His 5

901: Health Promot Int. 2005 Mar;20(1):61-8. Epub 2005 Jan 24.
Related Articles, Links
The spread of drug abuse in rapidly urbanizing communities in

Vientiane, Lao People's Democratic Republic.
Fujiwara T, Takano T, Nakamura K.
Health Promotion/International Health Division of Public Health, Graduated

School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku,
Tokyo 113-8519, Japan.
To determine the prevalence of drug abuse in city neighborhoods in a developing

country undergoing rapid urbanization, we performed a household survey on the
spread of drug abuse in Vientiane, Lao People's Democratic Republic. A total of
1497 households from 17 villages were selected by the stratified random sampling
method from urban districts in the city of Vientiane. Participatory style research
was employed to increase both the sensitivity of detection and the reliability of
information gathered. Local key players shared in the participatory process in this
study. We worked with national and city officers and community leaders, as well
as with neighborhood leaders who had received previous training for this survey,
and conducted household surveys using face-to-face interviews. We inquired
about the spread of drug abuse by asking if the families interviewed recognized
drug abuse problems in their community. To examine the extent of urbanization
of individual villages, the urban index was calculated by principle component
analysis from the following eight indicators: income, occupation, parents'
educational histories, diffusion of telephones, ownership of livestock, diffusion of
plumbing for running water and distance from the Vientiane city center to the
village. Distance was calculated by the Geographic Information System. Among
the 17 villages included in the study, the average percentage of recognition of
drug abuse in the community was 63.2%. The relationship between recognition of
cases of drug abuse in the community and the urban index showed a significant
correlation, with a Spearman coefficient of 0.650 (p < 0.01). The high reliability
of participatory style surveys is also discussed. In conclusion, city neighborhoods
in a developing country undergoing rapid urbanization showed evidence of the
spread of drug abuse, which was associated with the urban index. Participatory
style research activity was recommended to help raise awareness of community
participation in anti-drug-abuse activities.
PMID: 15668213 [PubMed - indexed for MEDLINE]
902: J Clin Pharm Ther. 2005 Feb;30(1):21-37.

A literature search on pharmacokinetic drug interactions of statins
and analysis of how such interactions are reflected in package
inserts in Japan.
Saito M, Hirata-Koizumi M, Urano T, Miyake S, Hasegawa R.
Division of Medicinal Safety Science, National Institute of Health Sciences,

Kamiyoga, Setagaya-ku, Tokyo, Japan. m-saito@nihs.go.jp
BACKGROUND AND OBJECTIVES: Statins (HMG-CoA reductase inhibitors)

are one of the most widely prescribed classes of drugs throughout the world,
because of their excellent cholesterol-lowering effect and overall safety profile
except for rare but fatal rhabdomyolysis arising either directly or indirectly by
pharmacokinetic interactions with certain other drugs. As package inserts in
pharmaceuticals are the primary source of information for health care providers,
we carried out a literature search to examine how crucial information was
provided in package inserts of five statins approved in Japan (simvastatin,
atorvastatin, fluvastatin, pravastatin and pitavastatin). METHODS: A MEDLINE
search from 1996 to June 2004 was carried out to identify studies on clinical
pharmacokinetic drug interactions for the five statins. We mainly collected
information on area under plasma concentration (AUC) following co-
administration of statins with other drugs. The current package inserts used in
Japan were obtained from the website of the Pharmaceutical and Medical Device
Agency whereas USA package inserts were obtained from the Food and Drug
Administration website. RESULTS: The majority of package inserts listed the
drugs that interacted with statins with most describing the risk of rhabdomyolysis
because of the possibility of increases in blood concentration. However,
quantitative information such as change in AUC was provided in only a few
cases. Instructions for dosage adjustment are seldom provided in the Japanese
package inserts. USA package inserts list almost identical drug interactions as the
Japanese package inserts, although they contain more quantitative data, especially
for typical cytochrome P450 (CYP) inhibitors. CONCLUSION: All
pharmacokinetic drug interactions including relevant quantitative data for
potential effectors and details on mechanisms of interaction need to be given in
package inserts as soon as the information becomes available, to ensure safe and
proper use of the drugs concerned. Including such information in the package
insert will be an extremely valuable aid for health care providers.
Publication Types:
• Comparative Study
• Research Support, Non-U.S. Gov't
903: Nippon Naika Gakkai Zasshi. 2004 Dec 10;93(12):2594-8.

[Home care services covered by long-term care insurance system in

Japan]
[Article in Japanese]
Funatani F.
Publication Types:
• Review
904: Rinsho Byori. 2004 Nov;52(11):906-14.

[Development of the reimbursement system based on DPC]
Nakamura K.
Medical Economics Division, Health Insurance Bureau, Ministry of Health,

Labour and Welfare, Chiyoda-ku, Tokyo 100-8916.
In the health insurance system of Japan, a fee-for-service system has been applied
to individual treatment services, but this fee system involves a structural problem
of causing increases in examinations and drug administration. Various attempts
have been made to solve this structural problem in several treatment fields, in
which a flat payment system can be introduced with the fee for-service system as
the basis. The diagnosis procedure combination (DPC) system introduced in April
2003, which is a flat payment system using a diagnosis classification, is the first
large scale revision of the medical fee system of Japan. This diagnosis
classification is considered to be effective for simplifying the medical fee system,
within the framework of EBM, and for providing patients with information.
However, since there are also structural problems in the flat payment system, such
as examination and treatment of low quality, selection of patients, and upcoding,
its introduction should be performed with sufficient caution. We will make more
efforts to establish a better medical fee system by evaluating these problems.
Publication Types:
• English Abstract
905: J Clin Nurs. 2005 Jan;14(1):28-34.

SARS (severe acute respiratory syndrome): reflective practice of a

nurse manager.
Lau PY, Chan CW.
Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin,

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

Comment in:
• J Chin Med Assoc. 2004 Oct;67(10):494-5.
Multiple sclerosis in Taiwan.
Tsai CP, Yuan CL, Yu HY, Chen C, Guo YC, Shan DE.
Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei,

Taiwan, ROC. cptsai@vghtpe.gov.tw
BACKGROUND: There is only 1 report about multiple sclerosis (MS) prevalence

in Taiwan, and this was published in 1976 and involved only 25 patients. The
clinical features and prevalence of MS in Taiwan still remain to be clarified. The
aim of this study was to determine the prevalence and delineate the clinical
features of MS in Taiwanese patients. METHODS: We retrospectively identified
43 ethnic Chinese multiple sclerosis (MS) patients over a 14-year period. The MS
prevalence in Taiwan was estimated based on Bureau of National Health
Insurance (BNHI) data. The clinical data (gender, family history, age at onset,
initial symptoms, clinical course, disability and laboratory findings, evoked
response and neuroimaging) were recorded, collected and analyzed. RESULTS:
The MS prevalence in Taiwan was as low as 1.9 per 100,000. The distribution of
most of the clinical features of our patients, like those in other Asian series, was
different from Western series except for the percentage of the conventional form
and sensory disturbances. Cerebrospinal fluid analysis for IgG index and OCB
seemed to be less sensitive in the diagnosis of MS in our series. CONCLUSIONS:
The prevalence of MS in Taiwan, as in other Asian countries, was low; the optic-
spinal form occurred very often, but predominant spinal cord involvement was not
unusual, as well as there being less functional disability. A larger, prospective
study is needed to provide more conclusive information.
Publication Types:
907: J Toxicol Clin Toxicol. 2004;42(7):965-75.

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

Afshari R, Majdzadeh R, Balali-Mood M.
Scottish Poisons Information Bureau, The Royal Infirmary, University of

Edinburgh, UK.
Drugs and chemicals are almost easily available in Iran. Natural toxins as
poisonous plants and animals also exist in most parts of the country. Therefore,
acute poisonings, either intentional or accidental and also drug abuse/addiction
are common in Iran. In spite of these difficulties there is no center for poison
control and surveillance in this country to gather information and analyse data.
The files of a systematic randomised ten percent of all hospital-referred poisoned
patients from 21 March 1993 to 20 March 2000 in Imam Reza (p) University
Hospital of Mashhad (71589 cases) were screened retrospectively. Young adults
(40.3%) and school children (22.9%) were the most vulnerable group. Mean age
was 22.3 (S.D. 14.38) years with a minimum of less than one and a maximum of
98 years old. A female predominance was found (53.4%). Intentional poisoning
was more common (54.4%) than accidental exposures (45.2%). Fourteen cases
were classified as criminal poisoning. 79.7% of exposures were via ingestion,
followed by dermal exposures (14.1%), and inhalation (6.2%). The majority
(83.7%) of patients were from urban areas. Most patients (68.6%) were treated in
the Emergency Toxicology Clinic and discharged, 19.2% were temporarily
hospitalized and 11.3% were hospitalized for 24 hr. Main groups of poisons were
pharmaceuticals (61.4%), chemicals (22.8%), and natural toxins (16.6%). The
overall number of poisoned patients was higher in spring and summer (62.8%). In
conclusion, acute poisonings, particularly self-poisonings, are common in Iran.
Since medical documentation is not routinely provided in this country the results
of this retrospective study can be used for surveillance. Establishment of fluent
data gathering and analysis within the local health system are challenges for the
future.
Publication Types:
• Clinical Trial
• Randomized Controlled Trial
908: Natl Med J India. 2004 Sep-Oct;17(5):243-5.

Use of complementary and alternative medicine by patients with

diabetes mellitus.
Mehrotra R, Bajaj S, Kumar D.

Motilal Nehru Medical College, 16/2 Lowther Road, Allahabad 211002, Uttar
Pradesh, India.
BACKGROUND: A wide variety of alternative medicines have been traditionally

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

Intake of phytochemicals among Japanese, calculated by the new

FFF database.
Kita J, Tada J, Ito M, Shirakawa M, Murashima M, Zhuo XG, Watanabe S.
Department of Nutritional Science, Tokyo University of Agriculture 1-1-1,

Sakuragaoka, Setagaya, Tokyo 156-8502, Japan.
Effects of phytochemicals on human health are suggested from various animal

experiments, but human studies remain insufficient. We have constructed a
database of various phytochemicals (polyphenols, carotenoids, and sulphur
compounds) (http://www.life-science.jp/fff/) and estimated the amount of intake
among Japanese population. The subjects were volunteers (16 males and 63
females, averagely aged 71 and 61, respectively) in Iwate city. Average BMI was
23 in both sexes. Intake of 36 phytochemicals was calculated from one-day
dietary records of all intake, by multiplying concentrations of each phytochemical
in foods. Phytochemicals with average intake of at least 10 micromole per day
were catechin, isoflavones, isothiocyanate, ferulic acid, quercetin, cinnamic acid
and chlorogenic acid. Chief component analysis yielded 12 factors (80%).
Publication Types:
910: Genomics Proteomics Bioinformatics. 2003 Nov;1(4):304-9.

HLA-A gene polymorphism defined by high-resolution sequence-

based typing in 161 Northern Chinese Han people.
Yan C, Wang R, Li J, Deng Y, Wu D, Zhang H, Zhang H, Wang L, Zhang C,

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

911: Wkly Epidemiol Rec. 2003 Sep 26;78(39):346-7.

Joint WHO HQ/SEAROP/WPRO meeting on DengueNet

implementation in South-East Asia and the Western Pacific, Kuala
Lumpur, 11-13 December 2003.
[Article in English, French]
[No authors listed]
912: Br J Ophthalmol. 2005 Jan;89(1):45-9.

Routine monitoring of visual outcome of cataract surgery. Part 1:

Development of an instrument.
Limburg H, Foster A, Gilbert C, Johnson GJ, Kyndt M.
International Centre for Eye Health, London School of Hygiene and Tropical
Medicine, London. UK. hlimburg@quicknet.nl
AIM: To develop a system for routine monitoring of visual outcome after cataract
surgery. METHODS: Staff from eight eye centres in Asia and Africa defined the
data collection form and report formats to be used for monitoring visual outcome
after cataract surgery. Several operational research questions were raised and
methods developed to address them. The system was field tested for 6 months and
the operational studies undertaken. The system was finalised based upon the
experience gained. FINDINGS: Two different systems for data collection were
developed: a manual paper tally system and a computer system (cataract surgery
record forms (CSRF)). Both systems report on operative complications; the
proportion with good outcome (can see 6/18) and poor outcome (cannot see 6/60);
and causes of poor outcome. Data are collected at discharge and at specified time
intervals at follow up. Both systems were well accepted. CONCLUSION: The
major problem in field testing was data entry errors in centres using the
computerised system. Routine monitoring of cataract outcome should be used by
individual surgeons or centres to follow trends in their own results over time, and
not to compare surgeons, in an atmosphere of trust and support. Visual acuity at
discharge, which can readily be collected on all patients, can be used providing it
is appreciated that the final results will be much better. Rapid feedback of results
can enhance the consciousness of the eye surgeons to causes of poor outcome.
Accuracy in data entry and an efficient flow of record forms are essential.
Publication Types:
• Evaluation Studies
• Multicenter Study
PMCID: PMC1772455
913: Respirology. 2004 Nov;9(4):466-73.

Cost impact of COPD in Japan: opportunities and challenges?
Nishimura S, Zaher C.
Kyoto University, Sakyo-ku, Kyoto, Japan.
OBJECTIVE: The Global Initiative for Obstructive Lung Disease highlights the
importance of COPD from public health, health policy and clinical perspectives.
In countries such as the USA, the economic impact of COPD exceeds that of
many chronic conditions. There is a paucity of data on the economic burden of
COPD in Japan. METHODOLOGY: Based upon publicly available information,
a prevalence-based approach was used to construct a deterministic model to
estimate the total direct and indirect costs of care for COPD in Japan. Data
sources included a spirometry-based epidemiological study, the peer-reviewed
literature, and governmental and industrial surveys. The most current data that
addressed direct and indirect costs of care were utilized. RESULTS: In Japan, the
estimated total cost of COPD is 805.5 billion yen (US 6.8 billion dollars) per year;
645.1 billion yen (US 5.5 billion dollars) in direct costs and 160.4 billion yen (US
1.4 billion dollars) in indirect costs. In direct costs, inpatient care accounted for
244.1 billion yen (US 2.1 billion dollars), outpatient care 299.3 billion yen (US
2.5 billion dollars), and home oxygen therapy 101.7 billion yen (US 0.9 billion
dollars). The average annual total cost per patient for moderate/severe COPD is
estimated to be 435,876 yen (US 3694 dollars); 349,080 yen (US 2958 dollars)
per COPD patient in direct costs and 86,797 yen (US 795 dollars) in indirect
costs. CONCLUSION: COPD imposes a high economic burden on the Japanese
healthcare system. Health policy makers should direct urgent attention to
increasing prevention, early diagnosis, and appropriate treatment of COPD.
914: Environ Biosafety Res. 2003 Jul-Sep;2(3):145-60.

Databases on biotechnology and biosafety of GMOs.
Degrassi G, Alexandrova N, Ripandelli D.
Biosafety Unit, International Centre for Genetic Engineering and Biotechnology,

Area Science Park, Padriciano 99, 34012 Trieste, Italy. degrassi@icgeb.org
Due to the involvement of scientific, industrial, commercial and public sectors of

society, the complexity of the issues concerning the safety of genetically modified
organisms (GMOs) for the environment, agriculture, and human and animal
health calls for a wide coverage of information. Accordingly, development of the
field of biotechnology, along with concerns related to the fate of released GMOs,
has led to a rapid development of tools for disseminating such information. As a
result, there is a growing number of databases aimed at collecting and storing
information related to GMOs. Most of the sites deal with information on
environmental releases, field trials, transgenes and related sequences, regulations
and legislation, risk assessment documents, and literature. Databases are mainly
established and managed by scientific, national or international authorities, and
are addressed towards scientists, government officials, policy makers, consumers,
farmers, environmental groups and civil society representatives. This complexity
can lead to an overlapping of information. The purpose of the present review is to
analyse the relevant databases currently available on the web, providing
comments on their vastly different information and on the structure of the sites
pertaining to different users. A preliminary overview on the development of these
sites during the last decade, at both the national and international level, is also
provided.
Publication Types:

• Review
915: Nucleic Acids Res. 2005 Jan 1;33(Database issue):D174-7.

TPMD: a database and resources of microsatellite marker
genotyped in Taiwanese populations.
Chang YH, Su WH, Lee TC, Sun HF, Chen CH, Pan WH, Tsai SF, Jou YS.
Division of Molecular and Genomic Medicine, National Health Research

Institutes, Taipei 115, Taiwan.
Taiwan Polymorphic Marker Database (TPMD) (http://tpmd.nhri.org.tw/) is a

marker database designed to provide experimental details and useful marker
information allelotyped in Taiwanese populations accompanied by resources and
technical supports. The current version deposited more than 372,000 allelotyping
data from 1425 frequently used and fluorescent-labeled microsatellite markers
with variation types of dinucleotide, trinucleotide and tetranucleotide. TPMD
contains text and map displays with searchable and retrievable options for marker
names, chromosomal location in various human genome maps and marker
heterozygosity in populations of Taiwanese, Japanese and Caucasian. The
integration of marker information in map display is useful for the selection of
high heterozygosity and commonly used microsatellite markers to refine mapping
of diseases locus followed by identification of disease gene by positional
candidate cloning. In addition, our results indicated that the number of markers
with heterozygosity over 0.7 in Asian populations is lower than that in Caucasian.
To increase accuracy and facilitate genetic studies using microsatellite markers,
we also list markers with genotyping difficulty due to ambiguity of allele calling
and recommend an optimal set of microsatellite markers for genotyping in
Taiwanese, and possible extension of genotyping in other Mongoloid populations.
Publication Types:
PMCID: PMC540056
916: Accid Anal Prev. 2005 Jan;37(1):137-41.

Epidemiological profile of mortality due to injuries in three cities in

the Guangxi Province, China.
Yang L, Lam LT, Liu Y, Geng WK, Liu DC.
School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
This study aimed to provide epidemiological information on injury mortality in

three major cities in Guangxi Province of South Western China. This was a
population-based descriptive study utilising surveillance and field-gathered data.
Data were obtained from the disease surveillance information system and record
on each death certificate. Mortality rates were compared between sex and among
different age groups for different causes of injury. Regression modelling was
applied to examine for any increasing trend of injury mortality within the study
period. Drowning was a severe problem for boys and girls younger than 5 years.
Among all estimated mortality rates (per 100,000 person-years) for all sex, age
groups, and categories of death, they were the highest with a rate of 29.8 (95%CI
= 16.7-42.9) for boys and 29.6 (95%CI = 15.9-43.3) for girls. The overall
mortality rates of motor vehicle and other transport-related injury was also similar
to those developed countries. There was a marginally significant trend of
increasing injury mortality within the study period.
Publication Types:
917: East Mediterr Health J. 2002 Jul-Sep;8(4-5):645-53.

Organization of the Saudi health system.
Al-Yousuf M, Akerele TM, Al-Mazrou YY.
General Directorate of Health Centres, Ministry of Health, Riyadh, Saudi Arabia.
Using existing data, we reviewed the organizational structure of the Saudi

Arabian health system: its demography and history, principal health indicators,
organization and management, type and distribution of facilities, financial base,
and the impact on it of the Haj. We noted duplication of services, inadequate
coordination between some health industry sectors, and the need for a more
extensive and rational health centre network with improved information systems
and data collection. We also noted scope for a greater role for the private health
sector and increased cooperation between it and the public sector to improve
health service delivery and population health.
Publication Types:
• Review
918: J Clin Gastroenterol. 2004 Nov-Dec;38(10 Suppl 3):S153-7.

Cost of chronic hepatitis B infection in South Korea.
Yang BM, Kim CH, Kim JY.
School of Public Health, Seoul National University, Seoul 110-799, South Korea.
GOALS: To estimate the direct medical costs of chronic hepatitis B (CHB)

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

919: Psychiatry Clin Neurosci. 2004 Dec;58(6):611-8.
Prevalence and incidence of schizophrenia among national health

insurance enrollees in Taiwan, 1996-2001.
Chien IC, Chou YJ, Lin CH, Bih SH, Chou P, Chang HJ.
Community Medicine Research Center and Institute of Public Health, Taipei,

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

A long journey home. For the wounded, medical miracles are just
the beginning.
Shute N.
Publication Types:
• News
921: J Prof Nurs. 2004 Nov-Dec;20(6):396-402.

Professional nursing in Iran: an overview of its historical and

sociocultural framework.
Nasrabadi AN, Lipson JG, Emami A.
School of Nursing and Midwifery, Tehran University of Medical Sciences, Tohid

Square, Tehran 141118, Iran. nikbakht2sina.tums.ac.ir
Nursing in Iran has progressed from the apprenticeship style of nurse training to
the higher education sector, with the baccalaureate degree required for registered
nurses. Despite these many changes since the Islamic Revolution, nursing is still
striving for acceptance and recognition as a profession. This article describes how
nursing is conceptualized and practiced in Iran and provides insight into
underlying sociocultural forces that have affected the profession in recent years.
Nursing education and research, the current status of nursing in the health care
system, and the public image of nursing are described based on combining
information from several sources: clinical experience, academic experience, and
selected qualitative research findings on Iranian nurses' experiences and
perceptions of their work. Because knowledge of modern Iranian nursing was
inaccessible in English until very recently, this description adds to the literature
on the nursing profession cross-nationally. It shows that in Iran, as in other West
and East Asian countries, the image of nurses has not changed despite advances in
nursing practice, education, and research, necessitating professional socialization
and policy changes.
Publication Types:
• Review
922: Fam Community Health. 2004 Jul-Sep;27(3):193-203.

Evidence of the effectiveness of health sector preparedness in

disaster response: the example of four earthquakes.
Bissell RA, Pinet L, Nelson M, Levy M.
Department of Emergency Health Services, University of Maryland Baltimore

County, Baltimore, MD 21250, USA. bissell@ndms.umbc.edu
In this article, evidence that health sector preparedness improves response

performance in disasters was examined. Case fatality and survival data were
compared for four earthquakes, in relation to health sector emergency
preparedness levels. Vast differences in performance were found. The two
California systems, with a high preparedness index, had low case fatality rates
(about one death per 100 injuries). Kobe, Japan, with mixed levels of
preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness
index) had 167. Public health and health sector preparedness made a significant
difference in the ability to respond effectively to meet patient needs in disasters,
although it is only one of several factors that determine the health outcome of
disaster victims.
Publication Types:
923: Ophthalmic Epidemiol. 2004 Dec;11(5):347-58.

Cataract in type 2 diabetes mellitus in Isfahan, Iran: incidence and

risk factors.
Janghorbani M, Amini M.
Department of Epidemiology Isfahan Endocrinology & Metabolism Research

Center, Isfahan University of Medical Sciences and Health Services Isfahan Iran.
janghorbani@yahoo.com
BACKGROUND: Evidence on the incidence of and risk factors for cataract in

type 2 diabetes mellitus is scarce and mainly derived from studies in developed
countries. Locally derived evidence is required for planning a well co-ordinated
approach to this public health problem in developing countries. OBJECTIVE: The
objective of the present study was to estimate the incidence of and risk factors for
the development of cataract in type 2 (insulin-treated and non-insulin-treated)
diabetes using routinely collected data from a clinical information system at
Isfahan Endocrinology and Metabolism Research Center, Iran. METHOD: During
the mean (standard deviation (SD)) follow-up period of 3.6 (2.7) (range 1-11)
years, 3888 diabetic patients (1348 male and 2540 female) from Isfahan
Endocrinology and Metabolism Research Center outpatient clinics have been
examined. The mean (SD) age of the participants was 52.0 (10.5) years with a
mean (SD) duration of diabetes of 12.6 (7.5) years at initial registration.
RESULTS: Among the 3888 patients who were free of cataract at initial
registration with at least one follow-up visit between 1992 and 2004, the
incidence of cataract was 33.1 (95% confidence interval (CI): 30.2, 36.1) (64.8
(95% CI: 57.7, 72.0) in males and 17.9 (95% CI: 15.2, 20.5) in females per 1000
person-years based on 14012 person-years of follow-up. The age-adjusted
incidence rate of cataract was 20% greater among insulin-treated than non-
insulin-treated type 2 diabetes mellitus clinic attenders and it increased with age.
Using a Cox's Proportional Hazards Model for insulin and non-insulin-treated
type 2 diabetes separately, age, age at diagnosis of diabetes, duration of diabetes,
and smoking were significant predictors of cataract for insulin and non-insulin-
treated type 2 diabetes patients. When all variables were entered in the model,
fasting blood glucose and insulin treatment were significant predictors of cataract.
In the insulin-treated group, fasting blood glucose was a significant predictor of
cataract. Systolic and diastolic blood pressure, gender, HbA(1), proteinuria, body
mass index, cholesterol, triglyceride and creatinine had no significant independent
association with cataract when other covariates were considered. CONCLUSION:
These data suggest that cataract in this population of Iranian type 2 diabetic
patients is common. With an estimated incidence of 33.1 per 1000 person-years of
observation after mean 3.6 years' follow-up, diabetic cataract clearly poses a
formidable health threat to Iranian diabetic patients. The results of this study
highlight the need for regular eye examination in people with diabetes.
Publication Types:
924: Appl Nurs Res. 2004 Nov;17(4):231-8.

Nurses' adoption of technology: application of Rogers' innovation-

diffusion model.
Lee TT.
Nursing Department, National Taipei College of Nursing, Taiwan.

tingting@ntcn.edu.tw
This qualitative study applied Everett Rogers' innovation-diffusion model to
analyze nurses' perceptions toward using a computerized care plan system.
Twelve nurses from three respiratory intensive care units in Taiwan voluntarily
participated in a one-on-one, in-depth interview. Data were analyzed by constant
comparative analysis. The content that emerged was compared with the model's
five innovation characteristics (relative advantage, compatibility, complexity,
trialability, and observability), as perceived by new users. Results indicate that
Rogers' model can accurately describe nurses' behavior during the process of
adopting workplace innovations. Related issues that emerged deserve further
attention to help nurses make the best use of technology.
Publication Types:
925: Psychiatr Serv. 2004 Dec;55(12):1427-30.

Use of health care services and costs of psychiatric disorders among

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

926: Osteoporos Int. 2004 Dec;15(12):981-91. Epub 2004 Jul 31.
Reference database of biochemical markers of bone turnover for the

Japanese female population. Japanese Population-based
Osteoporosis (JPOS) Study.
Iki M, Akiba T, Matsumoto T, Nishino H, Kagamimori S, Kagawa Y,

Yoneshima H; JPOS Study Group.
Department of Public Health, Kinki University School of Medicine , 377-2 Oono-

Higashi, Osaka-Sayama, 589-8511 Osaka, Japan. masa@med.kindai.ac.jp
The present study was conducted as a part of the Japanese Population-based

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

927: Nippon Hoshasen Gijutsu Gakkai Zasshi. 2004 Nov;60(11):1491-9.
[Brief explanation of discussion by Committee on Health

Information Network Infrastructure]
Shinoda H.
Publication Types:
• Review
928: BMC Public Health. 2004 Nov 25;4:55.

The lack of public health research output from India.
Dandona L, Sivan YS, Jyothi MN, Bhaskar VS, Dandona R.
Centre for Public Health Research, Administrative Staff College of India, Raj
Bhavan Road, Hyderabad - 500 082, India. dandona@asci.org.in
BACKGROUND: Systematic assessment of recent health research output from

India, and its relation with the estimated disease burden, is not available. This
information would help understand the areas in health research that need
improvement in India to enhance the health of India's population. METHODS:
The health research output from India during 2002, which was accessible in the
public domain, was assessed by searching PubMed and other internet health
literature databases, and was related to the disease burden suggested by the Global
Burden of Disease Study. The main outcome measures were number of health
papers with abstracts in basic, clinical and public health sciences; quality-adjusted
research output based on the impact factors of journals in which the papers were
published; classification of papers in disease/condition categories and comparison
of research output with the estimated disease burden in each category.
Comparison of the health papers from India during 2002 included in PubMed was
done with those from Australia during one quarter of 2002. RESULTS: Of the
4876 health papers from India in 2002 in PubMed, 48.4%, 47.1% and 4.4% were
in basic, clinical and public health sciences, respectively. Of the 4495 papers
based on original research, only 3.3% were in public health. Quality-adjusted
original research output was highest for non-communicable diseases (62% of
total). Of the total quality-adjusted original research output, the proportions in
injuries (0.7%), cardiovascular diseases (3.6%), respiratory infections (0.2%),
diarrhoeal diseases (1.9%), perinatal conditions (0.4%), childhood cluster diseases
(0.5%), unipolar major depression (0%), and HIV/AIDS (1.5%) were
substantially lower than their proportional contribution to the disease burden in
India. Human resources, health policy, health economics, and impact assessment
of interventions were particularly poorly represented in public health research.
The Australia-India ratio for quality-adjusted health research output per unit gross
domestic product was 20 and for public health research output was 31.
CONCLUSIONS: Good-quality public health research output from India is
grossly inadequate, and strategic planning to improve it is necessary if substantial
enhancement of population health were to be made possible. There is inordinately
low relative research output in several diseases/conditions that cause major
disease burden in India.
PMCID: PMC539252
929: Int J Epidemiol. 2005 Apr;34(2):397-402. Epub 2004 Nov 23.

Comment in:
• Int J Epidemiol. 2005 Apr;34(2):403-4.
Regression analysis of trends in mortality from hepatocellular

carcinoma in Japan, 1972-2001.
Shibuya K, Yano E.
Measurement and Health Information Systems, World Health Organization, CH-

1211 Geneva 27, Switzerland. shibuyak@who.int
BACKGROUND: In Japan, higher mortality rates from hepatocellular carcinoma

(HCC) have been observed than in any other industrialized country and the
reported numbers of deaths due to HCC have increased significantly in recent
years. We assessed whether there was a real increase in mortality from HCC and
which factors contributed to the recent increasing trends of the number of deaths
from HCC. METHODS: Poisson regression models were used to analyse panel
data for the period 1972-2001. RESULTS: In both sexes, age-standardized
mortality rates from HCC increased significantly over the past three decades.
Among males the annual percentage increase in age-adjusted mortality rates was
approximately 1-3% during the period 1972-96. On the other hand, female
mortality trends were less clear. The estimated birth cohort effects suggested that
there was a peak in the mortality risk among the cohorts born during the period
1927-36, which corresponded to those aged between 50-64 years during the
period 1987-96. This was the period when a large increase of both age-specific
mortality rates among older age groups and age-standardized mortality rates were
observed particularly among males. CONCLUSIONS: This study shows that an
upward trend of mortality from HCC in Japan was primarily due to the effects
among birth cohorts born around 1930, which are consistent with the pattern of
past exposure to hepatitis C virus. The cohort effects have contributed to a large
increase in mortality from HCC in recent years and the number of deaths from
HCC is expected to increase by 2010-15.
Publication Types:
930: Health Serv Res. 2004 Dec;39(6 Pt 2):2135-53.

Effects of global budgeting on the distribution of dentists and use of

dental care in Taiwan.
Hsueh YS, Lee SY, Huang YT.
OBJECTIVE: To examine the effects of global budgeting on the distribution of

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

PMCID: PMC1361116
931: Med J Malaysia. 2004 Mar;59(1):84-93.

Developing the Malaysian health system to meet the challenges of

the future.
Merican MI, Rohaizat Y, Haniza S.
General of Health Malaysia (Research and Technical Support) Ministry of Health,

Malaysia.
The Malaysian health care system is a success story among countries of

equivalent socio-economic status. However there are numerous challenges faced
by the nation, which create the need for changes and reform. There is rising
consumer demands and expectations for high technology and high cost medical
care due to improved standards of living, changing disease patterns and
demographic changes, inadequate integration of health services, maldistribution
of resources and the threats as well as opportunities of globalisation and
liberalisation. The changes in health policy, priorities and planning for the country
are guided by the country's development policies, objectives and the challenges of
Vision 2020, Vision for Health and the goals of the health system in ensuring
universal access, improving equity and efficiency and the quality of life of the
population. The essential services in the health system of the future are
information and education of individuals to empower support for the wellness
paradigm. There is also a need to restructure the national health care financing
and the health care delivery system. The present roles and responsibilities of
MOH also need to be reviewed.
932: Nippon Rinsho. 2004 Oct;62 Suppl 10:36-43.

[History and practice of gynecological cancer registration]
Okuda H, Nakatsuka M.
Faculty of Health Sciences, Okayama University Medical School.
Publication Types:
• Review
933: Pharmacoepidemiol Drug Saf. 2005 Jan;14(1):41-6.

A pilot study to build a database on seven anti-hypertensive drugs.
Fujita T, Miura Y, Mayama T.
Department of Epidemiology, National Institute of Public Health, Saitama, Japan.
PURPOSE: In Japan, all patients are able to see freely any clinics or hospitals. So
clinical data of all patients have been stored at clinics, hospitals and medical
institutes respectively. These patients' clinical course data stocks have not been
combined with one another. There is no large-scale database, which has been
available and has played its role in complementing spontaneous adverse drug
reaction (ADR) reporting system. We tried to build an original database using
anti-hypertensive drugs' data from Drug Use Investigation conducted for the
Japanese Drug Re-examination application by every pharmaceutical manufacturer
in conformity with Japanese Pharmaceutical Affairs Law and Related Regulation.
METHODS: The 43 565 case data of seven anti-hypertensive drugs (one Ca-
antagonist, one alpha-blocker, two beta-blockers, three ACE inhibitors) were
kindly offered from seven manufacturers who were members of RAD-AR
Council, Japan. After examining the data items and categories, they were
standardized into common codes based on Japanese Drug Category Classification
(JDCC), International Classification of Diseases 9 (ICD-9) and Japanese Adverse
Drug Reaction Terminology (J-ART). As each manufacturer had a different
coding method in accordance to manufacturer's own practice of data management,
the original forms were divided into several datasets. The data processing and
statistical analysis were conducted using Statistical Analysis System (SAS).
RESULTS: (1) Technology and know-how to combine data coded by different
methods were established for building a database that had never been tried in
Japan. (2) The following are the by-products of the study: a) Onset of ADR
concentrated in the early stage but onset of some disorders prevailed equally
throughout the investigation period. b) Although the number of collected cases of
anti-hypertensive drugs was 43 565, total number of administrated anti-
hypertensive drugs reached to 70 714 because additional anti-hypertensive drugs
were often used with subject drugs. CONCLUSION: There is no large-scale
database of patients' clinical course in Japan. However, since the Japanese Drug
Re-examination System started in 1979, almost eight million cases of Drug Use
Investigation on about 700 drugs have been collected with enormous human
power and huge expenditure for Japanese Drug Re-examination application by
pharmaceutical manufacturers. New and more appropriate information will be
detected by the database, built using Drug Use Investigation data that were
collected only for the Japanese Drug Re-examination application. Copyright (c)
2004 John Wiley & Sons, Ltd.
Publication Types:
934: Spine. 2004 Sep 1;29(17):1931-7.

The effect of previous low back surgery on general health status:

results from the National Spine Network initial visit survey of
patients with low back pain.
Hee HT, Whitecloud TS 3rd, Myers L.
Tulane University Medical Center, New Orleans, LA, USA.

hwantak@hotmail.com
STUDY DESIGN: A cross-sectional study on 18,325 patients with back pain

enrolled at first visit in the National Spine Network (NSN) database from January
1998 to April 2000. OBJECTIVES: To examine whether patients who had
previous low back surgeries had poorer general health status than patients with no
surgery. SUMMARY OF BACKGROUND DATA: Several studies have
described the role of psychological abnormalities in patients with chronic low
back pain. Some of these patients have had previous spinal surgeries performed.
No study has examined the effects of previous low back surgery on the general
health status. METHODS: The Short Form Health Survey 36 was administered to
the initial visit NSN patients. Of the 18,325 patients enrolled, 3,632 had previous
low back surgeries. RESULTS: Patients who had previous lumbar surgeries fared
significantly poorly in all 10 scores of the SF-36 health survey, even after
adjustment for confounding factors. Among these patients, decompression
achieved significantly higher scores for General Health, Role-Physical, and
Mental Component Summary scales. Patients who had decompression as their
most recent surgery had higher scores for General Health, Role-Physical, Role-
Emotional, and Mental Component Summary scales, when compared to those
who had other surgeries. Patients who had instrumentation as their most recent
surgery had higher scores for Bodily Pain and Physical Component Summary
scores. There is a positive correlation between time since last surgery and the SF-
36 outcomes. CONCLUSIONS: Previous back surgery is associated with
significantly worse general health status than those without surgery. Among
patients who had previous surgeries, decompression seems to exert better effects
on SF-36 health status. There is a positive correlation between time since last
surgery and the SF-36 outcomes, although the SF-36 scores are significantly
lower than those without previous surgery.
Publication Types:
935: Public Health. 2004 Dec;118(8):559-64.

Arsenicosis in Bangladesh: prevalence and socio-economic

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

75 Mohakhali, 1212 Dhaka, Bangladesh. hadi.a@brac.net
The potential effects of arsenic-contaminated drinking water on health are of

concern, but our understanding of the risk factors of arsenicosis remains limited.
This study assessed the prevalence of and socio-economic differentials in arsenic-
associated skin lesions in a rural community in Bangladesh. Data were collected
from a village where the Bangladesh Rural Advancement Committee has operated
a health surveillance system and a community-based arsenic mitigation project
since 1999. In total, 1654 residents in the study village were examined in May
2000 for arsenic-associated lesions on their skin. Socio-economic information was
extracted from the surveillance system database covering the village. Nearly 2.9%
of the study population had clinical manifestations of arsenic poisoning. The
prevalence of arsenicosis was associated with age, sex, education and the
economic status of the household. Multivariate analysis identified age and
economic status as significant predictors of arsenicosis controlling for education
and gender. In conclusion, a clear understanding of the socio-economic
distribution of arsenicosis in different demographic and socio-economic groups
will be useful in identifying the high-risk groups from arsenic-affected
communities. More studies are needed to design effective interventions to
mitigate the effects of arsenic in Bangladesh.
Publication Types:
936: Twin Res. 2004 Oct;7(5):430-4.

Characteristics of a Japanese adult twin database of high school

graduates.
Ooki S, Okazaki Y, Asaka A.
Department of Health Science, Ishikawa Prefectural Nursing University, Kahoku,

Ishikawa, Japan. sooki@kj8.so-net.ne.jp
This paper profiles a unique cohort of adult Japanese twins. The database contains
more than 700 twin pairs, aged 18 to 66 years, who are all graduates of the
secondary school attached to the faculty of education of the University of Tokyo.
This school was established in 1948, when the study of twins was burgeoning in
Japan, and about 10 to 20 pairs of twins have been admitted there every year to
participate in studies on twins in education and in related projects. The zygosity of
all twins was determined carefully on the basis of various sources. Data from the
perinatal period to adulthood were linkable using ID numbers. Follow-up surveys
in the field of medical genetics were performed in 1985, 1989 and 1999. For the
third survey, which was sent and received exclusively by mail, the distribution
and collection process was also assessed in detail. The response rate was around
40%, which statistically was influenced mainly by previous participation and sex.
The limitation of this cohort is its selection bias concerning socioeconomic status
and its imbalance in favor of monozygotic pairs.
Publication Types:

• Twin Study
937: Sangyo Eiseigaku Zasshi. 2004 Sep;46(5):181-7.

[Interview study on autonomous chemical management system and

the contribution of occupational health specialists in companies]
Mori K, Takebayashi T.
Occupational Health Training Center, University of Occupational and

Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 807-
8555, Japan. kmori@med.uoeh-u.ac.jp
Under the circumstance that autonomous risk management for chemicals is

required in Japan, it is necessary to define fundamental steps for developing
chemical management system that are applicable in various types of companies
and to understand the effective contribution of chemical or occupational health
specialists to the system. For the purposes, we conducted interviews with
companies which have an advanced chemical management system in Japan. As
the result, each company had a certain policy about detailedness level of collected
hazard and exposure information, and also had an efficient risk management
system to ensure workers' health in depending on the business type and situations.
Moreover, it was commonly observed that the specialists played major roles in
developing tools for risk assessment and control, and then business lines led
execution of the risk management with their supports. Based on the interviews,
we showed a hypothesis of basic steps in introducing autonomous chemical risk
management system at the workplaces. It is necessary to verify the hypothesis and
to develop a simple system that is applicable to middle or small size companies as
the next step.
Publication Types:
938: Cancer Nurs. 2004 Sep-Oct;27(5):407-12.

Breast cancer knowledge assessment in female Chinese immigrants

in New York.
Chen WT, Bakken S.
Department of Community Health Systems, University of California San

Francisco-School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA.
wche5454@itsa.ucsf.edu
The purpose of this study was to examine the relationships between acculturation
level and perceptions of health access, Chinese health beliefs, Chinese health
practices, and knowledge of breast cancer risk. This descriptive, correlational
cross-sectional study used a survey approach. The sample included 135 Chinese
women from the New York City metropolitan area. Data were analyzed using
correlational techniques and polytomous regression. There were no significant
relationships between acculturation and health access, Chinese health beliefs,
Chinese health practices, and breast cancer risk knowledge. Only "years of
education," "marital status," and "household income" significantly predicted
breast cancer risk knowledge level. The data indicate that women with a better
knowledge of breast cancer risk are twice as likely to have higher income and
have more education. The most knowledgeable women are less likely to be
married and less likely to have partners compared to least knowledgeable group.
Providers need to promote health knowledge and provide information about as
well as access to preventive health practices to the immigrant population, given
that acculturation to the new dominant society is inevitable.
Publication Types:

• Research Support, U.S. Gov't, P.H.S.
939: Comput Inform Nurs. 2004 May-Jun;22(3):145-52.

Integration of Internet-based learning and traditional face-to-face

learning in an RN-BSN course in Korea.
Yom YH.
Department of Nursing, Hallym University, Chunchon City, Kangwon Province,

South Korea. yhyom@hallym.ac.kr
This article describes the development of and student satisfaction with a distance
learning course using both online and face-to-face methods in an RN-BSN
program in Korea. Four steps were used for course development: (1) assessment
of students' learning needs and determination of objectives of the course, (2)
designing of module/assignment instructions, (3) development of the Internet-
based learning platform, and (4) evaluation of course and Internet-based learning
platform. Student satisfaction was evaluated by using a 4-point Likert-type
questionnaire. Forty-eight (92.3%) questionnaires were returned. Overall
satisfaction with this course was high (X = 3.29). Appropriateness of learning
methods (X = 3.35) was rated the most satisfactory, followed by appropriateness
of content (X = 3.31). Most of the students enjoyed the course and they wanted
more nursing courses to be offered through the online and on-site format. On the
basis of the findings, additional courses using both online and face-to-face
methods for RN-BSN students should be developed and implemented for RN-
BSN nursing programs in Korea.
Publication Types:
940: Indian J Med Res. 2004 Oct;120(4):207-12.

Genomics of Mycobacterium tuberculosis: old threats & new trends.
Ahmed N, Hasnain SE.
Centre for DNA Fingerprinting and Diagnostics, ECIL Road, Nacharam,

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

• Review
941: Ophthalmic Epidemiol. 2004 Oct;11(4):291-9.

Coverage of cataract surgery per person and per eye: review of a

community-based blindness survey in Oman.
Khandekar R, Mohammed AJ.
Department of Ophthalmology, Eye & Ear Health Care, NCD, DGHA, P.O. Box
393, Pin: 113, Muscat, Oman. rajshpp@omantel.net.om
BACKGROUND AND OBJECTIVE: The data from a national survey of

blindness and common eye diseases in Oman in 1996 were reviewed. The
objective was to compare the calculation of cataract surgery services coverage on
a per eye and per person basis. The advantages and limitations of both methods of
program management are evaluated. METHODS AND MATERIALS: The
information on cataract status, visual status and past history/evidence of cataract
surgery was collected for 11,415 Omani subjects. The coverage of existing
cataract services was calculated per eye and per person. The rates by gender, age
groups, regional groups and type of cataract were also compared. RESULTS: The
cataract surgery services could address more than 60% of the reported persons
with blinding cataract (vision less than 3/60) and more than half of the eyes with
blinding cataract. The services could cover more than one-fourth of the persons
with cataract (with any grade of vision defect) and less than one-fourth of the eyes
with cataract. If the coverage of cataract services for blinding cataract is
calculated using persons as the denominator, it is nearly 10% higher than that
calculated using eyes as the denominator. CONCLUSIONS: The two methods of
calculating the coverage of cataract services give different results and both are
useful for monitoring ophthalmic services. A national program should implement
a system for reporting the visual and cataract status of the fellow eye so that
coverage rates could be calculated by person and by eye and the impact of the
cataract services in relation to time, place, gender and resources could be
reviewed.
Publication Types:

942: J AHIMA. 2004 Oct;75(9):50-2, 54.
Creating an HIM profession in the Sultanate of Oman.
Mogli GD.
Oman Medical Record Institute, Ministry of Health, Sultanate of Oman.

gdmogli@yahoo.com
943: Technol Health Care. 2004;12(4):347-57.

Patient Record Information System (PaRIS) for primary health care

centers in Indonesia.
Pambudi IT, Hayasaka T, Tsubota K, Wada S, Yamaguchi T.
Department of Bioengineering and Robotics, Tohoku University, Sendai 980-

8579, Japan.
This study explores the Patient Record Information System (PaRIS) for primary
health care centers in a developing country such as Indonesia. The specific
geography of the thousand islands country Indonesia is the reason for
transportation difficulties as well as communication problems. This causes a
serious adverse effect on the public healthcare service especially in the rural area
within the country. Hence, a sustainable system is required that makes use of
appropriate Information and Communication Technology (ICT). We developed a
clinical information system with modest communication technology combined
with a unique database distribution system. The Internet and its free software are
the main tools for this system. It is a good opportunity for a developing country
such as Indonesia to apply open free software in regard to the healthcare sector.
This cost effective and sustainable system can enhance the work of physicians in
order to provide better and applicable public health care service.
Publication Types:

944: Indian J Med Res. 2004 Sep;120(3):131-2.
Women's health biobank in India.
Kennedy S.
Publication Types:
• Editorial
945: Eur J Clin Nutr. 2005 Feb;59(2):246-54.

Folate intake estimated with an updated database and its association

to blood folate and homocysteine in Korean college students.
Han YH, Yon M, Hyun TH.
Department of Food and Nutrition, Chungbuk National University, Gaeshin-dong,

Cheongju, Korea.
OBJECTIVE: To measure folate content in cooked foods commonly consumed in

Korea for evaluating its relation to folate nutriture of college students. DESIGN:
Folate content in 32 raw and cooked foods was measured by microbiological
assay after trienzyme extraction. These values and the previously published
values of 110 raw foods commonly consumed in Korea were used to update the
currently available food tables to estimate dietary folate intake of 106 students
based on a 3-day 24-h recall. The association of folate intake with blood folate
and homocysteine concentrations was evaluated. SETTING: Cheongju, Korea.
SUBJECTS: Healthy college students aged 18 to 27 y old (44 males and 62
females). RESULTS: The average folate loss in 32 foods caused by cooking was
29%. The mean daily dietary folate intakes estimated with an updated database
were 406 and 305 mug in males and females, respectively. About 10% of both
male and female students showed low serum folate (<6.8 nmol/l). Folate intake
was positively correlated with serum and erythrocyte folate concentrations in
female students (r=0.27 and 0.29, respectively, P<0.05), and negatively correlated
with serum homocysteine in male students (r=-0.41, P<0.05). CONCLUSIONS:
Mean dietary folate intake was higher than those of previous studies since the
database was updated using values obtained with trienzyme extraction. Folate
intake for the general population should be re-evaluated using reliable food folate
values obtained with trienzyme extraction.
946: Trop Med Int Health. 2004 Oct;9(10):1081-90.

Malaria epidemiology in a rural area of the Mekong Delta: a

prospective community-based study.
Erhart A, Thang ND, Bien TH, Tung NM, Hung NQ, Hung LX, Tuy TQ,
Speybroeck N, Cong LD, Coosemans M, D'Alessandro U.
Institute of Tropical Medicine Prince Leopold, Antwerp, Belgium. aerhart@itg.be
Over the past 10 years, the Mekong Delta region in Vietnam has experienced fast
socio-economic development with subsequent changes in malaria vectors
ecology. We conducted a 2-year prospective community-based study in a coastal
rural area in the southern Mekong Delta to re-assess the malaria epidemiological
situation and the dynamics of transmission. The incidence rate of clinical malaria,
established on 558 individuals followed for 23 months by active case detection
and biannual cross-sectional surveys, was 2.6/100 person-years. Over the 2-year
study period, the parasite rate and malaria seroprevalence (Plasmodium
falciparum and P. vivax) decreased significantly from 2.4% to almost 0%. Passive
case detection (PCD) of clinical cases and serological follow-up of newborns
carried out in a larger population confirmed the low and decreasing trend of
malaria transmission. The majority of fever cases were seen in the private sector
and most were unnecessarily treated with antimalarials. Training and involvement
of the private sector in detection of malaria cases would greatly improve the
quality of health care and health information system.
Publication Types:
947: J Clin Pharm Ther. 2004 Oct;29(5):417-24.

Beliefs of chronically ill Japanese patients that lead to intentional

non-adherence to medication.
Iihara N, Tsukamoto T, Morita S, Miyoshi C, Takabatake K, Kurosaki Y.
Department of Pharmacy, Kagawa University Hospital, Ikenobe Miki-cho, Kita-

gun, Japan. naomiiih@kms.ac.jp
OBJECTIVE: To identify factors, associated with personal beliefs, involved in

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

Comment on:
• Int J Cancer. 2004 May 1;109(5):777-81.
Trends in colorectal cancer mortality in Japan, 1970-2000.

Bosetti C, Malvezzi M, Chatenoud L, Negri E, Levi F, La Vecchia C.
Publication Types:
• Comment
• Letter
949: Gen Hosp Psychiatry. 2004 Sep-Oct;26(5):359-66.

Hospital preparedness for possible nonconventional casualties: an

Israeli experience.
Schreiber S, Yoeli N, Paz G, Barbash GI, Varssano D, Fertel N, Hassner A,

Drory M, Halpern P.
Department of Psychiatry, Tel Aviv Sourasky Medical Center, Weizmann Street

6, Tel Aviv, Israel. shaulsch@tasmc.health.gov.il
Since 9/11, hospitals and health authorities have been preparing medical response
in case of various mass terror attacks. The experience of Tel Aviv Sourasky
Medical Center in treating suicide-bombing mass casualties served, in the time
leading up to the war in Iraq, as a platform for launching a preparedness program
for possible attacks with biological and chemical agents of mass destruction.
Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure"
of the hospital, and including human behavior experts, we attempted to foster an
interactive emergency management process that would deal with contingencies
stemming from the potential hazards of chemical and biological (CB) weapons.
The main objective of our work was to encourage an organization-wide
communication network that could effectively address the contingent hazards
unique to this unprecedented situation. A stratified assessment of needs,
identification of unique dangers to first responders, and assignment of team-
training sessions paved the way for program development. Empowerment through
leadership and resilience training was introduced to emergency team leaders of all
disciplines. Focal subject matters included proactive planning, problem-solving,
informal horizontal and vertical communication, and coping through stress-
management techniques. The outcome of this process was manifested in an
"operation and people" orientation supporting a more effective and compatible
emergency management. The aim of article is to describe this process and to point
toward the need for a broad-spectrum view in such circumstances. Unlike military
units, the civilian hospital staff at risk, expected to deal with CB casualties,
requires adequate personal consideration to enable effective functioning. Issues
remain to be addressed in the future. We believe that collaboration and sharing of
knowledge, information, and expertise beyond the medical realm is imperative in
assisting hospitals to expedite appropriate preparedness programs.
950: Isr Med Assoc J. 2004 Oct;6(10):583-7.

Electronic medical record systems in Israel's public hospitals.
Lejbkowicz I, Denekamp Y, Reis S, Goldenberg D.
Galil Center for Medical Informatics and Telemedicine, Technion Faculty of

Medicine, Haifa, Israel. izabella@tx.technion.ac.il
BACKGROUND: Various medical centers in Israel have recently incorporated

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

951: Acad Emerg Med. 2004 Oct;11(10):1102-4.
A multicasualty event: out-of-hospital and in-hospital organizational

aspects.
Avitzour M, Libergal M, Assaf J, Adler J, Beyth S, Mosheiff R, Rubin A,

Feigenberg Z, Slatnikovitz R, Gofin R, Shapira SC.
Department of Orthopedic Surgery, Trauma Unit, Hadassah Medical

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

952: J Nutr. 2004 Oct;134(10):2592-602.
Multimicronutrient interventions but not vitamin a or iron

interventions alone improve child growth: results of 3 meta-
analyses.
Ramakrishnan U, Aburto N, McCabe G, Martorell R.
Department of International Health, Rollins School of Public Health, Emory

University, Atlanta, GA 30322, USA. uramakr@sph.emory.edu
Meta-analyses of randomized controlled intervention trials were conducted to

assess the effects of vitamin A, iron, and multimicronutrient interventions on the
growth of children < 18 y old. A PubMed database search and other methods
identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies
that met the design criteria. Weighted mean effect sizes and CI were calculated
using a random effects model for changes in height and weight. Tests for
homogeneity and stratified analyses by predefined characteristics were conducted.
Vitamin A interventions had no significant effect on growth; effect sizes were
0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight.
Iron interventions also had no significant effect on child growth. Overall effect
sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30)
for weight. The results were similar across categories of age, duration of
intervention, mode and dosage of intervention, and baseline anthropometric
status. Iron interventions did result in a significant increase in hemoglobin (Hb)
concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51).
Multimicronutrient interventions had a positive effect on child growth; the effect
sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for
weight. Interventions limited to only vitamin A or iron did not improve child
growth. Multimicronutrient interventions, on the other hand, improved linear and
possibly ponderal growth in children.
Publication Types:
• Meta-Analysis
• Review
953: Stud Health Technol Inform. 2002;90:821-5.

A framework for a diabetes mellitus disease management system in

southern Israel.
Fox MA, Harman-Boehm I, Weitzman S, Zelingher J.
The Goldman Health Sciences Faculty, Ben Gurion University of the Negev,
Israel.
Chronic diseases are a significant burden on western healthcare systems and

national economies. It has been suggested that automated disease management for
chronic disease, like diabetes mellitus (DM), improves the quality of care and
reduces inappropriate utilization of diagnostic and therapeutic measures. We have
designed a comprehensive DM Disease Management system for the Negev region
in southern Israel. This system takes advantage of currently used clinical and
administrative information systems. Algorithms for DM disease management
have been created based on existing and accepted Israeli guidelines. All data
fields and tables in the source information systems have been analyzed, and
interfaces for periodic data loads from these systems have been specified. Based
on this data, four subsets of decision support algorithms have been developed.
The system generates alerts in these domains to multiple end users. We plan to
use the products of this information system analysis and disease management
specification in the actual development process of such a system shortly.
Publication Types:
954: Saudi Med J. 2004 Sep;25(9):1153-9.

Health hazards of cement dust.
Meo SA.
Department of Physiology (29), College of Medicine, King Khalid University, PO

Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. sultanmeo@hotmail.com
Even in the 21st century, millions of people are working daily in a dusty
environment. They are exposed to different types of health hazards such as fume,
gases and dust, which are risk factors in developing occupational disease. Cement
industry is involved in the development of structure of this advanced and modern
world but generates dust during its production. Cement dust causes lung function
impairment, chronic obstructive lung disease, restrictive lung disease,
pneumoconiosis and carcinoma of the lungs, stomach and colon. Other studies
have shown that cement dust may enter into the systemic circulation and thereby
reach the essentially all the organs of body and affects the different tissues
including heart, liver, spleen, bone, muscles and hairs and ultimately affecting
their micro-structure and physiological performance. Most of the studies have
been previously attempted to evaluate the effects of cement dust exposure on the
basis of spirometry or radiology, or both. However, collective effort describing
the general effects of cement dust on different organ and systems in humans or
animals, or both has not been published. Therefore, the aim of this review is to
gather the potential toxic effects of cement dust and to minimize the health risks
in cement mill workers by providing them with information regarding the hazards
of cement dust.
Publication Types:
• Review
955: Nippon Koshu Eisei Zasshi. 2004 Jul;51(7):507-21.

[Evaluation of demographic factors for autonomy of the elderly and

their families in selecting long-term care insurance services]
Kutsumi M, Ito M, Mikami H.
Division of Health Promotion Science, Graduate School of Medicine, Osaka

University.
PURPOSE: This study was conducted to characterize (1) the autonomy of service
users, both frail elderly and of their family caregivers, in selecting Long-term care
insurance services, and to evaluate (2) influencing demographic factors. The aim
was to propose new directions for the care providing system. METHODS: The
subjects were 1,760 users of public Long-term Care Insurance who were
randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data
were collected through a mailed anonymous self-report questionnaire in October,
2001. The number returned was 1,178 (66.9%). In this study, 723 eligible cases
were analyzed in separate models: 146 cases for the elderly model, and 577 for
the family model. Multiple regression analysis and two-way analysis of variance
were performed to identify factors which have direct and interactive effects,
respectively, on the autonomy. RESULTS: 1) The degree of autonomy of the
elderly (3.1 +/- 0.8 (range 1-4)) was high in comparison with the family (2.8 +/-
0.8). 2) In the elderly model, the ability to collect service information and the
level of knowledge about the service contents had a direct effect on the autonomy.
In the family model, ability to collect service information and the level of
knowledge about the service contents, the degree of informing the provider of
own care needs, and good relations among family members had direct effects. 3)
In the elderly model significant two-way interactive effects on the autonomy were
observed between the level of knowledge about the service contents and the age;
attitudes of the service providers and the age or gender of the recipient; the degree
of informing the provider of own care needs and the gender. In the family model,
significant interactions were noted between the attitudes of the service providers
and the age of the family caregiver; the level of congitive disorders of the elderly
and the length of service usage. CONCLUSIONS: It was clarified that the score
for autonomy of the family was low in comparison with that for elderly, and the
essential requisites of service providers for enhancing the autonomy of elderly
people and families may vary depending on the basic characteristics or the
situation of the user. It was suggested that support to enhance users autonomy
should be provided by taking the demographic factors of the user into
consideration.
Publication Types:
• Clinical Trial
956: Br J Ophthalmol. 2004 Oct;88(10):1237-41.

Utilisation of eye care services in rural south India: the Aravind

Comprehensive Eye Survey.
Nirmalan PK, Katz J, Robin AL, Krishnadas R, Ramakrishnan R,

Thulasiraj RD, Tielsch J.
Lions Aravind Institute of Community Opthalmology, Aravind Eye Care System,

Madurai, India.
AIM: To determine utilisation of eye care services in a rural population of

southern India aged 40 years or older. METHODS: 5150 subjects aged 40 years
and older selected through a random cluster sampling technique from three
districts in southern India underwent detailed ocular examinations for vision
impairment, blindness, and ocular morbidity. Information regarding previous use
of eye care services was collected from this population through a questionnaire
administered by trained social workers before ocular examinations. RESULTS:
3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827
(35.5%) people gave a history of previous eye examinations, primarily from a
general hospital (n = 1073, 58.7%). Increasing age and education were associated
with increased utilisation of eye care services. Among the 3323 people who had
never sought eye care, 912 (27.4%) had felt the need to have an eye examination
but did not do so. Only one third of individuals with vision impairment, cataracts,
refractive errors, and glaucoma had previously utilised services.
CONCLUSIONS: A large proportion of people in a rural population of southern
India who require eye care are currently not utilising existing eye care services.
Improved strategies to improve uptake of services is required to reduce the huge
burden of vision impairment in India.
Publication Types:
• Duplicate Publication
PMCID: PMC1772350
957: Bull World Health Organ. 2004 Aug;82(8):580-6. Epub 2004 Sep 13.
Public-private mix for DOTS implementation: what makes it work?
Lönnroth K, Uplekar M, Arora VK, Juvekar S, Lan NT, Mwaniki D,

Pathania V.
Stop TB Department, World Health Organization, Geneva, Switzerland.

lonnrothk@who.int
OBJECTIVE: To compare processes and outcomes of four public-private mix

(PPM) projects on DOTS implementation for tuberculosis (TB) control in New
Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India.
METHODS: Cross-project analysis of secondary data from separate project
evaluations was used. Differences among PPM project sites in impact on TB
control (change in case detection, treatment outcomes and equity in access) were
correlated with differences in chosen intervention strategies and structural
conditions. FINDINGS: The analysis suggests that an effective intervention
package should include the following provider-side components: (1) orienting
private providers (PPs) and the staff of the national TB programme (NTP); (2)
improving the referral and information system through simple practical tools; (3)
the NTP adequately supervising and monitoring PPs; and (4) the NTP providing
free anti-TB drugs to patients treated in the private sector. CONCLUSION:
Getting such an intervention package to work requires that the NTP be strongly
committed to supporting, supervising and evaluating PPM projects. Further, using
a local nongovernmental organization or a medical association as an intermediary
may facilitate collaboration. Investing time and effort to ensure that sufficient
dialogue takes place among all stakeholders is important to help build trust and
achieve a high level of agreement.
Publication Types:
958: J Health Organ Manag. 2004;18(2-3):207-20.

A management information system to plan and monitor the delivery

of health-care services in government hospitals in India.
Ramani KV.
Indian Institute of Management, Ahmedabad, India.
Governments all over the world are getting increasingly concerned about their
ability to meet their social obligations in the health sector. In this paper, we
discuss the design and development of a management information system (MIS)
to plan and monitor the delivery of healthcare services in government hospitals in
India. Our MIS design is based on an understanding of the working of several
municipal, district, and state government hospitals. In order to understand the
magnitude and complexity of various issues faced by the government hospitals,
we analyze the working of three large tertiary care hospitals administered by the
Ahmedabad Municipal Corporation. The hospital managers are very concerned
about the lack of hospital infrastructure and resources to provide a satisfactory
level of service. Equally concerned are the government administrators who have
limited financial resources to offer healthcare services at subsidized rates. A
comprehensive hospital MIS is thus necessary to plan and monitor the delivery of
hospital services efficiently and effectively.
959: J Nurs Res. 2004 Sep;12(3):227-36.

The development of intelligent, triage-based, mass-gathering

emergency medical service PDA support systems.
Chang P, Hsu YS, Tzeng YM, Sang YY, Hou IC, Kao WF.
Institute of Health Informatics and Decision Making, National Yang-Ming

University, ROC. Polun@ym.edu.tw
The support systems for the Emergency Medical Services (EMS) at mass
gatherings, such as the local marathon or large international baseball games, are
underdeveloped. The purposes of this study were to extend well-developed,
triage-based, EMS Personal Digital Assistant (PDA) support systems to cover
pre-hospital emergency medical services and onsite evaluation forms for the mass
gatherings, and to evaluate users ' perceived ease of use and usefulness of the
systems in terms of Davis ' Technology Acceptance Model (TAM). The systems
were developed based on an established intelligent triage PDA support system
and two other forms the general EMS form from the Taipei EMT and the
customer-made Mass Gathering Medical form used by a medical center. Twenty-
three nurses and six physicians in the medical center, who had served at mass
gatherings, were invited to examine the new systems and answer the TAM
questionnaire. The PDA systems were composed of 450 information items within
42 screens in 6 categories. The results supported the potential for using triage-
based PDA systems at mass gatherings. Overall, most of the subjects agreed that
the systems were easy to use and useful for mass gatherings, and they were
willing to accept the systems.
Publication Types:
960: Trop Med Int Health. 2004 Sep;9(9):1016-21.

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

surveillance.
Jena AB, Mohanty KC, Devadasan N.
District Health Office, Baripada, Orissa, India. abanijena@yahoo.com
OBJECTIVE: To demonstrate the importance of surveillance systems in detecting

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

Development and pilot evaluation of user acceptance of advanced

mass-gathering emergency medical services PDA support systems.
Chang P, Hsu YS, Tzeng YM, Hou IC, Sang YY.
Institute of Health Informatics and Decision Making, National Yang-Ming

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

The Hong Kong Hospital Authority's information architecture.
Cheung NT, Fung V, Kong JH.
Health Informatics Section, Hospital Authority, Hong Kong, SAR.

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

A database for Chinese outpatients with rheumatic diseases.
Tian X, Hersh W, Logan J, Bennett R.
Department of Rheumatology and Clinical Immunology, Peking Union Medical

College Hospital, Shuaifuyuan 1, Wangfujing Street, Dongcheng District, Beijing
100730, China.
Although several databases have been developed in rheumatology aimed at

profiling the morbidity pattern of rheumatic diseases, or to capture the detailed
clinical and outcome information of patients with a specific rheumatic disease,
there is no database in China, as yet, for capturing visit-related health information
of all outpatients with rheumatic diseases. In this project, a relational database
was developed for the rheumatic outpatient clinic of Peking Union Medical
College Hospital (PUMCH). The primary goal of this database is to collect and
organize visit-related information of outpatients with rheumatic diseases to meet
information needs of clinical research, health care continuity and teaching of
rheumatic diseases. The implementation of this database can improve health
services, medical records management and clinical research of outpatients with
rheumatic disease at PUMCH.
Publication Types:
964: Ophthalmology. 2004 Sep;111(9):1778-81.

Ocular trauma in a rural south Indian population: the Aravind

Comprehensive Eye Survey.
Nirmalan PK, Katz J, Tielsch JM, Robin AL, Thulasiraj RD, Krishnadas R,
Ramakrishnan R; Aravind Comprehensive Eye Survey.
Aravind Medical Research Foundation, Aravind Eye Care System, Madurai,

India.
PURPOSE: To determine the rate of ocular trauma in a rural population of

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

Comment in:
• Indian J Med Res. 2004 Aug;120(2):70-2.
Communicable diseases monitored by disease surveillance in

Kottayam district, Kerala state, India.
John TJ, Rajappan K, Arjunan KK.

The Kerala State Institute of Virology & Infectious Diseases, Alappuzha, Kerala,
India. vlr_tjjohn@sancharnet.in
BACKGROUND & OBJECTIVES: A disease surveillance model developed in

the North Arcot district, Tamil Nadu, was found to be practical, efficient,
inexpensive and useful for public health action to monitor the success of ongoing
interventions and to detect and intercept outbreaks. It was centred in the private
(voluntary) sector with full co-operation and participation by the government
sector. As Kerala state wanted to replicate this model in all districts, one district
was chosen to pilot test it centred within the existing district public health system,
soliciting participation from the private sector. A two-year (1999-2001)
performance of this model is presented. METHODS: After elaborate preparations
including the selection of 14 diseases to be reported and training of doctors in the
private sector health care institutions and doctors and paramedical staff in all
government health centres and hospitals, printed post cards were widely
distributed. The business reply system was used so as to avoid handling postage
stamps. Cards were received by the nodal officer in the district public health
office and checked on a daily basis to detect disease prevalence and evidence of
clustering in time and space. Swift action was taken on detecting case clustering.
A monthly bulletin containing disease summaries and other useful information
was freely distributed to all reporting centres. RESULTS: On an average, just
over 100 disease reports were received every month. The most frequently reported
diseases were, in the descending order, leptospirosis, acute dysentery, typhoid
fever and acute hepatitis. Among vaccine-preventable childhood diseases, only
measles was reported, but no diphtheria, tetanus or whooping cough. Several
outbreaks were detected early and interventions applied to intercept them. The
most striking example was that of cholera, the occurrence of which was detected
swiftly for instituting highly successful control measures. INTERPRETATION &
CONCLUSION: The district level disease surveillance system centred in the
government public health system has been highly successful. Disease surveillance
was responsible for the government to obtain information on the prevalence of
leptospirosis in the district. The reports enabled the public health officers to detect
disease-clustering as the early signals of outbreaks and to take quick remedial
measures.
Publication Types:
966: Environ Sci Pollut Res Int. 2004;11(4):209-21.

Comment in:
• Environ Sci Pollut Res Int. 2004;11(4):207-8.
Long overlooked historical information on Agent Orange and

TCDD following massive applications of 2,4,5-T-containing
herbicides, Eglin Air Force Base, Florida.
Young AL, Newton M.
Institute for Science and Public Policy, Sarkeys Energy Center, The University of
Oklahoma, 100 East Boyd Street, Room 510, Norman, Oklahoma 73019, USA.
youngrisk@aol.com
BACKGROUND: From 1961-1971, The Air Development Test Center, Eglin Air
Force Base (AFB), Florida, developed, tested, and calibrated the aerial spray
systems used in support of Operation RANCH HAND and the US Army
Chemical Corps in Vietnam. Twenty major test and evaluation projects of aerial
spray equipment were conducted on four fully instrumented test grids, each
uniquely arrayed to match the needs of fixed-wing, helicopter, or jet aircraft. Each
of the grids was established within the boundary of Test Area 52A of the Eglin
Reservation. METHODS: The tests, conducted under climatic and environmental
conditions similar to those in Vietnam, included the use of the military herbicides
(Agents) Orange, Purple, White, and Blue. Approximately 75,000 kg of 2,4,5-
trichlorophenoxyacetic acid (2,4,5-T) and 76,000 kg of 2,4-dichlorophenoxyacetic
acid (2,4-D) were aerially disseminated on an area of less than 3 km2 during the
period 1962-1970. Data from the analysis of archived samples suggested that an
estimated 3.1 kg of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), present as a
contaminant, were aerially released in the test area. Because most of the
vegetation had been removed before establishing the test site in 1961, there was
an opportunity to follow ground-based residues independent of canopy
interception, and the resulting high solar exposure of initial residues. Studies of
the soils, fauna, flora, and aquatic ecosystems of the test grids and associated
perimeters of Test Area C-52A (an area totally more than 8 km2) were initiated in
1969 and concluded in 1984. RESULTS AND DISCUSSION: Data from soil
samples collected from 1974 through 1984 suggested that less than one percent of
the TCDD that was present in soil when sampling began persisted through the
ten-year period of sampling. More than 340 species of organisms were observed
and identified within the test area. More than 300 biological samples were
analyzed for TCDD and detectable residues were found in 16 of 45 species
examined. Examination of the ecological niches of the species containing TCDD
residues suggested each was in close contact with contaminated soil. Indepth field
studies, including anatomical, histological and ultrastructural examinations,
spanning more than 50 generations of the Beachmouse, Peromyscus polionotus,
demonstrated that continual exposure to soil concentrations of 0.1 to 1.5 parts-
per-billion (ng/g) of TCDD, had minimal effects upon the health and reproduction
of this species. CONCLUSIONS: Since Agent Orange with its associated TCDD
contaminant was aerially disseminated on the test grids, Test Area C-52A
provided a 'field laboratory' for what may have happened in Vietnam, had there
been no intercepting forest cover. However, in Vietnam a 'typical' mission would
have disseminated 14.8 kg of 2,4,5-T/ha, most of which was intercepted by the
forest canopy, versus the 876 kg 2,4,5-T/ha on the test grid at Eglin. Moreover,
each hectare on the Eglin test grid received at least 1,300 times more TCDD than
a hectare sprayed with Agent Orange in Vietnam. The disappearance or
persistence of TCDD is dependent upon how it enters the ecosystem. Spray
equipment test and evaluations missions at Eglin were generally scheduled and
conducted with environmental conditions that were optimal for spray operations.
This suggests that conditions favorable for dissemination of herbicide were the
same conditions favorable for photodegradation of TCDD. It was likely that 99
percent of the TCDD never persisted beyond the day of application. No long-term
adverse ecological effects were documented in these studies despite the massive
quantities of herbicides and TCDD that were applied to the site. Reviews by the
US Environmental Protection Agency and the National Academy of Sciences'
Institute of Medicine did not address the fate of Agent Orange and TCDD as
described in these studies from Eglin AFB, Florida.
Publication Types:
• Historical Article
• Review
967: Int J Cardiol. 2004 Oct;97(1):49-55.

Telecardiology for patients with chronic heart failure: the 'SHL'

experience in Israel.
Roth A, Kajiloti I, Elkayam I, Sander J, Kehati M, Golovner M.
Department of Cardiology, Tel-Aviv Sourasky Medical Center, the Sackler

Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239
Israel. arieroth@tasmc.health.gov.il
Background: Patients with chronic heart failure characteristically have multiple

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

A study on the needs of medical, maternal and child health care in

Chinese women students at the University of Tokyo.
Gu YH, Lee S, Ushijima H.
Department of Pediatrics, Teikyo University, Tokyo, Japan.
According to the information provided by the University of Tokyo (UT) in 2001,

317 Chinese women students were enrolled in the UT, and 88% of them were
graduate students. Although the surveys on the life of international students at the
UT had been conducted in 1989 and 1998, the medical and health issues were not
included. With the objective of exploring the medical and heath care needs of
Chinese women students at the UT a survey was carried out from December 2001
to January 2002. With the cooperation of the International Students Center at the
UT a questionnaire in Chinese was sent to each department in which 317 Chinese
women students were studying. Out of 104 students responded, eligible subjects
were 98. The results of present study revealed some problems, such as the
language barrier, preference for a translator in hospitals or health centers, and a
medical guidebook with information on vaccinations in Chinese. They also stated
their lack of knowledge about the Japanese medical and health system, and their
distress for being separated from their children. In conclusion, the most severe
problem was language barrier for Chinese women students in obtaining medical
and health care for themselves and their children. It was also noted that lack of
knowledge of the Japanese medical and health care system was another obvious
problem.
Publication Types:
969: Scand J Plast Reconstr Surg Hand Surg. 2003;37(6):325-31.

Development of a network system for the care of patients with cleft

lip and palate in Thailand.
Chowchuen B, Godfrey K.
Division of Plastic Surgery, Faculty of Medicine and Project Director of Center

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

970: Int J Med Inform. 2004 Sep;73(9-10):675-85.
Investigating public health emergency response information system

initiatives in China.
Liang H, Xue Y.
Department of Information Technology and Operations Management, College of

Business, Florida Atlantic University, Ft. Lauderdale, FL 33308, USA.
hliang@fau.edu
Infectious diseases pose a great danger to public health internationally. The

outbreak of SARS has exposed China's fragile public health system and its limited
ability to detect and respond to emergencies in a timely and effective manner. In
order to strengthen its capability of responding to future public health
emergencies, China is developing a public health emergency response information
system (PHERIS) to facilitate disease surveillance, detection, reporting, and
response. The purpose of this study is to investigate the ongoing development of
China's PHERIS. This paper analyzes the problems of China's existing public
health system and describes the design and functionalities of PHERIS from both
technical and managerial aspects.
Publication Types:
• Review
971: Health Info Libr J. 2004 Sep;21 Suppl 2:69-71.

Development of Library Services for disadvantaged people: a

Japanese perspective.
Nomura M.
Information Center & Japanese Society for Rehabilitation of Persons with

Disabilities. nomura@dinf.ne.jp

972: Public Health. 2004 Sep;118(6):395-402.
Public health improvement in Iran--lessons from the last 20 years.
Asadi-Lari M, Sayyari AA, Akbari ME, Gray D.
Division of Cardiovascular Medicine, Queens Medical Centre, University

Hospital, Nottingham NG7 2UH, UK. msxma@nottingham.ac.uk
INTRODUCTION: Health services are historically based on providers's and

policy makers's understanding of population health status. This does not
necessarily reflect the real needs of a population. Health needs assessment (HNA)
should improve individual or population health and optimize the way that limited
resources are utilized. OBJECTIVES: To review health needs literature and to
describe Iranian primary healthcare (PHC) achievements in developing a needs-
driven health system. FINDINGS: The Iranian PHC system was established to
meet healthcare needs identified through population health status surveys. Since
1984, the PHC system has become highly organized and efficient, resulting in a
dramatic decrease in infant, maternal and neonatal mortality rates, population
growth, increasing life span and a marked shift towards non-communicable
diseases. Through an organized partnership of the general population, volunteers,
health workers and health professionals, a needs-oriented healthcare system
became central to health policy in Iran. Several information sources were utilized
to establish need. Improving death certification was an immediate and important
part of this process. COMMENT: Improved knowledge about personal rights,
community and environmental health policies, and involvement of the media led
to an increased range and depth of needs. Moving towards quality improvement
and a needs-driven healthcare system requires continuous needs assessment.
Novel methods of HNA, such as postal and telephone surveys, group discussions,
surrogates for need such as quality-of-life measurement (commonly used in
developed countries) or other locally designed methods such as the basic
development needs approach, may be relevant to the Iranian PHC network.
973: Gan To Kagaku Ryoho. 2003 Dec;30(1 Suppl):104-8.

[Construction of a pharmacy network that supports home medical

care]
Kushida K.
Showa Pharmaceutical University.
Home medical care is recently being promoted thanks to the establishment of the
related medical insurance system and by patient choice. Home medical care
requires a collaboration of home treatment, home nursing, and drug supply, and
within this collaborative network, pharmacists also play the role to supply drugs
(dispensing). Drugs that used for home care include injectable agents for pain
control or hygiene management. Therefore, pharmacies need to be furnished with
clean rooms and clean benches to dispense drugs aseptically. However, because
of the enormous costs of capital investment and the uncertainty of the number of
patients who will use pharmacies, a very few pharmacies are adequately
furnished. The survey has revealed that 76 pharmacies are adequately furnished. It
is presumed that home medical care will continously promoted in the future so a
network of pharmacies that can dispense injectable drugs must be set up under the
home care support system.
Publication Types:
974: Parassitologia. 2004 Jun;46(1-2):67-70.

[A minimum medical GIS database (MMDb) for Europe]
[Article in Italian]
Brianti E, Malone JB, McCarroll JC, Bernardi M, Drigo M, Gruszynski K.
Department of Veterinary Public Health, School of Veterinary Medicine,

University of Messina, Messina, Italy.
Geographic information systems (GIS) and remote sensing (RS) technologies are
being used increasingly to study the spatial and temporal patterns of some
parasitic diseases of medical and veterinary importance. At the same time, the
incorporation of GIS in this field shows the scarcity of the data and images
available, which sometime discourage researchers that still look at GIS as a
system too difficult and unusable for medical study. Aware of this problem and
supported by success of earlier MMDb's for Africa, Asia and South America, the
authors' aim is to construct and offer an MMDb for Europe. The initial MMDb is
composed with vector images covering an area situated from -11 degrees-70
degrees N to 58 degrees-30 degrees E. Specifically, data layers include: a) Global
Moderate-Resolution Imaging Spectroradiometer (MODIS) Normalized
Difference Vegetation Index (NDVI) 16 days at 250 m spatial resolution designed
to provide consistent spatial and temporal comparisons of vegetation conditions,
supplied in the MMDb as seasonal and annual composite images from 2000 to
2003, b) MODIS Land Surface Temperature (LST) calculated from daytime and
nighttime observations at 8 day intervals at 1 km spatial resolution, supplied in the
MMDb as seasonal and annual composites images for day (maximum)
temperatures, night (minimum) temperatures from 2000 to 2003, c) GTOPO30
Digital Elevation Model (DEM) at 1 km spatial resolution, d) United States
Geological Survey (USGS) Land use/land cover scheme, e) USGS actual and
potential evapotranspiration supplied for all 12 months as a grid at 50 km spatial
resolution, f) USGS precipitation showing the amount of rainfall for all 12 months
supplied as a grid at 50 km spatial resolution, g) USGS shapefiles of
administrative and political boundaries, cities, towns, villages, lakes, rivers,
streams, road, railroads and more. The MMDb projection will be in geographic
latitude-longitude, decimal degree format. This global format is most commonly
used for public access map database resources and can be readily re-projected as
needed for compatibility with various national mapping systems. There is no
"required" software, and end users need only common commercial GIS software
packages that have mutual import-export functions. Additionally, the MMDb is
meant to be a dynamic resource that end users may improve and modify with
other regional data.
Publication Types:
• Review
975: Cancer. 2004 Aug 15;101(4):796-802.

Reevaluation of prognostic factors for survival after liver resection

in patients with hepatocellular carcinoma in a Japanese nationwide
survey.
Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma

Y, Okita K, Omata M, Takayasu K, Yamaoka Y.
Department of Gastroenterological Surgery, Kyoto University Graduate School of

Medicine, Kyoto, Japan. ikai@kuhp.kyoto-u.ac.jp
BACKGROUND: Advances in the diagnosis and surgical treatment of

hepatocellular carcinoma (HCC) have improved the prognosis for patients with
HCC who undergo liver resection. The objective of this study was to evaluate
prognostic predictors for patients with HCC who underwent liver resection in a
Japanese nationwide data base. METHODS: In this study, the authors analyzed
12,118 patients with HCC in a Japanese nationwide data base who underwent
liver resection between 1990 and 1999 and compared them with a previous
analysis of patients between 1982 and 1989. All patients were evaluated for
prognostic factors. RESULTS: During the last decade, the increases in patients
who were without hepatitis B virus surface antigen, who had small tumors, and
who had portal vein invasion were noted. The 5-year overall survival rates for
patients with HCC improved to 50.5%, compared with < 40% in the previous
analysis. A multivariate analysis using a stratified Cox proportional hazards
model according to associated liver disease indicated that age, degree of liver
damage, alpha-fetoprotein level, maximal tumor dimension, number of tumors,
intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic
vein invasion, surgical curability, and free surgical margins were independent
prognostic predictors for patients with HCC. Operative mortality decreased from
2.3% in 1990-1991 to 0.6% in 1998-1999. CONCLUSIONS: Outcomes and
operative mortality rates in patients with HCC improved during the last decade.
Age, degree of liver damage, alpha-fetoprotein level, maximal tumor dimension,
number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal
vein invasion, hepatic vein invasion, surgical curability, and free surgical margins
were prognostic factors for patients with HCC who underwent liver resection.
Publication Types:
976: Fertil Steril. 2004 Aug;82(2):338-42.

Predictors of success during the coasting period in high-responder

patients undergoing controlled ovarian stimulation for assisted
conception.
Ulug U, Ben-Shlomo I, Bahceci M.
Bahceci Women Health Care Center and German Hospital at Istanbul, Nisantasi,
80200 Istanbul, Turkey.
OBJECTIVE: To determine the prognostic factors analyzed during the coasting

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

Educational differentials in mortality from cardiovascular disease

among men and women: the Israel Longitudinal Mortality Study.
Manor O, Eisenbach Z, Friedlander Y, Kark JD.
School of Public Health and Community Medicine, Hebrew University-Hadassah

Medical Organization, Ein Karem, Jerusalem, Israel. om@cc.huji.ac.il
PURPOSE: While socioeconomic inequalities in cardiovascular disease have been

observed in most industrialized countries, available information in Israel centers
on ethnic variations and the role of education has yet to be investigated. This
study examines educational differentials in cardiovascular mortality in Israel for
both men and women aged 45 to 69 and 70 to 89 years. METHODS: Data are
based on a linkage of records from a 20% sample of the 1983 census with the
records of deaths occurring until the end of 1992. The study population includes
152,150 individuals and the number of cardiovascular deaths was 14,651.
Educational differentials were assessed for mortality of diseases of the circulatory
system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases,
and sudden death. RESULTS: Substantial mortality differentials were found
among individuals aged 45 to 69 years, with larger inequalities among women.
The age-adjusted relative risk for mortality of cardiovascular diseases among
those with elementary education (< or =8 years) compared with those with high
education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95%
CI: 1.76-2.41) for women. Differentials among the elderly were markedly
narrower than those for younger adults. Similar trends were observed for
mortality of subgroups of causes including cerebrovascular diseases and ischemic
heart diseases. Educational differentials were not affected by adjustment for
ethnic origin and car ownership. CONCLUSIONS: Those with 8 years of
education or less suffer higher risk of cardiovascular mortality compared with
adults with 13 or more years of education. Young, less educated women are more
vulnerable, and health and social policies oriented towards this group are needed.
Publication Types:
978: Ned Tijdschr Geneeskd. 2004 Jul 10;148(28):1390-4.

Comment in:
• Ned Tijdschr Geneeskd. 2004 Sep 4;148(36):1799.
[Surveillance of hepatitis A in the Netherlands 1993-2002]
[Article in Dutch]
Van Der Eerden LJ, Bosman A, Van Duynhoven YT.
Rijksinstituut voor Volksgezondheid en Milieu, Centrum Infectieziekten

Epidemiologie, Postbus 1, 3720 BA Bilthoven. liesbeth.van.der.eerden@rivm.nl
OBJECTIVE: To survey trends in data on hepatitis A using information from the

notification system of the Municipal Medical and Health Services 1993-2002.
DESIGN: Retrospective, descriptive. METHOD: Data collected from the
notification system of the Dutch Municipal and Medical Services were analyzed.
RESULTS: From 1993 to 2002, 64.4%, 6.5% and 11.5% of infections were
contracted in the Netherlands, Turkey and Morocco, respectively. Although the
absolute number of cases was highest for young people under the age of 16
infected in the Netherlands, incidence rates showed that the children of
immigrants infected in Turkey or Morocco were at highest risk, followed by adult
immigrants from Turkey and Morocco. In addition, a seasonal trend was observed
starting with an increase in the number of notifications of young travellers
infected in Turkey and Morocco during their summer holiday, followed by a steep
increase in notifications of young people infected in the Netherlands in autumn.
This was followed later in the year by a slight increase in notifications of adults
who acquired the infection in the Netherlands. However, between 1993-2002 the
total number of notifications was halved. This decrease was mainly restricted to
infections acquired in the Netherlands. In recent years, fewer outbreaks have been
reported in schools, households and families. In 2001, a peak of notifications from
the homosexual scene was observed. There was a continued trend in the rise of
the mean age of hepatitis-A onset. CONCLUSION: Risk of hepatitis A is highest
for the children of immigrants travelling to Turkey or Morocco in the summer
months. Secondary cases in the Netherlands are in strong decline, especially in
schools and families. However, the almost stable incidence of infections among
young people of Turkish or Moroccan extraction stresses the continued
importance of immunization of this group before they travel. The continuing trend
in the rise of the mean age of hepatitis-A onset deserves attention because of the
increasing risk of mortality of the disease amongst older people.
Publication Types:
979: Hu Li Za Zhi. 2004 Aug;51(4):27-32.

[Future trends in nursing education in Taiwan in the light of

globalization]
[Article in Chinese]
Lee S, Lu YC, Yen WJ, Lin SC.
School on Nursing, Chung-Shan Medical University, ROC. sheuan@csmu.edu.tw
The twenty-first century is the era of the knowledge-based economy. Its

information networks developing rapidly, Taiwan has already entered an age of
liberalization, diversity and globalization. Competition and change will be the
norm. As globalization continues it will pose substantial problems for nursing
education. Nursing is a service-oriented activity which has to develop constantly
to meet the changing demands of the public as people start to live longer, society
becomes more multi-cultural, the nature of diseases and other health problems
changes and public policy, such as that on National Health Insurance, is modified.
This article outlines the problems currently facing nursing education (i.e., the
complexity of the educational system, shortcomings in the learning environment,
curriculum design, the quality of faculty, evaluation methods, and the quality of
students' English and Mathematics) to predict likely difficulties (i.e. student
recruitment, the running of schools and the quality of clinical nurses) and trends
in nursing education. (i.e. changes in the way schools are run in line with the
impact of globalization, new teaching methods; faculty training and development,
lifelong learning, and the internationalization of education.) The article should be
of interest to nursing educators.
Publication Types:
980: Radiology. 2004 Aug;232(2):415-9.

Implementation of an international teleradiology staffing model.
Kalyanpur A, Neklesa VP, Pham DT, Forman HP, Stein ST, Brink JA.
Department of Diagnostic Radiology, Yale University School of Medicine, 789

Howard Ave, TE 2, New Haven, CT 06520-8042, USA.
arjun.kalyanpur@yale.edu
Although teleradiology is presently being used extensively in the United States-

for both overseas subspecialty consultations and overnight coverage of imaging
services at domestic medical centers-there has been limited investigation of its
potential to help provide staffing support to U.S. medical centers from offshore
locations. In this review, the authors describe an empirical assessment of the
clinical feasibility and applicability of body computed tomographic (CT) image
cases that originated at a U.S. university hospital being interpreted nearly
contemporaneously by a staff radiologist in India. During a 3-month period,
nonemergent CT cases obtained at a tertiary care institution (Yale-New Haven
Hospital) were transmitted daily to a satellite reading facility in Bangalore, India.
The cases were interpreted at the satellite reading facility by a faculty member
radiologist who maintained hospital privileges and academic appointment at the
parent institution in the United States. CT imaging reports were transcribed and
uploaded directly to the parent institution's radiology information system.
Technical problems temporarily prevented the transfer of image cases twice
during the study period. Overall, the project results demonstrated the feasibility
and reliability of an international teleradiology staffing model. Copyright RSNA,
2004
981: Cancer Causes Control. 2004 Sep;15(7):681-7.

A comparison of the sources of cancer mortality in China.
Yang L, Parkin DM, Li L, Chen Y.
Unit of Descriptive Epidemiology, International Agency for Research on Cancer,

Lyon, France.
OBJECTIVE: To compare the validity of mortality data from available sources in

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

Utilization of well-baby care visits provided by Taiwan's National

Health Insurance Program.
Chen L, Yang WS, Lee SD, Chang HC, Yeh CL.

Division of Health Policy Research, National Health Research Institutes, 2F, 109
Min-Chuan East Road, Sec. 6, Taipei 114, Taiwan. likwang@nhri.org.tw
In April of 1995, Taiwan's National Health Insurance Program started providing

each eligible child a total of six well-baby care visits. The first four are for
infancy, the fifth is for the second and the third years of life, and the sixth is for
the fourth year. These services are in addition to neonatal screening and a series
of primary immunizations that have been publicly financed and utilized
conventionally for years. The purposes of this study were to investigate the
utilization level of these well-baby care visits, and explore relevant factors. The
results reveal that 36% of eligible children did not use any of the first four visits,
58% did not utilize the fifth, and 82% did not use the sixth in the late 1990s. It
appears that the take-up of these services is much less than satisfactory. Maternal
awareness of and attitudes toward the services appeared to be the most important
factors influencing utilization. These two factors not only were most influential,
but also significantly contributed to disparities in utilization among different
regions and types of residential districts. As a result, they should be the focus of
interventions for advancing well-baby care. While these two factors are at the
individual level, they are not independent from the health care system because the
health care system has impacts on individual factors. Since physicians can serve
as a good vehicle for teaching parents about relevant information and correct
attitudes, and most physicians in Taiwan complained about the payment scheme,
offering stronger incentives for physicians to promote such services might be
helpful for achieving a high utilization level of well-baby care.
Publication Types:
983: Nagoya J Med Sci. 2004 May;67(1-2):51-8.

Associations between disease risk and eight polymorphisms adopted

for genotype announcements at Nagoya University Hospital.
Nishio K, Nakamura S, Sekido Y, Niwa T, Hamajima N.
Department of Preventive Medicine/Biostatistics and Medical Decision Making,

Nagoya University Graduate School of Medicine, Japan.
Genetic polymorphisms have the potential to predict disease susceptibility. This

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

Development and evaluation of a teleradiology and

videoconferencing system.
Kaidu M, Toyabe S, Oda J, Okamoto K, Ozaki T, Shiina M, Sasai K,

Akazawa K.
Department of Diagnostic Imaging and Internal Medicine, Sado General Hospital,

Sado Island, Japan.
We developed a teleradiology system linking a general hospital on Sado Island to

tertiary care hospitals in Niigata City. The island is 40 km from Niigata City on
the mainland and has only one diagnostic radiologist (for 72,000 islanders). Fibre
optic cables between Sado Island and Niigata City were used for transmission.
The introduction of the teleradiology system facilitated diagnostic and therapeutic
consultation with specialists in Niigata City. The performance of the system was
evaluated (on a scale of 0-6, with higher scores indicating better performance) by
five diagnostic radiologists, who rated 32 features of the system twice, once in
April 2002 and once in September 2003. The performance ratings improved from
1.38 to 2.86. While many of the initial problems with the software had been
resolved, many still remained.
Publication Types:
• Case Reports
985: Arch Environ Health. 2003 Aug;58(8):498-504.

Atmospheric transport of mold spores in clouds of desert dust.
Shinn EA, Griffin DW, Seba DB.
U.S. Geological Survey, St. Petersburg, Florida 33701, USA. eshinn@usgs.gov
Fungal spores can be transported globally in clouds of desert dust. Many species
of fungi (commonly known as molds) and bacteria--including some that are
human pathogens--have characteristics suited to long-range atmospheric transport.
Dust from the African desert can affect air quality in Africa, Europe, the Middle
East, and the Americas. Asian desert dust can affect air quality in Asia, the Arctic,
North America, and Europe. Atmospheric exposure to mold-carrying desert dust
may affect human health directly through allergic induction of respiratory stress.
In addition, mold spores within these dust clouds may seed downwind ecosystems
in both outdoor and indoor environments.
Publication Types:
• Review
986: ScientificWorldJournal. 2004 Jul 3;4:500-6.

Snoezelen: children with intellectual disability and working with the

whole family.
Nasser K, Cahana C, Kandel I, Kessel S, Merrick J.
Lev Hakadosh, Residential Care Center for Children, Haifa, Israel.

soad1@netvision.net.il
Snoezelen, or controlled multisensory stimulation, was first introduced in Israel in

1993. This paper presents a new concept of working with the whole family in the
Snoezelen room with the participation of a social worker. The purpose was to
facilitate family encounters with the child, to enable parents and siblings to
become better acquainted with the resident through his/her strengths and special
abilities, to encourage parental involvement in the care, to encourage increased
visits, to improve quality of life (QOL) for the resident, and to reinforce a better
relationship between resident, family, and home. Sessions were divided into two
major parts. The first segment (duration 20-40 min) was free activity and the
second was more structured (duration 15-30 min). Case stories are presented to
illustrate the positive effects of this approach. Snoezelen can be used with the
entire family with the participation of a social worker and can add new
dimensions to communication.
987: J Atheroscler Thromb. 2004;11(3):146-51.

Clinical features of familial hypercholesterolemia in Japan in a

database from 1996-1998 by the research committee of the ministry
of health, labour and welfare of Japan.
Bujo H, Takahashi K, Saito Y, Maruyama T, Yamashita S, Matsuzawa Y,

Ishibashi S, Shionoiri F, Yamada N, Kita T; Research Committeon Primary
Hyperlipidemia of the Ministry of Health, Labour, and Welfare of Japan.
Department of Genome Research & Clinical Application, Chiba University

Graduate School of Medicine, Chiba, Japan. hbujo@faculty.chiba-u.jp
Familial hypercholesterolemia (FH) is one of the most common primary

hyperlipidemias, characterized by a heterozygous or homozygous phenotype for a
severe serum low-density lipoprotein (LDL)-cholesterol level and advanced
atherosclerosis, leading to coronary artery diseases (CAD). Various kinds of
mutations in the LDL receptor gene responsible for the genetic disease have been
identified since the human LDL receptor gene has been identified. In this study,
the clinical features of FH were investigated using a database based on nationwide
surveillance for primary hyperlipidemia and related disorders by the Research
Committee on Primary Hyperlipidemia. The clinical features and the frequencies
of accompanying vascular diseases in 660 cases of FH homozygotes and
heterozygotes showed that the incidence of CAD was negatively associated with
plasma HDL-cholesterol levels, but not with plasma LDL-cholesterol levels, in
641 FH heterozygotes. Risk factor analyses revealed that hypertension, male,
smoking, low HDL-cholesterol levels, age > 50 y, diabetes mellitus, and
hypertriglyceridemia were positive risk factors for CAD. The summarized gene
analysis in FH heterozygotes showed at least 4 mutations in the LDL receptor
gene as common mutations in Japan. The average serum lipids and frequency of
CAD based on each common mutation suggested that their clinical features are in
part determined by responsive mutations in the LDL receptor gene.
Publication Types:
988: Int J Epidemiol. 2004 Dec;33(6):1329-36. Epub 2004 Jul 15.

Population survey to determine risk factors for Mycobacterium

leprae transmission and infection.
Bakker MI, Hatta M, Kwenang A, Faber WR, van Beers SM, Klatser PR,
Oskam L.
KIT (Koninklijk Instituut voor de Tropen/Royal Tropical Institute), KIT

Biomedical Research, Amsterdam, The Netherlands.
BACKGROUND: Not every leprosy patient is equally effective in transmitting

Mycobacterium leprae. We studied the spatial distribution of infection (using
seropositivity as a marker) in the population to identify which disease
characteristics of leprosy patients are important in transmission. METHODS:
Clinical data and blood samples for anti-M. leprae ELISA were collected during a
cross-sectional survey on five Indonesian islands highly endemic for leprosy. A
geographic information system (GIS) was used to define contacts of patients. We
investigated spatial clustering of patients and seropositive people and used logistic
regression to determine risk factors for seropositivity. RESULTS: Of the 3986
people examined for leprosy, 3271 gave blood. Seroprevalence varied between
islands (1.7-8.7%) and correlated significantly with leprosy prevalence. Five
clusters of patients and two clusters of seropositives were detected. In multivariate
analysis, seropositivity significantly differed by leprosy status, age, sex, and
island. Serological status of patients appeared to be the best discriminator of
contact groups with higher seroprevalence: contacts of seropositive patients had
an adjusted odds ratio (aOR) of 1.75 (95% CI 0.922-3.31). This increased
seroprevalence was strongest for contact groups living < or =75 m of two
seropositive patients (aOR = 3.07; 95% CI 1.74-5.42). CONCLUSIONS: In this
highly endemic area for leprosy, not only household contacts of seropositive
patients, but also people living in the vicinity of a seropositive patient were more
likely to harbour antibodies against M. leprae. Through measuring the serological
status of patients and using a broader definition of contacts, higher risk groups can
be more specifically identified.
Publication Types:
989: J Expo Anal Environ Epidemiol. 2004 Jul;14(4):354-62.

Exposure opportunity models for Agent Orange, dioxin, and other

military herbicides used in Vietnam, 1961-1971.
Stellman SD, Stellman JM.
Department of Epidemiology, Mailman School of Public Health, Columbia

University, New York, NY 10032, USA. sds91@columbia.edu
Nearly 19.5 million gallons of herbicides were sprayed on the Republic of

Vietnam between 1961 and 1971 for military purposes. Amounts of spray and
patterns of applications are available in an electronic file called HERBS that
contains records of 9141 defoliation missions, including detailed coordinates of
US Air Force Ranch Hand aircraft flight paths, along with chemical agent and
gallonage sprayed. Two classes of models for use in epidemiological and
environmental studies that utilize the HERBS data for estimating relative
exposure opportunity indices are presented: a discrete "hits" model that counts
instances of proximity in time and space to known herbicide applications, and a
continuous exposure opportunity index, E4, that takes into account type and
amount of herbicide sprayed, distance from spray application, and time interval
when exposure may have occurred. Both direct spraying and indirect exposure to
herbicide (or dioxin) that may have remained in the local environment are
considered, using a conservative first-order model for environmental
disappearance. A correction factor for dermal versus respiratory routes of entry
has been incorporated. E4 has a log-normal distribution that spans six orders of
magnitude, thus providing a substantial amount of discrimination between
sprayed and unsprayed areas. The models improve on earlier ones by making full
use of the geometry of the HERBS spray flight paths of Ranch Hand aircraft. To
the extent possible so many decades after the War, the models have been
qualitatively validated by comparison with recent dioxin soil and biota samples
from heavily contaminated areas of Vietnam, and quantitatively validated against
adipose dioxin obtained in epidemiological studies of Vietnamese. These models
are incorporated within a geographic information system (GIS) that may be used,
as one would expect, to identify locations such as hamlets, villages, and military
installations sprayed by herbicide. In a novel application, the GIS also facilitates
quantitative risk assessment in epidemiological and ecological studies by applying
the models within a framework of historical reconstruction of exposure history of
individuals based upon their location histories.
Publication Types:
• Research Support, U.S. Gov't, Non-P.H.S.

990: Oncol Nurs Forum. 2004 Jul 13;31(4):E69-74. Print 2004 Jul.
Asian/Pacific Islander American women: age and death rates during

hospitalization for breast cancer.
Polek C, Klemm P, Hardie T, Wheeler E, Birney M, Lynch K.
College of Health and Nursing Sciences, University of Delaware, Newark, USA.

cpolek@udel.edu
PURPOSE/OBJECTIVES: To investigate whether differences in age and death

rates exist between hospitalized Asian/Pacific Islander American (APIA) women
and women of other racial groups. DESIGN: Secondary data analysis of a
national data set. SETTING: The Healthcare Cost and Utilization Project
Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data
on women with breast cancer based on racial status. A total of 20,507
hospitalization records met the study criteria. SAMPLE: All women who were
hospitalized with a primary diagnosis of breast cancer, were older than 18, and
did not die during hospitalization, plus all women who met the criteria stated
above but died during hospitalization. METHODS: Secondary data analysis. Post
hoc analysis was used to identify significant differences among racial groups.
FINDINGS: Significant differences were found between APIA and Caucasian and
Latino women. Significant differences based on race were found between subjects
who had died during hospitalization. On average, APIA women were the
youngest to die. CONCLUSIONS: APIA women with breast cancer were among
the youngest women being hospitalized and the youngest to die during
hospitalization. IMPLICATIONS FOR NURSING: Cultural awareness by nurses
is critical when discussing methods for prevention and early detection of breast
cancer with minority women. Targeting new immigrants is a priority for those
who screen and educate women about detection and treatment of breast cancer.
Publication Types:
991: Fam Pract. 2004 Aug;21(4):415-9.

The clinical and economic burden of fibromyalgia compared with

diabetes mellitus and hypertension among Bedouin women in the
Negev.
Doron Y, Peleg R, Peleg A, Neumann L, Buskila D.
Department of Family Medicine, Soroka Medical Center and Faculty of the

Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
BACKGROUND: Fibromyalgia (FM) is a common idiopathic chronic,

widespread pain syndrome with tenderness in anatomically defined tender points.
OBJECTIVES: The purpose of the present study was to describe and characterize
the economic and daily work burden of FM compared with diabetes mellitus and
hypertension. METHODS: A retrospective study was conducted in 2001 in a
primary care clinic, the Kuseife clinic of the Clalit Health Services. Data for the
three study groups were obtained from the computerized database of the Kuseife
clinic and the Negev District, Israel. The study group included 102 FM patients.
The control groups included 102 diabetes patients and 103 patients with
hypertension. RESULTS: Hospitalization and hospital day care services were the
main expenses incurred by patients in this study. There were no differences
among the study groups in any cost parameter examined except for the cost of
diagnostic tests (P < 0.01), which was less for FM patients. FM patients were
referred to specialists and diagnostic procedures more frequently than the control
groups. No statistical difference was found in the total number of clinic visits, but
FM patients visited physicians more frequently and visited nurses less frequently
than patients in the other two groups (P < 0.05). CONCLUSIONS: FM patients
consume health care resources to a similar extent to patients with other chronic
diseases such as diabetes mellitus and hypertension, but the latter usually receive
much more attention from the health care system. Greater awareness of this
disorder can improve management and facilitate planning of health care
resources, thus improving quality of care.
Publication Types:
992: J Acquir Immune Defic Syndr. 2004 Aug 15;36(5):1051-6.

Study of antiretroviral drug-resistant HIV-1 genotypes in northern

Thailand: role of mutagenically separated polymerase chain
reaction as a tool for monitoring zidovudine-resistant HIV-1 in
resource-limited settings.
Saeng-Aroon S, Wichukchinda N, Myint L, Pathipvanich P, Ariyoshi K,

Rojanawiwat A, Matsuda M, Sawanpanyalert P, Sugiura W, Auwanit W.
National Institute of Health, Department of Medical Sciences, Ministry of Public

Health, Nonthaburi, Thailand.
As the number of HIV-1-infected individuals receiving antiretroviral drugs has

been rapidly increasing in developing countries, there is an urgent need for drug
resistance genotype information of non-B subtype HIV-1 and for the
establishment of a practical system of monitoring drug-resistant viruses. This
study first sequenced the reverse transcriptase region of HIV-1 in 112 infected
individuals who had been treated with zidovudine (AZT)/didanosine or
AZT/zalcitabine as dual therapy at a government hospital in northern Thailand
and then compared the above sequence method with mutagenically separated
polymerase chain reaction (MS-PCR) for detecting M41L and K70R mutations.
Concordant rates of detecting M41L and K70R mutations by the 2 methods were
96.9% (93/96) and 92.7% (89/96), respectively. The M41L and K70R MS-PCR
could detect 86.4% of AZT-resistant strains with any resistance mutation, which
was determined by the sequencing method. Then 292 drug-naive individuals were
screened for the presence of drug-resistant HIV-1 by the MS-PCR assay and it
was found that 2 individuals (0.7%) carried viruses with either the M41L or K70R
mutation. It is feasible to test a large number of samples with MS-PCR, which is
sensitive, cheap, and easy to perform and does not require sophisticated
equipment. The M41L and K70R MS-PCR is potentially a useful tool to monitor
the spread of AZT-resistant HIV-1 in resource-limited countries.
Publication Types:

993: J Cross Cult Gerontol. 2004 Sep;19(3):203-19.
The health and health status of older Korean Americans at the 100-
year anniversary of Korean immigration.
Sohn L.
VA Special Fellowship Program in Advanced Geriatrics, VA Greater Los

Angeles Healthcare System, Los Angeles, CA, USA. linda.sohn@med.va.gov
There are 28 subgroups in the Asian American Pacific Islander (AAPI) ethnic
population. They accounted for 12.5 million persons in the year 2002 or 4.4% of
the non-institutionalized US population (Reeves&Bennett, 2003). It is a rapidly
growing population in the United States, particularly in Southern California. The
Korean American population is the fifth largest ethnic group in the heterogeneous
AAPI population. Despite their increasing numbers there lacks data regarding the
health status and healthcare utilization of the AAPI population. The aim of this
study is to characterize the health status and healthcare utilization of an Asian
American ethnic group, the Korean Americans. The data are from the 2000
Korean American Health Survey (KAHS). This survey of 1,660 Korean
Americans living in Los Angeles County assessed their health status and medical
needs and composed the largest sample recruited for a health study on Korean
Americans to date. For the study 208 Koreans Americans aged 65 and over were
reported. Descriptive statistics were performed to illustrate the health status and
needs of the Korean American older persons. Over one-half of the sample, 69% of
the Korean American older persons in the study reported a fair or poor health
status. This is in stark contrast to a survey conducted by the Commonwealth
Fund, which found that 17% of the minorities and 30% of the Korean Americans
rated their health as fair or poor (Commonwealth Fund, 2002). With regards to
access to healthcare 21% of the Korean American older adults in the sample
lacked health insurance and 31% had never visited a medical doctor within the
last 12 months for a check up or consultation. It is felt that an individual's chance
of being uninsured varies across the life span and that people 65 years and older
have a minimal likelihood of being uninsured due to Medicare (IOM, 2001).
However when looking at certain subgroups higher percentages of uninsured are
revealed. One out of every three Koreans Americans in the US is uninsured
compared to 21% of all AAPI and 14% non-Latino whites. In California the
proportion is even higher with almost half of all Koreans being uninsured (Brown
et al. 2001). This type of discrepancy compounds the "Model Minority Myth" that
AAPI population is a successful minority group and do not have barriers to health
care (Chen et al. 1995). One study examining health services research status in the
AAPI found that Korean Americans were one of the most understudied
populations relative to their size (Andersen et al. 1995). Since the AAPI
population and subgroups are often not included in health services research this
results in "myths" or inaccuracies regarding their health. Studies of AAPI
populations are needed to provide information regarding the health of the
population, educate health care providers to assist them in the care of ethnic
populations and seek interventions to remove health disparities in minority
populations.
Publication Types:
994: Indian J Med Res. 2004 Jun;119(6):273-82.

Erratum in:
• Indian J Med Res. 2004 Aug;120(2):127.
Performance evaluation of APACHE II score for an Indian patient

with respiratory problems.
Gupta R, Arora VK.
LRS Institute of Tuberculosis & Respiratory Diseases, Sri Aurobindo Marg, New
Delhi, India.
BACKGROUND & OBJECTIVES: Realising the utility of scoring systems in

mortality prediction of critically ill patients admitted to intensive care units
(ICUs), studies worldwide have expressed a need to validate the Acute
Physiology and Chronic Health Evaluation (APACHE) II score for databases of
respective countries. Literature available in this area in the Indian context is
scanty. The present study was undertaken to evaluate the performance of
APACHE II score in prediction of mortality risk, as well as in determination of
model validity in critically ill Indian patients with respiratory problems.
METHODS: The study was prospectively carried out over 18 months at
respiratory ICU of a tertiary Institute in New Delhi, which admitted consecutive
medical (with lung ailments) and surgical (who had undergone any elective
thoracic surgical procedure under general anaesthesia) patients. Based on chief
indication of ICU admission, the medical patients were further divided into sub-
groups I (respiratory) and II (non-respiratory). APACHE II points were assigned
to all patients for calculating their individual predicted risks of mortality. Standard
mortality ratio (SMR) was computed with 95 per cent confidence intervals (CI).
Calibration of model was analysed by calculating Lemeshow and Hosmer
goodness of fit X(2) statistic and by plotting calibration curve, whereas
discrimination was evaluated by calculating area under a receiver operating
characteristic (ROC) curve. RESULTS: Of the 393 consecutive patients admitted
to respiratory ICU during the study period, 63 were left out on account of
exclusion criteria. Mean APACHE II score of the remaining 330 patients was
12.87+/-8.25 and range from 1 to 47. There were 287 (87%) survivors and 43
(13%) non-survivors, whose mean APACHE II scores, being respectively
11.34+/-6.75 (range 1-37) and 23.09+/-10.01 (range 5-47), were significantly
different (P<0.01). The study had a predicted mortality of 7.9 per cent and an
SMR value of 1.65 (95% CI from 0.4 to 3.0). Mean APACHE II score of those
having medical ailments was significantly higher (P<0.01) than surgical patients.
The non-respiratory sub-group had a significantly higher (P<0.01) mean
APACHE II score than respiratory sub-group. 59 per cent of patients did not get
APACHE II points owing to being <45 yr of age. In addition, against 10
immunocompromised patients, 77 others did not get APACHE II points despite
having apparently compromised immunity due to co-existence of tuberculosis
(TB), diabetes mellitus, dual pathologies or past history of anti-TB treatment.
Observed and predicted mortality rose with 5-point APACHE II score, but did not
correlate for patients of any comparable group. Average ICU stay of 16 days for
those with medical disease was significantly longer (P<0.01) than 9.5 days for
surgical patients. APACHE II scoring system showed a poor calibration and
discrimination ability for Indian respiratory patients. INTERPRETATION &
CONCLUSION: Despite the rise in observed and predicted mortality with 5-point
APACHE II score, predicted mortality did not correlate with observed mortality
for critically ill patients admitted to an Indian respiratory ICU. The scoring
system also showed a poor calibration as well as discrimination. The model may
be more useful for Indian patients by lowering down the cut-off value in allotment
of age points and by awarding the weightage to factor like co-existing
immunocompromised state.
Publication Types:
995: Indian J Lepr. 2003 Oct-Dec;75(4):335-45.

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

Leprosy situation in endemic states of India and prospects of
elimination of the disease.
Subramanian M, Showkath Ali MK, Thorat DM, Muthukumar M,

Sathiskumar E, Ramadoss C, Ali Khan M.
Division of Epidemiology and Statistics, Central Leprosy Teaching and Research

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

Prescription and dispensing practices in public sector health

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

dispensing practices and patient satisfaction in government health services of the
NWFP, Baluchistan and Punjab province. METHODS: A cross sectional study
design was used for this purpose. Ten health care facilities were selected from
each province keeping appropriate representation from first level health facilities,
district health facilities and tertiary care hospital. Analysis of selected indicators
was carried out on the basis of provinces, health facilities, gender and different
age groups. RESULTS: Documentation of 914 responses was completed from
three provinces. Almost equal distribution of encounters was maintained
representing different health facilities. Forty seven percent of encounters involved
children under 15 years of age. Female patients comprised of 56% and the mean
age of the entire sample was 26 years. The mean dispensing time was only 38
seconds, the mean consultation time was 1.79 minutes and the average number of
drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being
dispensed from the facility. More than half of the prescriptions contained
antibiotics and 15% of patients were prescribed with injectables. Only half of the
patients expressed satisfaction with their visit to health facility. CONCLUSIONS:
Like many other developing countries, prescription and dispensing practices are
not satisfactory in public sector health facilities of Pakistan. Appropriate and
workable solutions need to be developed and implemented in the country to
improve systems. Regular audits and qualitative studies should become part of the
effort.
Publication Types:
997: Cancer. 2004 Jul 15;101(2):421-9.

Predictors of place of death for Japanese patients with advanced-

stage malignant disease in home care settings: a nationwide survey.
Fukui S, Fukui N, Kawagoe H.
Department of Community Health Nursing, School of Nursing, Tokyo

Metropolitan University of Health Sciences, Tokyo, Japan. sfukui@post.metro-
hs.ac.jp
BACKGROUND: Although the place of death for patients with advanced

malignancy is influenced by multiple factors, few studies have systematically
investigated the determinants of place of death. The objective of the current
retrospective study was to clarify the predictors of home death throughout the
duration of home palliative care for Japanese patients with advanced malignant
disease. METHODS: In the current nationwide survey, the authors investigated
predictors involving patient demographics and clinical profiles, the roles and
status of family caregivers, and the support provided by the healthcare system in
the introductory phase (during the first week of home care), the stable phase
(between the introductory and dying phases), and the dying phase (during the
final week before death) of home care service in Japan. RESULTS: Multivariate
logistic regression models clarified that 1) patient-related clinical variables (e.g.,
functional status and rehospitalization); 2) the support of the healthcare system
(e.g., provision of information on the dying process and visitation by home care
nurses); and 3) the status and roles of family caregivers (e.g., psychologic distress
levels, assistance with patient evacuation, etc.) have an effect on place of death
throughout all three phases of home palliative care. Overall, the model used in the
current study was able to predict 94% of home deaths accurately.
CONCLUSIONS: A clearer understanding of factors that may influence place of
death for patients with advanced-stage malignant disease would allow healthcare
professionals to modify healthcare systems and tailor effective interventions to
help patients die in their preferred location. Copyright 2004 American Cancer
Society.
Publication Types:
998: Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Apr;25(4):302-7.

[The 'Beijing clinical database' on severe acute respiratory

syndrome patients: its design, process, quality control and
evaluation]
Beijing Commanding Center For SARS Treatment and Cure Scientific

Research Group.
OBJECTIVE: To develop a large database on clinical presentation, treatment and

prognosis of all clinical diagnosed severe acute respiratory syndrome (SARS)
cases in Beijing during the 2003 "crisis", in order to conduct further clinical
studies. METHODS: The database was designed by specialists, under the
organization of the Beijing Commanding Center for SARS Treatment and Cure,
including 686 data items in six sub-databases: primary medical-care seeking, vital
signs, common symptoms and signs, treatment, laboratory and auxiliary test, and
cost. All hospitals having received SARS inpatients were involved in the project.
Clinical data was transferred and coded by trained doctors and data entry was
carried out by trained nurses, according to a uniformed protocol. A series of
procedures had been taken before the database was finally established which
included programmed logic checking, digit-by-digit check on 5% random sample,
data linkage for transferred cases, coding of characterized information, database
structure standardization, case reviewe by computer program according to SARS
Clinical Diagnosis Criteria issued by the Ministry of Health, and exclusion of
unqualified patients. RESULTS: The database involved 2148 probable SARS
cases in accordant with the clinical diagnosis criteria, including 1291 with
complete records. All cases and record-complete cases showed an almost identical
distribution in sex, age, occupation, residence areas and time of onset. The
completion rate of data was not significantly different between the two groups
except for some items on primary medical-care seeking. Specifically, the data
completion rate was 73% - 100% in primary medical-care seeking, 90% in
common symptoms and signs, 100% for treatment, 98% for temperature, 90% for
pulse, 100% for outcomes and 98% for costs in hospital. CONCLUSION: The
number of cases collected in the Beijing Clinical Database of SARS Patients was
fairly complete. Cases with complete records showed that they could serve as
excellent representatives of all cases. The completeness of data was quite
satisfactory with primary clinical items which allowed for further clinical studies.
Publication Types:
999: Asia Pac J Clin Nutr. 2004;13(2):171-7.

Economic development and its influences and risks for nutrition,

cuisine and health.
McKay J.
Australian APEC Study Centre, Monash University, Melbourne.

john.mckay@analysisinternational.net.au
This paper reviews the evidence on some of the major trends in economic
development at a global level and assess their influence on food, nutrition and
health. Food and nutrition are themselves broad topics, and each is influenced by
a myriad of local and international forces, making them both interesting and
important, but also challenging in their complexity. It is especially difficult to deal
with such a vast and complicated terrain in such a short paper, and one must
inevitably deal only superficially with a number of complex areas. This paper will
review a number of key forces for change in the global system, with a focus on
the implications of each for food and nutrition. Each area is central to the
experience of economic, social and political development, particularly in the
period since 1945, and each is tied in various ways with that complex and
interrelated set of changes that we call globalisation. Seven key factors will be
explored: global population growth, leading to strong pressures on world
availability of arable land and food; increasing integration in the global economy,
as measured through such things as trade, financial flows and information
exchanges, and with specific implications for the food industry and for trade in
food products; growing gaps between rich and poor countries; similar increases in
disparities between rich and poor segments within individual countries; the rapid
growth of cities in the developing world, resulting in massive challenges for the
food supply systems of many nations; the growth within some countries, for
example in a number of Asian countries, of a "new middle class" with distinctive
patterns of consumption; and, high levels of population movements between
countries resulting in the creation of significant communities of immigrants in a
number of nations. Examples will be drawn from the two regions familiar to the
author, Asia and Sub-Saharan Africa, but with a particular emphasis on East Asia.
Publication Types:
• Review
1000: Methods Inf Med. 2004;43(3):268-72.

Physicians' choice in using Internet and fax for patient recruitment

and follow-up in a randomized controlled trial.
Rahman M, Morita S, Fukui T, Sakamoto J.
Department of Epidemiological and Clinical Research, Information Management,

Kyoto University Graduate School of Medicine, Yoshidakonoe-cho, Shogoin,
Sakyo-ku, Kyoto 606-8501, Japan. rahman@pbh.med.kyoto-u.ac.jp
OBJECTIVE: To examine the physicians' preference between Web and fax-based

remote data entry (RDE) system for an ongoing randomized controlled trial
(RCT) in Japan. METHODS: We conducted a survey among all the collaborating
physicians (n = 512) of the CASE-J (Candesartan Antihypertensive Survival
Evaluation in Japan) trial, who have been recruiting patients and sending follow-
up data using the Web or a fax-based RDE system. The survey instrument
assessed physicians' choice between Web and fax-based RDE systems, their
practice pattern, and attitudes towards these two modalities. RESULTS: A total of
448 (87.5%) responses were received. The proportions of physicians who used
Web, fax, and the combination of these two were 45.9%, 33.3% and 20.8%,
respectively. Multivariate logistic regression analyses revealed that physicians 55
years or younger [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.1-3.3]
and regular users of computers (OR = 4.2, 95% CI = 2.1-8.2) were more likely to
use the Web-based RDE system. CONCLUSIONS: This information would be
useful in designing an RCT with a Web-based RDE system in Japan and abroad.
Publication Types:
• Clinical Trial
1001: AAOHN J. 2004 Jun;52(6):230-41.

Defining the roles and functions of occupational health nurses in

Japan: results of job analysis.
Ishihara I, Yoshimine T, Horikawa J, Majima Y, Kawamoto R, Salazar MK.
Department of Public Health and Occupational Health Nursing, School of Health

Sciences, University of Occupational and Environmental Health, Japan.
The purposes of this study were to obtain descriptive information about the job
duties and tasks of Japanese occupational health nurses and to compare the roles
and functions of occupational health nurses in the United States and Japan. A
modified version of a job analysis survey developed by the American Board for
Occupational Health Nurses was used to collect data. The findings indicated 62%
of Japanese occupational health nurses perform direct care roles, approximately
half perform educating or advising and consulting roles, and approximately 40%
perform management roles. Details related to specific tasks and differences in
nurses with varying preparation also are presented. Although there were many
similarities in the types of tasks performed by nurses in Japan and the United
States, the proportion of time devoted to specific tasks in the two countries varied.
These results support the need for developing an educational system to enhance
occupational health nursing practice in Japan. The information derived from the
study provides a knowledge base that can be used to provide guidance and
direction to the content of occupational health nursing programs.
Publication Types:
1002: Health Qual Life Outcomes. 2004 Jun 25;2:31.

Quality of life assessment and reporting in randomized controlled

trials: a study of literature published from Japan.
Naito M, Nakayama T, Fukuhara S.
Department of Health Informatics, Kyoto University School of Public Health,

Konoe-cho, Yoshida, Sakyo-ku, Kyoto, Kyoto 606-8501, Japan.
naito@pbh.med.kyoto-u.ac.jp
BACKGROUND: Standardization of quality of life (QOL) assessment and

reporting in clinical trials is an imperative issue. While English-speaking
countries have led this movement in standardization, there persists to be a limited
amount of information from non-English-speaking including Japan. In this study,
we bibliographically analyze the reporting of randomized controlled trials (RCT)
conducted in Japan that used a QOL instrument. METHODS: A PubMed search
of reports published between 1970-2003 followed by an examination of QOL
reporting and its frequency of use in RCTs published from Japan. RESULTS:
Percentages of QOL reporting in RCTs have increased between 1970-2003 both
worldwide (0% for 1970-1974 to 4.4% for 2000-2003) and in Japan (0% to 1.8%
for the identical periods). We found and evaluated 46 RCT reports published from
Japan (32 in English, 14 in Japanese). The most commonly studied clinical
condition was cancer (26, 56.5%) and the most common intervention was drug
therapy (29, 63.0%). QOL was used as the primary endpoint in 10 studies
(21.7%). Authors used established QOL instruments in 12 studies (26.1%),
developed original instruments in 8 studies (17.5%) and assessed the symptoms or
performance status in 10 studies (21.7%). Authors conceptually defined QOL in
only 6 studies (13.0%). Neither response rate nor number of respondents for
questionnaire surveys was specified in 16 studies (34.8%); furthermore, 11 studies
(23.9%) did not describe respondents' attributes. CONCLUSIONS: Findings on
relative frequency suggested that Japanese authors of RCT reports have less
interest in QOL instruments than other international researchers in Western
Europe and North America. Examination of RCT reports published from Japan
revealed that there were several points to be improved in reporting QOL
instruments. This study highlights the need to define QOL measures specific to
clinical specialty and to examine methodology for assessing and reporting QOL.
Publication Types:
• Review
PMCID: PMC449732
1003: Health Policy Plan. 2004 Jul;19(4):187-98.

Effectiveness of an NGO primary health care programme in rural

Bangladesh: evidence from the management information system.
Mercer A, Khan MH, Daulatuzzaman M, Reid J.
Centre for Health and Population Research, ICDDR,B, Mohakali, Dhaka,

Bangladesh. amercer@icddrb.org
This paper considers evidence of the effectiveness of a non-governmental

organization (NGO) primary health care programme in rural Bangladesh. It is
based on data from the programme's management information system reported by
27 partner NGOs from 1996-2002. The data indicate relatively high coverage has
been achieved for reproductive and child health services, as well as lower infant
and child mortality. On the basis of a crude indicator of socio-economic status,
the programme is poverty-focused. There is good service coverage among the
poorest one-third and others, and the infant and child mortality differential has
been eliminated over recent years. A rapid decline in infant mortality among the
poorest from 1999-2002 reflects a reduction in neonatal mortality of about 50%.
Allowing for some under-reporting and possible misclassification of deaths to the
stillbirths category, neonatal mortality is relatively low in the NGO areas. The
lower child and maternal mortality for the NGO areas combined, compared with
estimates for Bangladesh in recent years, may at least in part be due to high
coverage of reproductive and child health services. Other development
programmes implemented by many of the NGOs could also have contributed.
Despite the limited resources available, and the lower infant and child mortality
already achieved, there appears to be scope for further prevention of deaths,
particularly those due to birth asphyxia, acute respiratory infection, diarrhoeal
disease and accidents. Maternal mortality in the NGO areas was lower in 2000-02
than the most recent estimate for Bangladesh. Further reduction is likely to
depend on improved access to qualified community midwives and essential
obstetric care at government referral facilities.
1004: Med Teach. 2004 May;26(3):215-22.

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

Creating a GIS application for local health care planning in Saudi

Arabia.
Murad AA.
Department of Urban & Regional Planning, King Abdulaziz University, Jeddah,

Saudi Arabia. amurad25@hotmail.com
The purpose of this paper is to show how Geographical Information Systems can
be used to support health planners on a micro-scale. The first part of this paper
discusses the issue that affect local health care planning which include monitoring
of catchment area and facilities management. The second part defines GIS and its
possible uses in the health care field. The relevant GIS functions have also been
explained. The third part of this paper discusses the created GIS application,
which is made for a local health centre in Makkah City, Saudi Arabia. In this
application, three sets of GIS models have been produced. These are catchment
area, patient profile and patient distribution and patient flows models. The created
GIS models are produced to help local health planners in their health care
decision output.
1006: BMC Public Health. 2004 Jun 18;4:23.

Exploratory spatial data analysis for the identification of risk factors

to birth defects.
Wu J, Wang J, Meng B, Chen G, Pang L, Song X, Zhang K, Zhang T, Zheng

X.
Institute of Geographical Sciences and Nature Resources Research, CAS, Beijing

100101, P. R. China. wujl@lreis.ac.cn
BACKGROUND: Birth defects, which are the major cause of infant mortality and
a leading cause of disability, refer to "Any anomaly, functional or structural, that
presents in infancy or later in life and is caused by events preceding birth, whether
inherited, or acquired (ICBDMS)". However, the risk factors associated with
heredity and/or environment are very difficult to filter out accurately. This study
selected an area with the highest ratio of neural-tube birth defect (NTBD)
occurrences worldwide to identify the scale of environmental risk factors for birth
defects using exploratory spatial data analysis methods. METHODS: By birth
defect registers based on hospital records and investigation in villages, the number
of birth defects cases within a four-year period was acquired and classified by
organ system. The neural-tube birth defect ratio was calculated according to the
number of births planned for each village in the study area, as the family planning
policy is strictly adhered to in China. The Bayesian modeling method was used to
estimate the ratio in order to remove the dependence of variance caused by
different populations in each village. A recently developed statistical spatial
method for detecting hotspots, Getis's 7, was used to detect the high-risk regions
for neural-tube birth defects in the study area. RESULTS: After the Bayesian
modeling method was used to calculate the ratio of neural-tube birth defects
occurrences, Getis's statistics method was used in different distance scales. Two
typical clustering phenomena were present in the study area. One was related to
socioeconomic activities, and the other was related to soil type distributions.
CONCLUSION: The fact that there were two typical hotspot clustering
phenomena provides evidence that the risk for neural-tube birth defect exists on
two different scales (a socioeconomic scale at 6.84 km and a soil type scale at
22.8 km) for the area studied. Although our study has limited spatial exploratory
data for the analysis of the neural-tube birth defect occurrence ratio and for
finding clues to risk factors, this result provides effective clues for further
physical, chemical and even more molecular laboratory testing according to these
two spatial scales.
Publication Types:
PMCID: PMC441386
1007: Rev Sci Tech. 2004 Apr;23(1):285-95; discussion 391-401.

Afghanistan and the development of alternative systems of animal

health in the absence of effective government.
Schreuder BE, Ward DE.
Dutch Committee for Afghanistan, Edelhertweg 15, P.O. Box 72, 8200 AB,
Lelystad, The Netherlands.
This case study describes the efforts by both non-governmental organisations and
United Nations agencies to develop an alternative system for delivering animal
health services in Afghanistan, during a period in which there was effectively no
government. The authors examine the period from the mid-1980s to the year
2003. During this time, Afghanistan experienced war and severe civil unrest,
resulting in the collapse of the veterinary infrastructure. As most trained animal
health professionals had fled the country, an initial emphasis was placed on
training intermediate and lower-level veterinary auxiliary personnel, as well as on
the implementation of emergency treatment and vaccination campaigns.
Gradually this programme has developed from an emergency-oriented approach
to a more development-oriented process, resulting in a community-based system
of animal health care in more than 250 districts (out of approximately 360). Some
500 paraveterinarians, trained for a period of five months, play a pivotal role in
this programme, supported in outlying villages by trained vaccinators and basic
veterinary workers. In this paper, the authors present an estimation of the impact
of this programme. Essential elements of the programme are, as follows: the
recruitment of trainees from areas where need has been identified; an emphasis on
practical and problem-oriented training; the deployment of staff in so-called
'veterinary field units', supervised by more highly qualified staff and monitors; a
guaranteed supply of veterinary medicines, anthelmintics and vaccines; a
gradually increasing rate of cost recovery. The ultimate objective of the
programme is to establish a self-sustaining system, based on the 'user-pays'
principle. The paper concludes by describing the present-day problems of the
animal health infrastructure in Afghanistan. Not only must the new government
try to regain its central position, it must also assimilate two decades of
development in the veterinary sector, which has occurred largely outside
governmental control.
Publication Types:
• Review
1008: Can J Cardiol. 2004 May 15;20(7):679.

Insourcing and outsourcing.
Malik P.
Queen's University, Kingston, Ontario, Canada. pgmalik@hotmail.com
1009: J Adv Nurs. 2004 Jul;47(2):223-9.

Characteristics of falls in hospitalized patients.
Kerzman H, Chetrit A, Brin L, Toren O.
Nursing Research Unit, Nursing Division, Chaim Sheba Medical Center, Tel
Hashomer, Israel. hanakert@sheba.health.gov.il
BACKGROUND: The high incidence of patient falls in a hospital setting is a

major concern in any health system. Research findings have reported the risk
factors for these falls as age, gender, certain medications, mental status, chronic
diseases and environmental factors. Falls may lead to fear, pain, slight or severe
injuries, increase the duration of hospital stay, cause patient discomfort and affect
quality of life. AIM: The aim of this paper is to report a study of the
characteristics of patient falls during hospitalization in 1998 and compare them
with those in the period 1978-1981. METHODS: A retrospective study was
performed in a large, 2000-bed medical center in Israel. Reports of 711 fall
incidents in 1998 were compared with 328 reports in 1978-1981. Information
gathered included age, gender, department, shift, reasons, severity of injury, tests
and treatment after injury. RESULTS: The rates of falls per 1000 admissions in
psychiatric, elder care and rehabilitation departments in 1998 were statistically
significantly higher than in the earlier period. Rates of 115, 91, 85, respectively,
per 1000 admissions were reported in 1998 compared with 34, 9, 19, respectively,
in the period 1978-1981. The percentage of reported falls in the younger age
group (under 50) was higher in the later survey (1998), and a higher proportion
occurred outside the patient's room. Most of the reported falls in 1998 occurred
during the morning shift (P < 0.001). CONCLUSIONS: The increased number of
falls could be an outcome of increased awareness. Nevertheless, the causes and
place of falls differ for the two periods. Some of the reasons may be related to an
intervention programme carried out after the first survey. The latest survey results
will serve as an important basis for a further intervention programme in specific
departments to ensure patient safety.
Publication Types:
1010: Arch Environ Contam Toxicol. 2004 Apr;46(3):413-8.

No effects of hematuria and proteinuria in school days, and

probably current pregnancy and current lactation also, as risk
factors of cadmium-induced renal tubular dysfunction among adult
women in general populations in Japan.
Tsukahara T, Ezaki T, Moriguchi J, Furuki K, Fukui Y, Ukai H, Okamoto S,

Sakurai H, Ikeda M.
Kyoto Industrial Health Association, 67 Nishinokyo-Kitatsuboicho, Nakagyoku,

Kyoto 604-8472, Japan.
This study was initiated to examine if hematuria and proteinuria in school days,
current pregnancy, or current lactation are risk factors of cadmium-induced
tubular dysfunction for adult women among general populations in Japan. For this
purpose, a database of 9,967 never-smoking adult women were reviewed for
urinary levels of cadmium (Cd) and three other elements, calcium (Ca),
magnesium (Mg), and zinc (Zn), and two tubular dysfunction markers of alpha1-
microglobulin (alpha1-MG) and beta2-microglobulin (beta2-MG); the analyte
concentrations were corrected for creatinine (cr) and expressed as, e.g., Cd-Ucr.
From the total, 160 cases were selected as those who were informed of urinary
abnormality (i.e., proteinuria, hematuria, or both) in their school days (the
abnormality being found to be transient, later), and each case was matched by age
and prefecture of residence. Separately, seven women with persistent urinary
abnormality, seven pregnant women, and six lactating women were identified,
and the case was matched with three cases each of the same age and living in the
same prefecture. Statistical analyses showed that Cd-Ucr and other markers were
not elevated in the transient urinary abnormality group as compared with the
matched controls. This was also observed in the subjects with persistent
abnormality. In the pregnant women, alpha1-MG-Ucr and possibly beta2-MG-Ucr
were elevated, but Cd-Ucr did not increase, suggesting that the observed elevation
in alpha1-MG and beta2-MG was not due to the effects of Cd but a part of the
physiology of pregnancy itself. There was no change in marker levels in lactating
women except for an increase in alpha1-MG. In overall evaluation, it was
considered prudent to conclude that urinary abnormality in school days does not
increase the risk of Cd-induced nephrotoxicity in adult women, whereas the
negative findings with pregnancy and lactation should be taken as preliminary
because the numbers of cases studied were limited.
Publication Types:
1011: J Clin Nurs. 2004 Jul;13(5):580-8.

Kidney transplantation: determination of the problems encountered

by Turkish patients and their knowledge and practices on healthy
living.
Talas MS, Bayraktar N.
Ankara University School of Health, 06340 Altindağ Ankara, Turkey.

talas@ankara.edu.tr
BACKGROUND: Although renal transplantations remove many limitations,

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

Initiating a novel therapy in preventing postpartum hemorrhage in

rural India: a joint collaboration between the United States and
India.
Kodkany BS, Derman RJ, Goudar SS, Geller SE, Edlavitch SA, Naik VA,
Patel A, Bellad MB, Patted SS.
Human Reproduction Research Collaborating Center (ICMR), J N Medical

College, Balgaum, Karnataka, India.
BACKGROUND: Maternal mortality rates in India are estimated at 560/100,000

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

1013: Vet Parasitol. 2004 Jun 21;122(2):141-9.
A geographic information systems model for mapping risk of

fasciolosis in cattle and buffaloes in Cambodia.
Tum S, Puotinen ML, Copeman DB.
Department of Animal Production and Health, 74 Monivong Boulivard, Sangkat

Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia.
A geographic information systems (GIS) model for mapping the risk of

fasciolosis in cattle and buffaloes was developed for the Kingdom of Cambodia
using determinants of inundation, proximity to rivers, land use, slope, elevation,
and the density of cattle and buffaloes. Determinants were subjectively weighted
according to their perceived relative importance before combining them to
produce a risk-map of fasciolosis. The model estimates that 28% of Cambodia is
potentially at risk of fasciolosis with areas of high and moderate risk concentrated
in southern and central Cambodia. The estimates of risk reflect the actual
prevalence of fasciolosis in most districts surveyed, suggesting that the
epidemiological determinants and weightings used to produce the model were
appropriate. These results will be progressively refined as more detailed field
surveys are completed to fully validate the model.
Publication Types:
1014: J Formos Med Assoc. 2004 Apr;103(4):280-5.

Outpatient drug expenditures and prescription policies for diseases

with high cost to the National Health Insurance system in Taiwan.
Lang HC, Lai MS, Chen GT.
Institute of Hospital and Health Care Administration, National Yang-Ming

University, Taipei, Taiwan.
BACKGROUND AND PURPOSE: The high cost of drugs, particularly those

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

[Social support network for patients with dementia]
Hirono N.
Faculty of Health Sciences, Ehime University School of Medicine.
1016: Obstet Gynecol. 2004 Jun;103(6):1273-7.

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

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka
University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva,
Israel. sheiner@bgumail.bgu.ac.il
OBJECTIVE: To investigate pregnancy outcome of patients with beta-

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

The global distribution and population at risk of malaria: past,

present, and future.
Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW.
TALA Research Group, Department of Zoology, University of Oxford, Oxford,

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

• Review
1018: Int J Med Inform. 2004 Jun 15;73(5):415-31.

Do doctors act on their self-reported intention to computerize? A

follow-up population-based survey in Hong Kong.
Lai TY, Leung GM, Wong IO, Johnston JM.
Department of Community Medicine, Faculty of Medicine Building, University

of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, PR China.
BACKGROUND AND OBJECTIVES: We performed a follow-up survey to

document changes in the level of computerization among physicians in Hong
Kong between 2000 and 2001, specifically examining whether their self-reported
intention to computerize various clinical or administrative tasks actually
translated into computerization of these tasks 1 year later. Determining such a
relationship will indicate the reliability, and thus the utility of questions regarding
self-reported intention to computerize clinical practice. METHODS: A self-
completed follow-up postal questionnaire was sent to all 949 physicians who
responded to the original questionnaire. Pairwise repeated dichotomous responses
from 2000 and 2001 on the computerization of specific functions were compared
using McNemar test. Wilcoxon sign-ranked test was employed to compare the
total number of tasks computerized in the 2 years. Multivariate logistic regression
modeling was carried out to determine predictors for the translation of intention to
computerize into actual computerization. RESULTS: The response rate was
77.0%. There was a significant increase in the number of tasks computerized for
both "corporate" and "individual" practices between 2000 and 2001. The
proportion of physicians who intended to computerize and actually computerized
ranged from 7.7 to 51.0% for different tasks. For five clinical tasks, more than
50% respondents in corporate practices translated the intention to implementation,
compared to fewer than 20% in individual practices. Predictors found to be
associated with the translation of intention to computerize into actual
computerization included higher number of tasks intended to computerize, higher
number of tasks already computerized, and more positive physicians' attitudes on
the impact of computerization to clinical practice. CONCLUSIONS: We conclude
that physicians' self-reported intention to computerize the clinical practice 12
months previously was moderately associated with actual implementation, with
varying degrees of concordance for different clinical and administrative tasks.
The identified predictors for the translation of intention to actual computerization
may be useful in targeting specific strategies to promote computerization of
clinical practice.
Publication Types:
1019: Int J Med Inform. 2004 Jun 15;73(5):403-14.

Physicians' perceptions towards the impact of and willingness to pay

for clinical computerization in Hong Kong.
Leung GM, Yeung RY, Lai TY, Johnston JM, Tin KY, Wong IO, Woo PP,
Ho LM.
Department of Community Medicine, Faculty of Medicine Building, The

University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, PR China.
gmleung@hkucc.hku.hk
BACKGROUND AND OBJECTIVES: We evaluated factors associated with

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

1020: J Hum Genet. 2004;49(7):391-5. Epub 2004 May 27.
Identification and evaluation of 55 genetic variations in the BRCA1

and the BRCA2 genes of patients from 50 Japanese breast cancer
families.
Kawahara M, Sakayori M, Shiraishi K, Nomizu T, Takeda M, Abe R,

Ohuchi N, Takenoshita S, Ishioka C.
Department of Clinical Oncology, Institute of Development, Aging and Cancer,

Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
We sequenced approximately 23 kb genomic regions containing all the coding

exons and their franking introns of two breast cancer susceptibility genes, BRCA1
and BRCA2, of 55 individuals from 50 unrelated Japanese breast cancer families.
We identified 55 single-nucleotide polymorphisms (SNPs) (21 in BRCA1 and 34
in BRCA2) containing nine pathogenic protein-truncating mutations (four in
BRCA1 and five in BRCA2 from ten patients). Among the remaining 46 SNPs,
allele frequencies of 40 were examined in both the breast cancer patients and 28
healthy volunteers with no breast cancer family history by PCR-RFLP or by direct
DNA sequencing. Twenty-eight SNPs were common and were also found in the
healthy volunteers and/or a SNP database. The remaining 18 were rare (allele
frequency <0.05) and were not found in the healthy volunteers and/or the
database. The pathogenic significance of these coding SNPs (cSNPs) remains to
be clarified. The SNP information from this study will be useful in the future
genetic testing of both BRCA1 and BRCA2 genes in the Japanese population.
Publication Types:
1021: J Huazhong Univ Sci Technolog Med Sci. 2004;24(1):103-6.

Quantitative analysis on economic contribution of community health

service in China.
Zhang X, Wang T.
Tongji Medical College, Huazhong University of Science and Technology,

Wuhan 430030.
In China, the implementation of community health service shows that the

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

High incidence rate of hip fracture in Taiwan: estimated from a

nationwide health insurance database.
Chie WC, Yang RS, Liu JP, Tsai KS.
School of Public Health, College of Public Health, College of Medicine, National

Taiwan University, Taipei, Taiwan.
The objective of this study was to describe the incidence rate of hip fracture from
1996 to 2000 in Taiwan, based on an inpatient database of the National Health
Insurance Program. A total of 54,199 patients, who had a first-time admission for
a diagnosis of hip fracture (ICD9 code 820.0 through 820.9, 820.21, 820.22, and
820.31) on discharge from January 1996 through December 2000 and aged 50 to
100 years, were identified and included in the study. The results showed that the
age-specific incidence rates of hip fractures were higher with increasing age in
both genders, in an exponential manner after 65 years of age. The incidence was
1.6 times higher and rose about 5 years earlier among women than among men.
Thus in these 5 years the age-adjusted incidence rates (95% confidence interval)
of hip fracture in Taiwan were 225 (95% CI, 188-263) per 100,000 in men and
505 (95% CI, 423-585) per 100,000 in women (adjusted to US white population
of 1989), as compared with US white rate of 187 in men and 535 in women. More
than half of the fractures were peritrochanteric, and the recorded cause in most
cases was a fall on the same level, from slipping, tripping, or stumbling (ICD9
E885). A total of 37.8% patients had hip hemiarthroplasty, 51.2% had open
reduction of fracture with internal fixation, and 10.5% had closed reduction of
fracture with internal fixation. We concluded that, using the data from a
nationwide health insurance database of Taiwan, we found a high annual
incidence rate of hip fracture for both men and women in 5 consecutive years.
These incidence rates were higher than other reports on Chinese populations
reported in the past 10 years and similar to that of Western countries. With the
rapid aging of the populations of Taiwan and other Asian countries in the years to
come, our results clearly demonstrated the impact of osteoporosis and hip fracture
in this region.
Publication Types:
1023: Drug Saf. 2004;27(8):491-7.

Risk management from an Asian/Pacific Rim regulatory

perspective.
McEwen J.
Therapeutic Goods Administration, Woden, ACT, Australia.

john.mcewen@health.gov.au
This article reviews the state of adverse drug reaction monitoring in five
Asian/Pacific Rim countries (Australia, Japan, Malaysia, New Zealand and
Singapore). Each country has an active pharmacovigilance programme managed
by a national regulatory agency. Current methods for assessing risks and current
methods used for risk management and communication are compared with the
'tools' used by the US FDA. Major positive attributes of the programmes in all
five countries include active involvement of independent expert clinical advisory
committees in identifying and evaluating risks through the assessment of reports
of serious and unusual reactions, and regular communications about risks from the
national agencies to doctors and pharmacists by means of pharmacovigilance
bulletins. Most components of the risk-management toolbox are currently used, in
some instances without legislated support. Variations in the way risk-management
tools are implemented within individual national health systems are illustrated.
Publication Types:
• Review
1024: Rinsho Shinkeigaku. 2003 Nov;43(11):840-2.

[Clinical practice guidelines in Japan: toward their appropriate use

and diffusion]
Nakayama T.
Department of Health Informatics, Kyoto University School of Public Health.
In Japan, the governmental report on health technology assessment in 1999

referred to the need to develop evidence-based clinical practice guidelines. The
Ministry of Health and Welfare established priorities for the development of
clinical practice guidelines, and started several projects. About 20 clinical practice
guidelines are to be developed by 2004. However, what "guideline" means and
how "guidelines" work are unclear because the word "guideline" is ambiguous in
Japan. Although it is generally accepted that "directives are stronger than
recommendations, which are stronger than guidelines" in the western countries,
Japanese people do not usually recognize these distinctions and tend to regard
guidelines as mandatory directives even in individual cases. Patients, consumers
and legal professionals may overestimate the authority of clinical practice
guidelines when they see them. What clinical practice guidelines are, or are not
should be clarified appropriately. Autumn 2003, the Japan Council for Quality
Health Care will open the information service that provides practice guidelines
and related literature. This will be accessible to both healthcare professionals and
the general public. Much remains to be done to bring other stakeholders to the
table. All of Japanese society can, and needs to, participate in the process of
developing a consensus on clinical practice guidelines.
Publication Types:
• Review
1025: Br J Cancer. 2004 Jun 1;90(11):2157-66.

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

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

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

• Review
1027: Public Health Nurs. 2004 May-Jun;21(3):287-94.

The evolution of the community health nurse practitioner in Korea.
Cho HS, Kashka MS.
College of Nursing, Texas Women's University, Dallas, 75235-7299, USA.

hcho@twu.edu
Community health nursing in Korea has undergone dramatic changes since 1980.
These changes arose through the efforts of Mo Im Kim, an internationally known
leader in Korean nursing, and colleagues who successfully worked to establish a
national community health nurse practitioner program. This article will review
these changes with the aim of describing the evolutionary process that culminated
in a community health care system that is meeting the needs of Korean citizens
who live in rural and isolated areas. The authors believe that the evolution of the
community health nurse practitioner in Korea provides a paradigm that can serve
as a model for other countries. Health care in Korea is organized differently than
that in the United States. However, the plan, process, and political activism can be
used for community and public health nursing change in the United States. The
information contained in this article is based upon interviews with Mo Im Kim
and 20 of her colleagues and associates. Interviewees were selected using a
"snowball" sampling technique. Additional data were derived from various
professional and personal documents of these individuals. The first author
conducted the interviews in both Korea and in the United States.
1028: Harefuah. 2004 Feb;143(2):111-5, 167, 166.

[Road traffic accidents--severe injuries. Decision-making on the

basis of partial data]
[Article in Hebrew]
Peleg K, Aharonson-Daniel L.
BACKGROUND: Road traffic accidents are the cause of approximately one

quarter of trauma hospitalizations in Israel. A comparison of figures on severe
traffic injuries, as published by the Israeli Central Bureau of Statistics (CBS) and
the Israeli Police with data from registries in medical systems, revealed significant
disparities. AIMS: To present gaps between registries and the possible
consequences that presenting incomplete data to decision makers may have on
their ability to set policy for reducing road traffic accidents. RESULTS: The
number of severe injuries according to the CBS, the National Council for Road
Safety and the Israeli Police ranges from 3,378 to 2,573 per year, for the period
1998-2000. During the same time period, the national trauma registry that
recorded data at only eight hospitals (of the 24 hospitals in the country), noted a
total of 4,442 to 4,800 patients per year. The Ministry of Health's data, that
includes figures from most of the hospitals in the country, reports between 10,290
to 11,009 road traffic accident hospitalizations per year for this same period of
time. The CBS data is the formal national data, hence the database which decision
makers use when considering the number of casualties due to road accidents
consists of less than half of the actual number of cases. Furthermore, it is not a
representative sample. When decisions are made without data, one uses common
sense and reason. However, when the decision maker is presented with
information, he assumes that these are valid, reliable, representative, well
established data and relates to the information as such in the decision making
process. If data is misleading, decisions may be ill-advised. SUMMARY AND
CONCLUSION: Gaps in information are presented, posing a question on the
possible effect that the interpretation of partial data by decision makers may have
on the decisions they make. It is strongly advocated that collaboration is needed
between police and health agencies and that a system for collecting and analyzing
data on road traffic casualties be established to combine health and police data.
The existence of a reliable, complete and valid database is essential in order to
succeed in the important battle to reduce morbidity and mortality from road traffic
accidents.
Publication Types:
• Review
1029: Natl Med J India. 2004 Mar-Apr;17(2):74-9.

Deaths due to road traffic crashed in Hyderabad city in India: need

for strengthening surveillance.
Dandona R, Mishra A.
Centre for Public Health Research, Administrative Staff College of India, Bella
Vista, Raj Bhavan Road, Hyderabad 500082, India. rakhi@asci.org.in
BACKGROUND: Road traffic crashes are an important cause of death and

disability in India. Reliable and accurate data are necessary to plan strategies to
reduce death and disability due to road traffic crashes. We assessed the utility of
the available data on deaths due to road traffic crashes for road crash surveillance
for a major metropolitan city of southern India. METHODS: We analysed the
Department of Police database on deaths due to road traffic crashes for 2002 in
Hyderabad, southern India and collected data from a leading newspaper for the
same information using a standardized format. RESULTS: A total of 3039 cases
of road traffic crashes were recorded in the police database for 2002, including
400 cases (13.2%) in which 411 people were killed. In the same year, 316 cases of
road traffic crashes resulting in 353 deaths were reported in the newspaper. The
majority of those who died due to these crashes were males. Seventy per cent of
those killed were between 16 and 49 years of age. Pedestrians and riders of two-
wheelers were the most vulnerable. Collision with a vehicle caused 86.4% of all
crashes and 60% of the victims died before reaching a hospital. The available data
were not comprehensive enough to provide a thorough basis for planning
intervention strategies to reduce fatalities due to road crashes. CONCLUSION:
Despite the gaps in reporting of fatalities in road traffic crashes in these data
sources, they provide insights into the magnitude and nature of deaths resulting
from such crashes in Hyderabad. The available data have limitations and there is a
need for strengthening the road traffic crash surveillance system to have reliable,
accurate and adequate data on road traffic crashes and the resulting fatalities and
injuries. These could then form the basis for planning effective intervention
strategies to improve road safety.
1030: Am J Emerg Med. 2004 May;22(3):164-70.

A geographic information system simulation model of EMS:

reducing ambulance response time.
Peleg K, Pliskin JS.
Trauma and Emergency Medicine Research Unit, The Gertner Institute for Health
Policy Research, Sheba Medical Center, Tel-Hashomer, Israel.
kobip@gertner.health.gov.il
Response time is a very important factor in determining the quality of prehospital

EMS. Our objective was to model the response by Israeli ambulances and to offer
model-derived strategies for improved deployment of ambulances to reduce
response time. Using a geographic information system (GIS), a retrospective
review of computerized ambulance call and dispatch logs was performed in two
different regional districts, one large and urban and the other rural. All calls that
were pinpointed geographically by the GIS were included, and their data were
stratified by weekday and by daily shifts. Geographic areas (polygons) of, at
most, 8 minutes response time were simulated for each of these subgroups to
maximize the timely response of calls. Before using the GIS model, mean
response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes,
respectively, with 34% and 62% of calls responded within 8 minutes. When
ambulances were positioned within the modeled polygons, more than 94% of calls
met the 8-minute criterion. The GIS simulation model presented in this study
suggests that EMS could be more effective if a dynamic load-responsive
ambulance deployment is adopted, potentially resulting in increased survival and
cost-effectiveness.
Publication Types:

1031: J Environ Sci (China). 2004;16(2):332-8.
An analysis on spatial variation of urban human thermal comfort in

Hangzhou, China.
Wang WW, Zhu LZ, Wang RC.
College of Environmental and Resource Sciences, Zhejiang University, Hangzhou

310029, China. wwwang@hzcnc.com
Urban human thermal comfort (UHTC) is affected for interacting of weather

condition and underlying surface framework of urban area. Urban underlying
surface temperature value and Normalized Difference Vegetation Index (NDVI)
were calculated using image interpreting and supervised classification technique
by ERDAS IMAGE software using 1991 and 1999 Landsat TM images data.
Reference to the relational standard of assessing human thermal comfort and other
meteorology data of Hangzhou City in summer, air temperature and relative
humidity variation of different land types of underlying surface were inversed. By
choosing discomfort index as an indictor, the spatial distribution characteristic
and the spatial variation degree of UHTC were estimated and mapped on a middle
scale, that is, in six districts of Hangzhou. The main characteristics of UHTC
spatial variation from 1991 to 1999 were revealed using a GIS-based calculation
model. The variation mechanism were analyzed and discussed from the viewpoint
of city planning, construction and environmental protection.
1032: Rinsho Byori. 2004 Mar;52(3):266-9.

[CAP quality management system in clinical laboratory and its

issue]
Tazawa H.
SBS, Inc., Sagamihara 229-1125.
The CAP (College of American Pathologists) was established in 1962 and, at

present, CAP-accredited laboratories include about 6000 institutions all over the
world, mainly in the U.S. The essential purpose of CAP accreditation is high
quality reservation and improvement of clinical laboratory services for patient
care, and is based on seven points, listed below. (1) Establishment of a laboratory
management program and laboratory techniques to assure accuracy and improve
overall quality of laboratory services. (2) Maintenance and improvement of
accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety
and health administration. (4) Reservation of the performance of laboratory
services by personnel and proficiency management. (5) Provision of appropriate
information to physicians, and contribution to improved quality of patient care by
close communication with physicians (improvement in patient care). (6)
Reduction of running costs and personnel costs based on evidence by employing
the above-mentioned criteria. (7) Reduction of laboratory error. In the future,
accreditation and/or certification by organizations such as CAP, ISO, etc., may
become a requirement for providing any clinical laboratory services in Japan.
Taking the essence of the CAP and the characteristics of the new international
standard, ISO151589, into consideration, it is important to choose the best suited
accreditation and/or certification depending of the purpose of clinical laboratory.
Publication Types:
• Review
1033: Mil Med. 2004 Apr;169(4):282-7.

The patient as a client: a model for evaluation of Israel Defense

Forces.
Zigdon A, Robinson A, Goldberg A.
Department of Health Systems Management, Ben-Gurion University of the

Negev, Beer Sheva, Israel.
The Israel Defense Forces (IDF) Medical Corps provides medical services-routine
and emergency--to all IDF personnel (conscripts, career personnel, and
reservists). Despite the fact that there are no differences in prevalence of disease
in the IDF compared with the civil sector, health consumer appraisal, in the
military, of the medical services they receive during peacetime at IDF medical
clinics is not high. The objective of this research was to develop an effective and
differential tool for monitoring the quality of medical service at IDF clinics drawn
from service quality indexes based on the perspective of the soldier patient. The
research tool used was an anonymous questionnaire comprised of five
demographic questions and 21 components of quality index measurements that
participants were asked to rank in terms of importance during a visit to their IDF
medical clinic. Those categories found to influence the client's perception of
quality medical service were accessibility and availability of services, information
provided by the clinic, and the efficiency of staff. The factors found to be less
influential in the clients' perceptions of quality were staffing and infrastructure.
Quality control using these significant indexes will allow monitoring programs to
focus on components that are important from the soldier's perspective, without
overlooking other significant aspects of the soldier's perceptions of the quality of
medical service as a client.
1034: Eye. 2004 May;18(5):509-13.

Knowledge, self-help and socioeconomic factors in South Asian and

Caucasian diabetic patients.
Pardhan S, Mahomed I.
Department of Optometry and Ophthalmic Dispensing, Anglia Polytechnic

University, Cambridge, UK. s.pardhan@apu.ac.uk
AIMS: We carried out a survey of important nonclinical issues including

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

1035: Ind Health. 2004 Apr;42(2):141-8.
Occupational health research in India.
Saiyed HN, Tiwari RR.
National Institute of Occupational Health, Meghani Nagar, Ahmedabad-380016,

Gujarat, India.
India being a developing nation is faced with traditional public health problems
like communicable diseases, malnutrition, poor environmental sanitation and
inadequate medical care. However, globalization and rapid industrial growth in
the last few years has resulted in emergence of occupational health related issues.
Agriculture (cultivators i.e. land owners + agriculture labourers) is the main
occupation in India giving employment to about 58% of the people. The major
occupational diseases/morbidity of concern in India are silicosis, musculo-skeletal
injuries, coal workers' pneumoconiosis, chronic obstructive lung diseases,
asbestosis, byssinosis, pesticide poisoning and noise induced hearing loss. There
are many agencies like National Institute of Occupational Health, Industrial
Toxicology Research Centre, Central Labour Institute, etc. are working on
researchable issues like Asbestos and asbestos related diseases, Pesticide
poisoning, Silica related diseases other than silicosis and Musculoskeletal
disorders. Still much more is to be done for improving the occupational health
research. The measures such as creation of advanced research facilities, human
resources development, creation of environmental and occupational health cells
and development of database and information system should be taken.
Publication Types:
• Review
1036: Indian J Public Health. 2003 Oct-Dec;47(4):208-9.

Status of leprosy in Uttar Pradesh.
Thakor HG, Mall RP, Tiwari R, Kumar A, Johri L.
State Leprosy Office, Govt. Health Service, Uttar Pradesh, Swasthya Bhawan,
Lucknow.
1037: MMWR Surveill Summ. 2004 Apr 30;53(1):21-34.

Malaria surveillance--United States, 2002.
Shah S, Filler S, Causer LM, Rowe AK, Bloland PB, Barber AM, Roberts
JM, Desai MR, Parise ME, Steketee RW.
Epidemic Intelligence Service, Epidemiology Program Office, CDC, USA.
PROBLEM/CONDITION: Malaria is caused by any of four species of

intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax,
P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective
female Anopheles species mosquito. The majority of malaria infections in the
United States occur among persons who have traveled to areas with ongoing
transmission. In the United States, cases can occur through exposure to infected
blood products, by congenital transmission, or by local mosquitoborne
transmission. Malaria surveillance is conducted to identify episodes of local
transmission and to guide prevention recommendations for travelers. PERIOD
COVERED: This report covers cases with onset of illness in 2002.
DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood film are
reported to local and state health departments by health-care providers or
laboratory staff. Case investigations are conducted by local and state health
departments, and reports are transmitted to CDC through the National Malaria
Surveillance System (NMSS). Data from NMSS serve as the basis for this report.
RESULTS: CDC received reports of 1,337 cases of malaria with an onset of
symptoms in 2002 among persons in the United States or one of its territories.
This number represents a decrease of 3.3% from the 1,383 cases reported for
2001. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 52.3%,
25.4%, 2.8%, and 2.8% of cases, respectively. Eleven patients (0.8% of total)
were infected by > or =2 species. The infecting species was unreported or
undetermined in 213 (15.9%) cases. Compared with 2001, the number of reported
malaria cases acquired in Asia (n = 171) and Africa (n = 903) increased by 4.3%
and 1.9%, respectively, whereas the number of cases acquired in the Americas (n
= 141) decreased by 41.2%. Of 849 U.S. civilians who acquired malaria abroad,
317 (37.3%) reported that they had followed a chemoprophylactic drug regimen
recommended by CDC for the area to which they had traveled. Five patients
became infected in the United States, one through congenital transmission, one
probable transfusion-related, and three whose infection cannot be linked
epidemiologically to secondary cases. Eight deaths were attributed to malaria. All
deaths were caused by P. falciparum. INTERPRETATION: The 3.3% decrease in
malaria cases in 2002, compared with 2001, resulted primarily from a marked
decrease in cases acquired in the Americas, but this decrease was offset somewhat
by an increase in the number of cases acquired in Africa and Asia. This limited
decrease probably represents year-to-year variation in malaria cases, but also
could have resulted from local changes in disease transmission, decreased travel
to malaria-endemic regions, fluctuation in reporting to state and local health
departments, or an increased use of effective antimalarial chemoprophylaxis. In
the majority of reported cases, U.S. civilians who acquired infection abroad were
not on an appropriate chemoprophylaxis regimen for the country in which they
acquired malaria. PUBLIC HEALTH ACTION: Additional information was
obtained concerning the eight fatal cases and the five infections acquired in the
United States. Persons traveling to a malarious area should take one of the
recommended chemoprophylaxis regimens appropriate for the region of travel,
and travelers should use personal protection measures to prevent mosquito bites.
Any person who has been to a malarious area and who subsequently experiences a
fever or influenza-like symptoms should seek medical care immediately and
report their travel history to the clinician; investigation should include a blood-
film test for malaria. Malaria infections can be fatal if not diagnosed and treated
promptly. Recommendations concerning malaria prevention can be obtained from
CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's
Internet site at http://www.cdc.gov/travel.
1038: Southeast Asian J Trop Med Public Health. 2003 Sep;34(3):517-28.

Erratum in:
• Southeast Asian J Trop Med Public Health. 2005 May;36(3):801-2.
Use of GIS-based spatial modeling approach to characterize the

spatial patterns of malaria mosquito vector breeding habitats in
northwestern Thailand.
Sithiprasasna R, Linthicum KJ, Liu GJ, Jones JW, Singhasivanon P.
Department of Entomology, US Army Medical Component, Armed Forces

Research Institute of Medical Sciences, Bangkok, Thailand.
We sampled 291 bodies of water for Anopheles larvae around three malaria-
endemic villages of Ban Khun Huay, Ban Pa Dae, and Ban Tham Seau, Mae Sot
district, Tak Province, Thailand during August 2001-December 2002 and
collected 4,387 larvae from 12 categories of breeding habitat types. We modeled
surface slope and wetness indices to identify the extent and spatial pattern of
potential mosquito breeding habitats by digitizing base topographical maps of the
study site and overlaying them with coordinates for each larval habitat.
Topographical contours and streamlines were incorporated into the Geographical
Information System (GIS). We used Global Positioning System (GPS)
instruments to locate accurately each field observed breeding habitat, and
produced a 30-m spatial resolution Digital Elevation Model (DEM). The slope (of
less than 12 degrees) and wetness (more than 8 units) derived from spatial
modeling were positively associated with the abundance of major malaria vectors
An. dirus, An. maculatus, An. minimus, and An. sawadwongporni. These
associations permit real-time monitoring and possibly forecasting of the
distributions of these four species, enabling public health agencies to institute
control measures before the mosquitos emerge as adults and transmit disease.
Publication Types:
1039: Southeast Asian J Trop Med Public Health. 2003 Dec;34(4):919-28.

Advantages of trained TBA and the perception of females and their

experiences with reproductive health in two districts of the
Luangprabang Province, Lao PDR.
Sirivong A, Silphong B, Simphaly N, Phayasane T, Bonouvong V, Schelp FP.
Provincial Health Department, Luangprabang, Lao PDR.
The study describes reproductive health in two districts of the Luangprabang

Province in northern Lao PDR. The aim was to find out whether training
traditional birth attendants (TBA) might have an impact on reproductive health. In
June/July 2000, a total of 298 women of reproductive age, with children below
two years of age, from 30 villages were interviewed by means of a closed
questionnaire. In 1996/1997, a training course for TBA was conducted in one of
the districts under survey. Information was obtained for demography, symptoms
and risks during pregnancy and delivery, antenatal care (ANC), tetanus
immunization, food taboos, place of delivery, birth attendant, practising of birth
spacing and their attitude towards the services of TBA. The results obtained
indirectly pointed towards a high fertility rate and a high rate of child death and
abortion. An overwhelming majority of the women delivered at home, attended
only by untrained individuals. During pregnancy and after delivery, the women
claimed that they often suffered from edema of legs and feet, high fever and
hemorrhages. Only 50% of the females in the district where TBA training were
conducted, made use of the services of trained TBA. Nevertheless, females in the
district with trained TBA, who made use of the TBA service in comparison with
women in the same district not using the service of TBA, were 3.8 times more
likely to also make use of the ANC service; 3.3 times more likely to seek
immunization, and 8.6 times more likely to give colostrum to their new-borns.
The educational level of the females proved to be an important factor. Literate
women were more likely to practise birth spacing and have been vaccinated.
Illiterate women were more likely to be at higher risk for losing a child. In the
district without TBA service the loss of a child was less likely among literate than
illiterate women. It is concluded that through adequately trained TBA and through
their continuous support and supervision, ANC and health education can be
improved. In addition to the improvement of the referral system for emergency
cases and manpower development within the obstetric curative service, the
training of TBA will have a positive impact on reproductive health. However,
maternal health depends, to a large extent, on the educational level of the women.
Publication Types:
1040: J Med Internet Res. 2004 Jan 30;6(1):e4.

DietPal: a Web-based dietary menu-generating and management

system.
Noah SA, Abdullah SN, Shahar S, Abdul-Hamid H, Khairudin N, Yusoff M,

Ghazali R, Mohd-Yusoff N, Shafii NS, Abdul-Manaf Z.
Faculty of Information Science & Technology (F T S M), Universiti Kebangsaan

Malaysia, 43600 UKM Bangi, Selangor, Malaysia. samn@ftsm.ukm.my
BACKGROUND: Attempts in current health care practice to make health care

more accessible, effective, and efficient through the use of information
technology could include implementation of computer-based dietary menu
generation. While several of such systems already exist, their focus is mainly to
assist healthy individuals calculate their calorie intake and to help monitor the
selection of menus based upon a prespecified calorie value. Although these prove
to be helpful in some ways, they are not suitable for monitoring, planning, and
managing patients' dietary needs and requirements. This paper presents a Web-
based application that simulates the process of menu suggestions according to a
standard practice employed by dietitians. OBJECTIVE: To model the workflow
of dietitians and to develop, based on this workflow, a Web-based system for
dietary menu generation and management. The system is aimed to be used by
dietitians or by medical professionals of health centers in rural areas where there
are no designated qualified dietitians. METHODS: First, a user-needs study was
conducted among dietitians in Malaysia. The first survey of 93 dietitians (with 52
responding) was an assessment of information needed for dietary management
and evaluation of compliance towards a dietary regime. The second study
consisted of ethnographic observation and semi-structured interviews with 14
dietitians in order to identify the workflow of a menu-suggestion process. We
subsequently designed and developed a Web-based dietary menu generation and
management system called DietPal. DietPal has the capability of automatically
calculating the nutrient and calorie intake of each patient based on the dietary
recall as well as generating suitable diet and menu plans according to the calorie
and nutrient requirement of the patient, calculated from anthropometric
measurements. The system also allows reusing stored or predefined menus for
other patients with similar health and nutrient requirements. RESULTS: We
modeled the workflow of menu-suggestion activity currently adhered to by
dietitians in Malaysia. Based on this workflow, a Web-based system was
developed. Initial post evaluation among 10 dietitians indicates that they are
comfortable with the organization of the modules and information.
CONCLUSIONS: The system has the potential of enhancing the quality of
services with the provision of standard and healthy menu plans and at the same
time increasing outreach, particularly to rural areas. With its potential capability
of optimizing the time spent by dietitians to plan suitable menus, more quality
time could be spent delivering nutrition education to the patients.
Publication Types:
PMCID: PMC1550583
1041: Can J Psychiatry. 2004 Mar;49(3):192-9.

Barriers to access to mental health services for ethnic seniors: the

Toronto study.
Sadavoy J, Meier R, Ong AY.
Mount Sinai Hospital, Toronto, Ontario. jsadavoy@utoronto.ca

OBJECTIVE: To identify and describe barriers to access to mental health services
encountered by ethnoracial seniors. METHOD: A multiracial, multicultural, and
multidisciplinary team including a community workgroup worked in partnership
with seniors, families, and service providers in urban Toronto Chinese and Tamil
communities to develop a broad, stratified sample of participants and to guide the
study. This participatory, action-research project used qualitative methodology
based on grounded theory to generate areas of inquiry. Each of 17 focus groups
applied the same semistructured format and sequence of inquiry. RESULTS: Key
barriers to adequate care include inadequate numbers of trained and acceptable
mental health workers, especially psychiatrists; limited awareness of mental
disorders among all participants: limited understanding and capacity to negotiate
the current system because of systemic barriers and lack of information;
disturbance of family support structures; decline in individual self-worth; reliance
on ethnospecific social agencies that are not designed or funded for formal mental
health care; lack of services that combine ethnoracial, geriatric, and psychiatric
care; inadequacy and unacceptability of interpreter services; reluctance of seniors
and families to acknowledge mental health problems for fear of rejection and
stigma; lack of appropriate professional responses; and inappropriate referral
patterns. CONCLUSIONS: There is a clear need for more mental health workers
from ethnic backgrounds, especially appropriately trained psychiatrists, and for
upgrading the mental health service capacity of frontline agencies through
training and core funding. Active community education programs are necessary to
counter stigma and improve knowledge of mental disorders and available
services. Mainstream services require acceptable and appropriate entry points.
Mental health services need to be flexible enough to serve changing populations
and to include services specific to ethnic groups, such as providing
comprehensive care for seniors.
Publication Types:
1042: Int J Gynaecol Obstet. 2004 May;85(2):213-20.

Comment in:
• Int J Gynaecol Obstet. 2004 May;85(2):201-2.
Experience from Bangladesh: implementing emergency obstetric

care as part of the reproductive health agenda.
Gill Z, Ahmed JU.
Averting Maternal Death and Disability (AMDD) program, Heilbrunn Center for
Population and Family Health, Columbia University, NY, USA.
zg41@columbia.edu
This paper describes the activities of the Ministry of Health and Family Welfare
of the Government of Bangladesh and UNFPA to introduce emergency obstetric
care (EmOC) services into the reproductive health care agenda. Working through
the existing system of Maternal and Child Welfare Centers (MCWC), the quality
and availability of comprehensive Reproductive Health and Emergency Obstetric
Care services was improved. Investments in training, infrastructure, management
information systems, quality assurance mechanisms and linkages between health
care facilities in Bangladesh, have produced positive results in terms of increased
utilization of these services. The Ministry of Health first implemented services in
one division of the country and later scaled up to include all of the MCWCs
nationally. While there are still obstacles to preventing obstetric deaths in
Bangladesh, this experience shows that improvements in the quality and
expansion of the range of services in existing health systems is an important step
toward increasing the use of reproductive health care services by the women who
need them most.
1043: Eur J Cardiothorac Surg. 2004 May;25(5):683-90.

Late outcome of patients with aortic dissection: study of a national

database.
Yu HY, Chen YS, Huang SC, Wang SS, Lin FY.
Department of Surgery, National Taiwan University Hospital and National

Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei
100, Taiwan, ROC.
OBJECTIVES: The incidence of late mortality and morbidity of aortic dissection

remained unchanged during the past 20 years. The present study was to analyze
the risk factors of late events for patients with aortic dissection. METHODS: A
total of 5654 cases of aortic dissection (3871 males) were collected from the
National Health Insurance Databases from 1996 to 2001. Age, gender, Marfan
syndrome, and initial treatment modality were the main factors to be investigated.
Corrective group was defined by surgical operation with cardiopulmonary bypass
and palliative group for the remaining. Late aortic events were defined by late
aneurysmal evolution of diseased aorta needing surgical intervention or death of
aortic causes from 6 months to 6 years. RESULTS: The incidence of aortic
dissection was 43 per 1000000 population in our country. Corrective group
accounted for 19.3% of them and palliative group for 80.7%. Marfan syndrome
accounted for 1.5% of all cases (4.3% of corrective surgery group). The rate of
freedom from mortality at 1, 6 months, and 6 years was 80.4+/-1.3, 69.0+/-1.5,
and 56.5+/-2.9% for corrective group and 89.5+/-0.5, 78.4+/-0.6, and 46.1+/-
1.35% for palliative group. Nearly half of the late mortalities were attributed to
atherosclerosis-related conditions (cardiac, stroke, or aortic causes). The
incidence of late aortic events was 2.48% per year on an average, comparable
between corrective and palliative groups. This incidence increased since the
fourth year after their initial episode. For corrective group, young age was a risk
factor of late aortic events (relative risk of 0.60-0.82 per decade, P = 0.037). For
palliative group, Marfan syndrome and male gender were risk factors of late
aortic events (relative risk of 4.08-10.7, P < 0.001 in the former; relative risk of
1.46-2.1, P = 0.002 in the latter). CONCLUSIONS: Late aortic events were not
uncommon for both corrective and palliative groups, and its incidence increased
since the fourth year after their initial episodes. Young age for corrective group,
Marfan syndrome and male gender for palliative group were risk factors of late
aortic events.
1044: Eur J Public Health. 2004 Mar;14(1):24-6.

Effects of working and residential location areas on air pollution

related respiratory symptoms in policemen and their wives in
Bangkok, Thailand.
Karita K, Yano E, Tamura K, Jinsart W.
Department of Hygiene and Public Health, Teikyo University School of

Medicine, Tokyo, Japan.
Factors, including air pollution, influencing the prevalence of respiratory

symptoms were investigated in a cross-sectional study in policemen and their
wives (530 couples) in Bangkok. Information on respiratory symptoms was
obtained using the American Thoracic Society Division of Lung Diseases (ATS-
DLD) questionnaire. Effects of working and residential locations were evaluated
using a multiple logistic model adjusted for several potential confounding factors.
In the policemen the increased risk of frequent cough or phlegm was related to
smoking (OR=2.19, 95% CI: 1.47-3.26) and working in heavy traffic locations
(OR=1.27, CI: 1.01-1.61), whereas in their wives it was related to their residential
locations (OR=1.53, CI: 1.10-2.13).
Publication Types:
1045: Chudoku Kenkyu. 2004 Jan;17(1):31-6.

[The introduction of clinical-pass, interlocked in electronic health

record, for acute poisoning patients]
Ikegami Y, Okazaki S, Hasegawa Y, Tase C.
1046: BMJ. 2004 Apr 3;328(7443):826-30.

Comment in:
• BMJ. 2004 Jun 19;328(7454):1497.
Importance of health research in South Asia.
Sadana R, D'Souza C, Hyder AA, Chowdhury AM.
Health Research Systems Analysis Initiative, Research Policy and Cooperation

Department, Evidence and Information for Policy Cluster, World Health
Organization, CH-1211 Geneva 27, Switzerland. sadanar@who.int
Publication Types:
• Review
PMCID: PMC383385
1047: J Intensive Care Med. 2004 Mar-Apr;19(2):105-10.
Outcome prediction for critically ill cirrhotic patients: a comparison

of APACHE II and Child-Pugh scoring systems.
Ho YP, Chen YC, Yang C, Lien JM, Chu YY, Fang JT, Chiu CT, Chen PC,
Tsai MH.
Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung

University, Taipei, Taiwan.
Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated
with high mortality rates. The prognosis of critically ill cirrhotic patients is
determined by the extent of hepatic and extrahepatic organ dysfunction. This
study was conducted to assess and compare the accuracy of the Child-Pugh
classification and APACHE II scores, obtained on the first day of ICU admission,
in predicting hospital mortality in critically ill cirrhotic patients. One hundred
thirty-five patients diagnosed with liver cirrhosis were admitted to the medical
ICU between January 2002 and March 2003. Information considered necessary to
compute the Child-Pugh and APACHE II scores on the first day of ICU
admission was prospectively collected. The overall hospital mortality rate was
66.6%. Liver disease was most commonly attributed to hepatitis B viral infection.
The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow
goodness-of-fit test. Furthermore, by using the areas under receiver operating
characteristic (AUROC) curve, the APACHE II scores demonstrated a better
discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC
0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the
cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE
II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients,
APACHE II is more powerful in discriminating the survivors from the
nonsurvivors.
Publication Types:
• Validation Studies
1048: J Transcult Nurs. 2004 Apr;15(2):114-21.

The effect of the health belief model in explaining exercise

participation among Jordanian myocardial infarction patients.
Al-Ali N, Haddad LG.
Jordan University of Science and Technology, Irbid, Jordan.
This study describes the effect of health belief model (HBM) in explaining
exercise participation among Jordanian myocardial infarction (MI) patients. A
convenient sample of 98 MI patients was recruited from four governmental
hospitals in northern Jordan. A self-reported questionnaire and structured
interview were designed to obtain the needed information. Study results indicated
that Jordanian MI patients had a high score in perceived severity and a low score
in perceived barriers. Results also showed a significant correlation between
exercise participation and health belief variables and sociodemographics such as
age, annual income, level of education, and physician recommendation. These
findings have implications for designing intervention programs aimed at
improving physical activity by all MI patients. These programs should consider
culture, socioeconomic status, personal system, and demographics. Further
research is needed to develop a culturally sensitive instrument that takes into
consideration the cultural variation and the specific needs of MI patients.
Publication Types:
1049: Food Nutr Bull. 2004 Mar;25(1 Suppl):S78-83.

Implementation of the WHO Multicentre Growth Reference Study

in Oman.
Prakash NS, Mabry RM, Mohamed AJ, Alasfoor D.
The World Health Organization (WHO) Multicentre Growth Study (MGRS)

Middle East site was Muscat, Oman. A survey in Muscat found that children in
households with monthly incomes of at least 800 Omani Rials and at least four
years of maternal education experienced unconstrained growth. The longitudinal
study sample was recruited from two hospitals that account for over 90% of the
city's births; the cross-sectional sample was drawn from the national Child Health
Register. Residents of all districts in Muscat within the catchment area of the two
hospitals were included except Quriyat, a remote district of the governorate.
Among the particular challenges of the site were relatively high refusal rates,
difficulty in securing adherence to the protocol's feeding recommendations,
locating children selected for the cross-sectional component of the study, and
securing the cooperation of the children's fathers. These and other challenges were
overcome through specific team building and public relations activities that
permitted the successful implementation of the MGRS protocol.
Publication Types:
• Review
1050: Food Nutr Bull. 2004 Mar;25(1 Suppl):S66-71.

Implementation of the WHO Multicentre Growth Reference Study

in India.
Bhandari N, Taneja S, Rongsen T, Chetia J, Sharma P, Bahl R, Kashyap

DK, Bhan MK.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
The World Health Organization (WHO) Multicentre Growth Reference Study

(MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent
neighborhoods in South Delhi. This community was selected to facilitate the
recruitment of children who had at least one parent with 17 or more years of
education, a key factor associated with unconstrained child growth in this setting.
A door-to-door survey was conducted to identify pregnant women whose
newborns were subsequently screened for eligibility for the longitudinal study,
and children aged 18 to 71 months for the cross-sectional component of the study.
A total of 111,084 households were visited over an 18-month period. Newborns
were screened at birth at 73 sites. The large number of birthing facilities used by
this community, the geographically extensive study area, and difficulties in
securing support of pediatricians and obstetricians for the feeding
recommendations of the study were among the unique challenges faced by the
implementation of the MGRS protocol at this site.
1051: J Pediatr. 2004 Apr;144(4):496-9.

Comment in:
• J Pediatr. 2005 Jan;146(1):149-50; author reply 150-1.
Early intravenous gamma-globulin treatment for Kawasaki disease:

the nationwide surveys in Japan.
Muta H, Ishii M, Egami K, Furui J, Sugahara Y, Akagi T, Nakamura Y,

Yanagawa H, Matsuishi T.
Department of Pediatrics, Kurume University School of Medicine, 67 Asahi-

machi, Kurume 830-0011, Japan. QZE05346@nifty.com
OBJECTIVE: To determine the optimal period of intravenous gamma-globulin

(IVGG) treatment, using the database from nationwide Kawasaki disease surveys
in Japan. STUDY DESIGN: We selected patients who first visited a doctor within
3 days of illness and received IVGG treatment within 9 days of illness. We
divided these patients into 2 groups: an early group (treated on days 1-4: 4731
cases) and a conventional group (days 5-9: 4020 cases). We compared the rate of
additional IVGG and prevalence of cardiac sequelae between these groups.
RESULTS: The rate of additional IVGG in the early group was significantly
higher than those of the conventional group (OR, 1.12 [95% CI, 1.10-1.16]).
There were no significant differences in cardiac sequelae between the two groups.
CONCLUSIONS: There is no evidence that IVGG treatment on day 4 or earlier
has greater efficacy in preventing cardiac sequelae than treatment on days 5 to 9.
In addition, early treatment is likely to result in a greater requirement for
additional IVGG. However, there is also no evidence that early treatment
increases the prevalence of cardiac sequelae in a clinical practice setting, where
additional IVGG can be given to those whose initial treatment fails.
Publication Types:
1052: Int J Med Inform. 2004 Mar 31;73(3):243-9.

A clinical management system for patient participatory health care

support. Assuring the patients' rights and confirming operation of
clinical treatment and hospital administration.
Ishikawa K, Konishi N, Tsukuma H, Tsuru S, Kawamura A, Iwata N,

Tanaka T.
Medical Informatics and Hospital Systems Management, Hiroshima University

Hospital, Hiroshima, Japan.
We conducted a drastic change in our hospital information system to support

patient participatory health care provided in the New Hiroshima University
Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima
University Hospital Medical Intelligence and Notice Delivery system II) is
designed as "clinical management system" (CMS). The core of this CMS is the
electronic health record (EHR), which aims to assure both the patients' right to
know, and the attendants' accountability. It is evident that the team practice
including patients requires close communication. Data in the EHR are written not
only by physicians, but also by all coworkers, which will enable them to realize
the team communication and the ordering in a reliable way and to leave the
evidence of conducted practices. Moreover, the bedside information systems were
set-up at all 700 beds. Patients can access their anamnesis and future clinical care
procedures themselves. Based on the demand outlined above, the new regulations
of HUH are composed of 21 requirements, conditions of information collection,
accumulation and use. Our focus was how to make patients' right compatible with
attendants' accountability. As the data owners, patients have the facility to access
their own data at their bedsides. They can view their own health condition and
treatment program and can control the data flow.
Publication Types:
1053: Int J Med Inform. 2004 Mar 31;73(3):217-27.

The Malaysian Telehealth Flagship Application: a national

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

54100 Kuala Lumpur, Malaysia. jmohan@pc.jaring.my
Telehealth refers to the integration of information, telecommunication, human-

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

[Quality of community-based healthcare services]
[Article in Hebrew]
Wilf-Miron R, Shemer J.
Israeli Center for Technology Assessment in Health Care, Gertner Institute for
Epidemiology and Health Policy Research, Tel Hashomer.
The recent concern regarding the quality of healthcare services is partly due to the
empowerment of health consumers, cost containment measures that may
compromise quality, increased complexity of the medical practice and the
accelerated growth of data on the magnitude and extent of quality problems. The
framework of the delivery of health services, including quality parameters, differs
fundamentally in the community as opposed to the hospital setting. In the
community, the episode of care lacks geographic and temporal boundaries, and is
divided among different facilities and caregivers. Hence, the healthcare systems
lack control over the management of care. In the solo practice, the physician lacks
the opportunity to discuss and share medical decisions with his/her peers and
physician's reimbursement does not encourage him/her to invest time and effort in
the provision of quality care. Furthermore, in the community setting, the patient is
expected to take responsibility for compliance to the therapeutic regimen, a
condition that may frequently interfere with regular life routines. Therefore,
quality promotion should embody the "quality triangle" encompassing patients,
caregivers, the healthcare system and appropriate interfaces. Ideally, the voice of
the health consumer should be an integral consideration in the design of health
policy, care should be patient-centered and physician reimbursement should
reflect the quality of care provided. In addition, the design of the healthcare
system information technology in supporting decision-making and training
"quality leaders" to facilitate quality improvement programs. Consequently, it is
pivotal to nurture agreement among policy-makers, patients and caregivers as to
the essence of the dilemma: "What is quality in community care?" Meanwhile, we
may suggest a primordial definition to community-based health care quality
management: An ongoing multidisciplinary effort to identify and respond to the
needs of patients, by providing systemic infrastructure that will support the
caregivers and help in achieving better outcomes in the six basic dimensions of
quality care-safe, timely, effective, efficient, equitable and patient-centered. In
conclusion, in light of the medical activities conducted in the community, and the
prevalent and ever-growing shortage of resources, there is a need to integrate
efforts to develop and implement both unique tools and strategies to manage
quality in community-based health services.
Publication Types:
1055: Health Policy. 2004 May;68(2):211-22.

Spatial pattern of private health care provision in Ujjain, India: a

provider survey processed and analysed with a Geographical
Information System.
Deshpande K, RaviShankar , Diwan V, Lönnroth K, Mahadik VK,

Chandorkar RK.
Department of Community Medicine, R.D. Gardi Medical College, Ujjain, MP,

India.
In developing countries like India, official information on private health care

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

Prevention of thalassemia: experiences from Samui Island.
Sangkitporn S, Chongkitivitya N, Pathompanichratana S, Sangkitporn SK,

Songkharm B, Watanapocha U, Pathtong W.
National Institute of Health, Department of Medical Sciences, Nonthaburi 11000,

Thailand.
Thalassemia is one of the most important genetic disorders in Thailand. A model

for prevention of thalassemia by combining 4 strategies including education,
carrier screening, counseling and prenatal diagnosis was developed by a
thalassemia task force. A thalassemia work group was formed in order to develop
a mechanism to integrate the model for real use on Samui Island where
thalassemia is common and a specific disease oriented program is required. 200
health professionals working on Samui Island participated in the thalassemia
educational courses. The specific training courses were also provided for
obstreticians, medical technologists and counselors. A team of well-trained health
professionals was established to manage public education. Information booklets,
posters, brochures and mass media including spot radio and newspapers were
used as educational materials. For carrier screening, blood samples of pregnant
women from all health care organizations on Samui Island were collected and
screened for thalassemia carriers by using the osmotic fragility (OF) test/the
dichlorophenol indophenol precipitation (DCIP) tests at Samui Hospital. Samples
with positive results were sent to the Regional Medical Sciences Center in Surat
Thani for thalassemia diagnosis. When a carrier was identified, her spouse was
offered testing. For at-risk couples, details of the disorder were included in
counseling to help them reach a decision that was right to them, in the context of
their unique medical, moral and social situations. Amniotic fluid samples were
collected for prenatal diagnosis. All patient information was registered by using
computer software. After 1 year of integration by using facilities of the Ministry
of Public Health service system, a wide range of problems were identified. They
underlined the need for effective health service structure co-operation, adequate
education of responsible health professionals, explicit policies and a clear line of
responsibility at local, regional and national levels for service development and
quality management. It is hoped that all information conducted in the present
study will be useful to health authorities to develop an explicit policy and promote
the health service structure co-operation in the country that will finally lead to
successfully reducing the frequency of severe thalassemia in the future.
Publication Types:
• Review
1057: Qual Life Res. 2004 Feb;13(1):81-9.

Association between patient education and health-related quality of

life in patients with Parkinson's disease.
Shimbo T, Goto M, Morimoto T, Hira K, Takemura M, Matsui K, Yoshida

A, Fukui T.
Department of General Medicine and Clinical Epidemiology, Graduate School of

Medicine, Kyoto University, Japan. shimbot@kuhp.kyoto-u.ac.jp
BACKGROUND: Providing patients with disease- and treatment-related

information is an important role of medical staff and is now reimbursed in Japan
by the national health insurance system under the rubric 'patient education'.
Evaluation of the effectiveness of patient education programs is necessary to
ensure that limited health care resources are used efficiently. OBJECTIVE: The
objective is to determine whether educating patients with Parkinson's disease
(PD) is related to better health-related quality of life (HRQOL). DESIGN: A
cross-sectional study was conducted. SETTING: Members of the Japan
Association of Patients with Parkinson's disease were randomly selected.
PARTICIPANTS: A total of 1200 patients with PD were asked to fill in written
questionnaires and replies from 762 (63.5%) were analyzed. MEASUREMENTS:
The questionnaire inquired about clinical characteristics, comorbidity, symptoms
of PD, complications of therapy, HRQOL, and patient education. SF-36 was used
to assess HRQOL. The section on patient education comprised one question each
on patient-perceived satisfaction with information provided on (1) disease
condition and pathophysiology, (2) effectiveness of drug therapy, (3) adverse drug
reactions, (4) publicly available financial and social resources, and (5)
rehabilitation and daily activities. Patient education score was defined as the sum
of the individual scores for these five questions. The relationships between scores
on the SF-36 subscales and the patient education score were examined.
RESULTS: More satisfaction with patient education was associated with higher
scores in all SF-36 subscales except physical functioning and bodily pain. The
difference in score between the most satisfied and the least satisfied patients
ranged from 8.4 points on the subscales of general health and 16.7 points on the
subscale of role limitation due to emotional problems. CONCLUSION: The
conclusion that patient education is associated with better HRQOL in patients
with PD is drawn.
Publication Types:
1058: Nippon Koshu Eisei Zasshi. 2004 Feb;51(2):79-93.

[Role of the social support network which influences age of death

and physical function of elderly people: study of trends in and
outside of Japan and future problems]
Kishi R, Horikawa N.
Department of Public Health, Hokkaido University Graduate School of Medicine,

Sapporo.
Concerning associations between the social support network and physical health
of the elderly, longitudinal studies have been conducted using various
measurement indexes. The studies indicated that the support network influences
on physical function and life expectancy. In this study we compared research
papers from Japan and elsewhere that appeared after 1980, from the viewpoint of
1) social support effects, and 2) social network effects, to examine potential
problems in the future. The main knowledge obtained was that the receipt of
emotional support, wide network size, and participation in social activities
reduced the risk of early death and decrease in physical function of elderly people.
Sex differences were indicated, and in many cases, the effects were more
remarkable in men than women. In addition the positive influence of receiving
help from a support network, a major subject of conventional research, the effects
of offering help to others and negative findings were also examined. It has been
indicated that participation in volunteer groups and offer of support to other
people can prevent decrease in physical function or early death. As negative
effects, improper instrumental support rather disturbs the mental and physical
independence of elderly people. As future issues, it is necessary to focus on both
positive/negative and receipt/offer effects of support network, and to clarify how
to provide example which best match the life of elderly people by comparing
sexes and regions. It is also important to actually apply the knowledge gained
from observational studies to prevent the elderly from becoming a condition
requiring care, and to develop intervention studies which can increase the social
contacts of elderly people at the same time as conducting health education and
medical treatment.
Publication Types:
1059: Int J Nurs Pract. 2004 Apr;10(2):64-71.

The perceived needs of Jordanian families of hospitalized, critically

ill patients.
Al-Hassan MA, Hweidi IM.
School of Nursing, Jordan University of Science and Technology, Irbid, Jordan.

alhassam@just.edu.jo
The purpose of this study was to identify needs of Jordanian families of

hospitalized, critically ill patients. The Critical Care Family Needs Inventory was
introduced to 158 family members who were visiting their hospitalized, critically
ill relatives. The findings revealed that > or = 80% of the family members
perceived 16 need statements as important or very important. The participants
ranked order needs for assurance, information and proximity the highest and
needs for support and comfort the lowest. Specifically, the most important needs
of the families were to receive information about the patients, to feel that the
hospital personnel care about the patients and to have the information given in
understandable terms. Results of this study indicated that Jordanian families had
specific and identifiable needs. Providing families of critically ill patients clear,
simple and updated information about the patients, and assuring them about the
quality of care the patients receive, should be essential components of the critical
care nursing delivery system.
1060: J Environ Monit. 2004 Apr;6(4):254-61. Epub 2004 Mar 19.

Determination of arsenic species in fish, crustacean and sediment

samples from Thailand using high performance liquid
chromatography (HPLC) coupled with inductively coupled plasma
mass spectrometry (ICP-MS).
Rattanachongkiat S, Millward GE, Foulkes ME.
School of Earth, Ocean and Environmental Sciences, University of Plymouth,

Plymouth, PL4 8AA, UK.
Suitable techniques have been developed for the extraction of arsenic species in a
variety of biological and environmental samples from the Pak Pa-Nang Estuary
and catchment, located in Southern Thailand, and for their determination using
HPLC directly coupled with ICP-MS. The estuary catchment comprises a tin
mining area and inhabitants of the region can suffer from various stages of arsenic
poisoning. The important arsenic species, AsB, DMA, MMA, and inorganic
arsenic (As III and V) have been determined in fish and crustacean samples to
provide toxicological information on those fauna which contribute to the local
diet. A Hamilton PRP-X100 anion-exchange HPLC system employing a step
elution has been used successfully to achieve separation of the arsenic species. A
nitric acid microwave digestion procedure, followed by carrier gas nitrogen
addition- (N2)-ICP-MS analysis was used to measure total arsenic in sample
digests and extracts. The arsenic speciation of the biological samples was
preserved using a Trypsin enzymatic extraction procedure. Extraction efficiencies
were high, with values of 82-102%(As) for fish and crustacean samples.
Validation for these procedures was carried out using certified reference
materials. Fish and crustacean samples from the Pak Pa-Nang Estuary showed a
range for total arsenic concentration, up to 17 microg g(-1) dry mass. The major
species of arsenic in all fauna samples taken was AsB, together with smaller
quantities of DMA and, more importantly, inorganic As. For sediment samples,
arsenic species were determined following phosphoric acid (1 M H3PO4)
extraction in an open focused microwave system. A phosphate-based eluant, pH
6-7.5, with anion exchange HPLC coupled with ICP-MS was used for separation
and detection of AsIII, AsV, MMA and DMA. The optimum conditions,
identified using an estuarine sediment reference material (LGC), were achieved
using 45 W power and a 20 minute heating period for extraction of 0.5 g
sediment. The stability and recovery of arsenic species under the extraction
conditions were also determined by a spiking procedure which included the
estuarine sediment reference material. The results show good stability for all
species after extraction with a variability of less than 10%. Total concentrations of
arsenic in the sediments from the Pak Pa-Nang river catchment and the estuary
covered the ranges 7-269 microg g(-1)and 4-20 [micro sign]g g(-1)(dry weight),
respectively. AsV was the major species found in all the sediment samples with
smaller quantities of AsIII. The presence of the more toxic inorganic forms of
arsenic in both sediments and biota samples has implications for human health,
particularly as they are readily 'available'.
Publication Types:
1061: Radiat Med. 2004 Jan-Feb;22(1):17-9.

Status of Japanese radiation oncology.
Nakano T.
Department of Radiation Oncology, Gunma University Graduate School of

Medicine, Showa-machi, Maebashi-shi, Gunma 371-8511, Japan.
PURPOSE: The Japanese status and structure of radiation oncology are reported
on the basis of a recent Japanese official survey database compiled by JASTRO.
METHODS: This report presents the status of human resources and equipment in
regard to radiation therapy, and comprehensive QA of radiation therapy in Japan,
mostly based on the database of the JASTRO survey of 2001 status. RESULTS:
About 13,000 patients are treated with radiation therapy per year, the leading sites
of which were lung, breast, head and neck, prostate, esophagus, and uterus, in that
order. There were about 700 radiation therapy institutions in Japan, two-thirds of
which consisted of university and public institutions. Approximately, 1,000 full-
time medical doctors, including 700 radiation oncologists, 1,500 technologists,
and 70 medical physicists were working with approximately 700 linacs, 25
microtrons, 55 telecobalts, 200 RALSs (Co-60, 95; Ir-192, 93), and 33 gamma
knives with various radiation treatment planning systems. Recently, 160
stereotactic radiotherapy, 10 cyber knives, and 10 IMRT units started operating in
Japan. CONCLUSION: One of the main problems in Japanese radiation oncology
is the shortage of human resources, including radiation oncologists and medial
physicists. Poor awareness of radiation oncology among the public and ignorance
of the necessity and importance of medical physicists in the medical field tends to
adversely affect QA/QC of recent high-technology radiation therapy.
Publication Types:
• Review
1062: Radiat Med. 2004 Jan-Feb;22(1):12-6.

Current status of radiotherapy in Vietnam, 2002.
To DA, Bui D.
Department of Breast and Gynecology Radiotherapy, National Cancer Institute (K

Hospital), Hoan Kiem District, Hanoi, Vietnam.
PURPOSE: Resources for radiation therapy in Vietnam were analyzed to obtain

an understanding of the current status of radiation oncological practice in
Vietnam. MATERIALS AND METHODS: Data were obtained through a report
on the locations of major equipment and personnel. RESULTS: The availability
of both teletherapy and brachytherapy was related to the economic status of the
country. Most departments were found to treat patients without simulator or
treatment planning systems. CONCLUSIONS: The information in the report is
currently available for radiation oncological practices in Vietnam and provides for
planning of development programs on radiation oncology.
Publication Types:
• Review
1063: Public Health. 2004 Mar;118(2):114-20.

Injuries among children in Karachi, Pakistan--what, where and

how.
Razzak JA, Luby SP, Laflamme L, Chotani H.
Department of Public Health, Karolinska Institute, Stockholm, Sweden.

jrazzak@emory.edu
OBJECTIVES: To describe the epidemiology of injuries among children in

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

[Structure and ecological benefits of urban forest in Shenyang build-

up area]
Hu Z, He X, Chen W, Li Y, Li H.
Institute of Applied Ecology, Chinese Academy of Scinces, Shenyang 110016,

China. Zhibinhu@163.com
Investigations were made in the sampling plots covering 243 km2 of the
Shenyang urban area, and the results were used as the input for the Urban Forest
Management Information System (UFMIS), which was developed based on the
model of CITY green. With this system, and using tree species, tree density, tree
height grade distribution, tree DBH (diameter at beast height) grade distribution,
and tree health condition as parameters, the land use and forest structure in
Shenyang City were analyzed. It was found that there were 1,914,500 trees in
Shenyang, belonging to 136 species. The 25 dominant species accounted for
84.78% of the total number of trees, and the forest coverage was 9.765%. Trees
with DBH < 0.25 m and > 0.5 m accounted for 82.8% of the total, and the young,
middle-aged and old trees occupied 27%, 58% and 15% of the total, respectively.
The healthy status of 84% of the trees was above middle level. Therefore, the
forest in Shenyang urban is at a stable stage. According to the statistical results
from UFMIS, the ecological value of forest in Shenyang urban is as high as
26,526,955. 1 USD in terms of economy.
Publication Types:
1065: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):201-17.

Erratum in:
• J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):table of contents.
How are biomarkers related to physical and mental well-being?
Seplaki CL, Goldman N, Weinstein M, Lin YH.
Office of Population Research, Princeton University, New Jersey 08544, USA.

cseplaki@princeton.edu
We investigate how biological markers of individual responses to stressful

experiences are associated with profiles of physical and mental functioning in a
national sample of middle-aged and elderly Taiwanese. Data come from a
population-based sample of middle-aged and elderly Taiwanese in 2000. The data
combine rich biological measures with self-reported information on physical and
mental health. Grade of membership methods are used to summarize functional
status, and multinomial logit models provide information on the association
between biological measures and function. The analysis identifies significant
associations between biomarkers of stressful experience and profiles of physical
and mental functioning. The estimates reveal the potential importance for health
of both low and high values of biological parameters. The findings point to
directions for future research regarding development of aggregate measures of
cumulative dysregulation across multiple physiological systems.
Publication Types:
1066: Soc Sci Med. 2004 May;58(10):2045-67.

Changing geographic access to and locational efficiency of health

services in two Indian districts between 1981 and 1996.
Kumar N.
Population Studies and Training Center, Brown University, Providence RI 02912,

USA. naresh.kumar@brown.edu
In developing countries, including India, the role of the private sector in the
provision of basic healthcare services is gradually expanding, since the public
sector provides limited services and covers only limited areas. Using location-
allocation models (LAM), this paper (1) examines the changing geographic access
to and locational efficiency of basic public healthcare vis-à-vis private healthcare
services in two districts located in northwestern part of India, and (2) interrogates
the factors that govern their geographic accessibility and locational-efficiency.
Although this research confirms regional inequalities in geographic accessibility
and locational efficiency of both public and private healthcare services in the
selected districts, the locational efficiency of private health services is
significantly lower than that of public health services. This paper further
demonstrates the use of LAM for new site identification (keeping the existing
healthcare sites intact) that will, in the future, improve locational efficiency of
these services. This paper not only recommends improved geographic access to
both public and private health services and their enhanced complementary role,
but also stresses the need to evaluate geographic access from the service-users'
perspective and the use of more realistic data on demand and supply in future
research. The findings of this paper can be extended to areas with similar
geographic settings, and socio-economic and demographic conditions.
Publication Types:
1067: Respirology. 2003 Nov;8 Suppl:S46-8.

SARS: public health measures in Hong Kong.
Tsang T, Lam TH.
Department of Health, Hong Kong Government, Hong Kong, SAR, China.

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

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

University, Hung Hom, Hong Kong Sar, Hong Kong.
A voluntary indoor air quality certification scheme has been proposed in Hong
Kong for assessing and evaluating the indoor air quality level in a variety of
public places like offices, restaurants and pubs. The scheme intends to promote
the public well being, however, its technical and financial practicality has led to
serious discussions among the government officials, practitioners and premises
owners. Accordingly, this study intends to develop a protocol for examining its
financial viability by linking the appropriate dose-response and economic data
with the results from indoor micro-environment models. The financial viability of
the scheme is evaluated by examining the cost and benefit associated with
compliance on the different prescribed indoor particulate (PM10) levels.
According to our analysis, the indoor action level of 180 microg/m3 as 8-h mean
(with the objective of protecting the health of general public) does not require
office owners to improve beyond the base setting. Nevertheless, owners should
consider altering the base settings in their air conditioning systems so as to secure
more benefit on every dollar they spent. On the contrary, the 20 microg/m3 level
as 8-h mean (with the objective of providing comfort) is not considered to be
financially viable for office owners as they will incur financial loss on
compliance. Subsequent sensitivity analysis indicates that the total net benefit
derived have a great dependency on the value-of-life estimates used. If
conservative health estimates are adopted, the optimum level determined to be
beneficial to both owners and the society will be 55 microg/m3, which can be
obtained by operating the air conditioning system with a ventilation rate of 10 l/s,
primary filters of 80-85% efficiency and secondary filters efficiency of 60-65%
arrestance. This information should be extremely valuable for government
officials and policy makers in assessing the financial viability of the voluntary
indoor assessment scheme.
Publication Types:
1069: Annu Rev Public Health. 2004;25:327-39.

The current state of public health in China.
Lee L.
Chinese Center for Disease Control and Prevention, Beijing 100050, China.
lmlee@163bj.com
In the past 50 years, China has made great achievements in controlling infectious
diseases and improving the public's health and hygiene. However, in the twenty-
first century, owing to the negative effects brought on by aging of the population
and the burdens of diseases, urbanization, industrialization, and globalization,
Chinese public health officials are encountering greater difficulties than ever. Old
operating models of public health cannot meet present requirements. The main
problems are poor capacity to respond to public health emergencies, severe
inequality of health care services, and lagging development of public health
information systems. Public health in China can gradually meet the requirements
of social development and the increasing public demand for health care services
only when the public health is directed by informatization, globalization,
technification, and humanization.
1070: J R Army Med Corps. 2003 Dec;149(4):277-83.

Comment in:
• J R Army Med Corps. 2004 Jun;150(2):153.

• J R Army Med Corps. 2004 Mar;150(1):66.
• J R Army Med Corps. 2004 Mar;150(1):66; author reply 66.
• J R Army Med Corps. 2004 Sep;150(3):225.
Impact of deployment of personnel with chronic conditions to

forward areas.
Hodgetts TJ, Greasley LA.
University of Birmingham. timothy.hodgetts@uhb.nhs.uk
AIM: To identify reasons for inappropriate deployment of soldiers with chronic

conditions to an operational environment. SETTING: Two British Army field
hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop
concentration prior to war-fighting (Operation Telic). POPULATION: All British
military personnel on land during the concentration phase, rising to an estimated
28,000 troops. METHODS: Real-time electronic record maintained of all cases
presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed.
RESULTS: 50 sequential cases were analysed. 34% were downgraded prior to
deployment. Of those who were P2 FE, 85% were judged to have required
protection from deployment by down-grading. 20% of all cases had a history of
chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of
all cases were deployed while waiting for secondary care investigation or review
that should have ensured protection from deployment. No patient had an existing
"FT" (forward temperate) or "LT" (lines of communication temperate) grading:
but in four cases it was predictable that the patient's underlying condition would
be adversely affected by deployment to a desert environment. In 5 cases it was
identified that the inappropriate deployment could be attributed to clinical
management within the civilian sector, with a consequent failure to institute the
necessary downgrading process. CONCLUSIONS: Review of the medical
grading process is needed to protect those soldiers who are awaiting outpatient
opinion or definitive diagnosis from investigation, and to provide an
employability grading that matches a soldier's fitness for operational role.
1071: Pediatr Infect Dis J. 2004 Mar;23(3):221-6.

Use of a computerized database to study the effectiveness of an

attenuated varicella vaccine.
Passwell JH, Hemo B, Levi Y, Ramon R, Friedman N, Lerner-Geva L.
Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
passwell@sheba.helth.gov.il
BACKGROUND: The varicella vaccine Varilrix (GlaxoSmithKline) was

introduced in Israel in June 2000 as an optional vaccination for children.
METHODS: We used the database of a single health maintenance organization
that serves 25% of the population in Israel to assess the effectiveness of the
vaccine retrospectively. Incidence and complications of varicella were derived
from the database from January 1, 1998 until December 31, 2002. RESULTS:
Since licensure >30000 individuals younger than 10 years in this health
maintenance organization have been immunized with the vaccine. Annual
incidence of disease per 1000 in the study population was 86.6 in 1998, 74.6 in
1999, 74.0 in 2000, 37.1 in 2001 and 44.6 in 2002. This declining trend in
incidence of disease was statistically significant. Complications of varicella
occurred in approximately 1% of patients throughout the 5-year study period, but
there was a parallel decline in the number of patients with complications
corresponding to the decline in disease incidence. Vaccine effectiveness for
prevention of clinical disease in this population was 92% (95% confidence
interval, 91.0 to 92.7). There were varying rates of utilization within communities
of varied socioeconomic class, so that in the higher socioeconomic class there was
an increased utilization and a corresponding decrease of attack rate; whereas in
communities where there were lower utilization rates, corresponding increased
numbers of varicella cases were seen. CONCLUSION: This database enables
long term follow-up of the effectiveness of this vaccine in a large population.

1072: J Telemed Telecare. 2004;10(1):25-8.
Reliability of Web-based teledermatology consultations.
Oztas MO, Calikoglu E, Baz K, Birol A, Onder M, Calikoglu T, Kitapci MT.
Department of Dermatology, Gazi University, Turkey. moztas@gazi.edu.tr
We studied the reliability of teledermatology diagnoses made using a Web-based

system. Clinical photographs and information relating to 125 patients were placed
on a Web server. Three dermatologists made the most likely diagnosis via a Web
interface. The reference diagnosis was made in a face-to-face consultation with a
fourth dermatologist; where appropriate it was confirmed histologically. The
teledermatologists were correct in 57% of cases when viewing the images alone.
Their diagnostic accuracy improved to 70% when additional clinical information
was available. The rate of agreement between the teledermatologists ranged from
44% to 70% (kappa= 0.22-0.32). Seventy-seven per cent of the patients were
correctly diagnosed by at least two dermatologists when clinical information was
provided. A Web-based system appears to be reliable for teledermatology. A
single well trained teledermatologist may give better results than a group of less
well trained clinicians.
1073: Rev Sci Tech. 2003 Dec;22(3):977-87.

Animal disease surveillance: prospects for development in Pakistan.
Akhtar S, White F.
Division of Epidemiology and Biostatistics, Department of Community Health

Sciences, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
Surveillance is a continuous and systematic process of collection, consolidation,

analysis, interpretation and dissemination of relevant information on the
occurrence of health problems. Data from surveillance can be used to calculate
the incidence and prevalence of events, to categorise disease distribution by
relevant characteristics, to guide investigations into the occurrence of epidemic
and endemic disease, and to contribute essential information for the design and
evaluation of effective disease prevention and control programmes. Disease
surveillance systems should also respond to the information needs of government
agencies, agribusiness, academia, producers and consumers. However, in most
developing countries, including Pakistan, animal disease surveillance systems are
not well developed, and do not produce a desirable quality of information on
disease status and trends. In this paper, the authors describe various facets of a
generic surveillance system and propose a structure for a surveillance system at
district level. Such systems have been designed and implemented for public health
surveillance in a number of countries, and may be developed to meet the needs of
veterinary public health.
Publication Types:
• Review
1074: Lancet Infect Dis. 2004 Mar;4(3):171-7.

Erratum in:
• Lancet Infect Dis. 2004 Aug;4(8):533.
Role of a sentinel surveillance system in the context of global

surveillance of infectious diseases.
Arita I, Nakane M, Kojima K, Yoshihara N, Nakano T, El-Gohary A.
Agency for Cooperation in International Health, Kumamoto City, Japan.

arita@acih.com
In some nation states, sustained integrated global epidemiological surveillance has

been weakened as a result of political unrest, disinterest, and a poorly developed
infrastructure due to rapidly increasing global inequality. The emergence of
severe acute respiratory syndrome has shown vividly the importance of sensitive
worldwide surveillance. The Agency for Cooperation in International Health, a
Japanese non-governmental organisation, has developed on a voluntary basis a
sentinel surveillance system for selected target infectious diseases, covering South
America, Africa, and Asia. The system has uncovered unreported infectious
diseases of international importance including cholera, plague, and influenza;
current trends of acute flaccid paralysis surveillance in polio eradication; and
prevalence of HIV, syphilis, hepatitis B, and hepatitis C in individual areas
covered by the sentinels. Despite a limited geographical coverage, the system
seems to supplement disease information being obtained by global surveillance.
Further development of this sentinel surveillance system would be desirable to
contribute to current global surveillance efforts, for which, needless to say,
national surveillance and alert system takes principal responsibility.
Publication Types:
1075: Radiol Technol. 2004 Jan-Feb;75(3):242.

Kuwaiti radiographers and PACS.
al-Shawaf H, Sayed MG.
Department of Health Information Administration, College of Allied Health,

Kuwait University, Kuwait.
1076: Mar Pollut Bull. 2004 Mar;48(5-6):449-57.

Marine litter prediction by artificial intelligence.
Balas CE, Ergin A, Williams AT, Koc L.
Department of Civil Engineering, Faculty of Engineering and Architecture, Gazi

University, Celal Bayar Bulvari, 06570 Maltepe, Ankara, Turkey.
cbalas@gazi.edu.tr
Artificial intelligence techniques of neural network and fuzzy systems were

applied as alternative methods to determine beach litter grading, based on litter
surveys of the Antalya coastline (the Turkish Riviera). Litter measurements were
categorized and assessed by artificial intelligence techniques, which lead to a new
litter categorization system. The constructed neural network satisfactorily
predicted the grading of the Antalya beaches and litter categories based on the
number of litter items in the general litter category. It has been concluded that,
neural networks could be used for high-speed predictions of litter items and beach
grading, when the characteristics of the main litter category was determined by
field studies. This can save on field effort when fast and reliable estimations of
litter categories are required for management or research studies of beaches--
especially those concerned with health and safety, and it has economic
implications. The main advantages in using fuzzy systems are that they consider
linguistic adjectival definitions, e.g. many/few, etc. As a result, additional
information inherent in linguistic comments/refinements and judgments made
during field studies can be incorporated in grading systems.
1077: J Contemp Dent Pract. 2004 Feb 15;5(1):31-41.

Medical health and medication use in elderly dental patients.
Jainkittivong A, Aneksuk V, Langlais RP.
Department of Oral Medicine in the Faculty of Dentistry at Chulalongkorn

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

biphenyls and dibenzofurans.
Guo YL, Lambert GH, Hsu CC, Hsu MM.
Department of Occupational and Environmental Health, National Cheng Kung

University, College of Medicine, Tainan, Taiwan. leonguo@mail.ncku.edu.tw
Yucheng ("oil-disease") victims were Taiwanese people exposed to

polychlorinated biphenyls (PCBs) and their heat-degradation products, mainly
polychlorinated dibenzofurans (PCDFs), from the ingestion of contaminated rice
oil in 1978-1979. Serial studies in Yucheng offspring born between 1978 and
1992 are summarized. Children of the exposed women were born with retarded
growth, with dysmorphic physical findings, and, during development, with
delayed cognitive development, increased otitis media, and more behavioral
problems than unexposed children. Recently, examination of the reproductive
system has suggested that prenatal exposure exerts late effects on semen
parameters in young men after puberty. Results of the investigation in Yucheng
children will provide important information about the human health effects and
toxicology of PCB/PCDF exposure. Prenatal exposure to these environmental
chemicals causes the fetus to be sensitive to the toxic effects of persistent organic
pollutants.
Publication Types:

• Review
1079: Masui. 2003 Dec;52 Suppl:S110-4.

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

1080: Turk J Pediatr. 2003 Oct-Dec;45(4):283-9.
Outcomes of very low birth weight infants in a newborn tertiary

center in Turkey, 1997-2000.
Atasay B, Günlemez A, Unal S, Arsan S.
Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of

Medicine, Ankara, Turkey.
Our purpose was to determine mortality and morbidity rates and selected outcome
variables for infants weighing less than 1500 g, who were admitted to the neonatal
intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the
study was to define a model for developing a regional database. Information on all
very low birth weight (VLBW) admissions to a tertiary level neonatal intensive
care unit (NICU) in Ankara between January 1997 and December 2000 was
prospectively collected by three neonatologists using a standard manual of
operation and definitions. The data consisted of patient information including
sociodemographic characteristics; antenatal history; mode of delivery; APGAR
scores; need for resuscitation; admission illness severity (Clinical Risk Index for
Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring
System-NTISS); selected NICU parameters and procedures such as respiratory
support, surfactant therapy, and postnatal corticosteroid therapy; and selected
patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing
enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of
VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other
maternity centers. The mean birth weight and gestational age of the infants were
1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen
of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB
and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been
given to 74 (55.6%) infants. Surfactant treatment and respiratory support were
given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected
outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity
(ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial
infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9
(8.1%), 3 (2.2%), 34 (25.5%) and 35 (26.3%) of the infants, respectively. Overall
survival rate was 83.5% (111/133); most of the deceased cases were under 750 g
(12/22). It was prospectively shown that 111 (100%) of the surviving infants
could be regularly followed in a newborn follow-up clinic to provide health
maintenance, developmental assessment and support. Compared with reports from
other developing countries, VLBW infants at our center had higher survival rates.
Compared to developed countries, survival rate was lower, especially for
extremely very low birth weight infants. There is interaction between birth weight
and survival rate. Among selected neonatal outcomes, chronic lung disease,
threshold retinopathy, severe intraventricular hemorrhage (IVH > or = grade III)
and nosocomial infection rates at this center were comparable with some reports
from developed nations.
1081: Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Dec;24(12):1096-9.

[Epidemiological features of severe acute respiratory syndrome in

Beijing]
Liang WN, Mi J; Information Branch, Joint Leadership Group of SARS

Prevention and Control in Beijing.
Beijing Health Bureau, Beijing 100053, China.
OBJECTIVE: To describe the epidemiologic features of severe acute respiratory

syndrome (SARS) in Beijing. METHOD: Database of the 2 521 probable cases of
SARS in Beijing Center for Disease Prevention and Control was used. RESULTS:
The course of SARS epidemic in Beijing could be divided into five phases:
import and spreading-from 1 to 31 in March, rising-from April 1 to April 15,
peak-from April 16 to May 4, declining-from 5 to 18 in May, terminating-from 19
to 28 in May. The proportions of portable cases of SARS in each phase were
2.7%, 13.6%, 71.0%, 11.6% and 1.1%, respectively. Totally, 2 521 portable cases
were diagnosed and verified according to the diagnostic criteria of SARS issued
by the Ministry of Health. Among them, 192 died from SARS. The incidence and
mortality rates of SARS were 18.57 per 100,000 and 1.41 per 100,000 with the
fatality of 7.6%. The ratio of male to female with SARS was 1:0.97. The highest
incidence rate of SARS was in the group of 20 - 29 years (30.85 per 100,000), and
the lowest was in the group of 0 - 14 years (2.54 per 100,000). People aged 20 -
49 accounted for 72.3% of all SARS cases. The incidence rates in urban, suburb
and far-suburb were 32.25/100,000, 20.57/100,000 and 8.90/100,000,
respectively, decreasing according to the population density. Health care
providers (17.3%), staff (12.9%), retirees (11.4%), workers (9.7%) and house-
hold unemployees (8.8%) appeared to be at the five top risk populations being
infected. The fatality increased significantly with age. CONCLUSION: Beijing
was the most severe epidemic region of SARS in the world, but the fatality was
the lowest.
Publication Types:
1082: Ann Trop Med Parasitol. 2003 Dec;97(8):793-802.

The burden of malaria in Ahmedabad city, India: a retrospective

analysis of reported cases and deaths.
Yadav RS, Bhatt RM, Kohli VK, Sharma VP.
Malaria Research Centre (ICMR), Field Station, Civil Hospital, Nadiad -- 387001,
India. rajpal_yadav@yahoo.com
Owing to the paucity of accurate information on the burden of malaria in urban

India, a retrospective, epidemiological study was carried out in Ahmedabad city,
which has a population of about 3 million. Surveillance data for the years 1965-
1998 showed a gradual resurgence of malaria between 1967 to 1976, followed by
waves of low and high incidences. Plasmodium vivax always predominated but
the proportion of cases attributed to P. falciparum increased markedly from 1983.
When the surveillance data and health records of the major public and private
health facilities in the city were analysed, for the period between 1991 and 1998,
P. vivax was found to account for 69% of all malaria cases and P. falciparum for
the other 31%. The incidence of infection with each Plasmodium species showed
seasonal variation, with that of P. vivax increasing from January to September but
then declining as the incidence of P. falciparum increased. The age-specific
differences seen in incidence were not statistically significant (P=0.7). The annual
numbers of malaria-attributable deaths were strongly correlated with the
incidence of P. falciparum (r=0.88). The malaria incidence detected (37431 cases,
representing a mean annual incidence of 12.2 cases/1000) was nine times greater
than that officially reported (4119 cases, or 1.3 cases/1000 each year). Similarly,
the annual malaria-attributable mortality detected (22 deaths/million) was far
higher than that officially notified (0.3 death/million). The results of the
retrospective analysis not only provide a more accurate, baseline estimate of the
burden of malaria in an urban area of India but also clearly indicate the need for a
much more efficient health-information system, for recording and managing
malaria in such a setting.
Publication Types:

1083: Immunol Allergy Clin North Am. 2003 Nov;23(4):665-97.
Erratum in:
• Immunol Allergy Clin North Am. 2004 May;24(2):335.
Allergic reactions to Japanese encephalitis vaccine.
Plesner AM.
Department of Medical Officers of Health, Copenhagen County, Islands Brygge

67 DK-2300 Copenhagen S, Denmark. apl@kbh.eli.dk
The JEV widely is used in Asian countries each year and is an important vaccine
for travelers to the East from other parts of the world. JE virus is a zoonotic
disease with natural reservoirs and cannot be eliminated. Although a declining
incidence of JE has been observed in Asia because of reduced transmission by
agricultural approaches and vaccination, the most important control measure now,
and in the future, is vaccination of humans against JE. The inactivated vaccine,
produced from infected mouse-brain-derived tissue, is the only commercially
available vaccine. There are several concerns with the use of this vaccine. It is
expensive, requires two or three doses to achieve protective efficacy, and, in
practice, requires further booster doses to maintain immunity. The apparent
increase in allergic reactions in the first part of the 1990s has set focus on the
safety of the JEV. A cheap, live attenuated SA 14-14-2 vaccine is used almost
exclusively in China and parts of Korea, but there have been no trials of SA 14-
14-2 vaccine outside JE endemic countries. The vaccine seems to be highly
efficient, and few adverse events have been observed; however, PHK cells are
used for the production of this vaccine, and these cells are not approved by the
WHO. A satisfactory cell substrate is needed. A committee under the WHO has
proposed that for the live JEV, there should be validity of the assays for retrovirus
when applied to PHK cell substrate and validity of the mouse assays for
neurovirulence. Further information should be reviewed on the long-term follow-
up of recipients of the vaccine. Several new types of vaccines have reached the
phase of clinical trials; however, studies remain to be completed. Until a new
vaccine is available, the priority of surveillance of adverse events and the
continuous reporting of such events to the users of the vaccines must be of
importance. This fact is highlighted by the possibility of the varying frequency of
adverse events with different batches over the years. The WHO offers information
and recommendations for vaccines in the EPI and issues a series of updated
papers on other vaccines that are of international public health importance (eg,
JEV). The development of alternative efficient, safe, and appropriately priced
JEVs is recommended, as is intensified surveillance of adverse events.
Prospective vaccine studies of safety may be limited because of sample size and
because rare adverse events may not be detected. Several new initiatives have
been taken to improve surveillance of adverse events to vaccines within the past
10 years. In Japan, there is an increasing awareness of the importance of efforts
taken to improve vaccine safety, and surveillance of adverse events and
possibilities of compensation for vaccine-related injuries are in place. In Vietnam,
a database to detect adverse events after vaccination has been established; the
project involves active visits to data collectors at the vaccination sites.
Comparative studies of adverse events, such as one recent study from Japan and
the United States, are important for the evaluation of the reporting systems. The
reporting rate for JEV adverse events from Japan was approximately one order of
magnitude lower than that in the United States. Japan had strict predefined
reporting criteria and time limits for observations. If time limits for the
observation are too strict (eg, defining a possible neurologic reaction to occur
within 1 week after vaccination), later reactions will not be included (eg, if
ADEM is elicited by a vaccine, the symptoms cannot be expected to occur until
weeks after the vaccination). The passive surveillance systems have limitations
with an underreporting of adverse events, depending on clinical seriousness,
temporal proximity to vaccination, awareness of healthcare workers, and tradition
of reporting particular events. In developed countries, surveillance of adverse
events is formalized, although not necessarily optimal. An increase in reporting
would be expected when the reporting of adverse events is mandatory. Reports
have been sent to VAERS, the Vaccine Safety Datalink Project, and the European
Union Pharmacovigilance System. A Brighton collaboration has been
implemented to enhance comparability of vaccine safety data. Public health
authorities in specific countries, such as the CDC in the United States and the
National Advisory Committee in Canada, regularly have published information on
the JE situation in Asia and the preventive measures to be taken, including
information on the vaccines and adverse reactions. The conventional
recommendation is that travelers should be vaccinated if they will spend more
than 1 month in a JE endemic area or in areas with epidemic transmission with
even shorter periods. Although the risk for JE for short-term travelers is
considered small (1 case per 1 million travelers per year), sporadic cases,
including deaths, have been reported among tourists traveling to endemic areas.
Risk for travelers in rural districts in the season of risk is considerably higher
(range, 1 case per 5000 travelers to 1 case per 20,000 travelers per week). Doctors
who advise travelers should be updated on the latest JE occurrences in Asia.
Updates on the JE situation can be found on bulletins at
http://www.promedmail.org or are available from the WHO or CDC. The allergic
reactions primarily described after vaccination with the inactivated mouse-brain-
derived JEV have been observed in several countries during the 1900s. Allergic
reactions, including the mucocutaneous and neurologic reactions reported after JE
vaccination, may vary in frequency, and these reactions should be evaluated
meticulously yearly. This step enables recommendations, including information
on possible side effects, to be given in an optimal way.
Publication Types:
• Review
1084: Lepr Rev. 2003 Dec;74(4):337-48.

Impairments and Hansen's disease control in Rondônia state,

Amazon region of Brazil.
De Oliveira CR, De Alencar Mde J, De Sena Neto SA, Lehman LF,

Schreuder PA.
Hansen's Disease Control Program, State Secretary of Health, Rondônia, Brazil.
This retrospective study of impairments in a decentralized and integrated, routine

Hansen's disease (HD) programme was done on a cohort of all new patients
detected in Rondônia state from 1996 to 1999. It shows that the dynamics of
impairments during treatment in Rondônia are similar to what has been published
in other recent studies from Africa and Asia. Data about impairments at detection
and at release from treatment (cure), the prescription of steroids, and
epidemiological information are provided. Of the original 5350 new patients,
4230 patients (80%) completed multidrug therapy (MDT) and had complete data
about their impairment status. At the start of treatment, 9% of the paucibacillary
(PB) and 26% of the multibacillary (MB) patients had WHO grade 1 impairment.
Three percent of the PB and 11% of the MB patients had visible deformities
(WHO grade 2 impairment). Of the patients without impairments (grade 0) at the
start of treatment, 5% of the PB and 20% of the MB patients developed
impairments during treatment. Of the PB patients with a WHO impairment grade
1 at start of treatment, 34% improved and 6% got worse. Of the MB patients 34%
improved and 12% became worse. In a separate study of patients from the 1997
intake, 17% of the PB and 58% of the MB patients were treated at least once with
a course of steroids or thalidomide during MDT treatment. It is noted in the
literature that the percentage of persons with recent nerve function impairment
(NFI), nerve pain or tenderness and/or reaction reactions differs between projects.
This may reflect real differences or may be caused by differences in routine
monitoring and/or criteria and methods of treatment. The use of the WHO
maximum score, particularly for the patients with grade 2, is not as sensitive to
change as utilizing the summary of Eye, Hand and Foot (EHF) scores. If overall
impairment figures are given, the proportions of MB patients may define the
differences between projects, therefore it is important to analysis and present the
results of PB and MB patients separately. The most simple (outcome) indicator to
estimate the effectiveness of patient management would be the proportions of
patients with impairment grade 0 at start of treatment who develop either grade 1
or 2 impairments during treatment. An additional (outcome) indicator could be the
proportion of patients with impairment grade 1 at start of treatment who develop
grade 2 impairments during treatment. Currently, no operational targets or
acceptable level of performance for patient management have been set. This
would be important to enable programme managers to determine if adequate
patient education, treatment and follow up have been provided after the disease
detection to prevent and/or minimize problems associated with the disease. The
available evidence strongly suggests that reactions and impairments related to HD
will continue to occur in large numbers, requiring the development of adequate
infrastructures and sustainable services to detect and to manage problems
associated with HD during and after MDT treatment.
Publication Types:
1085: Med J Malaysia. 2003 Aug;58(3):365-74.

Morbidity and process of care in urban Malaysian general practice:

the impact of payment system.
Teng CL, Aljunid SM, Cheah M, Leong KC, Kwa SK.
International Medical University, Jalan Rasah, 70300 Seremban, Negeri

Sembilan.
BACKGROUND: The majority of primary care consultations in Malaysia occur

in the general practice clinics. To date, there is no comprehensive documentation
of the morbidity and practice activities in this setting. OBJECTIVES: We reported
the reasons for encounter, diagnoses and process of care in urban general practice
and the influence of payment system on the morbidity and practice activities.
METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this
study. General practitioners in these clinics completed a 2-page questionnaire for
each of the 30 consecutive patients. The questionnaire requested for the following
information: demographic data, reasons for encounter, important physical
findings, diagnoses, investigations ordered, outpatient procedures performed,
medical certificate given, medication prescribed and referral made. The morbidity
(reasons for encounter and diagnoses) was coded using ICPC-2 and the
medication data was coded using MIMS Classification Index. RESULTS: During
3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses
(96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and
diagnoses are in the following ICPC Chapters: Respiratory, General and
unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies
of selected aspects of the process of care (rate per 100 encounters) were:
laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9,
referral 2.4, and medication prescription 244. Consultation for chronic diseases
and acute infections were influenced more by demographic variables (age,
employment) rather than payment system. Cash-paying patients were more likely
to receive laboratory investigations and injections. CONCLUSION: This study
demonstrated the breadth of clinical care in the general practice. Relatively fewer
patients consulted specifically for preventive care and treatment of chronic
diseases. The frequencies of outpatient procedures and referrals appeared to be
low. Payment system results in important differences in patient mix and
influences some types of practice activities.
Publication Types:
1086: J Clin Pharm Ther. 2004 Feb;29(1):59-63.

Longer than recommended empiric antibiotic treatment of urinary

tract infection in women: an avoidable waste of money.
Kahan NR, Chinitz DP, Kahan E.
Leumit Health Fund, Tel Aviv, Israel.
CONTEXT: Current Israeli guidelines for the empiric treatment of uncomplicated

urinary tract infection (UTI) in women recommend nitrofurantoin for 5 days.
Some physicians nevertheless opt for ofloxacin, which should be prescribed for 3
days according to universally accepted guidelines. OBJECTIVE: To evaluate the
economic consequences of longer than recommended durations of antibiotic
therapy in the empiric treatment of uncomplicated UTI in women. DESIGN,
SETTING AND PATIENTS: Data were derived from the electronic records of
one of the four health maintenance organizations in Israel. The sample included
all women aged 18-75 years who were diagnosed with acute cystitis or UTI from
January 2001 to June 2002 and were empirically treated with antibiotics. Of the
7738 patients identified, 1138 received nitrofurantoin and 1054 ofloxacin. The
excess expenditure accrued due to longer than recommended therapy with these
drugs was evaluated. RESULTS: The rate of adherence was 22.23% for
nitrofurantoin (95% CI=19.81%, 24.65%), and 4.08% for ofloxacin (95%
CI=2.88%, 5.28%). The average excess expenditure per case was 5.78 USD (US
Dollar) with ofloxacin and 3.43 USD with nitrofurantoin, resulting in an annual
loss to the health maintenance organizations of approximately 19,000 USD. When
extrapolated to the national population of 6.5 million, the loss due to inappropriate
treatment of adult women is 190,000 USD. CONCLUSIONS: The lack of
adherence to national and international guidelines with regard to the
recommended duration of antibiotic treatment of UTI in women resulted in a
significant and avoidable waste of health system resources. This study suggests
that drug utilization analyses that concentrate solely on the choice of drug may be
overlooking important information.
1087: Indian J Med Res. 2003 Jun;117:260-9.

Hand anthropometry of Indian women.
Nag A, Nag PK, Desai H.
National Institute of Occupational Health (ICMR), Ahmedabad, India.

anjalinag@yahoo.co.in
BACKGROUND & OBJECTIVES: Data on the physical dimension of the hand

of Indian women are scanty. This information is necessary to ascertain human-
machine compatibility in the design of manual systems for the bare and gloved
hand, such as design and sizing of hand tools, controls, knobs and other
applications in different kinds of precision and power grips. The present study
was undertaken to generate hand anthropometric data of 95 women, working in
informal industries (beedi, agarbatti and garment making). METHODS: Fifty one
hand measurements of the right hand (lengths, breadths, circumferences, depths,
spreads and clearances of hand and fingers) were taken, using anthropometric
sliding and spreading calipers, measuring tape and handgrip strength
dynamometer. The data were statistically analyzed to determine the normality of
data and the percentile values of different hand dimensions, and simple and
multiple regression analysis were done to determine better predictors of hand
length and grip strength. RESULTS: The hand breadths, circumferences and
depths were approximately normally distributed, with some deviation in case of
the finger lengths. Hand length was significantly correlated with the fist, wrist and
finger circumferences. The fist and wrist circumferences, in combination, were
better predictors of hand length. The hand lengths, breadths and depths, including
finger joints of the Indian women studied were smaller than those of American,
British and West Indian women. The hand circumferences of the Indian women
were also smaller than the American women. Grip strengths of Indian women
(20.36 +/- 3.24 kg) were less than those of American, British and West Indian
women. Grip strength was found to be statistically significant with hand
dimensions, such as hand height perpendicular to wrist crease (digit 5), proximal
interphalangeal joint breadth (digit 3) and hand spread across wedge 1.
INTERPRETATION & CONCLUSION: The women who are forced to
frequently use cutters, strippers and other tools, which are not optimally designed
to their hand dimensions and strength range, might have higher prevalence of
clinical symptoms and disorders of the hand. In view of the human hand-tool
interface requirements, the present data on Indian women would be useful for
ergo-design applications of hand tools and devices.
1088: J Digit Imaging. 2003 Dec;16(4):331-6. Epub 2004 Jan 30.

Medical Image Resource Center--making electronic teaching files

from PACS.
Lim CC, Yang GL, Nowinski WL, Hui F.
Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan

Tock Seng, Singapore 308433. tchoyoson_lim@ttsh.com.sg
A picture archive and communications system (PACS) is a rich source of images

and data suitable for creating electronic teaching files (ETF). However, the
potential for PACS to support nonclinical applications has not been fully realized:
at present there is no mechanism for PACS to identify and store teaching files;
neither is there a standardized method for sharing such teaching images. The
Medical Image Resource Center (MIRC) is a new central image repository that
defines standards for data exchange among different centers. We developed an
ETF server that retrieves digital imaging and communication in medicine
(DICOM) images from PACS, and enables users to create teaching files that
conform to the new MIRC schema. We test-populated our ETF server with
illustrative images from the clinical case load of the National Neuroscience
Institute, Singapore. Together, PACS and MIRC have the potential to benefit
radiology teaching and research.
Publication Types:
1089: Acta Trop. 2004 Feb;89(3):299-308.

The effectiveness of impregnated bed net in malaria control in Laos.
Kobayashi J, Phompida S, Toma T, Looareensuwan S, Toma H, Miyagi I.
Bureau of International Cooperation, International Medical Center of Japan

(IMCJ), Japan. junkobalao@aol.com
Impregnated bed net (IBN) were used in 366 villages in the central and southern
three provinces of Lao PDR from 1999 to 2000. It was confirmed that 81.0% of
40000 bed nets, which were donated by Japanese Grant Aid, were delivered
within 2 years. The strengthening of information network systems in anti-malaria
and strong relationship between community and local authorities ensured the
success of operation in a short period. The number of patients and the slide
positive rate of malaria decreased markedly in public health facilities in three
provinces after the use of IBN. An entomological survey was conducted in
Boualapha district, where malaria is endemic, to investigate the IBN efficacy on
malaria vector. The density and parous rate of Anopeles dirus, which is the main
malaria vector in the area, were markedly decreased in the village where IBN was
used. This mosquito's behavior, which was baiting mainly humans during the time
when the inhabitants sleep in the IBN, was considered to be advantageous in
preventing malaria infection using by IBN. The area of distribution of A. dirus is
similar to the high endemic area of malaria in Lao PDR. Thus, it is expected that
the expansion of the IBN program in the southern provinces will lead to
successful malaria control in subsequent years.
Publication Types:
1090: Educ Health (Abingdon). 2003 Jul;16(2):129-32.

Making community-based education programs sustainable?
Joseph A, Abraham S.
Publication Types:
• Editorial
1091: Am J Trop Med Hyg. 2003 Dec;69(6):634-40.

Use of a geographic information system for defining spatial risk for

dengue transmission in Bangladesh: role for Aedes albopictus in an
urban outbreak.
Ali M, Wagatsuma Y, Emch M, Breiman RF.
Centre for Health and Population Research, International Centre for Diarrhoeal
Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh. mali@ivi.int
We used conventional and spatial analytical tools to characterize patterns of

transmission during a community-wide outbreak of dengue fever and dengue
hemorrhagic fever in Dhaka, Bangladesh in 2000. A comprehensive household-
level mosquito vector survey and interview was conducted to obtain data on
mosquito species and breeding as well as illness consistent with dengue. Clusters
of dengue illnesses and high-density vector populations were observed in a
distinct sector of the city. Dengue clusters are less identifiable in areas further
away from major hospitals, suggesting that proximity to hospitals determines
whether cases of dengue are diagnosed. Focusing on those areas relatively close
to hospitals, we found a spatial association between dengue clusters and vector
populations. Households reporting a recent dengue illness were more likely to
have Aedes albopictus larvae present in the home when compared with
households not reporting cases. Households reporting a recent dengue illness were
also more likely to have a neighbor with Ae. albopictus present in the home. In
contrast, the presence of Aedes aegypti within the premises as well as the homes
of neighbors (within 50 meters) was not associated with dengue illness. Given
that the breeding habitats for Ae. albopictus are somewhat distinct from those of
Ae. aegypti, the findings of this study have implications for control of dengue
transmission in this urban setting where much of the focus has been on indoor
mosquito breeding and transmission. Public health officials may find the disease-
environment map useful for planning targeted interventions because it displays
areas where transmission is most intense.
Publication Types:


1092: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2003;(121):1-11.
[Safety information project on drug, food and chemicals. Division of

Safety Information on Drug, Food and Chemicals. National Institute
of Health Sciences]
Morikawa K, Yamamoto M, Nakano T, Kasuga F, Yamamoto M.
morikawa@nihs.go.jp
Recent issues on BSE(Bovine Spongiform Encephalopathy) and health hazards

caused by adverse reactions of medical drugs, have strongly emphasized the
necessity for safety measures to secure public health. These issues have been
attributed to the delay to obtain overseas information on safety and regulation,
and the lack of an adequate system for acquirement and assessment of such
information. In order to develop a system where domestic and international safety
information is collected, analyzed, assessed and presented both scientifically and
systematically, the Division of Chem-Bio Informatics of the National Institute of
Health Sciences was reorganized to the Division of Safety Information on Drug,
Food and Chemicals in April, 2003. Collection and evaluation of safety
information on medical drugs, food and chemical substances is now centralized at
the Division, which consists of 5 sections, the first, second and third sections
being newly established. The first section assesses information on medical drugs,
the second section deals with food microorganisms, and the third section focuses
on chemicals in food. The fourth and fifth sections retain their previous functions,
namely, chemical safety information research and information network
infrastructure support within the institute, respectively. The purpose of this paper
is to describe how we will manage safety information on drug, food and
chemicals, focusing on the role of the three new sections.
Publication Types:
• Review
1093: AMIA Annu Symp Proc. 2003:882.

Clinicians' perceptions and the relevant computer-based
information needs towards the practice of evidence based medicine.
Jiang G, Ogasawara K, Endoh A, Sakurai T.
Department of Medical Informatics, Hokkaido University Graduate School of

Medicine, Sapporo, Japan.
We conducted a survey among 100 clinicians in a university hospital to determine

the clinician's attitudes and the relevant computer-based information needs
towards the practice of evidence-based medicine in outpatient setting.
PMCID: PMC1480090
1094: AMIA Annu Symp Proc. 2003:244-54.

Will decision support in medications order entry save money? A

return on investment analysis of the case of the Hong Kong hospital
authority.
Fung KW, Vogel LH.
Department of Biomedical Informatics, Columbia University, USA.
The computerized medications order entry system currently used in the public
hospitals of Hong Kong does not have decision support features. Plans are
underway to add decision support to this system to alert physicians on drug-
allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical
dosages. A return on investment analysis is done on this enhancement, both as an
examination of whether there is a positive return on the investment and as a
contribution to the ongoing discussion of the use of return on investment models
in health care information technology investments. It is estimated that the addition
of decision support will reduce adverse drug events by 4.2 - 8.4%. Based on this
estimate, a total net saving of $44,000 - $586,000 is expected over five years. The
breakeven period is estimated to be between two to four years.
PMCID: PMC1480307
1095: Intensive Care Med. 2004 Feb;30(2):248-53. Epub 2004 Jan 15.
Prediction of mortality in an Indian intensive care unit. Comparison

between APACHE II and artificial neural networks.
Nimgaonkar A, Karnad DR, Sudarshan S, Ohno-Machado L, Kohane I.
Children's Hospital Informatics Program, Ender's Building, 5th Floor, 320

Longwood Avenue, Boston, Massachusetts, USA. ashish@chip.org
OBJECTIVE: To compare hospital outcome prediction using an artificial neural

network model, built on an Indian data set, with the APACHE II (Acute
Physiology and Chronic Health Evaluation II) logistic regression model.
DESIGN: Analysis of a database containing prospectively collected data.
SETTING: Medical-neurological ICU of a university hospital in Mumbai, India.
SUBJECTS: Two thousand sixty-two consecutive admissions between 1996 and
1998. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The 22
variables used to obtain day-1 APACHE II score and risk of death were recorded.
Data from 1,962 patients were used to train the neural network using a back-
propagation algorithm. Data from the remaining 1,000 patients were used for
testing this model and comparing it with APACHE II. There were 337 deaths in
these 1,000 patients; APACHE II predicted 246 deaths while the neural network
predicted 336 deaths. Calibration, assessed by the Hosmer-Lemeshow statistic,
was better with the neural network (H=22.4) than with APACHE II (H=123.5)
and so was discrimination (area under receiver operating characteristic curve
=0.87 versus 0.77, p=0.002). Analysis of information gain due to each of the 22
variables revealed that the neural network could predict outcome using only 15
variables. A new model using these 15 variables predicted 335 deaths, had
calibration (H=27.7) and discrimination (area under receiver operating
characteristic curve =0.88) which was comparable to the 22-variable model
(p=0.87) and superior to the APACHE II equation (p<0.001). CONCLUSION:
Artificial neural networks, trained on Indian patient data, used fewer variables and
yet outperformed the APACHE II system in predicting hospital outcome.
Publication Types:
1096: Disasters. 2003 Dec;27(4):288-304.

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

Analysing health care systems performance: the story behind the

statistics.
Healy J.
European Observatory on Health Care Systems. judith.healy@anu.edu.au
This commentary paper argues that the Asia-Pacific region would benefit from a
home-grown version of the European Observatory on Health Care Systems to
inform health sector policy: an Asia-Pacific Observatory. The countries in this
diverse region, ranging from highly developed to very poor countries, are
undergoing dramatic and diverse health sector changes, often on the basis of little
evidence and with little information on successes and failures in neighbouring
countries. The international community also is interested in knowing more about
the many distinctive models of Asia-Pacific health care. While statistical
comparisons are important, health policymakers and researchers need to
understand the story behind the statistics in order to interpret the numbers and to
formulate policies and strategies. Health system profiles therefore are useful
instruments that describe how a complex health sector works, offer a comparative
framework for cross-national comparisons, identify trends in health system
design, and with standardised measures and regular updates measure progress
against benchmarks. These reports and expanded analyses have influenced both
national and Europe-wide debates on health policy. In the Asia-Pacific region,
health systems research has built up a critical mass of studies and people with
strong links across countries. The next ambitious steps are to identify sponsors
able to support an enterprise that transcends national boundaries and to begin a
project of comparative studies of national health systems.
1098: Asian J Surg. 2004 Jan;27(1):58-64.

Peer review audit of trauma deaths in a developing country.
Jat AA, Khan MR, Zafar H, Raja AJ, Hoda Q, Rehmani R, Lakdawala RH,
Bashir S.
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy
of trauma systems. The objective of this study was to estimate teh proportion of
preventable trauma deaths and the factors contributing to poor outcome using peer
review in a tertiary care hospital in a developing country. METHODS: All trauma
deaths during a 2-year period (1 January 1998 to 30 December 1998) were
identified and registered in a computerized trauma registry, and the probability of
survival was calculated for all patients. Summary data, including registry
information and details of prehospital, emergency room, and definitive care, were
provided to all members of the peer review committee 1 week before the
committee meeting. The committee then reviewed all cases and classified each
death as preventable, potentially preventable, or non-preventable. RESULTS
AND CONCLUSION: A total fo 279 patients were registered in the trauma
registry during the study period, including 18 trauma deaths. Peer review judged
that six were preventable, seven were potentially preventable, and four were non-
preventable. One patient was excluded because the record was not available for
review. The proportion of preventable and potentially preventable deaths was
significantly higher in our study than from developed countries. Of the multiple
contributing factors identified, the most important were inadequate prehospital
transfer, limited hospital resources, and an absence of integrated and organized
trauma care. This study summarizes the challenges faced in trauma care in a
developing country.
1099: Isr Med Assoc J. 2003 Oct;5(10):706-8.

Influenza vaccination: reduction in hospitalizations and death rates

among members of "Maccabi Healthcare Services" during the 2000-
2001 influenza season.
Shapiro Y, Shemer J, Heymann A, Shalev V, Maharshak N, Chodik G,

Green MS, Kokia E.
BACKGROUND: Upper respiratory tract illnesses have been associated with an

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

1100: An Pediatr (Barc). 2004 Jan;60(1):35-41.
[Foreign minors in the protection system of the Autonomous

Community of Aragón (Spain)]
[Article in Spanish]
Oliván Gonzalvo G.
Servicios de Pediatría y Adolescencia. Instituto Aragonés de Servicios Sociales.

Departamento de Salud, Consumo y Servicios Sociales. Gobierno de Aragón.
Zaragoza. España. g.olivan@comz.org
OBJECTIVES: To determine the prevalence of foreign minors in protection

centers, their demographic characteristics, and reasons for entry, as well as the
relation with geographic area, family, social and health risk factors, and high-
priority health needs. PATIENTS AND METHODS: We performed a
retrospective cross-sectional study over an 11-year period (1992-2002). The
health and socio-familial reports of 1,619 minors who were admitted to protection
centers were reviewed and those from a foreign country were included.
Compilation of information, definition of concepts, and health assessments were
performed according to standard protocols. RESULTS: Two hundred forty-one
foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years
(adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study
period. The prevalence was 4.6 times higher than that expected. Origin: Africa
68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east
9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and
relation with geographic area were as follows: 1. Being an abandoned illegal
immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2.
Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by
sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy
ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7
%, no difference by geographic area); 3. Temporary incapacity for their care 18.7
% (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa
18.1 %, Europe 17.5 %); 4. Other causes 7 %. Risk factors: at least one (78.4 %)
and more than one (33.6 %); housing problems and especially living in a single
parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %);
main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %),
growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %).
CONCLUSIONS: Being a minor immigrant in a foreign country with problems of
documentation, housing or family regrouping and especially if there are language,
cultural or racial (ethnic minorities) barriers is a major risk factor for living in a
situation of vulnerability, risk or neglect/abandonment that requires social
protection measures. Continuous follow-up by the social services of the adoptive
community is required for the prevention and early detection of children in need
of protection.
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901: Health Promot Int. 2005 Mar;20(1):61-8. Epub 2005 Jan 24.

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