of treatment. METHODS: The study covered 35 districts spreading over 19 States
of the country. From 16 major States, two districts each were selected randomly
one from the list of districts with high utilization level and another with low level
of utilization. From other 3 States, one district each was selected randomly. From
each selected district, 1000 households with at least one sick person were covered.
This was achieved by selecting 50 Urban Frame Surveys (UFS)/villages and 20
sick persons each per village/UFS. Allocation of 50 First Stage Units (FSUs)
among rural and urban sectors was made in proportion to rural-urban population
of the district. From selected FSUs, 20 households with at least one sick person
was selected randomly. The data were collected on the health seeking behaviour
of persons who were sick (with common or serious ailments) in the last three
months before survey including at the time of survey. RESULTS: About 45,000
sick persons from 33,666 households from 35 districts of the country were
covered. The preference of ISM&H for common ailment was about 33 per cent
while only 18 per cent preferred to use these systems in case of serious ailments
in the country. The sick persons actually availing ISM&H treatment were about
14 per cent. Of those who preferred ISM&H, the reasons were mainly "no side
effect" and low cost of treatment. Slow progress was the main reason for not
preferring the indigenous systems. INTERPRETATION & CONCLUSION: The
findings of this study showed that about 14 per cent sick persons utilizing
indigenous system of medicine. Slow progress and non availability of
practitioners were the main reasons for not preferring the ISM & H treatment.
Publication Types:
749: Chin J Traumatol. 2005 Oct;8(5):259-62.

Development of the trauma emergency care system based on the

three links theory.
Jiang GY, Shen WF, Gan JX.
Emergency Center, the Second Hospital Affiliated to Zhejiang University Medical

College, Hangzhou 310009, China.
The three links theory applied in trauma emergency care system refers to an
integrated system with the three important components of trauma emergency care
system, viz. prehospital trauma services, hospital trauma services and critical care
services. The development of the trauma emergency care system should be guided
by the three links theory so as to set up a practical and highly efficient system: a
prompt operating and monitoring transportation system, a smooth and real-time
information system, a rational and sustainable system of regulations and
contingency plans, and a system for cultivating all-round trauma physicians.
Publication Types:
• Review
750: Bull World Health Organ. 2005 Jul;83(7):534-40.

An evidence-based approach to benchmarking the fairness of
health-sector reform in developing countries.
Daniels N, Flores W, Pannarunothai S, Ndumbe PN, Bryant JH, Ngulube TJ,

Wang Y.
Harvard School of Public Health, Department of Population and International

Health, Boston, MA 02115, USA. ndaniels@hsph.harvard.edu
The Benchmarks of Fairness instrument is an evidence-based policy tool

developed in generic form in 2000 for evaluating the effects of health-system
reforms on equity, efficiency and accountability. By integrating measures of these
effects on the central goal of fairness, the approach fills a gap that has hampered
reform efforts for more than two decades. Over the past three years, projects in
developing countries on three continents have adapted the generic version of these
benchmarks for use at both national and subnational levels. Interdisciplinary
teams of managers, providers, academics and advocates agree on the relevant
criteria for assessing components of fairness and, depending on which aspects of
reform they wish to evaluate, select appropriate indicators that rely on accessible
information; they also agree on scoring rules for evaluating the diverse changes in
the indicators. In contrast to a comprehensive index that aggregates all measured
changes into a single evaluation or rank, the pattern of changes revealed by the
benchmarks is used to inform policy deliberation aboutwhich aspects of the
reforms have been successfully implemented, and it also allows for improvements
to be made in the reforms. This approach permits useful evidence about reform to
be gathered in settings where existing information is underused and where there is
a weak information infrastructure. Brief descriptions of early results from
Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the
method can produce results that are useful for policy and reveal the variety of
purposes to which the approach can be put. Collaboration across sites can yield a
catalogue of indicators that will facilitate further work.
Publication Types:
751: Soc Sci Med. 2006 Apr;62(7):1685-96. Epub 2005 Sep 19.
Stigmatizing experience and structural discrimination associated
with the treatment of schizophrenia in Hong Kong.
Lee S, Chiu MY, Tsang A, Chui H, Kleinman A.
Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong

Kong. singlee@cuhk.edu.hk
This research examines the experience of stigma associated with psychiatric

treatment among Chinese patients with schizophrenia in Hong Kong. In focus
groups patients described stigma experiences related to clinic visits and the side
effects of antipsychotic medications. Additionally, they revealed various adverse
treatment experiences during hospitalization which point to the presence of
structural discrimination. Based on the focus group findings, a questionnaire was
developed and completed by 320 and 160 patients with schizophrenia and
diabetes mellitus, respectively. Results showed that patients with schizophrenia
were more likely to anticipate stigma, conceal illness, and default on clinic visits
than patients with diabetes. Medication-induced stigma occurred in 48% of
patients with schizophrenia. It brought about the unwelcome disclosure of illness,
workplace difficulties, family rejection, and treatment non-adherence. Adverse
experiences during hospitalization were reported by 44% of patients with
schizophrenia. They included negative staff attitudes, excessive physical/chemical
restraints, inadequate information/complaint systems, and limited rights. We
conclude that stigma, at both individual and structural levels, represents a central
experience of the treatment of schizophrenia in Hong Kong. Because inequitable
health policy, resource allocation, and service organization privilege service
providers' control over users, treatment-related stigma may be a prime example of
the social production of stigma and discrimination based on power difference
between the stigmatizers and the stigmatized. To examine this critically we need
to redirect stigma research to tractable clinical circumstances and structural
mechanisms that produce and maintain stigmatizing and discriminatory
psychiatric practice. Destigmatization programs must be evaluated not only by
change in public attitudes but also by how much they reduce structural stigma and
improve patients' lives.
Publication Types:
752: Childs Nerv Syst. 2006 Apr;22(4):352-62. Epub 2005 Sep 17.
Pediatric neurotrauma in Kathmandu, Nepal: implications for
injury management and control.
Mukhida K, Sharma MR, Shilpakar SK.
Division of Neurosurgery, University of Toronto, Toronto, Canada.

kmukhida@dal.ca
OBJECTS: There is a scarcity of data regarding childhood neurological injuries in

developing countries such as Nepal. The epidemiology of acute pediatric
neurotrauma in Kathmandu was studied to assess the implications of these data
for injury prevention programs. METHODS: The clinical records of patients
<or=18 years who presented to Tribhuvan University Teaching Hospital between
April 1, 2001 and April 1, 2004 with acute neurological trauma and were
subsequently admitted to hospital were retrospectively reviewed. A standard
proforma was used to collect information on patient demographics, the nature and
etiology of the injuries, their acute management, and outcomes. CONCLUSIONS:
Four hundred sixteen injured children were admitted to hospital, and the charts for
352 (85%) were available for review. Spinal injuries were relatively rare (4%)
compared to head injuries (96%). Falls were the most common cause of injuries
(61%). It took significantly longer (p<0.001) for children injured in rural Nepal
(62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu
(7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of
patients with mild, moderate, or severe head injuries, respectively. Besides efforts
to improve prehospital transport and acute management of these injuries,
preventive measures that are applicable to the Nepalese scenario are urgently
needed. Interventions should focus on health education programs directed at
parents and children and upgrading of road safety measures. Neurological injuries
must also be viewed in the context of the broader social issues in Nepal that
contribute to injury.
753: Hum Psychopharmacol. 2005 Oct;20(7):459-65.

Are they being used safely? A retrospective cross-sectional tertiary

health care survey of selective serotonin reuptake inhibitors
prescribing practice in Singapore.
Xie F, Tan CH, Li SC.
Department of Pharmacy, National University of Singapore, Singapore.

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

Implementation of the community network of reference laboratories

for human influenza in Europe.
Meijer A, Valette M, Manuguerra JC, Pérez-Breña P, Paget J, Brown C, van

der Velden K; Virology Working Group of the European Influenza
Surveillance Scheme.
European Influenza Surveillance Scheme Co-ordination Centre, Netherlands

Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The
Netherlands. a.meijer@nivel.nl
BACKGROUND: The increased need for accurate influenza laboratory

surveillance data in the European Union required formalisation of the existing
network of collaborating national influenza reference laboratories participating in
the European Influenza Surveillance Scheme (EISS). OBJECTIVE: To establish a
Community Network of Reference Laboratories for Human Influenza in Europe
(CNRL). METHODS: Virologists in EISS defined the objective and tasks of the
CNRL. Performance of the laboratories in the tasks was monitored by
questionnaire-based inventories and quality control assessments (QCA).
Subsequently, actions were defined to improve the performance of the CNRL.
RESULTS: The CNRL started in April 2003 and included as of May 2004 32
laboratories in 24 European countries. The objective is to provide high quality
reference services for human influenza surveillance, early warning and pandemic
preparedness in Europe. The defined basic tasks are direct detection, culture,
typing, subtyping and strain characterisation of influenza virus, diagnostic
influenza serology and storage of clinical specimens and virus isolates. The
questionnaire-based inventories and QCAs revealed that the majority of CNRL
laboratories perform well in most of the basic tasks, although improvements are
needed in certain areas of virus testing. Therefore, task groups have been
established to further improve the methods used in the network. The CNRL has
proven its usefulness during the 2003-2004 season by the reporting of accurate
data concerning the flu epidemic caused by A/Fujian/411/2002 (H3N2)-like
viruses and by the rapid sharing of information, protocols and reagents during the
A(H5N1) and A(H7N3) epizootics in Asia and Canada. CONCLUSION: EISS
has established a functioning Community Network of Reference Laboratories for
Human Influenza in Europe and laid the foundation for further enhancement and
collaborations. Important next steps include improving the laboratories to carry
out all basic tasks and collaboration with the European Centre for Disease
Prevention and Control.
Publication Types:
755: Prehosp Emerg Care. 2005 Jul-Sep;9(3):355-60.

Limitations of secondary data sets for road traffic injury

epidemiology: a study from Karachi, Pakistan.
Razzak JA, Laflamme L.
Division of Social Medicine, Department of Public Health Sciences, Karolinska

Institutet, Stockholm, Sweden. junaidrazzak@yahoo.com
OBJECTIVES: To evaluate the completeness of descriptive information and

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

Comparison of oral and pharyngeal cancer mortality in five

countries: France, Italy, Japan, UK and USA from the WHO
Mortality Database (1960-2000).
Tanaka S, Sobue T.
and Screening, National Cancer Center, 1-1 Tsujiki 5-chome, Chuo-ku, Tokyo
104-0045, Japan..
Publication Types:
757: Health Policy Plan. 2005 Nov;20(6):366-74. Epub 2005 Sep 2.

Community-based health insurance in poor rural China: the

distribution of net benefits.
Wang H, Yip W, Zhang L, Wang L, Hsiao W.
Global Health Division, Yale University School of Public Health, 60 College

Street, Suite 315, New Haven, CT 06520-8034, USA. hong.wang@yale.edu
The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in

the lack of an organized financing scheme for health care, adversely affecting
rural farmers' access to health care, especially among the poor. The Chinese
government recently announced a policy to re-establish some forms of
community-based insurance (CBI). Many existing schemes involve low premiums
but high co-payments. We hypothesized that such benefit design leads to unequal
distribution of the "net benefits" (NB)--benefits net of payment--because even
though low premiums are more affordable to poor farmers, high co-payments may
have a significant deterrent effect on the poor in the use of services in CBI. To
test this hypothesis empirically, we estimated the probability of farmers joining a
re-established CBI using logistic regression, and the utilization of health care
services for those who joined the scheme using the two-part model. Based on the
estimations, we predicted the distribution of NB among those who joined the CBI
and for the entire population in the community. Our data came from a household
survey of 4160 members of 1173 households conducted in six villages in
Fengshan Township, Guizhou Province, China. Three principal findings emerged
from this study. First, income is an important factor influencing farmers' decision
to join a CBI despite the premium representing a very small fraction of household
income. Secondly, both income and health status influence enrollees' utilization of
health services: richer/sicker participants obtain greater NB from the CBI than
poorer/healthier members, meaning that the poorer/healthier participants subsidize
the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low
premium and high co-payment features at every level of health status. In
conclusion, policy recommendations related to the improvement of the benefit
distribution of CBI schemes are made based on the results from this study.
Publication Types:
758: Forensic Sci Int. 2005 Oct 29;153(2-3):161-7. Epub 2004 Nov 11.
Malpractice and system of expertise in anaesthetic procedures in

Turkey.
Ozdemir MH, Cekin N, Can IO, Hilal A.
Faculty of Medicine, Dokuz Eylul University, Department of Forensic Medicine,

Izmir, Turkey. hakan.ozdemir@deu.edu.tr
Deaths which occur during the administration of anaesthetics require medicolegal

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

Managing knowledge integration in a national health-care crisis:

lessons learned from combating SARS in Singapore.
Devadoss PR, Pan SL, Singh S.
Department of Information Systems, School of Computing, National University

of Singapore, Singapore 17543, Singapore . paulraj@nus.edu.sg
The outbreak of Severe Acute Respiratory Syndrome is the first severe and
readily transmissible disease to emerge in the 21st century. Often one new
infection meant tracing of several people to monitor their health conditions as
well. In Singapore, several agencies coordinated their efforts to quickly bring the
outbreak under control. The current breed of health-care information systems
(HCIS) was not sufficient to handle new information-sharing needs during the
crisis. In this paper, we take a look at the measures taken during the crisis in
Singapore through a knowledge integration perspective. This perspective reveals
interesting implications for HCIS.
760: IEEE Trans Inf Technol Biomed. 2005 Jun;9(2):193-204.

A knowledge creation info-structure to acquire and crystallize the

tacit knowledge of health-care experts.
Abidi SS, Cheah YN, Curran J.
Faculty of Computer Science, Dalhousie University, Halifax, NS B3H IW5,

Canada. sraza@cs.dal.ca
Tacit knowledge of health-care experts is an important source of experiential

know-how, yet due to various operational and technical reasons, such health-care
knowledge is not entirely harnessed and put into professional practice. Emerging
knowledge-management (KM) solutions suggest strategies to acquire the
seemingly intractable and nonarticulated tacit knowledge of health-care experts.
This paper presents a KM methodology, together with its computational
implementation, to 1) acquire the tacit knowledge possessed by health-care
experts; 2) represent the acquired tacit health-care knowledge in a computational
formalism--i.e., clinical scenarios--that allows the reuse of stored knowledge to
acquire tacit knowledge; and 3) crystallize the acquired tacit knowledge so that it
is validated for health-care decision-support and medical education systems.
761: Biomed Environ Sci. 2005 Jun;18(3):153-8.

Assessment of impacts of public health interventions on the SARS

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

School of Health Management and Education, Capital University of Medical
Sciences, Beijing 100054, China. liangwannian@sina.com
OBJECTIVES: To assess the impacts of public health interventions on the

outbreak of SARS in Beijing by analyzing the intervals between symptom onset,
hospital admission and notification of its cases. METHODS: Data of SARS cases
reported from the Beijing Municipal Centers for Disease Prevention and Control
(BCDC) were collected and analyzed by descriptive epidemiology. RESULTS: In
the early epidemic period, the intervals between the disease onset and the hospital
admission seemed irregular, so was the intervals between the hospital admission
and the notification. After the middle ten days of April, the intervals turned out to
be more regular, and the disordered situation in terms of the hospital admission
and the case notification was gradually brought under control. CONCLUSIONS:
Public health interventions against SARS has revealed positive impacts on SARS
control program in Beijing. The timing and sensitivity of epidemic information
reporting systems has been greatly improved in Beijing as a result of successful
fight against this disease.
762: Int J Med Inform. 2006 May;75(5):369-83. Epub 2005 Aug 29.
Health information system for community-based multiple screening

in Keelung, Taiwan (Keelung Community-based Integrated
Screening No. 3).
Chiu YH, Chen LS, Chan CC, Liou DM, Wu SC, Kuo HS, Chang HJ, Chen
TH.
Institute of Public Health and Institute of Health Informatics and Decision

Making, National Yang-Ming University, Taipei, Taiwan.
BACKGROUND: Community-based multiple screening for common cancers and

chronic diseases has increasingly gained attention. However, as infrastructure and
evaluation system are more diversified and complicated compared with single
screening, the development of a novel health information system is paramount.
METHODS: The main goal of our health information system was to support the
multiple screening program not only from technical aspect but also from a broad
range of perspectives including quality assurance system, organized features
appertaining to screening, economic evaluation (cost-effectiveness or cost-utility
analysis), epidemiological applications, behavior risk factor surveillance system,
and social impact due to the introduction of the Keelung Community-Based
Integrated Screening (KCIS) program. RESULTS: Health information system was
designed and programmed on the basis of the demand derived from KCIS within
which five cancers and three chronic diseases were included. In addition to the
detailed description of infrastructure and process, design, relevant database and
security involved in health information system, an innovative and extensive
evaluation system in accordance with the main goals was included in our health
information system. CONCLUSION: Our information system proposed several
aspects regarding organized screening system that has never been addressed in
computerized system supporting for single screening. These included quality
assurance system, organization features, co-morbidity profiles, epidemiological
applications and social and economic considerations.
Publication Types:
763: Diabetes Res Clin Pract. 2005 Oct;70(1):71-80. Epub 2005 Apr 9.
Hypertension in type 2 diabetes mellitus in Isfahan, Iran: incidence

and risk factors.
Janghorbani M, Amini M.
Isfahan Endocrinology and Metabolism Research Centre, Isfahan University of

Medical Sciences and Health Services, Department of Epidemiology and
Biostatistics, School of Public Health, Isfahan, Iran. janghorbani@yahoo.com
BACKGROUND: Evidence on the long-term incidence of and risk factors of

hypertension in diabetic patients is scarce and mainly derived from studies in
developed countries. Evidence from developing countries is required for planning
a well-co-ordinated approach to this public health problem in these countries.
OBJECTIVE: The objectives of present study were to estimate the incidence of
and risk factors for the development of hypertension in people with type 2
diabetes mellitus using routinely collected data from a clinical information system
at Isfahan Endocrinology and Metabolism Research Centre, Iran. METHOD:
During the mean (standard deviation (S.D.)) follow-up period of 2.9 (2.5) (range
1-11) years, 3202 diabetic patients (1315 male and 1887 female) from Isfahan
Endocrinology and Metabolism Research Centre out patient clinics, Iran have
been examined. The mean (S.D.) age of participants was 48.3 (10.6) years with a
mean (S.D.) duration of diabetes of 6.5 (6.7) years at initial registration. Blood
pressure was measured by standardised protocols, and hypertension was defined
as at least in two consecutive measurements within 2 months a systolic and/or
diastolic blood pressure of >or=130 and/or >or=80 mmHg and/or taking anti-
hypertensive medication. RESULTS: Among the 3202 patients free of
hypertension at initial registration who attended the clinic at least twice in the
period 1992-2004, the incidence of hypertension was 20.8 (20.6 male and 20.9
female) per 100 person-years based on 9403 person-years of follow-up. The age-
adjusted incidence rate of hypertension was 22% lower among insulin-treated
than non-insulin-treated type 2 diabetes mellitus clinic attenders and it was greater
with older age. Using a Cox's Proportional Hazards Model, male gender, and
treatment regimen were significant independent predictors of hypertension.
Smoking, duration of diabetes, age at diagnosis of diabetes, fasting blood glucose,
glycosylated haemoglobin, BMI, proteinuria and creatinine, had no significant
independent association with hypertension when other covariates were
considered. CONCLUSION: These findings will help the identification of those
patients at particular risk of hypertension and strongly support the case for
vigorous control of blood pressure on type 2 diabetic patients.
764: Int J Med Inform. 2006 Feb;75(2):173-81. Epub 2005 Aug 24.
The impacts of smart cards on hospital information systems--an

investigation of the first phase of the national health insurance smart
card project in Taiwan.
Liu CT, Yang PT, Yeh YT, Wang BL.
Graduate Institute of Medical Informatics, Taipei Medical University, 250 Wu-

Xing Street, Taipei 107, Taiwan. ctliu@tmu.edu.tw
PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of

National Health Insurance (TBNHI) smart card project on existing hospital
information systems. SETTING: TBNHI has launched a nationwide project for
replacement of its paper-based health insurance cards by smart cards (or NHI-IC
cards) since November 1999. The NHI-IC cards have been used since 1 July
2003, and they have fully replaced the paper-based cards since 1 January 2004.
Hospitals must support the cards in order to provide medical services for insured
patients. METHODS: We made a comprehensive study of the current phase of the
NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30
November, 2003) to investigate the impacts of NHI-IC cards on the existing
hospital information systems. A questionnaire was distributed by mail to 479
hospitals, including 23 medical centers, 71 regional hospitals, and 355 district
hospitals. The returned questionnaires were also collected by prepaid mail.
RESULTS: The questionnaire return rates of the medical centers, regional
hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1
of the project, the average number of card readers purchased per medical center,
regional hospital, and district hospital were 202, 45 and 10, respectively. The
average person-days for the enhancement of existing information systems of a
medical center, regional hospital and district hospital were 175, 74 and 58,
respectively. Three months after using the NHI-IC cards most hospitals (60.6%)
experienced prolonged service time for their patients due to more interruptions
caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in
authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and
(4) problems with interfaces between the card readers and hospital information
systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was
2.86. Although most hospitals were OK with the project, there was about 22%
dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied
(about 10%). CONCLUSIONS: Our recommendations for those who are planning
to implement similar projects are: (1) provide public-awareness programs or
campaigns across the country for elucidating the smart card policy and educate
the public on the proper usage and storage of the cards, (2) improve the quality of
the NHI-IC cards, (3) conduct comprehensive tests in software and hardware
components associated with NHI-IC cards before operating the systems and (4)
perform further investigations in authentication approaches and develop tools that
can quickly identify where and what the problems are.
Publication Types:
765: Clin Ther. 2005 Jun;27(6):970-8.

A survey on the extent of medication storage and wastage in urban

Iranian households.
Zargarzadeh AH, Tavakoli N, Hassanzadeh A.
Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of

Medical Sciences, Iran. zargarzadeh@pharm.mui.ac.ir
BACKGROUND: Prescription and nonprescription medications constitute a

substantial proportion of the health care costs of countries. National drug policies
and attitudes toward medication use may play a role in irrational prescribing and
consumption of medicines, leading to drug wastage. The limited resources of
developing countries warrant more careful assessments of current national drug
policies. OBJECTIVE: This study quantified the amounts and types of
medications that are stored in a sample of urban Iranian households and estimated
the extent of drug wastage in these families. METHODS: A literature search was
conducted using MEDLINE and International Pharmaceutical Abstracts for 1966
to 2004 to identify articles on drug utilization and wastage. Randomly selected
households in a large city in Iran were visited to determine the amounts and types
of medicines stored in these households. A questionnaire was used to collect
information about medication use in these families. RESULTS: A total of 512
households were assessed. The mean (SD) family size of household respondents
was 4.3 (1.6) members. Mothers were responsible for managing medications in
58.1% (291/501) of families. Presence of chronic illness, insurance coverage,
higher economic status, literacy among fathers, and siblings without medically
related jobs were the variables that showed a significant relationship with the
amount of medicines found in the households. The mean (SD) numbers of unit
doses of medicines and of drug products found in these households were 238.5
(198.6) and 22.99 (20.1), respectively. The most common therapeutic classes of
medications kept at home were central nervous system agents, anti-infectives, and
gastrointestinal medications. The real and potential medication wastage was
estimated to be 38.8% and 53.8%, respectively. CONCLUSIONS: Medications
were stored in large quantities in these urban Iranian households, and a large
percentage was being wasted. Drug-use assessments and a comprehensive
evaluation of the current national drug policies are warranted to curtail this
problem.
Publication Types:
766: Med J Malaysia. 2005 Jun;60(2):180-7.

An evaluation of information dissemination during the severe acute

respiratory syndrome (SARS) outbreak among selected rural
communities in Kuala Kangsar.
Hazreen AM, Myint Myint S, Farizah H, Abd Rashid M, Chai CC, Dymna
VK, Gilbert W, Sri Rahayu S, Seri Diana MA, Noor Huzaimnah H.
Department of Social and Preventive Medicine, University of Malaya, Kuala

Lumpur.
To assess the level of knowledge, attitude and practice (KAP) on SARS and its
preventive measures among the rural population of Kuala Kangsar district. This
KAP study was also done to identify the expectation and preference of rural
population upon obtaining health information. This is a cross-sectional study of
201 households from four villages in Kuala Kangsar. Face-to-face interview was
done regarding knowledge, attitude and practice on SARS and its preventive
measures. Statistical analyses were performed with SPSS (Version 10.0). A
scoring system was used to assess the level of knowledge, attitude and practice
towards SARS. Ninety one percent of the study population was aware of SARS.
Majority of them have good attitude towards SARS based on the formulated
scoring system. Television was found to be the first hand information about
SARS and most preferred source of information by the rural population.
Knowledge and attitude of respondents concerning SARS were good. Television
was found to be the preference among the rural population in obtaining health
information.
Publication Types:
767: Int J Med Inform. 2005 Dec;74(11-12):952-9. Epub 2005 Aug 22.
Analysis of nursing records of cardiac-surgery patients based on the

nursing process and focusing on nursing outcomes.
Kim YJ, Park HA.
Asan Medical Center, Seoul, Korea.
This study analyzed what nurses wrote in narrative nursing notes for cardiac-
surgery patients. The nursing notes of 46 patients were analyzed based on the
nursing process. Eight patterns were extracted according to different combinations
of nursing process components, of which an assessment alone was the most
frequent nursing phrase (45.8%), followed by assessment or diagnosis-
intervention-outcome (25.9%). The content of the nursing notes was also
classified into 15 categories, of which nursing outcomes were recorded more
frequently in nursing care driven mainly by physician's order such as disease-
related symptom management, insomnia care, respiratory care, and pain control,
than in independent nursing care such as education and emotional care. A survey
on the attitudes of nurses toward the nursing record revealed that they do not
document nursing outcomes as much as they think they do. The main reasons for
this discrepancy were insufficient time for recording and lack of knowledge about
why, how, and what to evaluate. Even though there is room for improvement,
nursing notes represent a useful resource for determining nursing contributions to
patient outcomes.
768: Diabet Med. 2005 Sep;22(9):1226-33.

Comparison of processes and intermediate outcomes between South

Asian and European patients with diabetes in Blackburn, north-west
England.
McElduff P, Edwards R, Burns JA, Young RJ, Heller R, Long B, Jones G,

New JP.
Evidence for Public Health Unit, School of Epidemiology and Health Sciences,
University of Manchester, Manchester, UK. patrick.mcelduff@man.ac.uk
BACKGROUND: Diabetes and its complications are more prevalent among

South Asians than people of European origin and there is some evidence that
patients of South Asian origin with diabetes receive poorer quality care.
METHODS: Longitudinal study of patients with diabetes in Blackburn, UK.
Processes of care indicators [measurement of blood pressure (BP), cholesterol and
glycosolated haemoglobin (HbA1c)] and values of these intermediate outcomes
were extracted for all patients registered on a diabetes information system for the
period 1995-2001. Differences in processes of care indicators and intermediate
outcomes between ethnic groups were estimated after adjusting for the potential
confounding factors of sex, age and socioeconomic status (SES). Generalized
estimating equations were used to model trends and to test for differences in
trends over time. RESULTS: Process of care was similar in South Asian and
European patients. Mean BP and cholesterol concentration fell during the study
period. South Asians had a higher level of HbA1c throughout the study period.
South Asians had lower levels of BP and cholesterol in 1995 but the differences
diminished or were abolished over time. SES did not explain differences between
ethnic groups. Analyses stratified by baseline levels of intermediate outcomes
(above or within target) demonstrated improvements among above target patients
were greater among European patients. CONCLUSIONS: Processes of care
indicators are similar in diabetic patients of South Asian and European origin,
irrespective of SES. However, there are worrying differences in improvements
over time in the intermediate outcomes, and glycaemic control remained poorer
among patients of South Asian origin patients throughout.

769: Isr Med Assoc J. 2005 Aug;7(8):483-6.
The Western Galilee experience: reducing infant mortality in the

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

[Consulting work cited in the hospital laboratory annual progress

report of the laboratory information and consulting work and its
role in Toyama Medical and Pharmaceutical University Hospital]
Yamaguchi K, Tanaka Y, Takamori E, Kitajima I.
Department of Clinical Laboratory, Toyama Medical and Pharmaceutical

University Hospital, Toyama 930-0194.
Recently, it is difficult for general patients to understand clinical inspection.
Therefore we opened the laboratory information and consulting office (called
Kensa Yorozu Consulting Room) from April, 2004. It is most characteristic that
our office is managed by a clinical laboratory physician. A full time-specialized
doctor who is belong to clinical laboratory, is stationed in the office. Duties
contents of our office are consultation, publishing laboratory report and
information, education and the clinical studies. We don't limit a person of
consultation in particular. We accept consultations for 24 hours by coming our
office, telephone, Fax or E-mail. The amount of consultations is about 5-10 per
one month. The contents are suggesting inspection plan, explanation of
pathophysiologic information based on clinical inspect result and so on. The
examples compiled it into a database and maintains and their answers
information. Because there are clinical laboratory physicians in this office, there
are merits that follow. As for the medical technologist, it was not interfered with
routine duties. For doctors and co-medical staffs, it is possible for detailed
arguments to the diagnosis and treatment considered the condition of a patient and
a characteristic of laboratory method. Doctors of outside can talk with us by
telephones or emails easily. For patients, they can smoothly talk about their
diseases with their physicians knowing more laboratory information. More
medical stuffs need our office, because there are many repeaters although the total
number is small. Therefore it is important that we let everybody know about our
works and that we make good communication environment to talk easily, keeping
privacy. We want to compile and share database of laboratory information. Then
we can contribute to the area medical care.
Publication Types:
771: J Obstet Gynaecol Can. 2005 Jun;27(6):546.

2004 Shanghai international workshop of fetal macrosomia and

adult obesity.
Wen SW.
Publication Types:
• Letter
772: Vet Parasitol. 2005 Sep 30;132(3-4):249-72.

Disease and health management in Asian aquaculture.
Bondad-Reantaso MG, Subasinghe RP, Arthur JR, Ogawa K, Chinabut S,

Adlard R, Tan Z, Shariff M.
Fisheries Department, Food and Agriculture Organization of the UN, Vialle

Terme di Caracalla, 00100 Rome, Italy. Melba.Reantaso@fao.org
Asia contributes more than 90% to the world's aquaculture production. Like other
farming systems, aquaculture is plagued with disease problems resulting from its
intensification and commercialization. This paper describes the various factors,
providing specific examples, which have contributed to the current disease
problems faced by what is now the fastest growing food-producing sector
globally. These include increased globalization of trade and markets; the
intensification of fish-farming practices through the movement of broodstock,
postlarvae, fry and fingerlings; the introduction of new species for aquaculture
development; the expansion of the ornamental fish trade; the enhancement of
marine and coastal areas through the stocking of aquatic animals raised in
hatcheries; the unanticipated interactions between cultured and wild populations
of aquatic animals; poor or lack of effective biosecurity measures; slow awareness
on emerging diseases; the misunderstanding and misuse of specific pathogen free
(SPF) stocks; climate change; other human-mediated movements of aquaculture
commodities. Data on the socio-economic impacts of aquatic animal diseases are
also presented, including estimates of losses in production, direct and indirect
income and employment, market access or share of investment, and consumer
confidence; food availability; industry failures. Examples of costs of investment
in aquatic animal health-related activities, including national strategies, research,
surveillance, control and other health management programmes are also provided.
Finally, the strategies currently being implemented in the Asian region to deal
with transboundary diseases affecting the aquaculture sector are highlighted.
These include compliance with international codes, and development and
implementation of regional guidelines and national aquatic animal health
strategies; new diagnostic and therapeutic techniques and new information
technology; new biosecurity measures including risk analysis, epidemiology,
surveillance, reporting and planning for emergency response to epizootics;
targeted research; institutional strengthening and manpower development
(education, training and extension research and diagnostic services).
Publication Types:
• Review
773: Health Policy. 2006 Jul;77(2):172-81. Epub 2005 Aug 15.

Diagnosis and management of tuberculosis by private practitioners

in Manila, Philippines.
Auer C, Lagahid JY, Tanner M, Weiss MG.
Department of Public Health and Epidemiology, Swiss Tropical Institute,

Socinstr. 57, CH-4002 Basel, Switzerland. Christian.Auer@unibas.ch
SETTING: Private for-profit health care providers are prominent in the health
system of the Philippines. OBJECTIVES: To examine the practices of the private
practitioners in Malabon, Metropolitan Manila, Philippines, concerning diagnosis
and treatment of tuberculosis (TB). DESIGN: Forty-five private practitioners of
Malabon who treat adult TB patients were interviewed. RESULTS: For diagnosis,
most private practitioners relied on the clinical presentation and result of an X-
ray. Only 13% of the respondents routinely also asked for sputum examination.
Ninety-six percent used X-ray as a tool to monitor treatment. Sixty percent of the
respondents prescribed a regimen consisting of isoniazid, rifampicin,
pyrazinamide, and ethambutol. Except for rifampicin, over-dosage was common.
For re-treatment cases, none prescribed the WHO-recommended re-treatment
regimen. The private practitioners perceived the main reasons for patient non-
adherence to be the patients' lack of finances to buy drugs and patients' perceived
well being after a certain period of treatment. Patients' lack of money was seen as
the main obstacle to compliance. The only case holding mechanism mentioned
was occasional clinic appointments of the TB patients. CONCLUSION: Private
practices for diagnosis and treatment of TB typically deviate from guidelines. The
quality of care among private practitioners needs improvement. Innovative
strategies are required.
Publication Types:
774: Int J Med Inform. 2006 Feb;75(2):148-55. Epub 2005 Aug 10.
Results of a survey on medical error reporting systems in Korean
hospitals.
Kim J, Bates DW.
Seoul National University, College of Nursing, Research Institute of Nursing

Science, 28 Yongon-dong, Chongno-gu, Seoul, 110-799, Seoul, Republic of
Korea. kim0424@snu.ac.kr
BACKGROUND: Recent data suggest that medical injuries, or adverse events,

represent an important international problem, and that many are caused by errors.
Spontaneous reporting is the main tool used to detect errors and adverse events in
most countries, and reporting systems are believed to be important for improving
patient safety. Increasingly, such reporting can be done using information
systems, and information systems are widely used in Korea. However, few data
are available regarding the use of electronic medical error reporting systems in
Korea. OBJECTIVES: The objectives of this study were to investigate the present
status of reporting system of Korean hospitals, and to compare the current status
of medical error reporting systems with that of other health information sub
systems. METHODS: The chairs of nursing departments of all 283 hospitals
nationwide with more than 100 beds were surveyed using a structured
questionnaire. The response rate was 35%. In addition, two reports on the national
use of health information systems in Korea from 1999 and 2003 were analyzed.
RESULTS: Among reporting hospitals (n=99), medical errors were reported on
paper in 75 hospitals (77%), verbally in 30 hospitals (30%), using word
processing in 13 hospitals (13%), and using the hospital information system in
only three hospitals (3%). In contrast, there was widespread and increasing use of
health information technology (HIT) in areas such as medication administration,
inpatient and outpatient order entry, and radiology. CONCLUSIONS: While HIT
is increasingly widely used in Korea in many areas, it is not being used for error
reporting. Increasing the use of electronic reporting systems, and systemically
evaluating the medical errors and adverse events reported, represent essential
steps for reducing systemic errors and improving patient safety.
Publication Types:
775: Jpn J Thorac Cardiovasc Surg. 2005 Jul;53(7):337.

Managing surgical quality based on database.
Takamoto S.
Publication Types:
• Editorial
776: J Formos Med Assoc. 2005 Jul;104(7):468-75.

Effectiveness of coping strategies used by hospitals in response to

implementation of a case-based payment system by the National
Health Insurance program.
Huang CC, Chung KP, Kuo NC, Hung CL.
Department of Health Care Management, National Taipei College of Nursing,

Taipei, Taiwan.
BACKGROUND AND PURPOSE: The introduction of the case-based payment

system by the Bureau of National Health Insurance resulted in greatly increased
pressure on the health care industry in Taiwan. This study examined the
relationship between the coping strategies adopted and the results attained by
accredited teaching hospitals and non-teaching regional hospitals when
responding to this regulatory change. METHODS: A cross-sectional survey was
conducted using a structured questionnaire to assess the hospitals' characteristics,
and coping strategies at the technical, managerial and institutional levels in
response to the case-based payment system, and to compare these strategies with
self-evaluation of the effectiveness of these strategies. The questionnaire was sent
in early October 2000 to the superintendents of the 129 hospitals that were
accredited at the medical center, regional hospital, and district teaching hospital
levels in the year 2000. Factor analysis was applied to group the strategies into
categories and stepwise regression analysis was used to explore the relationship
between the reported coping strategies adopted and their effectiveness as
evaluated by participants. RESULTS: Among the selected hospitals, 89 responded
with complete data, a 69% response rate. The following 7 factors were extracted
from 30 coping strategies: information and financial analysis; service shifting and
unbundling; service integration and quality improvement; service specialization
and strengthening; education and training; financial incentives; and claim
submission skill. After adjusting for accreditation level or ownership status, 2
main findings were noted. First, hospitals that implemented financial incentives
strategies such as holding physicians responsible for all or part of the shortfall
between actual claim submissions and actual reimbursements, and reducing or
withholding payment to physicians beyond the standard length of stay, tended to
increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented
service integration and quality improvement strategies, such as implementing a
discharge plan, implementing clinical pathways and periodic review of quality
indicators, attained higher patient satisfaction rate (odds ratio, 1.40).
CONCLUSIONS: This study suggests that hospitals confronting the
implementation of a case based-payment system may benefit by adopting
financial incentives strategies and by efforts to improve service integration and
quality.
Publication Types:
777: J Travel Med. 2005 Jul-Aug;12(4):197-204.

Risk of travel-associated typhoid and paratyphoid fevers in various

regions.
Ekdahl K, de Jong B, Andersson Y.
Department of Epidemiology, Swedish Institute for Infectious Disease Control,

Stockholm, Sweden.
BACKGROUND: Although enteric fever (typhoid and paratyphoid fevers) is a

major global public health problem, comparable data on the risks of contracting
travel-associated enteric fever in various regions of the world are scarce.
METHODS: From the Swedish database on notifiable communicable diseases, we
retrieved all case records from 1997 to 2003 on typhoid and paratyphoid fevers.
The data set was compared with data on travel patterns obtained from a
comprehensive travel database with information from interviews with more than
16,000 Swedish residents with recent overnight travel outside Sweden.
RESULTS: The overall risk of being notified with enteric fever after travel was
0.42 in 100,000 travelers. The highest risk for typhoid fever was seen in travelers
from India and neighboring countries (41.7 in 100,000), the Middle East (5.91 in
100,000), and Central Africa (3.33 in 100,000), whereas the risk was
comparatively low in East Asia (0.24 in 100,000). Almost the same risk areas
stood out for paratyphoid fever: India and neighbors (37.5 in 100,000), the Middle
East (3.64 in 100,000), and East Africa (3.33 in 100,000). The epidemiology of
paratyphoid fever was considerably affected by a large outbreak of paratyphoid B
in a Turkish tourist resort in 1999. The youngest children were at highest risk for
typhoid fever (odds ratio 44.2), whereas youths ages 7 to 18 years were at highest
risk for paratyphoid fever (odds ratio 9.7). CONCLUSIONS: Detailed risk data
for enteric fever after travel could form the basis for travel advice. Vaccination
against typhoid fever should always be considered for travelers to the Indian
subcontinent, the Middle East, and Africa but should not routinely be given to
travelers to the Malay Peninsula.
Publication Types:
778: Int J Cardiol. 2006 Mar 22;108(1):89-95. Epub 2005 Aug 8.

Plasma triglycerides, an independent predictor of cardiovascular

disease in men: a prospective study based on a population with
prevalent metabolic syndrome.
Onat A, Sari I, Yazici M, Can G, Hergenç G, Avci GS.
Turkish Society of Cardiology, Istanbul, Turkey. tkd@tkd.org.tr
BACKGROUND AND METHODS: We aimed to assess whether fasting plasma

triglycerides independently predicted future fatal and nonfatal cardiovascular
disease (CVD) in a population having a high prevalence of the metabolic
syndrome. In the Turkish Adult Risk Factor Study, a population-based survey,
2682 men and women 20 years of age or over with fasting triglyceride values
available and free of CVD at baseline examination in 1990, were prospectively
followed up till 2003/04. Triglyceride concentrations were measured by the
enzymatic dry chemistry method and stratified into sex-specific quintiles.
Information on the mode of death was obtained from first-degree relatives and/or
health personnel of local health office. Diagnosis of coronary heart disease and
stroke among survivors was based on history, physical examination of the
cardiovascular system and Minnesota coding of resting electrocardiograms. A
total of 120 fatal and 221 new nonfatal CVD occurred among adults (mean age
43+/-14) during a mean 9.3 years of follow-up. RESULTS: CVD was
significantly and independently predicted by the top versus the bottom fasting
triglyceride quintile in logistic regression analyses when adjusted for age, sex,
BMI, systolic blood pressure, total cholesterol, lipid-lowering medication, status
of smoking and of glucose regulation (relative risk [RR] in men and all adults
2.38 and 1.79, respectively, p both <0.02). This corresponded to hazard ratios
(HR) of 1.43 in men and 1.28 in men and women combined. Adjustment for
HDL-cholesterol instead of total cholesterol in the same model gave also
significant HRs corresponding to 1.42 in men and 1.32 in sexes combined.
CONCLUSIONS: Fasting triglycerides are predictive of future CVD among men
with an HR of 1.4, independent of age, diabetes, lipid-lowering medication,
traditional risk factors including total cholesterol or HDL-C, in a population in
which metabolic syndrome prevails. A modest independent risk increment in
women did not reach significance.
Publication Types:
779: J Biomed Inform. 2005 Aug;38(4):298-313. Epub 2005 Jan 30.

A framework for capturing the interactions between laypersons'

understanding of disease, information gathering behaviors, and
actions taken during an epidemic.
Slaughter L, Keselman A, Kushniruk A, Patel VL.
Laboratory of Decision Making and Cognition, Department of Biomedical

Informatics, Columbia University, NY, USA.
laura.slaughter@dbmi.columbia.edu
This paper provides a description of a methodological framework designed to

capture the inter-relationships between the lay publics' understanding of health-
related processes, information gathering behaviors, and actions taken during an
outbreak. We developed and refined our methods during a study involving eight
participants living in severe acute respiratory syndrome (SARS)-affected areas
(Hong Kong, Taiwan, and Toronto). The framework is an adaptation of narrative
analysis, a qualitative method that is used to investigate a phenomenon through
interpretation of the stories people tell about their experiences. From our work,
several hypotheses emerged that will contribute to future research. For example,
our findings showed that many decisions in an epidemic are carefully considered
and involve use of significant information gathering. Having a good model of lay
actions based on information received and beliefs held will contribute to the
development of more effective information support systems in the event of a
future epidemic.
Publication Types:
• Clinical Trial
780: BMC Health Serv Res. 2005 Aug 6;5:51.

Predictors of failed attendances in a multi-specialty outpatient

centre using electronic databases.
Lee VJ, Earnest A, Chen MI, Krishnan B.
Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.

vernon_lee_jm@ttsh.com.sg
BACKGROUND: Failure to keep outpatient medical appointments results in

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

PMCID: PMC1190171
781: Harefuah. 2005 Jul;144(7):474-9, 527.

[Knowledge management in health organizations]
[Article in Hebrew]
Carasso S, Arbiv T, Yariv I, On E, Ashkenazi I, Levi H.
Medical Corps, Israel Defense Forces, Israel. carassos@netvision.net.il
BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF)

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

782: Yakugaku Zasshi. 2005 Aug;125(8):639-42.
[An examination in comparison Web site with other root on the

revised information of drug package insert]
Okuyama K, Terasawa M, Takahashi T, Yamada Y.
Hachioji Medical Center, Tokyo Medical University, Hachioji, Japan.

ok531@tokyo-med.ac.jp
To obtain revised information on drug package inserts, we evaluated the quality

and comprehensibility of such information provided by the Web site of the
Pharmaceuticals and Medical Devices Agency (PMDA site), medical
representatives (MRS), Drug Safety Updates (DSUS), and informational
publications of the wholesale distributor Company F (wholesaler F). In the
comparison of the total amount of revised information obtained from April 2003
to March 2004, the PMDA site was 90% or greater of comprehensible. In
comparison with the distribution information on the notice of the Ministry of
Health, Labor and Welfare, an informational delay or lack occasionally occurred
and variations among pharmaceutical companies were observed. Moreover, on the
PMDA site, the number of revisions was 1972. Among them, clinically important
information, such as warnings, contraindications, adverse effects, and drug
interactions, totaled 37%. From these results, it is suggested that there are
variations in the information from each pharmaceutical company on the PMDA
site although the site is excellent in terms of comprehensibility.
Publication Types:
783: Sex Transm Infect. 2005 Aug;81(4):345-50.

Epidemiology of HIV among black and minority ethnic men who

have sex with men in England and Wales.
Dougan S, Elford J, Rice B, Brown AE, Sinka K, Evans BG, Gill ON, Fenton
KA.
Department of HIV and Sexually Transmitted Infections, Communicable Disease

Surveillance Centre, Health Protection Agency, Centre for Infections, 61
Colindale Avenue, London, NW9 5EQ, UK. sarah.dougan@hpa.org.uk
OBJECTIVES: To examine the epidemiology of HIV among black and minority

ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W).
METHODS: Ethnicity data from two national HIV/AIDS surveillance systems
were reviewed (1997-2002 inclusive), providing information on new HIV
diagnoses and those accessing NHS HIV treatment and care services. In addition,
undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine
(GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring
Programme and having routine syphilis serology was examined by world region
of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly
diagnosed with HIV in E&W, representing 12% of all new diagnoses reported
among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black
African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44%
other/mixed. Where reported (n = 395), 58% of BME MSM were probably
infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4%
to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in
2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM
(p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and
2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7%
to 20.8%), while among MSM born in other regions it remained below 6.0%.
CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one
in 10 new HIV diagnoses among MSM in E & W; more than half probably
acquired their infection in the United Kingdom. In 2002, the proportion of BME
MSM living with diagnosed HIV in E&W was significantly higher than white
MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These
data confirm the need to remain alert to the sexual health needs and evolving
epidemiology of HIV among BME MSM in E&W.
Publication Types:
• Multicenter Study
PMCID: PMC1745025 [Available on 08/01/08]
784: J Med Libr Assoc. 2005 Jul;93(3):400-3.

ParsMedline: establishment of a Web-based bibliographic database

related to Iranian health and medical research.
Beiki O, Beiki D.
Pejouhan Company, Ltd. Number G-02, Yazd Science and Technology

Park,Yazd, Iran. beikiomid@yahoo.com
Publication Types:
PMCID: PMC1175808
785: J Am Med Inform Assoc. 2005 Nov-Dec;12(6):642-7. Epub 2005 Jul 27.
Computerized physician order entry and electronic medical record

systems in Korean teaching and general hospitals: results of a 2004
survey.
Park RW, Shin SS, Choi YI, Ahn JO, Hwang SC.
Department of Biomedical and Healthcare Informatics, Ajou University School of

Medicine, San 5, Youngtong-Gu, Suwon 442-721, Republic of Korea.
OBJECTIVE: To determine the availability of computerized physician order entry

(CPOE) and electronic medical record (EMR) systems in teaching and general
hospitals in the Republic of Korea. DESIGN: A combined mail and telephone
survey of 283 hospitals. MEASUREMENTS: The surveys assessed the
availability of CPOE and EMRs in the hospitals, as well as inducement,
participation, and saturation regarding CPOE use by physicians. RESULTS: A
total of 122 (43.1%) hospitals responded to the survey. The complete form of
CPOE was available in 98 (80.3%) hospitals. The use of CPOE was mandatory in
92 (86.0%) of the 107 hospitals that responded to the questions regarding the
requirement of CPOE use. In 85 (79.4%) of the hospitals in which CPOE was in
use, more than 90% of physicians used the system. In addition, physicians entered
more than 90% of their total orders through CPOE in 87 (81.3%) hospitals. In
contrast, a complete EMR system was available in only 11 (9.0%) of the
hospitals. CONCLUSION: Of the teaching and general hospitals in the Republic
of Korea that responded to the survey, the majority (80.3%) have CPOE systems,
and a complete EMR system is available in only 9%.
Publication Types:
PMCID: PMC1294035
786: Health Policy. 2006 Apr;76(2):233-42. Epub 2005 Jul 19.

Social capital and farmer's willingness-to-join a newly established

community-based health insurance in rural China.
Zhang L, Wang H, Wang L, Hsiao W.
Department of Health Policy and Management, Beijing University School of

Public Health, 38 Xue Yuan Road, Hai Dian District, Beijing 100083, China.
pkuzlc@hotmail.com
In 2002, China announced a new funding strategy that would reestablish

community-based health insurance (CHI) in rural areas, whereby the Chinese
government will entice farmers' participation by providing each participant an
annual subsidy of 10-20 Yuan (US 1.25-2.50 dollars). However, there is no
evidence demonstrating how many farmers would be willing-to-join (WTJ) such
newly developed government subsidized voluntary-based CHI scheme and what
factors influence farmers' willingness-to-join. In this study, we examine the
probability of farmers' willingness-to-join such CHI under the different scenarios
of government subsidy and individual contribution, and also explore factors that
influence farmers' willingness-to-join with the emphasis on social capital. The
study is based on data collected from a 2002 household survey conducted in
Fengsan Township, located in China's Guizhou Province. Logistic regression is
used in the analysis. The findings from this study show that even with the
government subsidy to the premium, the probability of WTJ the new voluntary-
based CHI only reach 50%. The results also indicate that community level social
capital, as measured by reciprocity index, and individual level social capital, as
measured by trust index, are significantly and positively associated with the
probability of farmers' WTJ newly developed government subsidized CHI. Policy
recommendations have been made based on those findings.
Publication Types:
787: Parassitologia. 2005 Mar;47(1):105-14.

A study of the environmental determinants of malaria and

schistosomiasis in the Philippines using Remote Sensing and
Geographic Information Systems.
Leonardo LR, Rivera PT, Crisostomo BA, Sarol JN, Bantayan NC, Tiu WU,
Bergquist NR.
College of Public Health, University of the Philippines Manila, Ermita, Manila,

Philippines. lydiarl2002@yahoo.com
Malaria and schistosomiasis are two water-related parasitic diseases affecting

millions of people worldwide particularly tropical and subtropical countries. In
the Philippines, malaria is found in 72 out of 78 provinces while schistosomiasis
is endemic in 24 provinces. The Anopheles mosquito and the Oncomelania snail
involved in the transmission of these diseases depend on certain environmental
determinants that support mosquito and snail populations. This study, done for the
first time in the Philippines, successfully showed how Remote Sensing (RS) and
Geographical Information Systems (GIS) can be effectively used in showing how
these environmental factors affect the spatial distribution of these two diseases.
The study sites, i.e. the municipalities of Asuncion and Kapalong, are known
endemic sites for both malaria and schistosomiasis. Georeferenced data enabled
visualization of prevalence data in relation to physical maps thus facilitating
assessment of disease situation in the two municipalities. RS and GIS data proved
that other factors aside from climate influence the epidemiology of the diseases in
the two sites. Topography and slope as main physical factors influence the
vegetation cover, land use and soil type prevailing in particular areas. In addition,
water sources especially irrigation networks differed in various places in the study
sites in turn affecting the magnitude and distribution of malaria and
schistosomiasis. Significant correlations found between the diseases and the
environmental variables formed the basis for development of models to predict
the disease prevalence in the two municipalities. Proximity to snail breeding sites
and irrigation networks and the highly agricultural nature of the barangays were
identified as the most common factors that define the high prevalence areas for
schistosomiasis confirming the fact that conditions that support the snail
populations will in turn favor the presence of the disease. For malaria, the
predictive models included temperature, humidity, soil type, predominance of
reproduction brush, presence of cultivated areas, distance from deep wells and
distance from conventional water source which are in turn influenced by the
factor of elevation.
Publication Types:
788: Jpn J Clin Oncol. 2005 Jul;35(7):420-3.

Comparison of leukemia mortality in five countries: France, Italy,

Japan, UK and USA from the WHO Mortality Database (1960-
2000).
Imamura Y, Mizuno S.
Publication Types:
789: Toxicol Appl Pharmacol. 2005 Sep 1;207(2 Suppl):750-4.

Lessons learned in building a global information network on

chemicals (GINC).
Kaminuma T.
Center for Quantum Life Science, Hiroshima University, 1-3-1 Kagamiyama,

Higashihiroshima-shi, Hiroshima-ken 739-8530, Japan.
The Global Information Network on Chemicals (GINC) was a project to construct

a worldwide information network linking international, national, and other
organizations working for the safe management of chemicals. Proposed in 1993,
the project started the next year and lasted almost 10 years. It was begun as a joint
project of World Health Organization (WHO), International Labor Organization
(ILO), and United Nations Environment Program (UNEP), and later endorsed by
the Intergovernmental Forum on Chemical Safety (IFCS). Asia, particularly East
Asia and the Pacific islands, was chosen as the feasibility study region. The
author's group then at the National Institute of Health Sciences (NIHS) of Japan
led this initiative and hosted numerous meetings. At these meetings, tutorial
sessions for communicating chemical safety expertise and emerging new
information technologies relevant to the safe management of chemicals were
offered. Our experience with this project, particularly the Web-based system and
the tutorial sessions, may be of use to others involved with Web-based instruction
and the training of chemical safety specialists from both developed and
developing countries.
PMID: 16023162 [PubMed - in process]
790: Health Care Women Int. 2005 May;26(5):448-55.

Perception of health care delivery in Israel: women's voices.
Warshawsky-Livne L, Cwikel J, Pliskin J, Avgar A.
Ben-Gurion University of the Negev, Beer-Sheva, Israel, and the Israel

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

791: Int J Neurosci. 2005 Jun;115(6):871-80.

Musculoskeletal complaints among a group of Turkish nurses.
Tezel A.
Health College of Erzurum, Ataturk University, Turkey. tezel@atauni.edu.tr
The aim of the present study was to describe the prevalence and distribution of
symptoms of musculoskeletal complaints among Turkish nurses who are
practicing general nursing. The study population consisted of 120 nursing staff
from four large general hospitals in Erzurum, Turkey. In every hospital six
departments (surgery, medical, obstetric and gynecology, psychiatry, pediatric,
and neurology) were selected. A Nordic standardized questionnaire described by
Kuorinka et al. (1987) about complaints of the musculoskeletal system and a self-
administered questionnaire involved information on the respondent's job and
employment history, individual characteristics, physical and psychosocial risk
factors at work, and general health status, were used by the researchers. Test data
were analyzed for the difference between two population proportion and
percentage. In the total population, 90% of all nurses reported at least one
musculoskeletal complaint, 60% reported at least two, and 36% reported spells of
three complaints in the past 6 months. Low back complaints were the most
prevalent of musculoskeletal complaints, reported by 69% of the nurses. Neck
complaints were less prevalent than shoulder (46% and 54%, respectively).
Nurses with back complaint more often reported neck (28%) and shoulder (34%)
complaints. Chronic low back, neck, and shoulder complaints were experienced
by 41%, 25%, and 33% nurses, respectively. On the other hand, chronic
complaints showed a correlation with working departments. The nurses working
in surgery and obstetric and gynecology departments have more chronic
complaints than the nurses working in other department (p<.05). The article's
findings do not differ from those of other countries. Despite its limitations, this
study points to the importance of perceived worked-related physical demands in
relation to reported neck, shoulder, and back musculoskeletal complaints in
Turkish nurses. But, further inquiries are needed to identify other physical
exposures that may be related to musculoskeletal complaints.
Publication Types:
• Multicenter Study
792: Ying Yong Sheng Tai Xue Bao. 2005 Apr;16(4):641-6.

[Spatial-temporal changes of Taishan Mountains scenery area

landscape patterns]
Guo L, Yu S.
School of Life Sciences, Zhongsan University, Guangzhou 510275, China.
By adopting the Landsat images of 1986 and 2001, and through field
investigation, this paper studied the characteristics and genesis of the spatial-
temporal changes of Taishan Mountains scenery area landscape patterns in
Shandong Province of East China since mid-80 s of last century, and approached
the effects of anthropogenic disturbances on them. The results showed that the
anthropogenic disturbances at that time were the main reasons of inducing the
significant changes of landscape patterns, and the large-scale pure forest
reconstruction and scenery area construction in late 80s of last century made the
forest vegetation patches more fragmented and the superiority of landscape types
decreased. The results also showed that the area of Pinus forest significantly
decreased, mainly due to its conversion to Quercus and mixed forests. The
increase of landscape patches intensified the fragmentation of certain landscape
patterns, and in particular, the increase of bare substrate on steep slopes could
potentially damage the health of mountain ecosystem.
Publication Types:
793: Mil Med. 2005 Jun;170(6):521-7.

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

Aeromedical evacuations from Operation Iraqi Freedom: a
descriptive study.
Harman DR, Hooper TI, Gackstetter GD.
Department of Preventive Medicine and Biometrics, Uniformed Services

University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
20814, USA.
OBJECTIVE: To describe health patterns in evacuated military members during

Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and
postdeployment health information to understand the utility of data collected for
aeromedical evacuations. METHODS: We conducted a descriptive analysis of
U.S. evacuees from 2003 using data from the U.S. Transportation Command's
Regulating and Command & Control Evacuation System and the Defense Medical
Surveillance System. RESULTS: The typical patient was an Army male under the
age of 29 requiring orthopedic or surgical care. Disease/nonbattle injuries were
six times as common as battle injuries and 94% were classified as routine
evacuees. Eighty-six percent had health data available in the Defense Medical
Surveillance System. Two thirds had pre- and/or postdeployment questionnaire
data. CONCLUSIONS: Combining data sources increases our understanding of
disease patterns in deployed troops. Targeted preventive interventions can then be
implemented. Changes in the U.S. Transportation Command's Regulating and
Command & Control Evacuation System database can improve its utility as an
epidemiological tool.
794: Eur Spine J. 2006 Jun;15(6):834-48. Epub 2005 Jul 6.

The prevalence of neck pain in the world population: a systematic

critical review of the literature.
Fejer R, Kyvik KO, Hartvigsen J.
Institute of Sports Science and Clinical Biomechanics, Faculty of Health

Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M,
Denmark. rfejer@health.sdu.dk
The objective of this study was to determine the prevalence of neck pain (NP) in
the world population and to identify areas of methodological variation between
studies. A systematic search was conducted in five databases (MEDLINE,
EMBASE, CINAHL, OSH-ROM, and PsycINFO), followed by a screening of
reference lists of relevant papers. Included papers were extracted for information
and each paper was given a quality score. Mean prevalence estimates were
calculated for six prevalence periods (point, week, month, 6 months, year, and
lifetime), and considered separately for age, gender, quality score, response rate,
sample size, anatomical definition, geography, and publication year. Fifty-six
papers were included. The six most commonly reported types of prevalence were
point, week, month, 6 months, year, and lifetime. Except for lifetime prevalence,
women reported more NP than men. For 1-year prevalence, Scandinavian
countries reported more NP than the rest of Europe and Asia. Prevalence
estimates were not affected by age, quality score, sample size, response rate, and
different anatomical definitions of NP. NP is a common symptom in the
population. As expected, the prevalence increases with longer prevalence periods
and generally women have more NP than men. At least for 1-year prevalence
Scandinavian countries report higher mean estimates than the rest of Europe and
Asia. The quality of studies varies greatly but is not correlated with the prevalence
estimates. Design varies considerably and standardisation is needed in future
studies.
Publication Types:
• Review
795: J Trauma. 2005 Jun;58(6):1272-6; discussion 1277.

M-study; arguments for regional trauma databases.
Joosse P, Goslings JC, Luitse JS, Ponsen KJ.
Trauma Unit, Dept. of Surgery, Academical Medical Center, University of

Amsterdam, 1100 DD Amsterdam, The Netherlands. pieterjoosse@hotmail.com
BACKGROUND: The TRISS methodology, in combination with coefficients

derived from the Major Trauma Outcome Study (MTOS), is the most widely used
outcome prediction model for the care of trauma patients. Utilizing the M-
statistic, different populations of trauma patients can be compared with the
population originally enrolled in the MTOS. PURPOSE: We hypothesized that
databases outside of North-America would not be well matched to the MTOS
study and thus the TRISS methodology would not accurately predict outcome in
these different populations. METHODS: All trauma studies utilizing TRISS
methodology that were published between 1990-2003 were reviewed and M-
statistics calculated based on the population described in the study. The
populations were grouped by the following geographic locations: Europe,
Asia/Africa and North-America. RESULTS: The median M-statistic for Europe
was 0.65, compared with 0.88 for Asian/African databases, and 0.90 for North-
American studies. There was a significant difference between European and
North-American studies (p < 0.05). CONCLUSION: The trauma populations
described in European studies differ significantly from the MTOS with respect to
injury severity match, indicating the need for the development of regional trauma
databases and modified TRISS coefficients based on the geographic location of
the injured population included.
Publication Types:
796: Comput Methods Programs Biomed. 2005 Oct;80(1):1-15.

Development of a deterministic XML schema by resolving structure

ambiguity of HL7 messages.
Huang EW, Wang DW, Liou DM.
Department of Information Management, National Taipei College of Nursing,

Taiwan, ROC.
Health level 7 (HL7) is a standard for medical information exchange. It defines

data transfers for the application systems in the healthcare environment.
Alternatively, the extensible markup language (XML) is a standard for data
exchange using the Internet. If exchange messages follow the content and the
sequence defined by HL7 and are expressed in the XML format, the system may
benefit from the advantages of both standards. In creating the XML schema, we
found ambiguities in HL7 message structures that cause the XML schema to be
non-deterministic. These ambiguous expressions are summarized within 12
structures and can be replaced with equivalent or similar unambiguous structures.
The finite state automata are used to verify expression equivalence. Applying this
schema, an XML document may eliminate redundant segment group definitions
and make the structure simple and easy to reproduce. In this paper, we discuss the
methods and our experience in resolving ambiguous problems in HL7 messages
to generate a deterministic XML schema.
Publication Types:
797: Sci Total Environ. 2005 Jun 15;346(1-3):184-99. Epub 2005 Jan 7.
Estimation of biogenic volatile organic compounds emissions in

subtropical island--Taiwan.
Chang KH, Chen TF, Huang HC.
Graduate School of Engineering Science and Technology (Doctoral Program),

National Yunlin University of Science and Technology, 123 University Rd. Sec.
3, Touliu, Yunlin, Taiwan. ken@airlab.yuntech.edu.tw
Elevated tropospheric ozone is harmful to human health and plants. It is formed

through the photochemical reactions involving volatile organic compounds
(VOCs) and nitrogen oxides (NO(x)). The elevated ozone episodes occur mainly
in summer months in the United States, while the high-ozone episodes frequently
occur during the fall in Taiwan. The unique landscape of Taiwan produces
tremendous amounts of biogenic VOCs in the mountain regions that are adjacent
to concentrated urban areas. The urban areas, in turn, generate prodigious
amounts of anthropogenic emissions. Biogenic VOC emissions have direct
influence on tropospheric ozone formation. To explore the air quality problems in
Taiwan, this study attempts to develop a biogenic VOC emission model suitable
for air quality applications in Taiwan. The emission model is based on the
Biogenic Emissions Inventory System Version 2 and coupled with a detailed
Taiwan land use database. The 1999 total Taiwan biogenic VOC emissions were
estimated at 214,000 metric tons. The emissions of isoprene, monoterpenes, and
other VOCs were about 37.2%, 30.4%, and 32.4% of total biogenic VOC
emissions, respectively. The annual total biogenic VOC emission per unit area
was more than two times the value of that in any European country, implying that
detailed emissions estimates in any size of region will benefit the global biogenic
emission inventories.
Publication Types:
798: Nat Cell Biol. 2005 Jul;7(7):639.

Databases in peril.
[No authors listed]
Publication Types:
• Editorial
799: Indian J Med Sci. 2005 Jun;59(6):243-52.

Correlates of tobacco-use pattern amongst adolescents in two

schools of New Delhi, India.
Kotwal A, Thakur R, Seth T.
Management Information Systems Organization, Army Headquarters, New Delhi,

India.
BACKGROUND: As adolescent tobacco use has been found to be a major

predictor of future use, preventive efforts need to be focused on this section of
population. OBJECTIVES: To assess the role of knowledge regarding tobacco,
risk-taking attitude, peers, and other influencers on tobacco and areca nut use,
amongst adolescents. SETTINGS AND DESIGN: A school-based cross-sectional
study covering two schools. Students of classes IX and XI, of selected schools,
participated in the study (n = 596). METHODS: A pretested and validated, close
ended, self-administered questionnaire was used. Sociodemographic factors,
awareness regarding tobacco, risk-taking attitudes, role of peers and other
influencers, and tobacco, areca nut and alcohol use, were studied. STATISTICAL
ANALYSIS: Point estimates, 98% Confidence Intervals, tests of significance,
bivariate and multivariate analysis (multiple logistic regression). RESULTS:
Almost 42% of tobacco users started before the age of 12 years. Peer pressure,
general stress, and media were important influencers. Logistic regression analysis
showed that students in public school were using more tobacco [Odds ratio (OR)
= 1.85, P = 0.174] and tobacco/areca nut (OR = 1.14, P = 0.02). The difference in
use between the genders and class in which studying was statistically not
significant. Lesser proportion of those possessing adequate knowledge regarding
tobacco used it as compared to those without adequate knowledge (OR = 0.13, P
< 0.001) however, possession of adequate knowledge was not a good predictor of
areca nut consumption (OR = 0.86, P = 0.585). The most important correlate for
tobacco use (OR = 6.41, P < 0.001) and areca nut use (OR = 11.17, P < 0.001)
was risk-taking attitude. CONCLUSION: Multi-pronged and concerted efforts
targeting children at an early age are required to prevent tobacco and areca nut use
among adolescents.
800: Hu Li Za Zhi. 2005 Jun;52(3):10-4.

[Caring for teenage girls: from the perspective of establishing

women's health consultations on campuses]
Tsao LI, Yu SH, Kao CH.
Department of Research and Development, Graduate Institute of Integration of

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

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

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