His 7

1301: Environ Health Perspect. 2002 Nov;110(11):1141-6.
Related Articles, Links
Comment in:
• Environ Health Perspect. 2002 Nov;110(11):A690.

• Environ Health Perspect. 2003 Jul;111(9):A451-2; author reply A452.
Exposures to the Kuwait oil fires and their association with asthma
and bronchitis among gulf war veterans.
Lange JL, Schwartz DA, Doebbeling BN, Heller JM, Thorne PS.
Department of Occupational and Environmental Health, College of Public Health,

College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Military personnel deployed to the Persian Gulf War have reported a variety of
symptoms attributed to their exposures. We examined relationships between
symptoms of respiratory illness present 5 years after the war and both self-
reported and modeled exposures to oil-fire smoke that occurred during
deployment. Exposure and symptom information was obtained by structured
telephone interview in a population-based sample of 1,560 veterans who served in
the Gulf War. Modeled exposures were exhaustively developed using a
geographic information system to integrate spatial and temporal records of smoke
concentrations with troop movements ascertained from global positioning systems
records. For the oil-fire period, there were 600,000 modeled data points with solar
absorbance used to represent smoke concentrations to a 15-km resolution.
Outcomes included respiratory symptoms (asthma, bronchitis) and control
outcomes (major depression, injury). Approximately 94% of the study cohort
were still in the gulf theater during the time of the oil-well fires, and 21%
remained there more than 100 days during the fires. There was modest correlation
between self-reported and modeled exposures (r = 0.48, p < 0.05). Odds ratios for
asthma, bronchitis, and major depression increased with increasing self-reported
exposure. In contrast, there was no association between the modeled exposure and
any of the outcomes. These findings do not support speculation that exposures to
oil-fire smoke caused respiratory symptoms among veterans.
PMID: 12417486 [PubMed - indexed for MEDLINE]
PMCID: PMC1241071
1302: Ann Nucl Med. 2002 Sep;16(6):383-5.
Japan's contribution to nuclear medical research.
Rahman M, Sakamoto J, Fukui T.
Department of Epidemiological and Clinical Research Information Management,

Kyoto University Graduate School of Public Health, Japan.
rahman@pbh.med.kyoto-u.ac.jp
We investigated the degree of Japan's contribution to the nuclear medical research

in the last decade. Articles published in 1991-2000 in highly reputed nuclear
medical journals were accessed through the MEDLINE database. The number of
articles having affiliation with a Japanese institution was counted along with
publication year. In addition, shares of top-ranking countries were determined
along with their trends over time. Of the total number of articles (7,788), Japan's
share of articles in selected nuclear medical journals was 11.4% (889 articles) and
ranked 2nd in the world after the USA (2,645 articles). The recent increase in the
share was statistically significant for Japan (p = 0.02, test for trend). Japan's share
in nuclear medical research output is much higher than that in other biomedical
fields.
Publication Types:
• Comparative Study
1303: Nippon Koshu Eisei Zasshi. 2002 Sep;49(9):967-82.

[A survey of infants requiring long-term neonatal intensive care in

Tokyo: 1989-1998]
[Article in Japanese]
Yoneyama H, Ohkubo S.
Maternal and Child Health Section, Public Health Promotion Division, Bureau of
Public Health, Tokyo Metropolitan Government.
In order to grasp the characteristics and outcomes with infants hospitalized long-
term in NICUs, we reviewed all summary charts of 18 perinatal medical centers in
Tokyo for the period from January 1989 to December 1998. We sampled 3,000
infants who required neonatal intensive care over 90 consecutive days out of
46,309 registered cases during the decade. The duration of hospital stay, making a
comparative analysis of the number of days for the 50 percentile, was as follows.
As a whole the infants required 125 days until discharge. Infants with 29-30
weeks gestation and infants with birth weights 1,000-1,499 g required shorter
stays (106 days in both cases). The "discharge with complications" group required
136 days, and the "discharge on remission" group 119 days. Within the 31-32
weeks gestation group, those with "discharge with complications" required 107
days. Within the 29-30 weeks gestation group, those with "discharge on
remission" required 104 days. Infants with 1,000-1,499 g birth weights for the
"discharge with complications" and "discharge on remission" groups required 116
and 104 days respectively. Focusing on birthplace, the group of "inside-born"
(born at perinatal medical centers) infants required 124 days, and the "outside-
born" (born at non-perinatal medical centers) required 127 days. Respiratory
distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and chronic lung
disease (CLD) were often seen in patients under 29 weeks gestation and under
1,000 g birth weight. Hypoxic ischemic encephalopathy (HIE), convulsions,
congenital malformations and chromosomal abnormalities were frequent in the
groups over 31 weeks and over 1,500 g. Apnoea and transient tachypnoea of
newborn (TTN) often occurred in these at 29-30 weeks and 1,000-1,499 g. Also,
apnoea and TTN were often seen in the "discharge on remission" group. RDS,
apnoea and TTN occurRed frequently in the "inside-born" infants with over 31
weeks of gestation and over 1,500 g birth weight. There were many cases of HIE
and convulsions in the "outside-born" infants of these groups. We found infants
who required long-term intensive care to comprise three main groups. The first
group consisted of infants of 29-30 weeks gestation and 1,000-1,499 g birth
weight and demonstrated mild or few complications. The second consisted of
under 29 weeks and under 1,000 g and exhibited complications of chronic lung
diseases caused by immaturity of respiratory organs. The third was the group of
over 31 weeks and over 1,500 g who had complications due to central nervous
system disease, congenital malformations and chromosomal abnormalities.
Publication Types:
• English Abstract
1304: Sangyo Eiseigaku Zasshi. 2002 Sep;44(5):188-99.

[A survey of utilization of and problems with the MSDS in chemical

substances management at workplaces in Kanagawa Prefecture]
Koshi K, Mouri T, Sugimori H, Numano T, Ashida T, Hiro H, Miyake H,

Fukushima M, Ishiwata K.
Kanagawa Occupational Health Promotion Center, Labour Welfare Cooperation,

2-2-1-1, Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8143, Japan.
Kanagawa Occupational Health Promotion Center conducted a survey on how the

MSDS is utilized at workplaces with more than 50 employees handling chemical
substances, and what measures are taken to help employees to thoroughly
understand information in the Material Safety Data Sheet (MSDS).
Questionnaires were sent out to 265 enterprises in Kanagawa prefecture, putting
questions to industrial physicians and industrial hygiene supervisors. The
objective of the survey was to find out how MSDS is adopted in the system to
manage occupational health, what improvements the survey respondents want in
MSDS and what expectations the respondents have of our center. 193 enterprises
(72.8%) returned answers to the questionnaire. The major findings are as follows.
(1) In many companies, information on hazardous/toxic materials is "controlled
by a division using such materials", and roughly half of the companies have
compiled a common list shared throughout the company. (2) For the most part
suppliers submit to the MSDS. Larger companies have a higher rate of posting up
or filing the MSDS at their workplaces. Only 25.8% of the companies "rewrite the
MSDS so that workers can understand it." (3) Companies that carry out a
hazard/toxicity assessment before introducing a new chemical substance account
for 72.1%, which is higher than we expected. It indicates that even though the
companies don't manage the MSDS adequately, they are highly concerned about
hazard control of chemical substances. (4) The rate of answering that "the current
MSDS is not easy to understand" is higher among large-sized enterprises and
lower among enterprises with fewer than 300 employees. (5) Asked what
improvement needs to be made on the MSDS, the industrial physicians and
industrial hygiene supervisors gave same answers such as "Workers find the
terminology difficult to understand." and "Levels of toxicity can't be clearly
identified." (6) The respondents expect our center to provide information for the
MSDS. In conclusion, it is considered that in order to prepare understandable
MSDSs to workers in enterprises, the role of our center to provide information
and education on the MSDS to respondents was important.
Publication Types:
1305: Sangyo Eiseigaku Zasshi. 2002 Sep;44(5):175-9.

[Stress management for office workers]
Hayashi T.
Hitachi Health Care Center, 3-16, Ose 4-chome, Hitachi-shi, Ibaraki, 317-0076,
Japan.
The environment which surrounds office workers has undergone a big

transformation with the collapse of lifetime employment, the shift from the long
employment principle to meritocracy, the results principle, the introduction of
flexible work hours, outsourcing and dispatch work. Today's office worker
stressor include 1. VDT work, 2. meritocracy, 3. management by objective, 4.
excessive load on the middle and advanced age generations, 5. the collapse of the
lifetime employment system and 6. non-employee changes. (1) VDT work
management, (2) the use of Information technology, (3) Improvement of office
environments, (4) Management of long overtime work and (5) Support of
superiors and colleagues are thought as stress management.
Publication Types:
• Review
1306: Int J Environ Health Res. 2002 Jun;12(2):175-9.

Respiratory effects and arsenic contaminated well water in

Bangladesh.
Milton AH, Rahman M.
Arsenic Cell, NGO Forum for Drinking Water Supply & Sanitation, Dhaka,
Bangladesh. arsenic@bttb.net.bd
Arsenic in drinking water causes a widespread concern in Bangladesh, where a

major proportion of tube wells is contaminated. Arsenic ingestion causes skin
lesions, which is considered as definite exposure. A prevalence comparison study
of respiratory effects among subjects with and without arsenic exposure through
drinking water was conducted in Bangladesh. Exposed participants were recruited
through health awareness campaign programs. Unexposed participants were
randomly selected, where tubewells were not contaminated with arsenic. A total
of 169 individuals participated (44 exposed individuals exhibiting skin lesions;
125 unexposed individuals). The arsenic concentrations ranged from 136 to 1000
micro g l(-1). The information regarding respiratory system signs and symptoms
were also collected and the analyses were confined to nonsmokers. The crude
prevalence ratio for chronic bronchitis and chronic cough amounted to 2.1 (95%
CI 0.7-6.1). The prevalence ratios for chronic bronchitis increased with increasing
exposure, i.e., 1.0, 1.6, 2.7 and 2.6 using unexposed as the reference. The
prevalence ratios for chronic cough were 1.0, 1.6, 2.7 and 2.6 for the exposure
categories, using the same unexposed as the reference. The dose-response trend
was the same (P < 0.1) for both conditions. These results add to evidence that
long-term ingestion of arsenic exposure can cause respiratory effects.
1307: Biotechniques. 2002 Oct;33(4):822, 824-6, 828 passim.

SNPkit: an efficient approach to systematic evaluation of candidate

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

• Technical Report
1308: Int J Qual Health Care. 2002 Oct;14(5):383-91.

Assessing the factors influencing continuous quality improvement

implementation: experience in Korean hospitals.
Lee S, Choi KS, Kang HY, Cho W, Chae YM.
OBJECTIVE: To assess the extent of continuous quality improvement (CQI)

implementation in Korean hospitals and to identify its influencing factors.
DESIGN: Cross-sectional study by mailed questionnaire survey. STUDY
PARTICIPANTS: One hundred and seventeen staff members with responsibility
for CQI at 67 hospitals with > or = 400 beds. MAIN OUTCOME MEASURES:
The degree of CQI implementation was measured using the Malcolm Baldrige
National Quality Award Criteria (MBNQAC). Factors related to the degree of
CQI implementation were the four components of the CQI pyramid, namely the
cultural, technical, strategic, and structural attributes of individual hospitals.
RESULTS: The average CQI implementation score across the seven dimensions
by MBNQAC was 3.34 on a 5-point scale. The highest score was achieved in the
dimension of 'customer satisfaction' (3.88), followed by 'information/analysis'
(3.59), and 'quality management' (3.35). Regression analysis showed that
hospitals which better fulfilled technical requirements, such as improving
information systems (P< 0.05), using more scientific CQI tools, and adopting
systematic problem-solving approaches (P<0.01), tended to achieve higher
degrees of CQI implementation. Although statistically insignificant, positive
trends were observed for group/developmental culture and the degree of employee
empowerment, and the use of prospective strategy. CONCLUSION: It appears
that the most important contributing factors to active CQI implementation in
Korean hospitals were the use of scientific skills in decision-making and the
adoption of a quality information system capable of producing precise and valid
information.
Publication Types:
• Research Support, Non-U.S. Gov't
1309: Clin Infect Dis. 2002 Nov 1;35(9):1047-52. Epub 2002 Oct 10.
Epidemiology and clinical features of imported dengue fever in
Europe: sentinel surveillance data from TropNetEurop.
Jelinek T, Mühlberger N, Harms G, Corachán M, Grobusch MP, Knobloch

J, Bronner U, Laferl H, Kapaun A, Bisoffi Z, Clerinx J, Puente S, Fry G,
Schulze M, Hellgren U, Gjørup I, Chalupa P, Hatz C, Matteelli A, Schmid M,
Nielsen LN, da Cunha S, Atouguia J, Myrvang B, Fleischer K; European
Network on Imported Infectious Disease Surveillance.
Department of Infectious Diseases and Tropical Medicine, University of Munich,

80802 Munich, Germany. jelinek@lrz.uni-muenchen.de
Travelers have the potential both to acquire and to spread dengue virus infection.
The incidence of dengue fever (DF) among European travelers certainly is
underestimated, because few centers use standardized diagnostic procedures for
febrile patients. In addition, DF is currently not reported in most European public
health systems. Surveillance has commenced within the framework of a European
Network on Imported Infectious Disease Surveillance (TropNetEurop) to gain
information on the quantity and severity of cases of dengue imported into Europe.
Descriptions of 294 patients with DF were analyzed for epidemiological
information and clinical features. By far the most infections were imported from
Asia, which suggests a high risk of DF for travelers to that region. Dengue
hemorrhagic fever occurred in 7 patients (2.4%) all of whom recovered. Data
reported by member sites of the TropNetEurop can contribute to understanding
the epidemiology and clinical characteristics of imported DF.
Publication Types:
1310: J Healthc Inf Manag. 2002 Fall;16(4):24-5.

IHE around the world.
Vegoda P.
MalvernGroup, Incorporated, Malvern, Pennsylvania, USA.

1311: Fam Pract. 2002 Oct;19(5):537-42.
The place of evidence-based medicine among primary health care

physicians in Riyadh region, Saudi Arabia.
Al-Ansary LA, Khoja TA.
Department of Family and Community Medicine, College of Medicine, King

Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia. lansari@ksu.edu.sa
BACKGROUND: Evidence-based medicine (EBM) is a style of practice in which

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

1312: Chang Gung Med J. 2002 Jul;25(7):458-63.
Factors delaying hospital arrival after acute stroke in southern

Taiwan.
Tan TY, Chang KC, Liou CW.
First Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung,

Niaosung, Taiwan, ROC. tengyeowtan@yahoo.com
BACKGROUND: Acute stroke management emphasizes prompt recognition of

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

Strengthening national health programmes. Applied research and

technical assistance.
[No authors listed]

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

Related Articles
Establish information feedback system: Heping, Tianjin.
[No authors listed]
PIP: In 1997, Heping District in China was designated as one of the five localities
to pilot the Quality of Care program in family planning (FP). Over the last two
years, the district has achieved encouraging results in forging an alternative path
for implementing the family planning program in urban areas. District FP leaders
have acknowledged the importance of meeting clients' needs in providing quality
services, hence a service network was established to better meet the needs of the
local residents. This network consists of a petition reception office, a
district/subdistrict help center, a district FP publicity service center, a
contraceptive distribution center and a subdistrict/neighborhood service center. It
provides policy consulting, healthy childbirth and child rearing, education of the
newlyweds and gynecological check-up, private counseling mailbox, sales and
distribution of contraceptives, open publicity corners and provide publicity
package, compilation and distribution of a handbook for FP work and
implementing quality of care program. In addition to this service network, KAP
surveys and training programs were also conducted. Lastly, the establishment of
the information feedback system has facilitated the implementation of the Quality
of Care program and avoided the wastage of resources.
1315: China Popul Today. 1999 Oct;16(4-5):6-8.

Related Articles
Integrate FP with community-based health service: Xuanwu,

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

Related Articles
MIS promotes contraception and reproductive health: Yandu,

Jiangsu.
Liu G.
PIP: Yandu county, Jiangsu Province has made much progress in improving its
family planning services through an effective management information system
(MIS). Birth rate has decreased from 23.65/1000 in 1990 to 8/1000 in 1999. The
MIS software was developed by the State Family Planning Commission and was
applied in 1995 when the quality of care program was launched. The application
of microcomputers in the family planning program makes it possible to integrate
management with service provision at the county, township and village levels.
Subsequently, it creates an information transmission system centering on
townships and strengthens basic data management on a regular basis. In addition,
the MIS also delivers services, which include information dissemination on
contraception, informed choice, regular follow-up visits, and prevention and
treatment of complications and side effects of contraception. In the context of
reproductive health, services include health care for the periods of puberty,
premarital, marital, contraceptive and menopausal; genetic counseling, sex
education and prenatal care; and gynecological check-ups, infertility treatment,
and counseling on sexually transmitted disease prevention.
1317: China Popul Today. 1999 Apr;16(1-2):16-22.

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

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

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

Schistosomiasis control in China: GIS training.
[No authors listed]
PIP: A training course on Geographic Information Systems (GIS) recently held at

Jiangsu Institute of Parasitic Diseases (JIPD), Wuxi, Jiangsu Province was
attended by 22 participants from schistosomiasis control programs and research
institutes in schistosomiasis-endemic areas of China. Participants were introduced
to the principles of GISs and learned how to create, edit, and digitize maps, set up
databases with demographic or research data which could be linked to the maps;
associate those databases with digitized maps; and then produce customized maps
showing data or conduct spatial analyses. Case studies were used to give the
participants some real public health applications. In addition to other activities
during the 2-week course, the students produced maps of schistosomiasis
incidence for their own provinces, related them to satellite images, and were
guided through the creation of a GIS for Jiangsu Province based upon results
collected during a UNDP/World Bank/WHO Special Program for Research and
Training in Tropical Diseases (TDR)-funded project. A network on the use of
GISs for schistosomiasis control in China was established to link participants.

1320: JOICFP News. 1998 Feb;(284):4.
The adolescent girl in focus. Bangladesh.
[No authors listed]
PIP: The Integrated Family Development Project (IFDP) was launched in

Bangladesh in 1993 as a community-based project providing quality reproductive
health (RH) services through the primary health care system and reinforcing
women's networking through volunteerism, education, skills training, and
economic activities. Local women's status and level of health were raised through
their direct involvement in all stages of the project. The IFDP is implemented in
project areas of Panchdona and Dhalia unions by the Family Planning Association
of Bangladesh (FPAB) together with JOICFP. Providing sustainable RH services
which focus upon female adolescents is a key focus of the IFDP's second phase
spanning 1996-99. The approximately 50 participants who attended the Workshop
on Sustainable Reproductive Health Focusing on Adolescents in Cox's Bazar
during December 2-4 discussed how to best reach the desired target population.
Participants also focused upon developing strategies and policies to promote
positive attitudes among young people toward family life education, to help
adolescents delay marriage and parenthood until their late 20s, and to provide
appropriate RH information and counseling for adolescents.
1321: Soc Sci Med. 2002 Nov;55(9):1579-87.

Factors influencing private health providers' technical quality of

care for acute respiratory infections among under-five children in
rural West Bengal, India.
Chakraborty S, Frick K.
World Bank, Washington DC, USA. schakraborthy1@worldbank.org
In many developing countries, private health practitioners provide a significant

portion of curative care for diseases which are of public health importance.
Currently, health sector reform efforts in these countries are fostering increased
participation of private providers in the delivery of health services, including
those of public health importance. Guaranteeing good technical quality of care is
critical to the process. However, little is known about private providers' technical
quality of care (disease management practices) and the factors influencing these
services. The purpose of this study was to contribute information on this topic.The
study was conducted among private providers in rural West Bengal, India and
focused on providers' disease management practices for acute respiratory
infections (ARI) among under-five children. World Health Organization (WHO)
guidelines for ARI case management were used as the expected standard of care.
Observations of patient-provider encounters and interviews with the providers and
mothers were the main sources of data.The study found that private health
providers in rural West Bengal have inadequate technical quality of care. The
problem was related both to low levels of performance (limited potential) and
inconsistency in performance (within-provider variation). Limited potential for
good technical quality for ARI among the providers was related to lack of
knowledge (technical incompetence). One of the important factors influencing
within-provider variation was patient load. Since rural private providers operate
on a fee-for-service payment system, there are incentives related to seeing many
patients. The study concluded that to bring about sustainable improvements in
private providers' ARI disease management practices, training programs and
interventions that improved compliance were necessary.
1322: Arrows Change. 1999 Dec;5(3):3.

Learning from India's traditional birth attendants, the dais.
[No authors listed]
PIP: In India, Matrika (Motherhood and Traditional Resources, Information,

Knowledge and Action) was established to learn from traditional birth attendants
or dais, document their indigenous knowledge and assemble a database of
therapies from alternative medical systems. The organization is committed to
motivating health policy makers to include the participation of dais in all
government reproductive health initiatives as knowledgeable resource people.
Extensive research was conducted in the villages to gather gender and caste-
sensitive information about the knowledge and practice of dais. The findings
revealed that dais have indigenous knowledge of herbs, diet, and massage
techniques to ease the pains of pregnancy and delivery. Such knowledge was
found to be a combination of several factors: empirical observation, extensive
experience, intuition and emphatic understanding. Matrika stresses that in India,
culturally appropriate, affordable and gender-sensitive perspectives can only be
implemented when health care providers and trainers have an appreciation of
existing local health knowledge and practice.
1323: AIDS Wkly Plus. 1999 May 17:10-1.

India: HIV spreads despite World Bank project.
[No authors listed]
PIP: According to estimates of India's Parliamentary Standing Committee on

Dreaded Diseases, 25% of all people infected with HIV worldwide live in India.
This statistic was presented in Parliament even as another World Bank AIDS
prevention project worth $250,000 was launched. This new project follows the
bank's $84 million AIDS control project which ran from 1992 to 1997. India
could face a major public health crisis with severe socioeconomic implications.
UN agencies estimate that an HIV/AIDS epidemic could cost India $11 billion, or
5% of its total national income, by 2000 in health care and lost economic
productivity. However, these latest UNAIDS calculations are based upon the
assumption that only 4 million people in the country are currently infected with
HIV. The World Bank funds to combat AIDS are provided to the National AIDS
Control Organization (NACO) which invests it on information and
communication activities, as well as the importation of expensive blood banking
equipment which is mostly unused due to the country's lack of basic infrastructure
like a steady power supply. India should instead follow the example of Thailand
which successfully integrated HIV/AIDS management into its primary health care
(PHC) system, for the types of HIV/AIDS control programs being promoted by
donors cannot work in India in the absence of an effective PHC system.
1324: Reprod Contracept. 1999 Mar;10(1):49-57.

Cross-sectional study on their reproductive health status of 604

female floating residents in Beijing.
Wang Y, An L, Zhang XB, Wang SX.
PIP: The rapid increases in the numbers of female labor migrants ("floating
residents") in cities such as Beijing have created challenges for China's
reproductive health care system. An exploratory study conducted in Beijing in
1996 of 507 floating workers engaged in household management work (average
age, 27.4 years) sought to gain information to facilitate the design of reproductive
health services for this group. The women had resided in Beijing for an average of
3.7 years, generally with their families. 84% were married, at a mean age of 21.87
years; married women had an average of 1.43 live births, 42% of which had
occurred in Beijing. 25% did not receive any prenatal care and 60% did not know
whom to consult about maternal-child health care problems. Contraceptive
prevalence was 81.1% among floating workers compared with 97% among a
comparison group of nonmigrant agricultural and textile workers. Most floating
workers were unaware of any contraceptive methods other than the one they were
using (generally the IUD or female sterilization). Finally, only 8.4% could cite
symptoms of sexually transmitted diseases and 33.9% had not heard of AIDS.
Laboratory examinations revealed a 29.3% prevalence of reproductive tract
infections among female floating residents. bacterial vaginitis (11.6%) and
Mycoplasma infection (6.7%) were most prevalent. These findings confirm that
female floating residents remain in Beijing a long time and have a serious unmet
need for targeted reproductive health care services.
1325: Int J Popul Geogr. 1999 Jan-Feb;5(1):19-29.

Factors affecting the performance of family planning workers:

importance of geographical information systems in empirical
analysis.
Ali M, De Francisco A, Khan MM, Chakraborty J, Myaux J.
PIP: Substantial variation in contraceptive prevalence rates (CPRs) and fertility

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

1326: AVSC News. 1998 Summer;36(2):1, 6-7.
Voices of Mongolia.
Antarsh L.
PIP: Mongolia's rapid transformation in 1990 into a democratic, market economy

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

Related Articles
Into reproductive health.
Nazareno MI, Eleserio G, Kenney AM, Collado E.
PIP: Now that the government of the Philippines' Department of Health (DOH)
has endorsed the notion of reproductive health (RH), the current UNFPA-funded
program, Strengthening the Management and Field Implementation of the Family
Planning/Reproductive Health Program, has taken initial steps to implement the
RH agenda of the 1994 International Conference on Population and Development.
The program is being implemented by the DOH, LGU, and NGO tracks of the
Philippine Family Planning Program, although the NGO track has progressed
faster than the other two tracks in operationalizing RH. In light of its success, the
NGO track will likely be used to develop and test models which may later be used
in the other tracks. The authors present an overview of what has thus far been
done to implement the reproductive health care agenda over the past 3 years under
the NGO track. Reproductive tract infection (RTI) and HIV prevention, the
detection and treatment of RTIs, syndromic case management, integrating RH
into RTI/HIV services, preliminary results, human sexuality, maternal care, RH
service statistics and management information systems, and lessons learned are
discussed.
1328: Health Millions. 1997 Sep-Dec;23(5-6):5-6.

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

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

Information barriers to the implementation of economic evaluations

in Japan.
Nishimura S, Torrance GW, Ikegami N, Fukuhara S, Drummond M,

Schubert F.
Faculty of Economics, Kyoto University, Kyoto, Japan. shuzo@econ.kyoto-

u.ac.jp
With increasing cost-containment pressures within healthcare systems worldwide,

economic evaluations of medical technologies, particularly pharmaceuticals, are
used to aid the allocation of expenditure and resources. Facing similar pressures,
Japan will probably also introduce economic evaluation of health technology.
However, the structure of the healthcare system in Japan does not lend itself
naturally to the collection of the epidemiological and cost data required for
economic evaluations in medicine. In addition, there are no formal
methodological guidelines in place for these analyses. To overcome these
information barriers in Japan, progress may be aided by the adoption of
approaches used in other countries for data collection and guideline development.
Publication Types:
• Review
1331: Prog Biophys Mol Biol. 2002 Jul-Aug;80(1-2):23-42.

Bioinformatics for the genomic sciences and towards systems

biology. Japanese activities in the post-genome era.
Yao T.
RIKEN Genomic Sciences Center, 1-7-22, Suehiro, Tsurumi, Yokohama 230-

0045, Japan. yao@riken.go.jp
The knowledge gleaned from genome sequencing and post-genome analyses is

having a very significant impact on a whole range of life sciences and their
applications. 'Genome-wide analysis' is a good keyword to represent this
tendency. Thanks to innovations in high-throughput measurement technologies
and information technologies, genome-wide analysis is becoming available in a
broad range of research fields from DNA sequences, gene and protein
expressions, protein structures and interactions, to pathways or networks analysis.
In fact, the number of research targets has increased by more than two orders in
recent years and we should change drastically the attitude to research activities.
The scope and speed of research activities are expanding and the field of
bioinformatics is playing an important role. In parallel with the data-driven
research approach that focuses on speedy handling and analyzing of the huge
amount of data, a new approach is gradually gaining power. This is a 'model-
driven research' approach, that incorporates biological modeling in its research
framework. Computational simulations of biological processes play a pivotal role.
By modeling and simulating, this approach aims at predicting and even designing
the dynamic behaviors of complex biological systems, which is expected to make
rapid progress in life science researches and lead to meaningful applications to
various fields such as health care, food supply and improvement of environment.
Genomic sciences are now advancing as great frontiers of research and
applications in the 21st century.This article starts with surveying the general
progress of bioinformatics (Section 1), and describes Japanese activities in
bioinformatics (Section 2). In Section 3, I will introduce recent developments in
Systems Biology which I think will become more important in the future.
Copyright 2002 Elsevier Science Ltd.
Publication Types:
• Historical Article
• Review
1332: Entre Nous Cph Den. 1999 Summer-Autumn;(43-44):12.

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

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

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

Related Articles
India: using stakeholder analysis to forecast success.
Kumar Y, Chaudhury NR, Vasudev N.
PIP: This article presents the use of stakeholder analysis to examine the efficacy
of health reform programs in India. Stakeholder analysis assists planners in
identifying groups affected by proposed activities, their reactions to prospective
changes, and the roles they might play in supporting or opposing them. Such
information is then used to develop strategies involving national and local
officials and communities in reform. Stakeholder analysis was used by the US
Agency for International Development (USAID) for the proposed Women's and
Children's Health (WACH) project. It involved interviews among major
stakeholders regarding their views on the effectiveness of the current health
system, the new roles that health care organizations and individuals would have
after changes in service delivery under WACH, and their institutional capacity to
handle new roles. In addition to stakeholder analysis, three other tools are
available to policy managers and health sector reform teams to help them manage
and influence the process of health sector reform: 1) institutional mapping, which
involves identification and analysis of an organization's structure; 2) political
mapping through graphic display of sources and degrees of political support and
opposition; and 3) interest mapping, a combination of stakeholder analysis and
political mapping. With the use of stakeholder analysis, USAID was provided
with crucial information for the evaluation of community support and success
capability of the WACH project.
1335: Environ Int. 2002 Sep;28(4):235-45.

Arsenic contamination of the environment: a new perspective from

central-east India.
Pandey PK, Yadav S, Nair S, Bhui A.
Department of Engineering Chemistry, Bhilai Institute of Technology, MP, India.

drpiyush_pandey@yahoo.com
This paper reports a regional contamination of the environment in central-east

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

Disease transmission models for public health decision making:
toward an approach for designing intervention strategies for
Schistosomiasis japonica.
Spear RC, Hubbard A, Liang S, Seto E.
Center for Occupational and Environmental Health, School of Public Health,

University of California, Berkeley, California 94720, USA.
spear@uclinik4.berkeley.edu
Mathematical models of disease transmission processes can serve as platforms for

integration of diverse data, including site-specific information, for the purpose of
designing strategies for minimizing transmission. A model describing the
transmission of schistosomiasis is adapted to incorporate field data typically
developed in disease control efforts in the mountainous regions of Sichuan
Province in China, with the object of exploring the feasibility of model-based
control strategies. The model is studied using computer simulation methods.
Mechanistically based models of this sort typically have a large number of
parameters that pose challenges in reducing parametric uncertainty to levels that
will produce predictions sufficiently precise to discriminate among competing
control options. We describe here an approach to parameter estimation that uses a
recently developed statistical procedure called Bayesian melding to sequentially
reduce parametric uncertainty as field data are accumulated over several seasons.
Preliminary results of applying the approach to a historical data set in
southwestern Sichuan are promising. Moreover, technologic advances using the
global positioning system, remote sensing, and geographic information systems
promise cost-effective improvements in the nature and quality of field data. This,
in turn, suggests that the utility of the modeling approach will increase over time.
Publication Types:

PMCID: PMC1240991
1337: Lepr Rev. 2002 Jun;73(2):177-85.

Processes and challenges: how the Sri Lankan health system

managed the integration of leprosy services.
Kasturiaratchi ND, Settinayake S, Grewal P.
Medical Education Unit, Faculty of Medicine, University of Peradeniya,

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

Lessons in integration--operations research in an Indian leprosy

NGO.
Porter JD, Ogden JA, Rao PV, Rao VP, Rajesh D, Buskade RA, Soutar D.
Departments of Public Health and Policy and Infectious and Tropical Diseases,
London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
j.porter@lshtm.ac.uk
Since the Alma Ata Declaration in 1978, health systems supporting the treatment
and control of infectious diseases like leprosy and tuberculosis have been
encouraged to 'integrate' into the primary health care structure within countries.
Now, more than 20 years later, countries are still grappling with the concept of
integration and looking for ways to achieve it. This study reports findings from a
leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a
leprosy non-governmental organization (NGO), between 1996 and 2000 in
Koraput district, Orissa. The project addressed the issue of integration on two
levels. On the one hand LEPRA used the context of the project to explore ways in
which to integrate TB services into their existing leprosy control structure. On the
other hand, lessons from the pilot study were intended to help the organization
find ways of linking with the government health care structure. Following a
'qualitative approach', this operations research project assessed the perceptions of
communities and providers about leprosy and tuberculosis services. Providers
across the spectrum of this plural healthcare system were asked to provide
comment on developing stronger networks with each other, with NGOs and with
government, while patients and communities were asked to describe the resources
available to them and the constraints they face in accessing health care in general,
and for leprosy and TB in particular. LEPRA staff from top management to the
outreach workers were also approached for their views. Patients and communities
noted that physical access to treatment was a major constraint, while the existence
of local providers and family support structures facilitated health and health care.
Providers expressed a willingness to collaborate (with LEPRA and the
government), but lacked training, adequate staff support and the appropriate
equipment/technical resources. Also lacking were adequate information
campaigns to inform the public about these diseases and their treatment. This
information has provided LEPRA with an understanding of how they might best
fill gaps in the existing system and therefore assist in the process of integrating
services in their own organization and through the primary health care structure.
To achieve this aim, LEPRA will increasingly become involved in developing
relationships and partnerships with government in the delivery of training and
services and in infrastructure development.
Publication Types:
1339: J Med Liban. 2001 May-Jun;49(3):123-5.

What does the World Health Report 2000 bring to Lebanon?
Ammar W, Awar M.
Ministry of Public Health, Beirut, Lebanon. mphealth@cyberia.net.lb
The World Health Report 2000 has been the subject of extensive debate. The
authors highlight in the following, what they consider as major limitations that are
either inherent to methods followed and the validity of data used, or related to the
particular situation of Lebanon. This article tackles the first two of the set goals
i.e. level of health and responsiveness as well as the overall system performance.
The Report clearly states that extensive use has been made of estimates of
indicators, and that there were often conflicting sources of information on these
indicators. In the case of Lebanon, data was not available for most of the values
used. In fact, the last national population census was conducted in 1932, and vital
registration is incomplete. Therefore, one would question the value of the
estimates, based on which the calculations were made for Lebanon, such as Life
tables, and Causes of Deaths. Finally, the authors conclude that despite the critics,
embarking in this exercise is useful for Lebanon, particularly at this stage, for
monitoring the reform process in the health sector.
1340: Demogr Res. 2000 Jun 27;2:[40] p..

The Household Registration System: computer software for the

rapid dissemination of demographic surveillance systems.
Phillips JF, Macleod BB, Pence B.
Although longitudinal experimental community health research is crucial to

testing hypotheses about the demographic impact of health technologies,
longitudinal demographic research field stations are rare, owing to the complexity
and high cost of developing requisite computer software systems. This paper
describes the Household Registration System (HRS), a software package that has
been used for the rapid development of eleven surveillance systems in sub-
Saharan Africa and Asia. Features of the HRS automate software generation for a
family surveillance applications, obviating the need for new and complex
computer software systems for each new longitudinal demographic study.
1341: Harefuah. 2002 May;141 Spec No:31-3, 122.

[Surveillance systems for early detection and mapping of the spread

of morbidity caused by bioterrorism]
[Article in Hebrew]
Green MS, Kaufman Z.
Sackler Faculty of Medicine, Tel Aviv University.
The early clinical presentations of many infectious diseases, including those

initiated by bioterrorism, tend to have non-specific features such as flu-like
symptoms, skin rashes, encephalitis and acute flaccid paralysis. Standard public
health infectious disease surveillance systems depend on reports of specifically
diagnosed diseases and thus may be relatively insensitive to the early
identification of outbreaks. During the past few years, efforts have been made to
improve the sensitivity of traditional systems, partly through implementation of
new technologies such as electronic reporting and use of geographical information
systems. In the United States, intensive efforts are being made to develop new
surveillance systems for the early detection and mapping of the spread of diseases
caused by bioterrorism. The development of such systems is based on the concept
that surveillance for non-specific syndromes will enable earlier detection of
infectious disease outbreaks compared with traditional systems. In addition,
surveillance for non-specific syndromes could enable monitoring of the spread the
outbreak, even before a definitive diagnosis has been made. In this paper, we
describe several examples of prototype syndrome surveillance systems developed
in the United States. These include the telephone hot-line system maintained by
the New York City public health department, two internet based systems,
LEADERS and RSVP, and an electronic reporting system, ESSENCE, operating
in military facilities in the Washington DC area.
Publication Types:
1342: Harefuah. 2002 May;141 Spec No:22-8, 123, 122.

[The Israeli medical response plan for an unusual biological event]
[Article in Hebrew]
Poles L.
Kaplan Medical Center
Lack of national preparedness for biological warfare or a bioterrorism event as

well as for a natural outbreak of a dangerous agent may lead to grave
consequences (large-scale morbidity and mortality) in the short and long term.
Threat assessment and its consequences are the basis for the contingency for such
an event, with the medical community playing the leading role. In this article we
present the principles of the Israeli medical response plan for an unusual
biological event--whether of natural origin or a deliberate attack. The primary
goals of the preparedness program are reducing mortality and morbidity,
preventing a disaster, decreasing the irrational public response and inducing the
resumption of the normal course of life. The program presented and its phases are
universal, with the proper modifications needed to be implemented according to
the specific etiology and the circumstances of the event. In order to successfully
deal with the incident, national-level coordination of many non-medical
organizations is required. An integration body in the Ministry of Health is a
prerequisite for the early detection of the outbreak and for the rapid and proper
identification of the etiologic agent. An effective triage system which screens the
truly-exposed, the sick and their contacts among the many worried-well
engorging the medical organizations, should be the spearhead for an integrated
health system dealing with disease prevention and treatment. Public relations and
recruitment of the media for transferring relevant information are a vital part of
the response. In this rare and unfamiliar emergency situation the basic principle is
to use existing response systems, implementing most of the routine procedures
and functions, modified according to guidelines from central governmental
bodies.
Publication Types:
1343: Harefuah. 2002 May;141 Spec No:111-7, 118.

[Chemical and biological terrorism: psychological aspects, and

guidelines for psychiatric preparedness]
[Article in Hebrew]
Bleich A, Kutz I.
Lev-HaSharon, Psychiatric Hospital, Pardesyyia.
Chemical or biological terror may cause mass casualties, but the major damage of
such a threat is related mainly to psychological terror. Anxiety and panic that
accompany chemical or biological threat, may affect mass populations, disrupt
their lives, and enormously increase the demands from the medical systems. In the
case of real attack, such an increased demands may be critical, especially to the
functional ability of hospitals. The Israeli experience, during the Persian Gulf war,
concerning preparations to chemical attacks at the national level, was unique in its
nature. In addition, the Scud missiles attacks, accompanied with non-conventional
threat, supplied valuable information on the populations behavior, and on the
needed preparations for similar threats. In the case of chemical or biological threat
or attack, the main task of the psychiatrist is to treat stress and anxiety casualties.
At the same time, he should be aware of the possibility that the psychological &
behavioral symptoms may reflect organic brain damage due to the pathogenic
agent, and that such a differential diagnosis may be life saving for the patient.
Stress casualties will be referred from the ER, and treated by the mental health
team, at a specifically designed "center for stress casualties". In addition, the
psychiatrist will consult the medical teams, or sometimes directly intervene, with
combined casualties, at other locations of the hospital. At the regional or
community level, one should plane and exercise deployment and activation of
multi-professional teams, including mental health, in existing installations
designed for screening, treatment, and temporary containment of casualties. It is
recommended that the head of the local authority, will be responsible for the
preparations and activation of this formation. A planned and rational usage of the
media may have a critical influence on the ability of the authorities to manage the
crisis situation and on shaping the behavior of the population. In certain scenarios,
the media may even serve as the main tool for calming and instructing the people
being isolated at their homes.
Publication Types:
• Review
1344: Ren Fail. 2002 May;24(3):285-96.

Integration of APACHE II and III scoring systems in extremely high

risk patients with acute renal failure treated by dialysis.
Chen YC, Hsu HH, Chen CY, Fang JT, Huang CC.
Department of Medicine, Chang Gung Memorial Hospital, Chang Gung

University, Taoyuan, Taiwan.
OBJECTIVE: Acute physiology, age, chronic health evaluation II and III

(APACHE II and III) scoring systems obtained on the day of the initiation of
dialysis were compared the mortality rate among in critically ill patients with
acute renal failure requiring dialysis. DESIGN: Retrospective study. SETTING:
Intensive care units in a tertiary care university hospital in Taiwan. PATIENTS:
100 patients diagnosed with acute renal failure and requiring dialysis were
admitted to intensive care units from January 1997 through December 1998.
INTERVENTIONS: Information deemed necessary to compute the APACHE II
and APACHE III score on the day of dialysis initiation was collected.
MEASUREMENTS AND RESULTS: The overall hospital mortality rate was
71%. The relationship between APACHE II and APACHE III scores for patients
was linear and correlated significantly in all subgroups. Goodness-of-fit was good
for APACHE II and APACHE III models. Both reported good areas under
receiver operating characteristic curve. Death in most patients was related to a
higher APACHE II or APACHE III score during the 24 h immediately preceding
the initiation of acute hemodialysis. Our results indicated a significant rise in
mortality rates associated with higher APACHE II or III scores among all
patients. Although less than 60%, the mortality rates markedly increased extent
when APACHE II score of 24 or higher or APACHE III score above 90 had
mortality rates exceeding 85%. CONCLUSION: Both predictive models
demonstrated a similar degree of overall goodness-of-fit. Although APACHE II
showed better calibration, APACHE III was better in terms of discrimination. The
prediction accuracy of the APACHE II score for extremely high-risk patients is
further enhanced by specific utility of APACHE III scoring as a second prediction
model when the AII score is 24 or higher.
Publication Types:
• Clinical Trial
1345: Bull World Health Organ. 2002;80(7):555-61. Epub 2002 Jul 30.
Inadequacies of death certification in Beirut: who is responsible?
Sibai AM, Nuwayhid I, Beydoun M, Chaaya M.
Department of Epidemiology and Biostatistics, Faculty of Health Sciences,

American University of Beirut, Beirut, Lebanon. ansibai@aub.edu.lb
OBJECTIVE: To assess the completeness of data on death certificates over the

past 25 years in Beirut, Lebanon, and to examine factors associated with the
absence of certifiers' signatures and the non-reporting of the underlying cause of
death. METHODS: A systematic 20% sample comprising 2607 death certificates
covering the 1974, 1984, 1994, 1997 and 1998 registration periods was
retrospectively reviewed for certification practices and missing data. FINDINGS:
The information on the death certificates was almost complete in respect of all
demographic characteristics of the deceased persons except for occupation and
month of birth. Data relating to these variables were missing on approximately
95% and 78% of the certificates, respectively. Around half of the certificates did
not carry a certifier's signature. Of those bearing such a signature, 21.6% lacked
documentation of the underlying cause of death. The certifier's signature was
more likely to be absent on: certificates corresponding to the younger and older
age groups than on those of persons aged 15-44 years; those of females than on
those of males; those of persons who had been living remotely from the
registration governorate than on those of other deceased persons; and those for
which there had been delays in registration exceeding six months than on
certificates for which registration had been quicker. For certificates that carried
the certifier's signature there was no evidence that any of the demographic
characteristics of the deceased person was associated with decreased likelihood of
reporting an underlying cause of death. CONCLUSION: The responsibility for
failure to report causes of death in Beirut lies with families who lack an incentive
to call for a physician and with certifying physicians who do not carry out this
duty. The deficiencies in death certification are rectifiable. However, any changes
should be sensitive to the constraints of the organizational and legal infrastructure
governing death registration practices and the medical educational systems in the
country.
Publication Types:
1346: J Nutr. 2002 Aug;132(8):2215-21.

The high prevalence of low hemoglobin concentration among

Indonesian infants aged 3-5 months is related to maternal anemia.
De Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S.
Helen Keller International, Indonesia and Asia Pacific, Jakarta, Indonesia.

sdepee@compuserve.com
Iron deficiency anemia among young children is a large health problem.

However, there is little information about the prevalence of anemia among young
infants because it has been assumed that normal, breast-fed infants have adequate
iron stores until 4-6 mo of age. We analyzed cross-sectional data from the
HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from
Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants
(n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100
g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that
normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an
odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low
Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth
weight. Infants of nonanemic mothers but with low birth weight had an OR of
1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68
[1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young
mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West
Java or East Java. Considering that maternal postpartum Hb reflects Hb during
pregnancy, that anemia among mothers in this population is due mainly to iron
deficiency, and that children born to anemic mothers are at higher risk of a low
Hb, we hypothesize that low infant Hb in this population is due to iron deficiency.
Intervention studies in iron deficient populations should test this hypothesis.
Publication Types:

• Research Support, U.S. Gov't, Non-P.H.S.
1347: Leuk Res. 2002 Oct;26(10):903-8.

Trends in mortality from non-Hodgkin's lymphomas.
Levi F, Lucchini F, Negri E, La Vecchia C.
Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut
Universitaire de Médecine, Sociale et Préventive, CHUV-Falaises 1, Lausanne,
Switzerland. fabio.levi@inst.hospvd.ch
Trends in death certification rates from non-Hodgkin's lymphomas (NHL) were

analyzed on the basis of the World Health Organization database over the period
1969-1998. Until the late 1970s, mortality from NHL was similar in the European
Union (EU), the USA and Japan, i.e. around 3/100,000 males and 2/100,000
females. Over the last two decades, NHL mortality in the EU rose to 4.4/100,000
males and 2.8/100,000 females. Upward trends were greater in the USA, whose
rates approached 6/100,000 males and 4/100,000 females in the late 1990s, and
were observed in Japan, too.
Publication Types:
1348: Methods Inf Med. 2002;41(3):220-3.

Standard protocol for exchange of health-checkup data based on

SGML: the Health-checkup Data Markup Language (HDML).
Sugimori H, Yoshida K, Hara S, Furumi K, Tofukuji I, Kubodera T, Yoda T,

Kawai M.
Department of Preventive Medicine, St. Marianna University School of Medicine,

Kawasaki, Japan. hsugimor@marianna-u.ac.jp
OBJECTIVES: To develop a health/medical data interchange model for efficient

electronic exchange of data among health-checkup facilities. RESULTS: A
Health-checkup Data Markup Language (HDML) was developed on the basis of
the Standard Generalized Markup Language (SGML), and a feasibility study
carried out, involving data exchange between two health checkup facilities. The
structure of HDML is described. RESULTS: The transfer of numerical lab data,
summary findings and health status assessment was successful. CONCLUSIONS:
HDML is an improvement to laboratory data exchange. Further work has to
address the exchange of qualitative and textual data.
Publication Types:
1349: Biomed Instrum Technol. 2002 Jul-Aug;36(4):274-6.

Global initiative strives to link health care information systems.
Sensmeier J.
1350: Ann Acad Med Singapore. 2002 Jul;31(4):467-73.

Asthma disease management: a provider's perspective.
Abisheganaden J.
Department of Respiratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock
Seng, Singapore 308433.
Asthma is a highly prevalent problem in Singapore, with an increasing societal

and economic burden. However, asthma is also an eminently treatable condition,
with evidence that integrated education-treatment efforts directed at important
patient sub-groups can be cost-effective. What is important is a comprehensive
and integrated asthma management programme, aimed at reducing the burden of
asthma at all levels of the healthcare system, with the long-term goal of improving
asthma care cost-effectively. This refers to asthma disease management. Asthma
disease management should focus on identifying deficiencies in asthma
management across the population diagnosed with the condition and establish a
partnership between the patient, provider and the healthcare system to improve
the overall quality of asthma care. The framework for implementing such a
programme bridges key concepts and programmes that are already in place in the
various institutions. These include patient and physician education, the use of
clinical practice guidelines, clinical pathways, outcomes management, quality
improvement processes, information technology, case management and existing
asthma shared-care programmes and resources. In order to significantly reduce
asthma morbidity, an integrated approach is required, involving individuals
providing asthma care at various levels of care delivery. There is also a need to
co-ordinate the efforts of such individuals and institutions involved so that there is
good horizontal and vertical integration of care. The disease management
approach described is intended to raise the overall standard of asthma care across
a spectrum of patients with asthma.
Publication Types:
• Review
1351: Adolesc Educ Newsl. 1999 Dec;2(2):11.

Related Articles
Democratic reform paves the way for new reproductive health

strategy and advocacy. Mongolia.
[No authors listed]

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

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

Information technology and flexible learning in public health.

Proceedings of a conference and workshop organized by the Asia
Pacific Academic Consortium for Public Health and the Graduate
School of Health Science and Management, Yonsei University.
Seoul, Korea. April 18-20, 2001.
[No authors listed]
Publication Types:
• Congresses
• Overall
1354: Health Place. 2002 Sep;8(3):201-10.

Identifying environmental risk factors for endemic cholera: a raster

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

1355: Am J Trop Med Hyg. 2002 Jan;66(1):40-8.

Control of aedes vectors of dengue in three provinces of Vietnam by

use of Mesocyclops (Copepoda) and community-based methods
validated by entomologic, clinical, and serological surveillance.
Kay BH, Nam VS, Tien TV, Yen NT, Phong TV, Diep VT, Ninh TU, Bektas
A, Aaskov JG.
Queensland Institute of Medical Research and University of Queensland Tropical

Health Program, Brisbane, Australia.
We describe remarkable success in controlling dengue vectors, Aedes aegypti (L.)

and Aedes albopictus (Skuse), in 6 communes with 11,675 households and 49,647
people in the northern provinces of Haiphong, Hung Yen, and Nam Dinh in
Vietnam. The communes were selected for high-frequency use of large outdoor
concrete tanks and wells. These were found to be the source of 49.6-98.4% of Ae.
aegypti larvae, which were amenable to treatment with local Mesocyclops, mainly
M. woutersi Van der Velde, M. aspericornis (Daday) and M. thermocyclopoides
Harada. Knowledge, attitude, and practice surveys were performed to determine
whether the communities viewed dengue and dengue hemorrhagic fever as a
serious health threat; to determine their knowledge of the etiology, attitudes, and
practices regarding control methods including Mesocyclops; and to determine
their receptivity to various information methods. On the basis of the knowledge,
attitude, and practice data, the community-based dengue control program
comprised a system of local leaders, health volunteer teachers, and
schoolchildren, supported by health professionals. Recycling of discards for
economic gain was enhanced, where appropriate, and this, plus 37 clean-up
campaigns, removed small containers unsuitable for Mesocyclops treatment. A
previously successful eradication at Phan Boi village (Hung Yen province) was
extended to 7 other villages forming Di Su commune (1,750 households) in the
current study. Complete control was also achieved in Nghia Hiep (Hung Yen
province) and in Xuan Phong (Nam Dinh province); control efficacy was > or =
99.7% in the other 3 communes (Lac Vien in Haiphong, Nghia Dong, and Xuan
Kien in Nam Dinh). Although tanks and wells were the key container types of Ae.
aegypti productivity, discarded materials were the source of 51% of the standing
crop of Ae. albopictus. Aedes albopictus larvae were eliminated from the 3 Nam
Dinh communes, and 86-98% control was achieved in the other 3 communes.
Variable dengue attack rates made the clinical and serological comparison of
control and untreated communes problematic, but these data indicate that clinical
surveillance by itself is inadequate to monitor dengue transmission.
Publication Types:
1356: Chin Med J (Engl). 2002 Apr;115(4):607-11.

Evaluation of referrals for genetic investigation of short stature in

Hong Kong.
Lam WF, Hau WL, Lam TS.
Clinical Genetic Service, Department of Health, Hong Kong Special

Administrative Region, Kowloon, Hong Kong, China.
wflam@hingtek.hong.com.hk
OBJECTIVE: To establish a profile of the causes of apparently unexplained SS in

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

A development framework for promoting evidence-based policy
action: drawing on experiences in Sri Lanka.
Hornby P, Perera HS.
Centre for Health Planning and Management, Keele University, Staffs, UK.
100423.3400@compuserve.com
Most developing countries have embarked on one form or another of 'health

sector reform' as a result of the global trend for health and health care reform that
has emerged during the past decade. One consequence is that the issue of health
sector performance is moving higher on the agenda of many developing countries,
and particularly that of the corporate performance of health sector staff. Along
with this movement has come increased attention to strengthening evidence-based
management decision-making. To date, studies on measuring health sector
performance, have had little impact on developing country health systems and
have been limited to explorations primarily at an operational level. However,
there is a growing recognition that there is a need to strengthen the policy function
of ministries and their ability to monitor policy impact. Sri Lanka is one country
that has identified the need to strengthen policy at national level. Many
developing countries, like Sri Lanka, are familiar with input, process and output
dimensions of operational performance. However, most are not ready to engage in
routine performance assessment that can strengthen policy processes at national
level. This paper explores (1) the implication and the use of indicators to support
evidence based policy decision-making, and (2) the complexity of doing so in
Ministries of Health that are undergoing some form of health sector reform. The
paper emphasizes that new forms of organizational support are required for
performance management at policy level. A conceptual framework for managing
the collection and use of performance evidence is developed, including proposals
for the introduction of outcome indicators into that process. The paper concludes
with recommendations on initiatives required to develop appropriate
organizational and technical capacity to engage with performance management at
policy level and for further research towards creating ministries of health as
'learning organizations' that can change and adapt with informed decisions.

Evaluating health information sites on the Internet in Korea: a

cross-sectional survey.
Aeree S, Mee-Kyung S.
Graduate School of Health Sciences and Social Welfare, Sahmyook University,
South Korea. aerees@hanmail.net
Through the internet the public in South Korea has access to a growing supply of
information on health and disease. In South Korea an estimated 13.93 million
people used the internet in 2000. The number has increased rapidly compared to
1.63 million in 1997. Health information is often said to be one of the most
retrieved types of information on the internet. However, a concern has emerged
for the quality of health information documents contained on the World Wide
Web. Lack of evaluation and oversight, and ease of publication, have led to
inaccurate and misleading health-related publications on the Internet. For those
seeking easy ways to identify high-quality and reliable information, rating
systems to evaluate the quality of health information on the internet should be
provided and developed. Given this background, the purpose of this research was
to evaluate health information web sites on the internet. In this study we aimed to
survey websites providing health information. 440 websites were selected using
four search engines, YahooKorea (http://www.yahoo.co.kr), LycosKorea
(http://www.lycos.co.kr), Empas (http://www.empas.co.kr), and Naver
(http://www.naver.com), to conduct searches in December 2000. General quality
criteria were used for the evaluation. These included ownership, currency,
authorship, source, feedback mechanism, links, and functionality. More than 50%
of web sites did not provide the date of publication or update of information,
author and author credentials, references to source, etc. Websites of universities
and universities' hospitals were more likely to provide name and type of provider
(p < .01), author's name (p < .001), and references to source (p < .01) than other
service providers. There is a need for better evidence-based health information as
well as a need to develop simple criteria that ordinary people can understand and
use. In addition, gateway services that operate a selective process and provide
links to other organizations that provide high-quality health information should be
offered and developed.
Publication Types:
• Evaluation Studies
1359: Neoplasma. 2002;49(2):129-32.

The cost effectiveness of dual phase 201Tl thyroid scan in detecting

thyroid cancer for evaluating thyroid nodules with equivocal fine-
needle aspiration results: the preliminary Taiwanese experience.
Chen YS, Wang WH, Chan T, Sun SS, Kao A.
Institute of Industrial Engineering and Enterprise Information of Tunghai

University, Taichung, Taiwan. a5604@www.cmch.org.tw
The purposes of this study were to assess the helpfulness of dual phase 201Tl
thyroid scan for differentiating malignant from benign thyroid lesions in cases of
thyroid nodules with equivocal fine-needle aspiration (FNA) biopsy results. In
addition, for thyroid nodules with equivocal FNA biopsy results, we try to make a
decision analysis model compared the FNA biopsy alone strategy (strategy A)
with decision strategy for the assistance of dual phase 201Tl thyroid scan
(strategy B) before diagnostic thyroidectomy as thyroid cancer evaluation
strategies for hypothetical cohorts of estimated 17,280-29,160 Taiwanese
patients/per year with equivocal FNA biopsy results. Based on the findings of
surgical histopathology, dual phase 201Tl thyroid scan sensitivity, specificity, and
accuracy were 100%, 90%, and 96%, respectively, in cases of 27 thyroid nodules
with equivocal FNA biopsy results. In cost effectiveness analysis, the strategy B
showed a cost saving of 16,340,480-27,574,560 US dollars in unnecessary
diagnostic thyroidectomy cost. The total cost of strategy B showed a cost saving
of 13,932,232-23,520,564 US dollars than that of strategy A. The preliminary data
indicate that dual phase 201Tl thyroid scan can save the cost of unnecessary
diagnostic thyroidectomy in Taiwanese patients with equivocal FNA biopsy
results. In addition, we may provide a noninvasive diagnostic method--dual phase
201Tl thyroid scan, as the first priority for Taiwanese patients with equivocal
FNA biopsy before diagnostic thyroidectomy under the coverage of the national
health insurance system in Taiwan.
1360: Nippon Koshu Eisei Zasshi. 2002 May;49(5):456-62.

[Construction and application of an information transfer system on

prevalence of infectious disease for subscriber in a regional medical
association]
Ohkuma K, Teramoto Y, Fukuta M, Takahashi H, Nakayama O, Wada F.
Mie Prefectural Science and Technology Promotion Center, Public Health and
Environment Research Division.
PURPOSE: To assess the utility of an e-mail information exchange system, for

subscription by members of a regional medical association, focusing on
surveillance of infectious disease. METHODS: Questionnaires regarding addition
to the mailing list were first addressed to all 474 members of Yokkaichi regional
medical association. After management for about three months, questionnaires
focused on utility and application of the system were mailed out. RESULT: One
hundred and seventy-three members (36.5%) responded in the questionnaire
survey, then 73 of them (subsequently 75) actually subscribed. Forty-six
subscribers (61.3%) responded to the second questionnaire, and 23 of them
(56.5%) were in favor of 'weekly and monthly infectious disease reports
transmitted from our research division', and 22 (47.8%) were in favor of 'e-mail
exchanges of information'. CONCLUSION: These findings suggest that an
electronic information transfer system is a useful medium for regional infectious
disease efforts and contributions from primary care physicians.
Publication Types:
1361: Eur J Epidemiol. 2001;17(8):757-64.

Risk factor profile for atherosclerosis among young adults in Israel--

results of a large-scale survey from the young adult periodic
examinations in Israel (YAPEIS) database.
Sharabi Y, Grotto I, Huerta M, Eldad A, Green MS.
Israel Defence Forces, Medical Corps, Tel Aviv. yina@internet-zahav.net
Assessing the prevalence of relevant risk factors among young adults is a critical
step in the process of preventing atherosclerotic cardiovascular diseases
(ASCVD) later in life. The Israel Defense Force Periodic Health Examination
Center performs a routine check-up for subjects aged 25-45 years. Medical
history, physical examination notes, laboratory results and ECG tracings are
recorded, computerized and processed to form the Young Adults Periodic
Examinations in Israel (YAPEIS) database. Data representing 31,640 subjects
(27,769 males and 3871 females) examined between the years 1991-1999 were
analyzed. The prevalence of documented risk factors for ASCVD were evaluated.
The results of all parameters were graded categorically as low, moderate or high
and the Framingham risk score was calculated. Fifty-one percent of the study
participants were found to be overweight (body mass index > or = 25 kg/m2),
8.5% had high systolic blood pressure and 14.6% had high diastolic blood
pressure. The prevalence of hypercholesterolemia and hyperglycemia was found
to be 44.7 and 9.7%, respectively. Thirty-two percent of the subjects smoked
cigarettes, and 76.7% reported not performing any routine physical activity.
Furthermore, 31.8% had a Framingham score indicating a greater than 5% risk for
developing a coronary event within the next 10 years. As expected, the prevalence
of these risk factors increased with age and were found to be less frequent among
females. Thus we conclude that many young Israeli adults hold significant risk
factors for future ASCVD. Many of these risk factors are modifiable, and risk
behavior is often amenable to alteration. Awareness to the high prevalence of risk
factors among young adults should spark vigorous health-promotion programs as
well as screening, education, and interventional measures aimed at altering the
expected outcome of future ASCVD.
1362: Nippon Rinsho. 2002 Jun;60(6):1070-6.

[PulseNet Japan--network system for the utilization of

epidemiological information and the results of pulsed-field gel
electrophoresis]
Terajima J, Izumiya H, Tamura K, Watanabe H.
Department of Bacteriology, National Institute of Infectious Diseases.
Since 1996, we have been analyzing DNA pattern of enterohemorrhagic

Escherichia coli(EHEC) O157: H7 isolates in Japan by the use of pulsed-field gel
electrophoresis. The method, capable of discriminating genotypical difference of
the isolates, enabled us to find the contaminated food such as salmon roe which
was the causative agent for the multiprefectual outbreaks in Japan. These
outbreaks which we are referring as diffuse outbreaks seem to be increasing in
number, because it reflects that some of widely distributed or mass-produced food
products are being contaminated by pathogens such as EHEC. In order to find a
diffuse outbreak promptly and prevent it becoming large, we are constructing a
network, called PulseNet Japan, for sharing the results of pulsed-field gel
electrophoresis and epidemiological information among municipal public health
institutes and National Institute of Infectious Diseases.
Publication Types:
• Review
1363: Ann Acad Med Singapore. 2002 May;31(3):261-75.

Comment in:
• Ann Acad Med Singapore. 2002 May;31(3):259-60.
Are maternal deaths on the ascent in Singapore? A review of

maternal mortality as reflected by coronial casework from 1990 to
1999.
Lau G.
Centre for Forensic Medicine, Health Sciences Authority, 11 Outram Road,

Singapore, 169078. Gilbert_LAU@HSA.GOV.SG
INTRODUCTION: In Singapore, published maternal mortality rates (MMR) over

the last decade (1990 to 1999) have been so low (0.0 to 1.0 per 1000 live births
and still births) as to imply that maternal deaths are rare to the point of being non-
existent in some years. This inference is counterintuitive, and earlier studies on
maternal mortality, amniotic fluid embolism (AFE) and pulmonary
thromboembolism (PTE) have also suggested otherwise. Accordingly, local trends
in maternal mortality warrant further examination. MATERIALS AND
METHODS: A descriptive and comparative study, comprising a clinico-
pathological review of maternal deaths, for which autopsies were conducted by
the Centre for Forensic Medicine, during a 10-year period from 1990 to 1999. The
annual necropsy-based, MMR (estimated MMR), as well as the prevalence of
maternal deaths during this time, were estimated with the aid of the relevant,
published demographic data on live births and still births. These were compared
with the corresponding rates calculated (calculated MMR) from raw demographic
data on maternal deaths classified as such in the published data. RESULTS:
Coronial autopsies were conducted on a total of 51 cases of maternal death, of
which 33, 17 and 1 were direct, indirect and fortuitous deaths, respectively. The
annual, estimated MMR ranged from 0.4 to 1.8 per 10,000 live births and still
births. The estimated MMR was twice as high as the calculated MMR and a
statistically significant upward linear trend was demonstrated for the former (P =
0.046). AFE (16/51) and PTE (10/51) were the two most common causes of
maternal death; their corresponding cause-specific, 10-year prevalence being 0.33
and 0.21 per 10,000 live births and still births, respectively. There was apparent
clustering of the cases of PTE during the earlier part of the last decade (1990 to
1995), corresponding to a statistically significant, upward trend in its overall
necropsy incidence during that time (P = 0.019). Cardiovascular and pulmonary
disorders constituted the bulk of indirect deaths (13/17), while antenatal suicides
accounted for 3 of these deaths (0.06 per 10,000 live births and still births).
CONCLUSIONS: This was an upward trend in MMR, as reflected in coronial
casework, over the last decade. It would appear that the local, estimated (direct
and indirect) maternal mortality prevalence compares favourably with the MMR
reported in developed countries. The apparent rate of AFE was no less than 4
times higher than that reported in the United Kingdom, while the maternal
mortality rate from PTE was at least as high. Allowing for the possibility that
such deaths were under-reported, the actual annual MMR and 10-year prevalence
could be appreciably higher than the estimates presented here. There may well be
a case for the establishment of a comprehensive database of maternal deaths, that
is updated continually and contemporaneously, in Singapore.
Publication Types:
1364: Nippon Eiseigaku Zasshi. 2002 May;57(2):527-34.

[General practitioner's recognition of service cooperation with

community pharmacists related to home care in a suburban area]
Onda M, Kono K, Watanabe T, Watanabe M, Akashi M.
Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan.
m-onda@hw.hirokoku-u.ac.jp
OBJECTIVES: To clarify the factors affecting a general practitioner's demands

and the recognition of service cooperation with community pharmacists related to
home care in a suburban area. METHODS: A questionnaire on pharmacy services
and functions was administered to 215 general practitioners in a suburban area.
Gender, age, specialty, length of practice, status of home visiting, requests for
community pharmacists, awareness of a home visiting service by community
pharmacists, status of issues about home visiting orders to community
pharmacists and the criteria for deciding to issue an order, recognition of the
necessity of a home visiting service by pharmacists, expectation value to the
community of the pharmacists' participation in the home care service and
requests, recognition of cooperation with other home care related professions,
ease of cooperation with community pharmacists, disincentives for cooperation
with community pharmacists, factors necessary to promote cooperation between
practitioners and community pharmacists, and factors necessary to promote the
home care system were surveyed. Using the results, chi 2 test and principal
component analysis were performed. RESULTS: It was found that the general
practitioners' main demands were support and management of pharmaceutical
therapy. Meanwhile, the practitioners' low cognition of pharmacists' home visiting
seemed to be one disincentive to cooperation with pharmacists. Every practitioner
who had issued visiting orders to pharmacists practiced home visiting and issued
the visiting orders based on patients' condition at home. Practitioners who
practiced home visiting were more active in promoting the home care system and
had a better cognition and more extensive demands for pharmacists' home visiting
compared to practitioners with no home visiting. Practitioners with good
recognition of cooperation with community pharmacists had better cognition,
realized the necessity of, and expected pharmacist's home visiting compared to
practitioners with low awareness. However, practitioners' overall recognition of
cooperation with pharmacists was relatively low. As disincentives, practitioners
pointed out lack of acquaintance, the unclear function of pharmacists, and no
opportunity for cooperation. So, enhancing practitioners' awareness of home care,
clarifying the pharmacist's role, establishing a relationship of mutual trust through
information feedback and/or exchange based on practice would be effective in
promoting service cooperation with community pharmacists.
Publication Types:
1365: Palliat Med. 2002 May;16(3):185-93.

Family satisfaction with inpatient palliative care in Japan.
Morita T, Chihara S, Kashiwagi T; Quality Audit Committee of the Japanese

Association of Hospice and Palliative Care Units.
Seirei Hospice, Seirei Mikatabara Hospital, Hamamatsu, Shizuoka, Japan.

inomoteh@ma4.justnet.ne.jp
Whereas satisfaction is one of the most important outcomes in palliative care

settings, there have been no systematic studies investigating the effects of family-
and organization-related variables on family satisfaction with care. To clarify
factors contributing to family satisfaction with inpatient palliative care services, a
cross-sectional mailed survey was performed. A 60-item questionnaire was
mailed to 1026 bereaved subjects who had lost family members at one of 37
palliative care units in Japan to evaluate their sociodemographic characteristics
and satisfaction levels with care. An institution survey was performed to collect
organization-related variables. Caregiver satisfaction was rated on the Satisfaction
scale for Family members receiving Inpatient Palliative Care (Sat-Fam-IPC). A
total of 640 responses were analysed (response rate = 62%). The responses to
overall satisfaction were 'satisfied' in 41 % and 'very satisfied' in 47%. The mean
total score of the Sat-Fam-IPC was 82.4 +/- 13.2 on the 0-100 scale. The mean
subscale scores were: 85.8 +/- 14.5 (Nursing Care), 81.5 +/- 18.4 (Symptom
Palliation), 85.0 +/- 13.8 (Facility), 83.3 +/- 16.6 (Information), 83.1 +/- 17.3
(Availability), 78.3 +/- 18.9 (Family Care), and 79.8 +/- 17.3 (Cost). Significant
determinants of family satisfaction identified were: nursing system, the number of
nurses at night and presence of attending medical social workers (Nursing Care),
patient age and the number of physicians (Symptom Palliation), floor space per
bed (Facility), duration of admission and presence of attending medical social
workers (Availability), patient age, family age, gender and occupational status
(Family Care), patient age and the extra charge for a private room (Cost). In
conclusion, informal caregivers are generally satisfied with inpatient palliative
care services provided by members of the Japanese Association of Hospice and
Palliative Care Units. The levels of satisfaction are influenced by various family-
and organization-related variables.
1366: Aust Health Rev. 2002;25(2):170-4.

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

1367: Occup Med. 2002 Jul-Sep;17(3):427-35, iv.
Occupational health in Taiwan.
Wang JD, Cheng TJ, Guo YL.
Department of Internal Medicine, National Taiwan University, College of Public

Health, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan.
Challenges facing a developing country during transition to newly developed

status include lack of: a hazard communication system, a prudent industrial
zoning policy, and occupational safety and health (OSH) technology and
personnel. The authors offer an approach to the future that encompasses
implementation of a pollution prevention system, comprehensive coverage of
occupational injuries and diseases, and integration of information technology with
OSH protection.
Publication Types:

• Review
1368: Public Health Nutr. 2002 Feb;5(1A):183-9.

The nutrition and health transition in Thailand.
Kosulwat V.
Institute of Nutrition, Mahidol University, Phutthamonthon, Salaya, Nakhon

Pathom, Thailand. grvpt@mucc.mahidol.ac.th
OBJECTIVE: To explore and describe the nutrition and health transition in

Thailand in relation to social and economic changes, shifts in food consumption
patterns and nutritional problems, as well as morbidity and mortality trends.
DESIGN: This report reviews the nutrition and health situation and other related
issues by compiling information from various reports and publications from
several sources. Yearly statistics and reports from the National Statistical Office
were used as well as data from the Food and Agriculture Organization (FAO) and
national surveys on the nutrition and health situation of the Thai population.
RESULTS: Thailand has undergone social and economic transitions during the
past three decades and is approaching the post-demographic transitional period.
These are evidenced by an increase in life expectancy at birth of the population,
and declines in the total fertility and infant mortality rates. The economic
structure has also moved from agricultural to industrial. Industrial growth has
surpassed that of the agricultural sector as indicated by a steady rise in the share
of the industrial sector in the gross domestic product, which is greater than that of
other sectors. At the same time, results from several nation-wide surveys indicate
that the food consumption pattern of the population has changed considerably;
Thai staples and side dishes are being replaced by diets containing a higher
proportion of fats and animal meat. A shift in the proportion of expenditure on
food prepared at home and that expended on purchased, ready-to-eat food, in both
rural and urban settings, gives another reflection of the change in food
consumption of the Thai population. The prevalence of overweight and obesity
among children and adolescents has increased dramatically during the past 20
years and is more pronounced in children from private schools and urban
communities than in those from public schools or rural areas. Among adults,
results from two national surveys in 1991 and 1996 indicated that the problem of
overweight and other risk factors for cardiovascular disease have increased
significantly. In considering the overall causes of death among the Thai
population, the leading causes are diet-related chronic degenerative diseases.
Diseases of the circulatory system have become the number one cause of death in
Thailand and cancer has ranked as the number three cause of death since the late
1980s. CONCLUSIONS: The rapid changes in food intake and lifestyle patterns
in Thailand clearly demonstrate a significant impact on the shifting pattern of
disease burden of the population. These changes should be monitored carefully
and must be reversed through appropriate behaviour modification and the
promotion of appropriate eating practices and physical activities.
Publication Types:
• Review
1369: J Med Syst. 2002 Jun;26(3):249-54.

A network system of medical and welfare information service for the

patients, their families, hospitals, local governments, and
commercial companies in a medical service area.
Matsumura K, Antoku Y, Inoue R, Kobayashi M, Hanada E, Iwasaki Y,

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

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

Epidemiology and control of mekongi schistosomiasis.
Urbani C, Sinoun M, Socheat D, Pholsena K, Strandgaard H, Odermatt P,

Hatz C.
World Health Organization 63, Trang Hung Dao Street, P.O. Box 52, 10000,
Hanoi, Vietnam. urbanic@vtn.wpro.who.int
Since the first case of Schistosoma mekongi infection was reported in 1957,
control measures have been implemented in Laos and in Cambodia. Operational
research provided the necessary information on parasite epidemiology and the
associated morbidity in order to develop adequate control measures. S. mekongi
transmission occurs in rocky banks of the river according to a seasonal cycle.
Common daily activities of villagers living in the endemic areas constitute the risk
factors for infection. The potential role of an animal reservoir is not fully
understood. Severe disease is associated with advanced infection status. Signs and
symptoms of portal hypertension dominate the clinical situation, and death is
usually due to bleeding from ruptured esophageal varices. Schistosomiasis control
in both Laos and Cambodia was based on universal treatment campaigns and
resulted in a dramatic fall in the prevalence of the infection and in morbidity
control. However, even if the disease and the infection have been satisfactorily
controlled, transmission still occurs, and in very limited areas the prevalence
reaches rates of more than 15%. Today, 60000 people are estimated to be still at
risk of infection in Laos and about 80,000 in Cambodia. The new challenge in
schistosomiasis control in endemic areas along the Mekong river is to consolidate
the results, to establish a sensitive and reliable surveillance system, and finally to
adapt control strategies to the low endemic situation. The impoverished nature of
the region makes the possibility of sanitation unfeasible, and external support is
still needed to sustain activities in the near future and to enable the substantial
reduction of risk behaviors.
1372: Drug Saf. 2002;25(5):323-44.

Panax ginseng: a systematic review of adverse effects and drug

interactions.
Coon JT, Ernst E.
Department of Complementary Medicine, School of Postgraduate Medicine and

Health Sciences, University of Exeter, Exeter, United Kingdom. J.Thompson-
Coon@exeter.ac.uk
Panax ginseng C. A. Meyer is a perennial herb native to Korea and China and has
been used as an herbal remedy in eastern Asia for thousands of years. Modern
therapeutic claims refer to vitality, immune function, cancer, cardiovascular
diseases, improvement of cognitive and physical performance and sexual
function. A recent systematic review of randomised controlled trials found that
the efficacy of ginseng root extract could not be established beyond doubt for any
of these indications. In order to obtain a balanced assessment of the therapeutic
value of P. ginseng it is also necessary to consider the safety profile. In view of
the extremely widespread use of P. ginseng it seems important to ask whether this
herbal medicine involves health risks for the consumer. This review was
conducted as a systematic attempt to document and evaluate all the available
safety data on P. ginseng root extracts. Systematic searches were performed in
five electronic databases and the reference lists of all papers located were checked
for further relevant publications. All articles containing original data on adverse
events and drug interactions with P. ginseng were included. Information was also
requested from 12 manufacturers of ginseng preparations, the spontaneous
reporting schemes of the WHO and national drug safety bodies. No language
restrictions were imposed. Data from clinical trials suggest that the incidence of
adverse events with ginseng monopreparations is similar to that with placebo. The
most commonly experienced adverse events are headache, sleep and
gastrointestinal disorders. The possibility of more serious adverse events is
indicated in isolated case reports and data from spontaneous reporting schemes;
however, causality is often difficult to determine from the evidence provided.
Combination products containing ginseng as one of several constituents have been
associated with serious adverse events and even fatalities. Interpretation of these
cases is difficult as ingredients other than P. ginseng may have caused the
problems. Possible drug interactions have been reported between P. ginseng and
warfarin, phenelzine and alcohol. Collectively, these data suggest that P. ginseng
monopreparations are rarely associated with adverse events or drug interactions.
The ones that are documented are usually mild and transient. Combined
preparations are more often associated with such events but causal attribution is
usually not possible.
Publication Types:
• Case Reports
• Review
1373: Radiat Environ Biophys. 2002 Mar;41(1):75-80.

Fallout from nuclear tests: health effects in Kazakhstan.
Grosche B, Land C, Bauer S, Pivina LM, Abylkassimova ZN, Gusev BI.
Federal Office for Radiation Protection, Institute of Radiation Hygiene,

Oberschleissheim, Germany. bgrosche@bfs.de
Publication Types:

Comment in:
• Radiat Environ Biophys. 2002 Mar;41(1):13-8.
Fallout from nuclear tests: health effects in the Altai region.
Shoikhet YN, Kiselev VI, Algazin AI, Kolyado IB, Bauer S, Grosche B.
Institute of Regional Medico-Ecological Problems, Barnaul, Russia.
Publication Types:

Comment in:
• Radiat Environ Biophys. 2002 Mar;41(1):13-8.
Fallout from nuclear tests: dosimetry in Kazakhstan.
Gordeev K, Vasilenko I, Lebedev A, Bouville A, Luckyanov N, Simon SL,

Stepanov Y, Shinkarev S, Anspaugh L.
State Research Center, Institute of Biophysics of the Ministry of Health, Moscow,

Russian Federation.
Publication Types:

Fallout from nuclear tests: dosimetry in the Altai region.
Shoikhet Y, Loborev V, Sudakov V, Kiselev VI, Zelenov V, Azarov L.
Research Institute of Regional Medical-Ecological Problems, Ministry of Health,

Barnaul, Russian Federation.
1377: Mil Med. 2002 Apr;167(4):326-30.

International use of an academic nephrology World Wide Web site:

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

Human aspects of shift work in the developing countries--I: A case

study in Bangladesh.
Ahasan R, Khaleque A, Mohiuddin G.
Work Science Laboratory, University of Oulu, FIN-90570 Oulu, Finland.
There currently is little information available that allows objective prediction of

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

Distinct pattern of age-specific incidence of Guillain-Barré

syndrome in Harbin, China.
Cheng Q, Wang DS, Jiang GX, Han H, Zhang Y, Wang WZ, Fredrikson S.
Division of Neurology, Huddinge University Hospital, Sweden.

Qi.Cheng@neurotec.ki.se
We describe the age-and sex-specific incidence of Guillain-Barré syndrome

(GBS) in Harbin, China, based on the information from a prospective survey
among a well-defined large population during one year. A network of physicians
reported incident patients with a GBS diagnosis from a general population of 5.4
million inhabitants in Harbin, China, during the period from 1 October 1997 to 30
September 1998. Each reported patient was examined by senior neurologists and
the GBS diagnosis was validated according to standard diagnostic criteria. All
GBS patients were followed-up for six months after onset. Admission registers at
all hospitals in Harbin were also checked afterwards for screening patients with a
GBS diagnosis who might have been missed. During the study period, 79 patients
with a GBS diagnosis were reported. After validation, the GBS diagnosis was
confirmed in 70 patients. Another GBS patient was found through the screening
of admission registers at hospitals. Among them, 36 GBS patients were residents
in Harbin and the other 35 patients were from geographical areas out of Harbin.
The GBS incidence, age-adjusted to the European standard population, was 0.66
(95% CI 0.46-0.91) per 100,000 person-years, with a male to female ratio of 1.4.
The highest GBS incidence was found in the youngest age-group and the
incidence among the elderly was remarkably lower than those reported from other
populations in Western countries. Possible explanations for the distinct pattern of
age-specific incidence of GBS are discussed. Further studies are needed.
Publication Types:
1380: AIDS. 2002 May 3;16(7):953-9.

National program for preventing mother-child HIV transmission in

Thailand: successful implementation and lessons learned.
Kanshana S, Simonds RJ.
Department of Health, Ministry of Public Health, Tivanon Road, Nonthaburi

11000, Thailand.
OBJECTIVE: To describe the development, components, and initial uptake of

Thailand's national program for preventing mother-child HIV transmission.
DESIGN: Historical review, interpretation of experience, national program
monitoring. SETTING: Public health system, Thailand. PARTICIPANTS:
Policymakers, clinicians, HIV-infected pregnant women. INTERVENTION:
Voluntary counseling and HIV testing of pregnant women; short-course
zidovudine for HIV-infected women and their infants and formula feeding for
infants. MAIN OUTCOME MEASURES: Program components implemented and
program uptake. RESULTS: Research, monitoring and evaluation of pilot
projects, training, and policy-making provided the information, experience,
infrastructure, and guidance to develop a program for preventing mother-child
HIV transmission that was implemented in all Ministry of Public Health hospitals
in Thailand in 2000. A national system was established to monitor program
implementation. Monitoring reports were received from 669 hospitals in 65
provinces for the period October 2000 through July 2001. During this period, 93%
of 318 721 women who gave birth were tested for HIV; 69% of 3958 HIV-
infected women giving birth received zidovudine; and 86% and 80% of the 3865
children born to HIV-infected women received zidovudine and infant formula,
respectively, through the program. CONCLUSIONS: A national program for
preventing mother-child HIV transmission was successfully implemented in
Thailand. Early monitoring indicates good program uptake. Lessons learned from
implementing this program include the importance of paying attention to
counseling, communication, and training in the program, and using pilot projects
and focused monitoring and evaluation data to guide the program development,
expansion, and improvement.
Publication Types:
• Editorial
• Review
1381: Int J Infect Dis. 2001;5(4):214-9.

Are the environmental niches of Vibrio cholerae O139 different

from those of Vibrio cholerae O1 El Tor?
Ali M, Emch M, Yunus M, Sack RB.
Centre for Health and Population Research, Dhaka, Bangladesh. mali@ivi.int
BACKGROUND: Vibrio cholerae are known to be normal inhabitants of surface

water. However, the environmental niches of the different strains of cholera are
not well known, and therefore, populations at risk for cholera outbreaks cannot be
clearly identified. METHODS: This study identifies environmental risk factors for
cholera caused by V. cholerae O1 El Tor and O139 and environmental niches of
the two strains present in Matlab, a cholera endemic area of Bangladesh. The
study year was 1993, the year that the O139 strain first appeared in the study area.
Patients who had either strain of cholera identified in a laboratory were included
in the study. A geographic information system was used to map the household
locations of the patients, to describe the human sanitary environment and
population density, and to address potential anthropogenic and environmental risk
factors of the disease. Spatial point pattern and exploratory spatial data analysis
techniques were used to define the environmental niches of the two cholera
strains. RESULTS: The study suggests the niches of O1 El Tor and O139 strains
of V. cholerae appear to be similar, based on common environmental risk factors.
CONCLUSIONS: The results of this study support a theory that O1 El Tor could
possibly be replaced by the newer O139 strain in the future.
Publication Types:
1382: Health Place. 2002 Jun;8(2):85-92.

Spatial filtering using a raster geographic information system:

methods for scaling health and environmental data.
Ali M, Emch M, Donnay JP.
ICDDR,B, Mohakhali, Dhaka, Bangladesh. mali@ivi.int
Despite the use of geographic information systems (GIS) in academic research, it

is still uncommon for public health officials to use such tools for addressing
health and environmental issues. Complexities in methodological issues for
addressing relationships between health and environment, investigating spatial
variation of disease, and addressing spatial demand and supply of health care
service, hinder the use of GIS in the health sector. This paper demonstrates simple
spatial filtering methods for analyzing health and environmental data using a
raster GIS. Computing spatial moving average rates reduces individual affects and
creates a continuous surface of phenomena. Another spatial analytical method
discussed is computation of exposure status surfaces including neighbors'
influences weighted by distance decay. These methods describe how health and
environmental data can be scaled in order to better address health problems.
Spatial filtering methods are demonstrated using health and population
surveillance data within a GIS that were collected for approximately 210,000
people in Matlab, Bangladesh.
Publication Types:
1383: Int J Tuberc Lung Dis. 2002 Apr;6(4):307-12.

Factors affecting patient compliance with anti-tuberculosis

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

OBJECTIVES: To establish factors affecting compliance of patients with anti-
tuberculosis chemotherapy, their knowledge of the disease, and views on
improving the DOTS strategy. DESIGN: Interviews with compliant patients
attending clinics for DOTS treatment and with non-compliant patients in their
homes, in August and September 2000. RESULTS: A total of 63 compliant and
23 non-compliant patients were interviewed. For non-compliant patients, reaching
the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005)
compared to compliant patients. Cost of transport was the reason most frequently
given for non-attendance. Non-compliant patients were more likely to have
completed secondary education (P < 0.05), and to be working (P < 0.01). More
non-compliant patients had family members who had had the disease (P < 0.01).
There was no difference between the groups for overall tuberculosis knowledge
scores; however, non-compliant patients were more likely to think that treatment
could be stopped once they were symptom free (P < 0.01). Most patients (73%)
felt that the DOTS system could be improved by provision of more information
about tuberculosis. CONCLUSION: Compliance with DOTS in the Kota
Kinabalu area is affected by travel expenses, time spent travelling to treatment
centres, and having family members who have had the disease. Patients would
like more information on tuberculosis.
Publication Types:
1384: Clin Microbiol Rev. 2002 Apr;15(2):223-46.

Dracunculiasis (Guinea worm disease) and the eradication initiative.
Cairncross S, Muller R, Zagaria N.
Department of Infectious and Tropical Diseases, London School of Hygiene and

Tropical Medicine, London WC1E 7HT, United Kingdom.
sandy.cairncross@lshtm.ac.uk
Dracunculiasis, also known as guinea worm disease, is caused by the large female
of the nematode Dracunculus medinensis, which emerges painfully and slowly
from the skin, usually on the lower limbs. The disease can infect animals, and
sustainable animal cycles occur in North America and Central Asia but do not act
as reservoirs of human infection. The disease is endemic across the Sahel belt of
Africa from Mauritania to Ethiopia, having been eliminated from Asia and some
African countries. It has a significant socioeconomic impact because of the
temporary disability that it causes. Dracunculiasis is exclusively caught from
drinking water, usually from ponds. A campaign to eradicate the disease was
launched in the 1980s and has made significant progress. The strategy of the
campaign is discussed, including water supply, health education, case
management, and vector control. Current issues including the integration of the
campaign into primary health care and the mapping of cases by using geographic
information systems are also considered. Finally, some lessons for other disease
control and eradication programs are outlined.
Publication Types:
• Review
PMCID: PMC118073
1385: Patient Educ Couns. 2002 Apr;46(4):277-85.

The interaction between physician and patient communication

behaviors in Japanese cancer consultations and the influence of
personal and consultation characteristics.
Ishikawa H, Takayama T, Yamazaki Y, Seki Y, Katsumata N, Aoki Y.
Department of Health Sociology, School of Health Sciences and Nursing, The

University of Tokyo, Tokyo, Japan. hirondo@m.u-tokyo.ac.jp
The communications of physician and patient vary with the characteristics of

patient and consultation, as well as the communications of the counterpart. The
purpose of this study is to explore the interaction between physician and patient
communications in Japanese cancer consultation in view of the influence of
patient and consultation characteristics. One hundred and forty cancer outpatients
and 12 physicians were included in this study. The Roter Interaction Analysis
System (RIAS) was used to analyze the physician-patient interaction. Patient
information giving was positively related to physician facilitation, while patient
question asking and emotional expression were associated with the warm and
empathetic attitude of the physician. On the other hand, the encouraging
statements of the physician were greater in shorter consultations, which implies
physicians might have interrupted patients with encouragement before thoroughly
listening to the patients concern. Further investigation is needed to confirm the
causal relationships of these interactions.
Publication Types:
1386: Psychiatr Serv. 2002 Apr;53(4):476-8.

A computerized patient information system in a psychiatric hospital.
Modai I, Ritsner M, Silver H, Kurs R.
Institute of Psychiatric Studies of Sha'ar Menashe Mental Health Center, Mobile,

Israel. shrmodai@matat.health.gov.il
The authors describe a computerized patient information system at a psychiatric

hospital in Israel. The system is a fully implemented work instrument that
promotes clinical safety and cost containment. It allows interactive online
consultations, clinical cross-checking, the production of computerized reports and
schedules, fast response to laboratory results, and safer drug administration, all of
which help improve the quality of care. Cost savings have been achieved in areas
such as pharmacy and food distribution. The initial investment in the system was
$400,000, which is expected to be recouped after 11.4 years.
1387: Am J Public Health. 2002 Apr;92(4):615-23.

A multilevel analysis of the relationship between institutional and

individual racial discrimination and health status.
Gee GC.
Training Program in Identity, Self, Role, and Mental Health, Department of

Sociology, Indiana University, Ballantine Hall 744, 1020 E Kirkwood Avenue,
Bloomington, IN 47405-7103, USA. ggee@indiana.edu
OBJECTIVES: This study examined whether individual (self-perceived) and

institutional (segregation and redlining) racial discrimination was associated with
poor health status among members of an ethnic group. METHODS: Adult
respondents (n = 1503) in the cross-sectional Chinese American Psychiatric
Epidemiologic Study were geocoded to the 1990 census and the 1995 Home
Mortgage Disclosure Act database. Hierarchical linear modeling assessed the
relationship between discrimination and scores on the Medical Outcomes Study
Short-Form 36 and revised Symptom Checklist 90 health status measures.
RESULTS: Individual and institutional measures of racial discrimination were
associated with health status after control for acculturation, sex, age, social
support, income, health insurance, employment status, education, neighborhood
poverty, and housing value. CONCLUSIONS: The data support the hypothesis
that discrimination at multiple levels influences the health of minority group
members.
Publication Types:
PMCID: PMC1447127
1388: J Nurses Staff Dev. 2000 Sep-Oct;16(5):222-6.

Preparing for an international consultation.
Brunt BA.
Summa Health System, Akron, Ohio, USA.
This article outlines the experiences of a staff development educator in preparing

for an international staff development consultation. Sections on preparing for
travel and for the actual consultation visit provide suggestions in each of these
areas. The consultation is described in terms of work done before, during, and
after the visit. This information will be helpful to staff development educators
considering an international consultation.
1389: Epilepsia. 2002 Mar;43(3):311-6.

Comment in:
• Epilepsia. 2003 Feb;44(2):268-9; author reply 269-70.
Public awareness, attitude, and understanding of epilepsy in Hong

Kong Special Administrative Region, China.
Fong CY, Hung A.
University Department of Medicine, Queen Mary Hospital, Hong Kong.

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

Ambulatory medical visits among anthrax-vaccinated and

unvaccinated personnel after return from southwest Asia.
Rehme PA, Williams R, Grabenstein J.
Air National Guard, Office of the Air Surgeon, 3500 Fetchet Avenue, Andrews
Air Force Base, MD 20762, USA.
The Department of Defense launched a mandatory anthrax immunization program

for military personnel in December 1997. This program has been criticized for
many reasons, including concern over side effects. This study was designed to
give a quick answer to the question of whether vaccinated persons who deployed
to southwest Asia were more likely to seek medical care upon their return than
their unvaccinated counterparts. The results demonstrated that there was no
greater risk for vaccinated persons to have a diagnosis recorded in the Ambulatory
Data System (0.96 RR) than unvaccinated persons. In addition, there was no
significant increased risk for a recorded diagnosis in any 1 of the 17 International
Classification of Diseases, Ninth Revision, categories or for 16 specific adverse
health conditions.
1391: Am J Hum Biol. 2002 Mar-Apr;14(2):264-74.

Lay perceptions of genetic risks attributable to inbreeding in

Pakistan.
Hussain R.
Senior Lecturer in Health Management, School of Health, University of New

England, Australia. rhussain@metz.une.edu.au
Pakistan along with many other West and South Asian countries has a very high
prevalence of consanguineous, especially close cousin, marriages. Although there
is substantial empirical information on offspring morbidity and mortality
attributable to parental consanguinity, population-based information on how
communities in general, and women in particular, perceive the health risks
associated with consanguineous unions is limited. This paper considers
community perceptions of health effects associated with consanguineous
marriages using qualitative data from 15 focus group discussions and 294 in-
depth interviews. The study was conducted in four low-income, multi-ethnic, and
multi-religious communities in Karachi, the principal commercial center of
Pakistan. The results show a general lack of awareness of the possible adverse
health effects of consanguineous marriage. In cases where a link between
consanguinity and ill health was acknowledged, it often centered on the familial
origins of non-communicable disorders such as diabetes and hypertension or
infectious diseases such as tuberculosis. Belief in fate and the "evil eye" was
widespread across all ethnic and religious groups. Many respondents did not agree
with medical explanations of a genetic mode of disease inheritance, even in cases
where there was an affected child in the family. The absence of a uniform
manifestation of disease among all children of a couple who were identified as
carriers of a specific mutation added to the confusion among participants. The
study highlights the need for further quantification of risks associated with
consanguinity and a need for provision of appropriate information to primary-care
clinicians and also to communities. The likely impact of increasing morbidity
attributable to inbreeding on the health care system in resource poor settings is
also discussed.
Publication Types:
1392: Am J Emerg Med. 2002 Mar;20(2):118-21.

The feasibility of full computerization in the ED.
Hu SC, Yen DH, Kao WF.
Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital,

Buddhist Tzu-Chi University, Hualien, Taiwan. shengchuan@tzuchi.com.tw
For understanding the feasibility of full computerization of an emergency

department (ED), we investigated the completion rate performed by doctors,
nurses, or registration clerks since the implementation of full computerization in
our ED. We evaluated the changing style of chart-recording, from hand-writing
pattern to full computer recording, by recording the execution rate of different
information keyed by doctors, nurses, or registration clerks according to their
work in ED. We recorded and analyzed different monthly reports of the execution
rate in the 18-month period of study. Statistical analysis was performed using
Wilcoxon rank-sum test or Kruskal-Wallis one-way ANOVA. The average
monthly census was 4570.1 +/- 580.7 (95% confidence interval [CI] for mean:
4281.3, 4858.9). The average execution rate for mode of arrival and triage
classification were 97.1 +/- 4.1% (95% CI for mean: 95.1%, 99.1%) and 97.2 +/-
4.1% (95% CI for mean: 95.2%, 99.2%), respectively. In comparison with the
execution rate for disposition status between the period of the first 10 months
(keying data by nurses) and the late 8 months (keying data by clerks), it showed
72.0 +/- 33.2% v 96.7 +/- 2.0%; 66.7 +/- 35.0% v 95.8 +/- 1.9%; 57.5 +/- 32.0% v
88.2 +/- 8.2% in nontrauma, trauma and pediatric section, respectively, with
statistic significance (P <.01). To compare the rate of execution performed by
physicians, we divided the study period into 3 phases (phase 1: first 6 months,
phase 2: 7-12 months, phase 3: 13-18 months of the study period). The results
were statistically significant (P =.004) in phase 3 (83.4 +/- 5.3%) with higher
execution rate than phase 1 (69.7 +/- 7.7%) and phase 2 (75.2 +/- 4.9%) in trauma
physician. In the pediatric section, it was also significantly higher in phase 3 than
phase 2 (88.2 +/- 7.7% v 70.7 +/- 5.9%, P =.012). We concluded that it is efficient
to key in data by registration clerks instead of nurses, and it takes time to persuade
and educate most physicians to cooperate in using the computer while seeing
patients. Copyright 2002, Elsevier Science (USA). All rights reserved.)
1393: J Public Health Med. 2001 Dec;23(4):278-85.

Development and validation of a computerized South Asian Names

and Group Recognition Algorithm (SANGRA) for use in British
health-related studies.
Nanchahal K, Mangtani P, Alston M, dos Santos Silva I.
Department of Epidemiology and Population Health, London School of Hygiene

and Tropical Medicine. kiran.nanchahal@lshtm.ac.uk
BACKGROUND: Studies on ethnic variations in health have played an important

role in aetiological and health services research. Most routine datasets, however,
do not include information on ethnicity. South Asians, one of the largest minority
ethnic groups in Britain, have distinctive names that also allow differentiation of
the main sub-groups with their important differences in health-related exposures
and disease risks. METHODS: A computerized name recognition algorithm
(SANGRA) was developed incorporating directories of South Asian first names
and surnames together with their religious and linguistic origin. SANGRA was
validated using health-related data with self-ascribed information on ethnicity.
RESULTS: SANGRA was successful in recognizing South Asian origin in
reference datasets, with sensitivity of 89-96 per cent, specificity of 94-98 per cent,
positive predictive value (PPV) of 80-89 per cent and negative predictive value
(NPV) of 98-99 per cent. Religious origin was correctly assigned in the majority
of cases: sensitivity, specificity and PPV were 94 per cent, 91 per cent and 90 per
cent for Hindus; 90 per cent, 99 per cent and 98 per cent for Muslims; and 76 per
cent, 99 per cent and 94 per cent for Sikhs. SANGRA correctly identified 76 per
cent Gujerati and 70 per cent Punjabi names, although only 62 per cent of
Gujerati names were sufficiently distinct to be allocated to the Gujerati-only
category and only 53 per cent Punjabi names were allocated to the Punjabi-only
category. However, specificity and PPV were high for both languages
(respectively 97 per cent and 93 per cent for Gujerati, and 99 per cent and 97 per
cent for Punjabi). CONCLUSIONS: SANGRA provides a practical and valid
method of ascertaining South Asian origin by name and, to a lesser degree of
accuracy, of differentiating between the main religious and linguistic subgroups
living in Britain. This algorithm will be useful in health-related studies where
information on self-ascribed ethnicity is not available or is of a limited nature.
Publication Types:

• Validation Studies
1394: World Hosp Health Serv. 2001;37(3):19-23, 40-3.

Implementing chronic disease management in the public healthcare

sector in Singapore: the role of hospitals.
Cheah J, Heng BH.
Department of Community, Occupational and Family Medicine, National

University of Singapore.
The public health care delivery system in Singapore faces the challenges of a
rapidly ageing population, an increasing chronic disease burden, increasing
healthcare cost, rising expectations and demand for better health services, and
shortage of resources. It is also fragmented, resulting in duplication and lack of
coordination between institutions. A disease management approach has been
adopted by the National Healthcare Group (NHG) as a critical strategy to provide
holistic, cost-effective, seamless and well-coordinated care across the continuum.
The framework in the development of the disease management plan included
identifying the diseases and defining the target population, organizing a multi-
disciplinary team lead by a clinician champion, defining the core components,
treatment protocols and evaluation methods, defining the goals, and measuring
and managing the outcomes. As disease management and case management for
chronic diseases are new approaches adopted in the healthcare delivery system,
there is a lack of understanding by healthcare professionals. The leadership and
participation of hospital physicians was sought in the planning, design and
outcomes monitoring to ensure their 'buy-in' and the successful implementation
and effectiveness of the program. The episodic diagnosis related group (DRG)-
based framework of funding and subvention for healthcare, and the shortage of
step-care care facilities, have been recognized by the Ministry of Health as an
impediments to the implementation, and these are currently being addressed.
1395: Child Care Health Dev. 2002 Jan;28(1):87-93.

Disability in children from different ethnic populations.
Morton R, Sharma V, Nicholson J, Broderick M, Poyser J.
Ronnie Mackeith Child Development Centre, Derbyshire Childrens' Hospital,

Derby, UK.
We report on the prevalence of severe neurodisability in children in the Southern

Derbyshire Health Authority from different ethnic groups. Information was
obtained from the health records of children at the Child Development Centre
(CDC), and analysed according to ethnic group. There were 53 in the Pakistani
group, 20 in the Indian group and 764 in a mixed group, of which 95% were of
European origin. It was estimated that all children with severe disability in the
area of the Health Authority had notes at the CDC, except for 10% of the mixed
group living on the periphery. The numbers of children with different disabling
conditions were recorded, together with a measure of the level of individual
disability; the 'Disability Scores'. We also noted if the condition was genetic or
chromosomal in origin. Pakistani children showed a higher prevalence than the
other groups of severe learning disorder, severe and profound hearing loss and
severe visual problems. They also had a slightly increased prevalence of autism
and cerebral palsy. Conversely, they showed a lower prevalence of language
disorder. Disability scores for Pakistani children attending the CDC were higher
than for other groups. Genetic disease causing disability was 10 times more
common in the Pakistani children than other ethnic groups. Disability is more
common in Pakistani children probably as a result of the cultural practice of
consanguineous marriages. This community needs special help for disabled
children, and their families, for general support and appropriate genetic
counselling.
Publication Types:
1396: Harefuah. 2002 Jan;141(1):89-92, 123.

[Sports injuries among children]
[Article in Hebrew]
Dankner R, Barel V.
Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and

Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
In addition to the very positive effect of physical activity on health, sport is liable
to cause injury and disability. In Israel, physical activity has become part of
leisure time activity over the years. This combination has led to a consequential
rise in the risk of injury. Most sport injuries are mild and do not require hospital
treatment, but they may be severe and sometimes lead to hospitalization,
permanent disability and even death. In 1995-6, there were 356 sports related
injuries among children 5-17 years old, which were registered in the Israeli
National Trauma Registry (INTR). These represented 8.8% of all injuries
registered in the INTR for children of that age in 1995-6. In order to promote the
prevention of sports related injuries, the magnitude of the problem must first be
identified and the incidence and severity of the sports injuries described. In Israel
there is no systematic surveillance of sports injuries, nor knowledge of the
specific patterns of injury in Israel. In order to reduce the incidence and severity
of sports injuries in Israel, there is a necessity to improve the level of information
regarding such injuries through the establishment of a national sports injury
surveillance system.
Publication Types:
• Review
1397: Trop Med Int Health. 2002 Feb;7(2):140-8.

A systematic review of current knowledge of HIV epidemiology and

of sexual behaviour in Nepal.
Furber AS, Newell JN, Lubben MM.
Nuffield Institute for Health, University of Leeds, UK.

OBJECTIVE: To systematically review information on HIV epidemiology and on
sexual behaviour in Nepal with a view to identifying gaps in current knowledge.
METHODS: Systematic review covering electronic databases, web-based
information, personal contact with experts and hand searching of key journals.
RESULTS: HIV-1 seroprevalence has been rising rapidly in association with
high-risk behaviours, with current levels of 40% amongst the nation's injecting
drug users and approaching 20% amongst Kathmandu's female commercial sex
workers (FCSWs). HIV seroprevalence remains low in the general population
(0.29% of 15-49 year olds). There are significant methodological limitations in
many of the seroprevalence studies identified, and these estimates need to be
treated with caution. There are extensive migration patterns both within the
country and internationally which provide the potential for considerable sexual
networking. However, studies of sexual behaviour have focused on FCSWs and
the extent of sexual networks within the general population is largely unknown.
CONCLUSIONS: Whilst some of the ingredients are present for an explosive
HIV epidemic in Nepal, crucial knowledge on sexual behaviour in the general
population is missing. Research on sexual networking is urgently required to
guide HIV control in Nepal. There is also a need for further good-quality
epidemiological studies of HIV seroprevalence.
Publication Types:
• Review
1398: Soc Work Health Care. 2001;33(3-4):129-51.

Comparing social work's role in renal dialysis in Israel and the

United States: the practice-based research potential of available
clinical information.
Auslander G, Dobrof J, Epstein I.
Hebrew University, School of Social Work, Mt Scopus, Jerusalem, Israel.

msgail@mscc.huji.ac.il
This paper demonstrates the use of clinical data-mining in a study of social work
interventions with dialysis patients in two countries, the US and Israel. We aimed
to examine the role of social workers in improving kidney patient outcomes and
to determine the potential of readily available patient information for studying this
process. The findings showed considerable differences between the patient
samples in both countries, as far as the socio-demographic background was
considered. In spite of this, there were numerous similarities in the type of
psycho-social problems and reactions, as well as the social workers' interventions.
Differences which arose in various patient states and outcomes were examined in
light of variations in the health care systems and socio-cultural contexts of renal
dialysis in both sites.
Publication Types:
1399: Pharmacoepidemiol Drug Saf. 2001 Oct-Nov;10(6):487-92.

Construction of the Korea Elderly Pharmacoepidemiologic Cohort:

drug utilization review of cephalosporins in geriatric inpatients.
Park BJ, Cho YK, Kim SA.
Department of Preventive Medicine, Seoul National University College of

Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-799, Korea.
bjpark@snu.ac.kr
We performed a cohort-based pharmacoepidemiologic study in order to evaluate

the pattern of cephalosporin prescriptions in elderly inpatients in Korea. The
Korea Elderly Pharmacoepidemiologic Cohort was composed of a geriatric
population of beneficiaries of the Korea Medical Insurance Corporation residing
in Busan in 1993. The cohort consisted of 23,649 members, comprising 15,221
women (64.4%) and 8428 men (35.6%). The study population for drug utilization
review consisted of those cohort members who were admitted into hospitals
during the period January 1993 through December 1994. The number of
hospitalized patients was 4262, comprising 2631 women (61.7%) and 1681 men
(38.3%). The trend of cephalosporin prescriptions over the 2-year period showed
that the use of second and third generation cephalosporins increased relative to the
use of first generation. The use of cephalosporins combined with other antibiotics
was found to occur in 22.8% aminoglycosides (76.7%) and quinolones (17.1%)
being the most common antibiotics combined with cephalosporins. Our result
demonstrates an increase in the prescription of second and third generation
cephalosporins in Korea, which has implications not only for the elderly
population but also for the total population because of the impact on health care
costs and the potential for the emergence of antimicrobial resistance.
Publication Types:
1400: Cancer Causes Control. 2001 Dec;12(10):909-16.

Arsenic in drinking water and skin cancers: cell-type specificity

(Taiwan, ROC).
Guo HR, Yu HS, Hu H, Monson RR.
Graduate Institute of Environmental and Occupational Health, College of

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

1401: Nippon Rinsho. 2001 Nov;59 Suppl 7:566-73.
[Non-Hodgkin lymphoma]
Sawada U.
First Department of Internal Medicine, Nihon University School of Medicine.
Publication Types:
• Review
1402: Nippon Rinsho. 2001 Nov;59 Suppl 7:182-8.

[Parasitic infections]
Fujita K.
Section of Environmental Parasitology, Department of International Health

Development, Graduate School, Tokyo Medical and Dental University.
Publication Types:
• Review
1403: Ann N Y Acad Sci. 2001 Apr;928:281-6.

Anti-aging and health-promoting constituents derived from

traditional oriental herbal remedies: information retrieval using the
TradiMed 2000 DB.
Chang IM.
Graduate Studies in Natural Products Science, Natural Products Research

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

The use of medical quality indices as a performance-enhancement

tool for community clinics.
Elhayany A.
Clalit Health Services, Rishon Lezion, Israel. elasher@clalit.org.il
One of the most important issues for a country, its population and doctors is the
effective use of its health system. The extensive variation in doctors' performance
leads to a tremendous waste of resources. To combat this, and at the same time
ensure that medical quality plays a role when making decisions on interventions,
it is essential to equip doctors and clinic directors with information on the quality
of the medical care they are providing. In order to assist clinic directors in
maintaining medical quality, Clalit Health Services has developed comparative
medical indices enabling doctors to compare their performance to that of their
colleagues, as well as to the standard and their performance over time. The
development of an index to evaluate the quality of medical treatment offered in
clinics provides doctors and the health system with an essential tool to lessen the
existing variation among doctors and to enhance and evaluate performance.
Publication Types:
• Review
1405: Jpn J Cancer Res. 2002 Jan;93(1):6-14.

Smoking and risk of premature death among middle-aged Japanese:

ten-year follow-up of the Japan Public Health Center-based
prospective study on cancer and cardiovascular diseases (JPHC
Study) cohort I.
Hara M, Sobue T, Sasaki S, Tsugane S.
Epidemiology and Biostatistics Division, National Cancer Center Research

Institute East, Kashiwa, Chiba 277-8577, Japan. stsugane@east.ncc.go.jp
To update the evidence on the association between smoking and mortality, we

analyzed data from a population-based prospective study in Japan. In total, 19950
men and 21534 women aged 40 - 59 who reported their smoking history and had
no serious disease at baseline survey were followed. During 1990 - 1999, 1014
men and 500 women died. Smokers were associated with an unhealthy lifestyle.
Relative risks (RRs) for selected cause of death due to smoking were slightly
attenuated by adjusting for possible confounding factors. Age- and area-adjusted
RRs of male current smokers compared with never smokers were 1.66 (95%
confidence intervals (CI): 1.40, 1.95) for all causes, 1.69 (1.31, 2.18) for all
cancers, 1.67 (1.20, 2.34) for all circulatory system disease, and 1.63 (1.24, 2.15)
for other causes, while those of females were 2.03 (1.52, 2.73), 2.06 (1.35, 3.15),
2.99 (1.75, 5.11), 1.31 (0.69, 2.51), respectively. After adjusting for multivariate
variables, the corresponding RRs of male smokers were 1.55 (1.29, 1.86), 1.61
(1.20, 2.15), 1.41 (0.97, 2.03), and 1.61 (1.17, 2.19), against 1.89 (1.36, 2.62),
1.83 (1.14, 2.95), 2.72 (1.45, 5.07), and 1.39 (0.71, 2.73) for females. Twenty-two
percent of death from all causes, 25% of all cancer, and 17% of all circulatory
system disease deaths, could be attributed to cigarette smoking in males, and 5%,
4%, and 11% in females, respectively. Cumulative dose as indicated by pack-
years was clearly associated with cancer death. These findings provided
information as to the quantitative risk for premature death due to smoking among
middle-aged Japanese men and women, and showed that the elevated risk was not
explained by the unhealthy lifestyle of smokers.
Publication Types:
1406: East Mediterr Health J. 2000 Jul;6(4):822-5.

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

[Survey on opinions among employers regarding special health

examinations in small-scale enterprises]
Tsutsui T, Horie S, Kaji H.
Department of Health Policy and Management, Institute of Industrial Ecological

Science, University of Occupational and Environmental Health, Yahatanishi-ku,
Kitakyushu 807-8555, Japan.
In order to clarify the employers' opinions regarding special health examinations

and follow-up measures, we conducted a survey targeting small-scale enterprises
that had less than fifty employees and no obligation to assign an occupational
physician. We received 354 answers, a response rate of 49.5%. More than 60% of
the employers felt that the special health examination was useful for preventing
occupational diseases and for the health promotion of employees, and 83.9% of
employers felt that the special health examinations were effective. On the other
hand, about 30% of the employers felt that it was difficult to allocate a time and
pay financial costs for special health examinations. The limited number of
employees and financial restriction might prohibit them from carrying out and
performing appropriate follow-up measures after the special health examination.
Only 21.2% of enterprises had an occupational physician, 44.7% of employers
had no information regarding the local occupational health service center, 51.4%
of employers did not request an opinion related to employee's health problems
after health examination. We concluded that it is important to build a social
system to give employers information on where and how they may find sufficient
medical resources for the effective application of the special health examination
in small-scale enterprises.
Publication Types:
1408: Journal (Inst Health Rec Inf Manag). 2001 Mar;42(1):22-4.

Oman towards electronic medical records.
Mogli GD.
Ministry of Health, Sultanate of Oman.
1409: Health Commun. 2001;13(4):387-408.

Media, audience, and policy perspectives in health broadcasting.
Sharada PV, Venkataramana C, Nirupama KR.
Reproductive and Child Health Project, Commissionerate of Family Welfare,

Government of Andhra Pradesh, Hyderabad, India.
Effective coordination between service delivery systems and communication

networks is essential for the success of development programs. This becomes
particularly crucial when the number of agencies involved is large and they are
not working under 1 authority. Information needs of the community are another
major concern. This article attempts to assess the extent of convergence between
electronic media, government policy, and the targeted audience on the coverage
of health topics. The Indian state of Andhra Pradesh was chosen as the field. The
study adopts a mix of both quantitative and qualitative techniques. The findings
reveal limited convergence, indicating the need for more effective reflection of
the policy guidelines into media programs.
1410: MMWR CDC Surveill Summ. 2001 Dec 7;50(5):1-20.

Malaria surveillance--United States, 1998.
Holtz TH, Kachur SP, MacArthur JR, Roberts JM, Barber AM, Steketee
RW, Parise ME.
Division of Parasitic Diseases, National Center for Infectious Diseases, USA.
PROBLEM/CONDITION: Human malaria is caused by one or more of four

species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum,
P. vivax, P. ovale, or P. malariae). The protozoa are transmitted by the bite of an
infective female Anopheles species mosquito. The majority of malaria infections
in the United States occur among persons who have traveled to areas with
endemic transmission. Cases occasionally occur that are acquired through
exposure to infected blood products, by congenital transmission, or by local
mosquitoborne transmission. Malaria surveillance is conducted to identify
episodes of local transmission and to guide prevention recommendations for
travelers. REPORTING PERIOD: Cases with an onset of symptoms during 1998.
DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are
reported to local and state health departments by health-care providers and
laboratory staff members. Case investigations are conducted by local and state
health departments, and reports are sent to CDC through the National Malaria
Surveillance System (NMSS). This report uses NMSS data. RESULTS: CDC
received reports of 1,227 cases of malaria with onsets of symptoms in 1998,
among persons in the United States and its territories. This number represents a
decrease of 20.5% from the 1,544 cases reported during 1997. P. falciparum, P.
vivax, P. malariae, and P. ovale were identified in 42.8%, 37.8%, 3.5%, and 2.1%
of cases, respectively. More than one species was present in seven patients (0.6%
of total). The infecting species was not determined in 162 (13.2%) cases.
Compared with reported cases in 1997, reported malaria cases acquired in Africa
increased by 1.3% (n = 706); those acquired in Asia decreased by 52.1% (n =
239); and those acquired in the Americas decreased by 6.5% (n = 229). Of 636
U.S. civilians who acquired malaria abroad, 126 (19.8%) reportedly had followed
a chemoprophylactic drug regimen recommended by CDC for the area to which
they had traveled. Five persons became infected in the United States. One case
was congenitally acquired; one was acquired by blood transfusion; and three were
isolated cases that could not be epidemiologically linked to another case. Four
deaths were attributed to malaria. INTERPRETATION: The 20.5% decrease in
malaria cases during 1998 compared with 1997 resulted primarily from decreases
in P. vivax cases acquired in Asia among non-U.S. civilians. This decrease could
have resulted from local changes in disease transmission, decreased immigration
from the region, decreased travel to the region, incomplete reporting from state
and local health departments, or increased use of effective antimalarial
chemoprophylaxis. In a majority of reported cases, U.S. civilians who acquired
infection abroad had not taken an appropriate chemoprophylaxis regimen for the
country where they acquired malaria. PUBLIC HEALTH ACTIONS TAKEN:
Additional information was obtained from state and local health departments and
clinics concerning the four fatal cases and the five infections acquired in the
United States. Persons traveling to a malarious area should take a recommended
chemoprophylaxis regimen and use personal protection measures to prevent
mosquito bites. Any person who has been to a malarious area and subsequently
develops fever or influenza-like symptoms should seek medical care immediately;
the investigation should include a blood smear for malaria. Malaria infections can
be fatal if not diagnosed and treated promptly. Current recommendations
concerning prevention and treatment of malaria can be obtained from CDC.
Publication Types:
• Case Reports
1411: Indian J Pediatr. 2001 Nov;68(11):1047-50.

National Family Health Survey and children.
Dwivedi SN, Sundaram KR.
Department of Biostatistics, All India Institute of Medical Sciences, Ansari

Nagar, New Delhi, India. dwivedi7@hotmail.com
This article aims to describe the National Family Health Survey (NFHS) being
carried out in India with its first round during 1992-93 (NFHS-I) and second
round during 1998-99 (NFHS-II), with special reference to information available
in relation to children. The survey was on lines of the existing systems of
Demographic Surveys (DHS) in various developed as well as developing
countries. Another important objective of the survey was to provide quality data
to the researchers to carry out analytical work on various aspects. Further, the
survey has paved the way to carry out comparative studies not only between states
in India but also between countries. An attempt has also been made here to
present salient features of comparative results under NFHS-I and NFHS-II.
1412: Kekkaku. 2001 Nov;76(11):707-13.

[Medical treatment support to tuberculous patients--from the

standpoint of community support]
[No authors listed]
A symposium with "Medical Treatment Support to Tuberculous Patients--From

the standpoint of community support" as its theme was held at the 76th Annual
Meeting of the Japanese Society for Tuberculosis (April 20, 2001). "Once, It is
infected with tuberculosis, one have to complete medication with a sensitive
antituberculosis drug by observing the prescribed dose and duration for successful
treatment". For this to be promoted community, it is necessary that (1) to manage
patient's medication by medical facilities, (2) to support patient's medication by
health center and (3) to support patient's living by welfare offices. Not that each
facilities takes such responsibilities alone, but various community must fulfill
them continuously in liaison with one another. On what measures should be taken
to that end, reports based on practical examples from Nagoya City, Yokohama
City and Kanagawa Prefecture have been compiled as follows. 1. It was in-office
liaison by conference that supported the DOTS activities of health nurses. 2. It is
cooperating, without health, medical treatment, and welfare going out, as follows.
(1) A system for hospitals and clinics to carry out DOTS treatment consistently
has been kept in good condition. (2) For a patient to take a drug in front of a nurse
has become common, causing the patients to be motivated. (3) Assignment of
MSW and nurses in charge of DOTS sent from hospitals has make it possible to
offer or exchange information smoothly among those concerned. (4) A system for
many persons concerned to support patients timely has been kept in good
condition. This resulted in an increase in the cure rate of tuberculosis in the areas
which have day laborers' lodgings. 3. By DOTS for in-patients, the number of
self-discharges has decreased by 1/3, and the treatment completion rate was 94%.
4. In promotion of DOTS for the patients who have health problems other than
tuberculosis, the role MSW plays is great. 5. As conditions for supporting DOTS
promotion, it is necessary to create a system by which to stabilize the living of the
patient himself, guarantee earnings to support it and dissolve the living problem
faced by the patient. 6. Introduction of the "early guidance system for the patients
in whom the treatment of tuberculosis" was discontinued has strengthened the
liaison between health offices and medical facilities, has led to early detection in
persons yet to receive medical treatment and resumption of medical treatment,
making it possible to deal with problem cases effectively on a priority basis. It has
been confirmed that liaison between health, medical service and welfare for
community support of the treatment of tuberculous patients who live in that
community resulted in improvement of clinical results of tuberculous patients. In
this connection, Dr. Shirai advised "For a tuberculous patient to form a habit of
taking a drug wherever he lives needs to be recognized as a major subject". He
presented the forcible yell. "Any local government office has the homeless. I want
you to make efforts so that DOTS be given to all the tuberculous persons. If there
is any problem, I am ready to give advice."
Publication Types:
1413: Ind Health. 2001 Oct;39(4):341-5.

Relationships between chemical structures and mutagenicity: a

preliminary survey for a database of mutagenicity test results of new
work place chemicals.
Sawatari K, Nakanishi Y, Matsushima T.
National Institute of Industrial Health, Kawasaki, Japan.
A database of mutagenicity test results of new chemicals has been developed.

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

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

Comment in:
• Obes Res. 2001 Dec;9(12):806-9.
Association of BMI with the beta3-adrenergic receptor gene

polymorphism in Japanese: meta-analysis.
Kurokawa N, Nakai K, Kameo S, Liu ZM, Satoh H.
Department of Environmental Health Sciences, Tohoku University Graduate

School of Medicine, Sendai, Japan. n-kuro@ehs.med.tohoku.ac.jp
OBJECTIVE: To assess the effect of the Trp64Arg polymorphism in the beta3-

adrenergic receptor gene (ADRB3) on body mass index (BMI) in the Japanese
population. RESEARCH METHODS AND PROCEDURES: We selected studies
that evaluated the association between BMI and ADRB3 polymorphism among
Japanese, using MEDLINE and PubMed. After data collection, an extension of
ANOVA was performed to assess the differences according to the genotype.
RESULTS: In a total of 35 subgroups including 2316 subjects with the Trp64Arg
variant and 4266 subjects without this variant, the weighted mean difference in
BMI was 0.26 kg/m(2) (95% confidence interval: 0.18 to 0.42; p < 0.01),
indicating that variant carriers exhibited higher BMI than did normal homozygous
subjects. DISCUSSION: Although it is known that the allele frequency of the
ADRB3 polymorphism differs among races, this study focuses on the Japanese
population, which has a high allele frequency of ADRB3 polymorphism. We
assumed that statistical errors would be prevented due to the sufficient number of
subjects. In conclusion, the results support the hypothesis that ADRB3 gene
polymorphism is associated with BMI.
Publication Types:
• Meta-Analysis
1416: Health Policy Plan. 2001 Dec;16(4):412-20.

Determining the full costs of medical education in Thai Binh,

Vietnam: a generalizable model.
Bicknell WJ, Beggs AC, Tham PV.
Department of International Health, Boston University School of Public Health,

Boston, MA 02118, USA.
We summarize a model for determining the full cost of educating a medical

student at Thai Binh Medical School in Vietnam. This is the first full-cost analysis
of medical education in a low-income country in over 20 years. We emphasize
policy implications and the importance of looking at the educational costs and
service roles of the major health professions. In Vietnam fully subsidized medical
education has given way to a system combining student-paid tuition and fees with
decreased government subsidies. Full cost information facilitates resource
management, setting tuition charges at a school and adjusting budget allocations
between medical schools, teaching hospitals, and health centres. When linked to
quality indicators, trends within and useful comparisons between schools are
possible. Cost comparisons between different types of providers can assist policy-
makers in judging the appropriateness of expenditures per graduate for nursing
and allied health education versus physician education. If privatization of medical
education is considered, cost analysis allows policy-makers to know the full costs
of educating physicians including the subsidies required in clinical settings. Our
approach is intuitively simple and provides useful, understandable new
information to managers and policy-makers. The full cost per medical graduate in
1997 was 111 462 989 Vietnamese Dong (US$9527). The relative expenditure per
Vietnamese physician educated was 2.8 times the expenditure in the United States
when adjusted for GNP per capita. Preliminary findings suggest that, within
Vietnam, the cost to educate a physician is 14 times the cost of educating a nurse.
Given the direct costs of physician education, the lifetime earnings of physicians
and the costs that physicians generate for the use of health services and supplies,
it is remarkable that so little attention is paid to the costs of educating physicians.
Studies of this type can provide the quantitative basis for vital human resource
and health services policy considerations.
Publication Types:
1417: J Adv Nurs. 2001 Dec;36(5):676-84.

The effects of postpartum stress and social support on postpartum

women's health status.
Hung CH, Chung HH.
College of Nursing, Kaohsiung Medical University, Taiwan.

chich@nursing.upenn.edu
BACKGROUND: Eastern sociocultural systems differ in many ways from

Western ones, and these differences influence many aspects of the postpartum
period. AIM: The purpose of this study was to determine postpartum women's
health status in the wider social context of the Taiwanese family after women
return home from the hospital or clinic. METHOD: A longitudinal study was
conducted with data collected at the first, the third, and the fifth weeks of the
postpartum period. Five hundred and twenty-six postpartum women were
included in the study using stratified sampling from clinics and hospitals in
Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress
Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health
Questionnaire were used to obtain information about the women's postpartum
stress, social support, and health status at each time point. Data were analysed
with factor analysis, repeated measures MANOVA, and multiple logistic
regression. RESULTS: Three factors associated with postpartum stress were
identified by factor analysis: (1) maternity role attainment, (2) lack of social
support, and (3) body changes. Furthermore, the level of postpartum stress at the
third and the fifth postnatal weeks was higher than at the first. Social support
scores at this postnatal week were the highest among the three points in time. In
addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks,
respectively, had minor psychiatric morbidity. CONCLUSIONS: Because the
postpartum women's self-reported stress is relatively low whereas the social
support is relatively high, especially from the family, this confirms Pillsbury's
conclusion regarding the significance of social support during the Chinese
women's postpartum period. The study also showed that the three factors
associated with postpartum stress were important predictors of postpartum
women's health status. Future studies should compare the level of postpartum
stress, social support, and women's health status in both Western and Eastern
cultures.
Publication Types:
1418: Med J Malaysia. 2001 Sep;56(3):350-8.

Quality of life--how do Malaysian asthmatics fare?
Sararaks S, Rugayah B, Azman AB, Karuthan C, Low LL.
Health Systems Research Division, Institute of Public Health, 50590 Kuala

Lumpur.
Asthma can place considerable restrictions on the physical, emotional and social
aspects of the lives of patients. The assessment of quality of life aims to provide a
means of measuring the impact of this disease on patients' lives, from the patients'
perspective. A cross sectional multi-centre study was conducted in six
government hospitals throughout the country. Self-administered SF-36 was used,
and clinical information obtained through interviews and examination. 1612
asthmatics responded. Females constituted 63% of the respondents; mean age was
40.9 years; Malays were the majority ethnic group, while 70.8% had secondary
level education and 53.7% were employed. Half had suffered from asthma for at
least 13 years, while 46.8% and 23.6% have moderate and severe disease
respectively. Quality of life was affected by severity of disease. Asthmatics, had a
significantly poorer quality of life than the general US population. Severe asthma
disease was associated with a compromised quality of life, similar to that of
COPD.
Publication Types:
1419: IHRIM. 2000 Jan;41(1):19.

Health Management Strengthening Project. West Bank and the

Gaza strip.
Nicholson L.
1420: Ann Acad Med Singapore. 2001 Jul;30(4 Suppl):13-6.

Funding and future diagnosis related group development.
Vertrees JC.
PURPOSE: Diagnosis Related Groups (DRGs) are widely used for a variety of
purposes including quality improvement, hospital output measurement and
funding. DRGs are a patient classification scheme which provides a means of
relating the type of patients a hospital treats (i.e., its casemix) to the costs incurred
by the hospital. This is done by classifying patients into mutually exclusive
groups based on the patient's principal diagnosis and other information. The
original Health Care Financing Administration DRGs (HCFA DRGs) have been
in use since 1982. This document provides an overview of future directions for
the newer DRG systems and it provides a framework for understanding the use of
DRGs for funding. FUTURE DIRECTIONS: Newer DRG systems incorporate
explicit adjustment for severity of illness, include separate measures for the
likelihood of mortality, and are more independent of the underlying coding
systems (e.g., ICD-10 for diagnoses, ICD-9-CM for procedures). THE
FRAMEWORK: The framework for a casemix-based budgeting system consists
of five basic aspects. They are: 1) Categories--which kind of DRG will be the
basis for the casemix system; 2) Relative Weights--relative weights reflect the
expected cost of a case in one DRG relative to the expected cost of the average
patient; 3) Base Rates/Pricing--the base rate converts the relative values to prices
or budgets; 4) Adjustments--adjustments account for exogenous factors; 5)
Transition Policy--this provides time so hospital administrators can learn to
respond to the incentives contained in the DRG system.
1421: J Med Internet Res. 2001 Jan-Mar;3(1):E12.

Internet medical usage in Japan: current situation and issues.
Tatsumi H, Mitani H, Haruki Y, Ogushi Y.
Department of Anatomy, Sapporo Medical University, Sapporo, 060-8556, Japan.

tatsumi@sapmed.ac.jp
Internet use by physicians and patients has become very popular in Japan. Fifty
percent of physicians use the Internet to search for medical and other information.
Over the past year, 22% of patients used the Internet to obtain medical
information. Because there are no restrictions within Japan on using Web sites to
advertise medical treatment, information can be freely sent out, and over the past
two or three years this practice has increased dramatically. Internet medical
information provides information about illnesses and medications, and it helps
improve the quality of life of patients and families. Yet, depending on the content
of the information provided and the way this information is used, there is a
potential negative side as well. On principle, users are responsible for the way
information is used, but there is a need for information providers to consider users
safety and to make the information effective for use. Because there is no absolute
standard for evaluating the value of medical information, it is necessary to
establish a system that opens a dialogue with society and that continuously
accumulates high-quality information through the collection of various
evaluations, rather than rely on an established authority. For industries and
organizations related to commercial pursuits, in particular, it is most effective to
establish their own codes for ethical conduct, rather than rely on governmental
regulations. At the same time, it is important to have a confirmation function to
evaluate how goals set by the outside are being implemented. Aiming at
establishing a framework for the Internet medical usage, the Japan Internet
Medical Association (JIMA) was founded in 1998 by medical professionals,
lawyers, researchers, consumer representatives, patients and their families. We
propose a system that would combine feedback from users, who would take on
the role of evaluators of the implementation of an ethical code, with a displayed
mark that verifies the identity of the Web site. Objective evaluation of
information is needed to ensure that users have the power to make choices.
Medical experts or patient and family groups would assist in this task. The
development of medical care will be promoted through patients and physicians
working together in the accumulation of shared resources for good medical care
information.
Publication Types:
PMCID: PMC1761890
1422: J Interprof Care. 2001 Aug;15(3):215-21.

Changing systems in health and social care for older people in

Japan: observations and implications for interprofessional working.
Tompsett H.
Faculty of Health and Social Care Sciences, St George's Hospital Medical

School/Kingston University, Kenry House, Kingston Hill, KT2 7LB, UK.
h.tompsett@hcs.sghms.ac.uk
The impact of a rapidly ageing population on the development of insurance

policies and health and social care services of older people is a major concern in
Japan. The discussion in this paper draws on information gained from recent visits
to leaders of these services in Japan. The paper briefly reviews the policy and
demographic background to recent legislative changes in the long-term care
insurance system, models of care management and assessment and outstanding
challenges for health and social care professionals. Some key issues have emerged
with implications for interprofessional working, such as the lack of integrated care
systems, contradictions within the scope and responsibilities of care management,
and the absence of quality and ethical frameworks to safeguard the interests of the
service user and carer.
Publication Types:

• Review

1423: J Med Invest. 2001 Aug;48(3-4):198-209.
The development of a pollen information system for the

improvement of QOL.
Moriguchi H, Matsumoto M, Nishimoto Y, Kuwada K.
Division of Medical Informatics, University Hospital, University of Tokushima

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

Evaluation of a comprehensive home-based midwifery programme

in South Kalimantan, Indonesia.
Ronsmans C, Endang A, Gunawan S, Zazri A, McDermott J, Koblinsky M,

Marshall T.
Department of Infectious and Tropical Diseases, London School of Hygiene and

Tropical Medicine, London, UK. carine.ronsmans@lshtm.ac.uk
We report the findings of an evaluation of a programme in three districts in South

Kalimantan, Indonesia, which consisted of the training, deployment and
supervision of a large number of professional midwives in villages, an
information, education and communication (IEC) strategy to increase use of
village midwives for birth, and a district-based maternal and perinatal audit
(MPA). Before the programme, the midwives had limited ability to manage
obstetric complications, and 90% of births took place at home. Only 37% were
attended by a skilled attendant. By 1998-99, 510 midwives were posted in the
districts and skilled attendance at delivery had increased to 59%. Through in-
service training, continuous supervision and participation in the audit system
midwives also gained confidence and skills in the management of obstetric
complications. Despite this, the proportion admitted to hospital for a caesarean
section declined from 1.7 to 1.4% and the proportion admitted to hospital with a
complication requiring a life-saving intervention declined from 1.1% to 0.7%.
The strategy of a midwife in every village has dramatically increased skilled birth
attendance, but does not yet provide specialized obstetric care for all women
needing it. The high cost of emergency obstetric interventions may well be the
most important obstacle to the use of hospital care.
Publication Types:
1425: Am J Hum Genet. 1999 Feb;64(2):335-8.

Eugenics and the misuse of genetic information to restrict

reproductive freedom: ASHG statement.
American Society of Human Genetics. Board of Directors.
Publication Types:
• Guideline
PMCID: PMC1377741
1426: Dentomaxillofac Radiol. 2001 Nov;30(6):336-41.

Management of oral and maxillofacial radiology clinics in Taiwan's

dental schools.
Chen SK, Chien HH, Lin L.
School of Dentistry, College of Medicine, National Taiwan University, Taipei,

Chinese Taipei. cskchen@ccms.ntu.edu.tw
OBJECTIVES: To investigate management of Taiwanese dental school Oral and

Maxillofacial Radiology (OMFR) clinics and to suggest alternative management
strategies. METHODS:A management questionnaire was designed for the faculty
responsible for teaching the Oral and Maxillofacial Radiology curriculum.
RESULTS: Data from all seven Taiwanese schools indicated inadequate
supervision of the prescription of radiological examinations in the absence of
guidelines. Most schools are understaffed and not properly equipped. There is a
significant shortage of trained dentists in the field of OMFR. In some schools no
dentist is involved in the management of OMFR clinics. Some aspects of quality
assurance procedures should be enhanced. An average of 21.4% of films were
reported lost, with the highest rate at 40%, demonstrating serious problems in
image archiving. Clinician satisfaction with clinic management averaged 74.3%,
with a minimum of 50%. CONCLUSION: A set of standards is recommended by
the Taiwanese OMFR Association after reviewing the survey findings.
Prescription for OMFR examination should be supervised by licensed clinicians,
and there is a need for guidelines. Trained and dedicated personnel should be
assigned for the management of OMFR clinics. More quality assurance
procedures should be performed. A computer-based image archiving system is
desirable.
1427: Stud Health Technol Inform. 2001;84(Pt 1):849-53.

EMR-based TeleGeriatric system.
Pallawala PM, Lun KC.
School of Computing, National University of Singapore, Singapore, 119260,

Singapore. pererapa@comp.nus.edu.sg
INTRODUCTION: As medical services improve due to new technologies and

breakthroughs, it has lead to an increasingly aging population. There has been
much discussion and debate on how to solve various aspects such as
psychological, socio-economic and medical problems related to aging. Our effort
is to implement a feasible telegeriatric medical service with the use of the state of
the art technology to deliver medical services efficiently to remote sites where
elderly homes are based. The TeleGeriatric system will lead to rapid decision-
making in the presence of acute or subacute emergencies. This triage will also
lead to a reduction of unnecessary admission. It will enable the doctors who visit
these elderly homes once a week basis to improve their geriatric management
skills by communication with geriatric specialist. Nursing skills in the geriatric
care will also benefit from this system. Integrated electronic medical record
(EMR) system will be indispensable in the face of emergency admissions to
hospitals. Evolution of EMR database would lead to future research in
telegeriatrics and will help to identify the areas where telegeriatrics can be
optimally used. METHODOLOGY: This system is based on current web
browsing technology and broadband communication. The TeleGeriatric web
based server is developed using Java Technology. The TeleGeriatric database
server was developed using Microsoft SQL server. Both are based at the Medical
Informatics Programme, National University of Singapore. Two elderly homes
situated in the periphery of Singapore and a leading government hospital in
geriatric care have been chosen for the project. These 3 institutions and National
University of Singapore are connected via ADSL protocol. ADSL connection
supports high bandwidth, which is necessary for high quality videoconferencing.
Each time a patient needs a teleconsultation a nurse or a doctor in the remote site
sends the patient's record to the TeleGeriatric server. The TeleGeriatric server
forwards the request to the Alexandra Hospital for consultation. Geriatrics
specialists at the Alexandra Hospital carry out teleward rounds twice weekly and
on demand basis. SUMMARY OF RESULTS: Following the implementation of
the system, a trial run has been done. Total results have demonstrated a high
degree of coordination and cooperation between remote site and the Alexandra
Hospital. Also the patient compliance is very high and they prefer
teleconsultation. CONCLUSION: Initial results show that the TeleGeriatric
system has definite advantages in managing geriatric patients at a remote site. As
the system evolves, further research will show the areas where telegeriatrics can
be used optimally.
Publication Types:
1428: Stud Health Technol Inform. 2001;84(Pt 1):724-6.

Community health information and its management system: a new

form for the next century.
Din BF, Wu LP, Zhang Y.
Department of Information, Nanjing Chest Hospital, Nanjing Jiangsu, 210029,

China. Cshi@njutcm.edu.cn
The development of community health service brings a new branch of Medical

Informatics, Community health care informatics and a new management system,
Community Health Care Information System in the beginning of nest century.
The paper first advance and explore this new concept. It states the focus of
Community health care informatics as the promotion of health for the whole
community. It not only gives treatment to individual patients through ways of
disease management and information network, but also improves health condition
of the whole community by "diagnosis of community health" and "prescription
for community health". The paper also introduces the community health
information system and its formation, technology, function and practical use,
pointing out the crucial point of its research work to be precisely discovering the
"information origin" and "three-in-one" working group.
1429: Comput Biol Med. 2001 Nov;31(6):513-23.

A model approach to sharing electronic medical records between

and within the state hospitals in Turkey.
Güler I, Müldür S.
Electronics & Computer Education Department, Faculty of Technical Education,

Gazi University, 06500 Teknikokullar, Ankara, Turkey. iguler@tef.gazi.edu.tr
It has always been a research interest to solve hospital management problems with
systematic approach by using modern management tools. Almost all the Hospital
Information System (HIS) software packages in Turkey keep track of local
transactions in administrative activities and material flow. In state hospitals in
Turkey, very little medical information is processed and most of the records are
still kept manually and archived on papers.In this paper, a cost-effective, flexible
and easy-to-use Hospital Information System model is proposed in order to give
better diagnostic and treatment services. It is also demonstrated that this model
makes it possible to exchange information between and within the hospitals over
Transmission Control Protocol/Internet Protocol (TCP/IP) network. User needs
are taken into consideration during model development and the benefits of model
implementation to the hospital administration are stated. According to the model
proposed in this paper, only a single health care record number (HCRN) is
required for a patient to access all her/his medical records stored in different
locations, from any state hospital in Turkey.
1430: Patient Educ Couns. 2001 Oct;45(1):59-68.

Client communication behaviors with health care providers in

Indonesia.
Kim YM, Kols A, Bonnin C, Richardson P, Roter D.
Center for Communication Programs, Johns Hopkins University, Suite 310, 111
Market Place, Baltimore, MD 21202-4024, USA. ykim@jhuccp.org
Patient participation in health care consultations can improve the quality of

decision making and increase patients' commitment to the treatment plan. This
study examines client participation, operationally defined as client active
communication, during family planning consultations in Indonesia. Data were
collected on 1203 consultations in the provinces of East Java and Lampung.
Sessions were audiotaped and the conversation coded using an adaptation of the
roter interaction analysis system (RIAS). Culturally acceptable ways for
Indonesian clients to participate in consultations include asking questions,
requesting clarification, stating opinions, and expressing concerns. Factors
significantly associated with client active communication were, in order of
importance, providers' information giving, providers' facilitative communication,
providers' expressions of negative emotion, client educational level, and province.
The latter suggests the influence of culture on client participation. The results
suggest that a combination of provider training and client education on key
communication skills could increase client participation in health care
consultations.
Publication Types:

1431: Biomed Environ Sci. 2001 Jun;14(1-2):98-103.

Fortification challenges and needs.

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

Perspectives on nutrition needs for the new millennium for South

Asian regions.
Krishnaswamy K.
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad,

AP, India.
South Asia is the most populated region of the world with several nutritional
challenges. Though per capita food energy supply, child survival and life
expectancy have improved, and even today large segments of the population are
below the poverty line with high infant and maternal mortality rates. It is
important to recognize the crucial role of nutrition throughout the life cycle-from
conception to old age. It is very necessary now to move from food security to
nutrition security and improve the quality of foods both in macro- and
micronutrients in order to break the transgenerational effects of malnutrition. The
key solutions to the problems should address the issue of social development,
population stabilization, environmental degradation and inadequate health and
nutritional services. Strategies for empowering women and actuating community
participation as sustainable programmes for human development, measures to
reduce underweight and stunting in children and prevention of micronutrient
malnutrition across the population are required. Enhancing food and nutrition
security through innovative diversified agriculture and dietary practices,
prevention and control of infection, promotion of food safety and fortification of
staples with appropriate attention on emerging chronic disorders are essential.
Population control measures to stabilize the fertility rates, biotechnological
approaches for genetically modified foods, nutrition surveillance based on
assessment, analysis and action to address the logistic, technical and compliance
issues with emphasis on promotion of breast feeding and complementary foods
with adequate attention on the reproductive needs of adolescent girls, pregnant
mothers and lactating women would eliminate low birth weight, stunting, and
chronic energy deficiency in vulnerable groups. Focused studies on bioavailability
of micronutrients and its enhancement, innovative horticulture interventions,
fortifications, social marketing strategies would promote the intake of
micronutrient and phytonutrient rich foods. In-depth epidemiological research, an
insight into foetal origins of adult disease and nutrition-genes interaction and life
style alterations will avert the emerging epidemic of chronic diet related disorders.
An investment in preventing foetal malnutrition improves nutrition of women in
reproductive age, infant and child nutrition and prevents the onset of chronic
disease in adult life. Human resource development, IEC measures, technology
transfer, operational and logistic research, building of databases, integrated,
intersectoral, multidisciplinary plans and sound management information system
and surveillance with net working and experience sharing in the region will help
to overcome the common challenges and lay the foundation for a better scenario
in these regions in the near future.
1433: Psychiatr Clin North Am. 2001 Sep;24(3):421-31.

From diversity to unity. The classification of mental disorders in

21st-century China.
Lee S.
Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong,

China.
Psychiatric disease constructs represent social constructs and genuine states of

distress that have biopsychosocial sources. As such, they have social uses peculiar
to the social groups in which they are created and legitimized. This is as true in
the United States as in the rest of the world. The DSM schema, for instance, is so
organized that every possible mental condition is listed as a disease to legitimate
remuneration to practitioners from private medical insurance and government
programs. This particular social use may be irrelevant to other societies where
health care is financed differently. The CCMD-3 system represents an attempt at
global unification and preservation of features that are salient for local
application. Compared with its previous editions, noticeable changes have been
made to render it in tune with international usage. This remarkable speed of
adaptation speaks to the global flows of information technology and China's
openness under rapid economic reform. It also demonstrates that the middle-aged
cohort of more pragmatic Chinese psychiatric leaders who headed the CCMD-3
task force are now less vulnerable to the domination of the most senior generation
of Chinese psychiatrists. Having been trained in the Russian system of psychiatry
and gone through the various periods of national shame that traumatized China,
they used to be very cautious about adopting foreign technology in general. This
is why much less harmonization with the ICD-10 occurred with the CCMD-2-R,
when the responsible task force was, for better or worse, dominated by these
senior psychiatrists. Nonetheless, as Stengel and Sartorius remarked, an
international classification must not aim to oust or replace regional classifications
that serve valuable functions in the local contexts. No single classificatory system,
Kirmayer submits, will suffice for all purposes--the correct diagnostic scheme is
the one that accomplishes its explicit pragmatic aim by addressing the relevant
level of description. The particular additions (e.g., travelling psychosis, culture-
related mental disorders), deletions (e.g., depressive neurosis, pathologic
gambling, avoidant and borderline personality disorders), retentions (e.g.,
unipolar mania, neurosis, hysteria, homosexuality), and epistemologic variations
(e.g., somatoform disorder, neurasthenia) of diagnostic categories reflect exactly
this simultaneous need to globalize and to take account of the changing reality of
illness in contemporary China. Stengel advised that "no psychiatric classification
can help being partly etiological and partly symptomatological, because these are
the criteria by which psychiatrists distinguish mental disorders from each other."
To an extent, the CCMD-3 is a critique of certain nosologic assumptions of
Western psychiatry, such as the feasibility of a neo-Kraepelinian taxonomy
grounded exclusively in symptomatology across all diagnostic categories, and the
validity of syndromic architectures based on a firm adherence to the mind-body
dichotomy. From this angle of vision, local systems of classification such as the
CCMD-3 may offer an opportunity for needed reflections by North American
psychiatrists who have simply taken the DSM-IV schema for granted. Sartorius
reckoned that a classification is a way of seeing the world at a point in time. A
deep study of the CCMD-3 is thus an avenue for achieving an understanding of
the contemporary Chinese mind and the social realities in China. The remarkable
diversity of China at present, namely, a Communist Party dominated state
socialist political structure but the most rapidly growing capitalist economy in the
world, guarantees that Chinese people's social and moral experience of illness will
continue to change. The study of such culture-specific categories as travelling
psychosis, neurasthenia, qigong-induced mental disorder, and dysfunctional
homosexuality sheds light on the larger sociomoral processes and destabilizing
changes in subjectivity that are occurring in this most populous country in the
world.
Publication Types:
1434: Saudi Med J. 2001 Sep;22(9):743-8.

Global directions for reforming health systems and expanding

insurance. What is suitable for the Arab Gulf countries?
Banoob SN.
College of Public Health, University of South Florida, Tampa, Florida 33612-

3805, United States of America.
Most countries are exploring and implementing reforms of their health care
systems. The Arab countries in the Gulf are no exception after establishing
modern governmental health care systems accessible to all and free of charge.
Current problems of the Arab systems include financial, managerial and quality
issues. The private sector in these countries has no defined national role and is
gowing abruptly and unplanned. The paper presents the major global health
reform directions, analyzing the current activities in the Arab Gulf countries and
proposing certain practical relevant approaches for health reform, and expansion
of insurance in these activites.
Publication Types:
• Review
1435: Science. 2001 Oct 5;294(5540):82-5.

So many choices, so little money.
Pennisi E.
Publication Types:
• News
1436: J Adv Nurs. 2001 Oct;36(2):270-3.

Chinese values, health and nursing.
Chen YC.
Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, Taiwan, Republic
of China. ycchen@vghtpe.gov.tw
PURPOSE: To describe the roots of Chinese values, beliefs and the concept of
health, and to illustrate how these ways have influenced the development of
health care and nursing among Chinese in the Republic of China (ROC) and the
People's Republic of China (PRC). Scope. Based on the literature and direct
observation in the PRC and ROC, this is an introduction to Chinese philosophies,
religion, basic beliefs, and values with a special meaning for health and nursing.
Chinese philosophies and religion include Confucian principles, Taoism, theory
of "Yin" and "Yang", and Buddhism. Beliefs and values include the way of
education, practice of acupuncture, herbal treatments and diet therapy. How
people value traditional Chinese medicine in combination with western science,
and the future direction of nursing and nursing inquiry are also briefly addressed.
CONCLUSION: Chinese philosophies and religions strongly influence the
Chinese way of living and thinking about health and health care. Nurses must
combine information about culture with clinical assessment of the patient to
provide cultural sensitive care. A better way may be to combine both western and
Chinese values into the Chinese health care system by negotiating between the
traditional values while at the same time, respecting an individual's choice. The
foundation of China's philosophical and aesthetic tradition, in combination with
western science is important to the future advancement of nursing research that
will be beneficial to the Republics, Asia, and the world.
Publication Types:
• Review
1437: Nippon Koshu Eisei Zasshi. 2001 Aug;48(8):613-9.

[An attempt to estimate geographical accessibility to day service

facilities among the elderly with a geographical information system]
Kitajima T, Kitazawa T, Ing CK, Noyama O.
Department of Health Administraton School of Health Sciences, Kyorin

University.
OBJECTIVE: The objective of this study was to assess inequality in geographical

accessibility to day service among the elderly in a municipality using a
geographical information system (GIS). We also examined problems in measuring
geographical accessibility and ways to validate results. METHODS: The target
was Hachioji City. The following two data sets were constructed: a data set for
day service facilities for all of Hachioji City and a data set for the people aged 65
and over, living within 1 km meshes in Hachioji City. These were integrated and
displayed on a digital map with GIS software. Geographical accessibility was
estimated by measuring the shortest road distance from the center point of each
mesh to day service facilities. RESULTS: There were 47 day service facilities
serving Hachioji City in October, 2000 and 139 meshes that had elderly residents.
Their center points were all located within Hachioji City, which was estimated to
have 73,760 elderly in 2000. The mean distance from the center point of each
mesh to the nearest day service facility was 1.99 km (SD = 1.75, max = 9.21, min
= 0.03). The proportions of the elderly who had 5 or more facilities within 3 km
and 5 km from their residence were estimated to be 57.3% and 96.4%,
respectively. CONCLUSIONS: The results of this study suggest that there is
variation in geographical accessibility to day service facilities among the elderly
living in a relatively large municipality. It is now necessary to examine whether
the difference in geographical accessibility to day service affects the service
utilization.
Publication Types:
1438: Ann Pharmacother. 2001 Sep;35(9):1122-9.

Infrastructure of pharmaceutical research and development in
Japan.
Ono S, Kodama Y, Nagao T.
National Institute of Health Sciences, Ministry of Health and Welfare, Tokyo,

Japan. shunono@pep.ne.jp
OBJECTIVE: To examine the roles of different types of hospitals in

implementation of multicenter Phase II/III trials in Japan, specifically focusing on
two dichotomies: public versus private, and academic versus nonacademic.
Possible explanation was sought as to why a hospital of one category was more
likely to participate in specific types of trials in the Japanese medical
environment. METHODS: A database containing attributes of published clinical
trials (n = 217) was established from four journals featuring reports of clinical
trial results. The preferences of public and academic hospitals for specific types of
trials were estimated by applying a linear regression model. The trial
compositions of these institutions were also estimated, taking the actual
prevalence of trials in 1995 into consideration. RESULTS: Public sector hospitals,
which were established for particular policy purposes in the national healthcare
system, were more likely to accept trials in some fields (e.g., cardiovascular
diseases, anesthesiology, antineoplastics, pediatrics) and of some kinds (e.g.,
Phase II rather than Phase III trials, trials supervised by the principal investigator
in the public sector). Academic hospitals also showed preferences for some types
of trials (e.g., cardiovascular diseases, dermatology; Phase II rather than Phase III
trials). The analysis focusing on public hospitals suggested that policy purposes
were achieved at least in some fields such as antineoplastics and anesthesiology.
CONCLUSIONS: Japanese clinical trials were unevenly distributed between
public and private sectors, and also between academic and nonacademic sectors.
These data provide fundamental information about the clinical research
environment for future pharmaceutical research and development strategies and
policies.
Publication Types:
• Review
1439: Int Dent J. 2001 Aug;51(4):313-24.

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

comparative study.
Johnson PM.
PMJ Consultants, Toronto, ON, Canada. patjpmjc@sympatico.ca
AIM: Development of an international longitudinal database to examine patterns,

trends and changes in dental hygiene. METHOD: Three surveys of national dental
hygienists' associations, mainly members of the International Federation of Dental
Hygienists. Data were collected by mail in 1987, 1992 and 1998, using a 40-item
questionnaire. Sample size increased over time; results presented are based on
responses for 13, 15 and 19 countries respectively. Preliminary tabulations were
circulated to respondents for validation. RESULTS: Overall, characteristics of the
profession were remarkably similar; most noteworthy was the scope of dental
hygiene clinical practice. Regarding historical development, education and
professional organisation, the profession was more similar than dissimilar.
Greater variation was evident in terms of numbers, distribution, workforce
behaviour, predominant work setting and remuneration. While apparent change
over the relatively short period 1987 to 1998 was viewed with caution, several
observations were of particular interest: marked increases in the supply of dental
hygienists, scope of practice and range of practice settings, accompanied by a
decline in mandated level of work supervision. A slight but gradual increase in
independent dental hygiene practice also was noted. CONCLUSION: By 1998 the
profiles reflected the vast majority of the world's population of dental hygienists.
While rate of change varied across the countries examined, the nature of the
change tended to be consistent, resulting in a continuing homogeneity in the
profession worldwide. Changes and emerging trends should continue to be
monitored in terms of improved access to quality oral health services and
technical efficiency in the provision of those services.
Publication Types:
1440: J UOEH. 2001 Sep 1;23(3):285-95.

[An analysis of medical expenses of outpatient service for the elderly

at one health insurance society in Fukuoka prefecture--focused on
medical service and concentration of medical expenses]
Homan M, Matsuda S.
Department of Preventive Medicine and Community of Health, School of

Medicine, University of Occupational and Environmental Health, Japan.
Yahatanishi-ku, Kitakyushu 807-8555, Japan.
To determine the best way to reduce medical expenses of the elderly, we analyzed
the aged outpatients' receipts covered by the Health and Medical Service Law for
the Aged at one health insurance society in Fukuoka prefecture. We used 312
medical receipts during July, 1997. The proportion of frequency of each medical
service was 89.7% for medications, 45.8% for laboratory tests and 26.3% for
procedures. The proportion of expenses of each medical service was 38.3% for
medications, 20.0% for examinations and 12.1% for laboratory tests. Medication
is considered as one of the main causes of increasing medical expenses. As a
result of multiple regression analysis, the number of consulting days, urinary and
genital disorder, the number of diseases, home care, laboratory tests and
prescriptions for outside pharmacies were detected as statistically significant
factors associated with medical expenses. There was a concentration of medical
expenses, i.e. about 10% of higher rank receipts consumed around 40% of total
outpatients' expenses and included 6 of 10 home medical care receipts. One of the
causes of expensive outpatients' medical expenses was medication. The separation
of dispensary and prescription of drugs does not contribute to the reduction of
medical expenses. In the higher rank of the expenses group, compared with the
lower rank of the expenses group, the consultation days were longer, the number
of diseases was greater and the proportions of expenses for procedures and home
care were larger. Medical expenditures for patients receiving home medical care
were higher than those of others, but home care should be compared with
admissions. Because the insurance societies are now facing financial difficulties
in Japan, analyzing the data of medical receipts is very important. During our
analysis, we had to make an enormous effort to combine two data sources,
because the receipts were made separately by clinics and pharmacies. It is
strongly suggested that a computerized information system with a standardized
format for clinics and pharmacies be developed.
Publication Types:
1441: J Oral Rehabil. 2001 Aug;28(8):717-20.

Oral health care status of homebound elderly in Japan.
Morishita M, Takaesu Y, Miyatake K, Shinsho F, Fujioka M.
Department of Preventive Dentistry, Hiroshima University School of Dentistry,

Hiroshima, Japan. mark@ipc.hiroshima-u.ac.jp
We examined the present conditions of oral health care in order to contribute

towards an effective system to provide oral health care for homebound elderly in
Japan. A questionnaire was mailed to homebound elderly subjects (n=908) and
returned by mail. A 73.6% response was achieved. The questionnaire was
designed to elicit information with respect to the general condition of the subjects
and independence of oral health care. About 70% of the subjects were chair- or
bed-bound. Among all subjects, 37.6% required partial or full assistance on
toothbrushing, 55.6% on cleaning dentures and 46.7% on eating. The degree of
oral health care tended to be poor for chair- or bed-bound elderly compared with
independent or house-bound elderly. Homebound elderly with lower Activities of
Daily Living Scale (ADL) required more support for oral health care compared
with elderly with higher ADL.
Publication Types:
1442: Methods Inf Med. 2001;40(4):307-14.

Building a controlled health vocabulary in Japanese.
Liu Y, Satomura Y.
Division of Medical Informatics, Chiba University Hospital, Japan.

lybmn@ho.chiba-u.ac.jp
OBJECTIVES: This study is aimed at developing a controlled clinical vocabulary

for use in electronic patient record (EPR) systems. METHODS: In this paper, we
propose a model for building the vocabulary. The model is composed of a
Canonical Term Dictionary, an Atom Dictionary, a Composite Atom Dictionary,
and an Index. Parsing and composing functions are included in this model.
Canonical terms were extracted from reference terminologies. Atoms were
extracted from the Canonical Term Dictionary and reduced to a set from which
the Composite Atom Dictionary can be built. The index was built to link these
two dictionaries. For testing the model, we compiled a sample vocabulary and
applied the model to a SNOMED translation system (English to Japanese) and a
term similarity estimation system. RESULTS: The sample vocabulary consisted
of 15,600 atomic terms and 4,450 composite terms. 33,441 SNOMED terms were
translated by the SNOMED translation system. The system gave adequate
Japanese candidates in 56.3% of cases. The similarity estimation system found an
average of 5.4 candidates when the equality ratio was over 50%.
CONCLUSIONS: The trial applications produced good results. The model seems
promising for building a standard clinical vocabulary system. This system can be
applied in certain other Asian countries, such as China and Korea.
1443: Med Parazitol (Mosk). 2001 Jan-Mar;(1):37-9.

[Current malaria situation in Turkmenistan]
[Article in Russian]
Amangel'diev KA.
Malaria is one of the main health problems facing most developing countries
having a hot climate. It is a problem in Turkmenistan. The country is situated in
Central Asia, north of the Kopetdag mountains, between the Caspian Sea to the
west and the Amu-Darya river to the east. Turkmenistan stretches for a distance of
1,100 km from west to east and 650 km from north to south. It borders
Kazakhstan in the north, Uzbekistan in the east and north-east, Iran in the south,
and Afghanistan in the south-east. Seven malaria vector species are found in
Turkmenistan, the main ones being Anopheles superpictus, An. pulcherrimus, and
An. martinius. The potentially endemic area consists of the floodplains of the
Tejen and Murgab rivers, with a long chain of reservoirs built along them. In 1980
most cases of imported malaria were recorded in military personnel who had
returned from service in Afghanistan. In the past years, only tertian (Plasmodium
vivax) malaria has been recorded and there have been no death from malaria over
that period. In the Serkhetabad (Gushgi) district there are currently 5 active foci of
malaria infection, with a population of 22,000 people. In 1999, forty nine cases of
P. vivax malaria were recorded in Turkmenistan. Of them, 36 cases, including 4
children under 14 years were diagnosed for the first time while 13 were relapses.
There were 88 fewer cases than those in the previous year (by a factor of 2.8).
There were 17 more cases of imported malaria than those in 1998 (by a factor of
1.7), most of which occurred in the foci of malaria infection (Serkhetabad,
Tagtabazar, and Kerki districts), in the city of Ashkhabat and in Lebap,
Dashkhovuz and Akhal Regions. The emergence of indigenous malaria in the
border areas was due to the importation of the disease at intervals by infected
mosquitoes flying in from neighbouring countries (e.g. Afghanistan), the lack of
drugs to treat the first cases and the lack of alternative insecticides. Most patients
suffer from tertian malaria, which is the most dangerous from the epidemiological
point of view since the main vectors in Turkmenistan, are highly susceptible to P.
vivax infection. The particular dangerous phenomenon is the higher incidence of
imported tertian malaria in rural areas where sick people and those who carry the
parasite come into close contact with highly susceptible vectors. Thus, the risk
that new malaria outbreaks will occur and the disease will become reestablished
in the country is very high. It is also influenced by major changes in water use in
the country, which have aggravated the mosquito situation. In the area around the
Karakum canal and river basins, 17 large reservoirs have been constructed, with
very extensive filtration ponds around them, which have become breeding
ground's for malaria mosquitoes. There are 1219 water areas without any
economic significance in the country, covering a total area of 1054 ha, which
require regular treatment with insecticides. With assistance from the WHO
European Regional Office, Dr. Guido Sabatinelli in particular, Turkmenistan has
developed a plan for preventive malaria control measures for 1999-2001, which
has been approved in a decree issued by the Ministry of Health and Medical
Industry. The material support received has made it possible to provide large-
scale prophylaxis for people who suffered from malaria in 1997-1999, seasonal
treatment for people living near the active foci of the disease and interseasonal
prophylaxis for people visiting these areas. Seasonal treatment with Dellaguil was
made in 4,590 people living in the active foci of malaria infection, and 2,281
fixed-term military personnel belonging to the units stationed in the active foci of
malaria infection. In all foci of infection, every person with malaria or carrying
the parasite underwent epidemiological investigation and all cases were entered in
health clinic records. In 1999, four seminars were held to train 75 specialists from
all administrative areas in ways of improving senior staff's skills in the laboratory
diagnosis of malaria. The laboratory equipment which the country has received
makes it possible to train high-level specialists and to equip its main malaria
diagnosis centers with microscopes and reagents. The received insecticides and
sprayers enable mosquitoes to be eliminated in an area of 960,000 sq. km (240
foci of infection): for this, our sincere thanks and gratitude are due to Dr. Guido
Sabatinelli. Specialists teams have been created in each region by a decree of the
Ministry of Health and Medical Industry to conduct mosquito elimination
activities, with personal responsibility for their progress. Three-day vector control
seminars have been held for disinfectors in all regions. We should stress that 5
extra posts have been created in the parasitology department of the Central
Laboratory of Hygiene and Epidemiology, State Epidemiological Surveillance
Service in order to strengthen preventive malaria control activities in
Turkmenistan (organizational and methodological support for health facilities,
staff training, etc.). To prevent the emergence of new breeding grounds for
malaria vectors, the state system of health surveillance over the hygiene and
technical status of water facilities and the rules governing their work have been
reinforced. Local executive authorities do every effort to eliminate small,
economically unprofitable water areas by draining, filling in or cleaning them. All
existing and potential mosquito breeding grounds within a three-kilometer radius
of any community were identified. These water areas were certified and their
previous certifications analyzed, taking into account any changes and additional
information which has become available about the area. Seasonal variations in the
number of larvae and imagoes were monitored in the specimen areas of water and
daytime resting sites. The existing vector species were identified and a list of the
main species in all areas was prepared. Water areas were treated in accordance
with epidemiological instructions. These activities yielded positive results: only
10 cases of locally transmitted malaria were recorded throughout the country in
1999. To interrupt the endemic process of malaria in Turkmenistan, the following
plan for 1999-2001 has been adopted. To improve the equipment and material
base of a sanitary and epidemiological surveillance service and malaria diagnosis
laboratories (vehicles, sprayers, microscopes, chemical reagents, etc.). To
continue effort to recruit staff to fill vacancies for parasitologists, entomologists,
and parasitology laboratory physicians in the sanitary and epidemiological
surveillance service at regional, subregional, and district level. In April 2000, two
six-day seminars were held for epidemiologists, parasitologists, and
entomologists, organized jointly with WHO representatives at the Central
Laboratory for Hygiene and Epidemiology. Two seminars on the laboratory
diagnosis of malaria for laboratory physicians were also intended to be held in
April 2000. To continue to treat malaria patients and parasite carriers throughout
the year to prevent relapses. To continue activities to eliminate mosquitoes, to
monitor seasonal variations in the number of vector larvae and imagoes in the
specimen areas of water and daytime resting sites mosquito habitats, to identify
the existing vector species, and to prepare a list of main species in all areas. To
strengthen preventive health monitoring. To provide effective support of health
care service by the state border guard service of Turkmenistan by supplying drugs
for curative and preventive treatment of its staff. To provide the quantities of
insecticides required for mosquito elimination and support staff training. To
improve malaria control activities by reporting all cases of malaria promptly,
conducting a high-quality epidemiological investigation of every case and a
prompt laboratory diagnosis, and providing the parasitology departments of
sanitary and epidemiological surveillance service at all levels with all-terrain
vehicles, microscopes, and effective communication systems which they require.
We are very happy to be cooperating with WHO and grateful for the help it has
provided.
Publication Types:
1444: Med Parazitol (Mosk). 2001 Jan-Mar;(1):24-33.

[Current malaria situation in the Republic of Kazakhstan]
[Article in Russian]
Bismil'din FB, Shapieva ZhZh, Anpilova EN.
The Republic of Kazakhstan is situated in the northern hemisphere on the

boundary of two continents--Europe and Asia--at a longitude of 45 degrees E--87
degrees E and a latitude of 40 degrees N--55 degrees N. The total area of the
republic is 2,724,900 square kilometers. Kazakhstan shares a border with the
Russian Federation to the north-west, north and east: the border between the two
countries is almost 6500 km long. To the south, Kazakhstan shares a border with
the Central Asian states of Turkmenistan (380 km), Uzbekistan (2300 km) and
Kyrgystan (980 km). To the south-east, it shares a border with China (1460 km):
to the west is the Caspian Sea (600 km). Thus, the total length of Kazakhstan's
external borders is 12,000 km. Because of the geographical, natural and climatic
features prevailing throughout most of the Republic, there is a potential danger
that local transmission of malaria may begin again if the disease is imported from
abroad. The areas most at risk are the Panfilov and Uigur raions of Almaty oblast,
which share a border with malaria-endemic regions of China, and the Saryagash
and Makhtaral' raions of South Kazakhstan oblast along the border with
Uzbekistan. The Government of the Republic of Kazakhstan places particular
emphasis on malaria prevention and control, taking into account the historical
data about the prevalence of malaria from the late 1920s to the early 1940s,
amounting to hundreds of thousands of cases every year. Government Decree No.
840 entitled "Urgent Measures to Protect the Population from Blood-Sucking
Insects and Ticks Dangerous to Humans", which lays down measures for the
control of malarial mosquitoes in the areas most susceptible to malaria
resurgence, was adopted in 1996. The Ministry of Health of the Republic of
Kazakhstan issued instructions in 1998 and 1999 which were designed to
motivate all health facilities in the field of malaria prevention and control. At
present, as part of the directives developed by the Republican Health
Epidemiology Posts, work is being done on the planning of malaria control
measures in Kazakhstan for the period 2001-2003. In 1994 a programme of
epidemiological malaria surveillance was introduced, which has enabled us to
improve our monitoring of the epidemiological situation of malaria. The number
of cases of imported malaria has declined: in 1997, there were 102 cases, in 1998-
87 and in 1999-52. There have been occasional local cases in some years, and in
1998 there were four local cases in the south and north-west of the country: two
cases in Almaty oblast, one case in Zhambyl oblast and one in West Kazakhstan
oblast (see Fig. 1). Most malaria infections are imported from Tajikistan and
Azerbaijan, with occasional cases from Pakistan, India, Turkey and Afghanistan.
Analysis of the occupational status of patients shows that around 45% are military
personnel who have served on the Tajik-Afghan border. The others are refugees,
merchants, unemployed people or students. The overall aetiological structure of
malaria cases is dominated by P. vivax malaria. For example, in 1999, there were
48 cases of P. vivax malaria (90.5% of the total), one case of tropical malaria
(1.9%), two cases of quartan malaria (3.8%) and two cases of P. vivax + P.
malariae (3.8%). In order to prevent indigenous malaria occurring within the
country, a system of malaria screening has been set up; screening is carried out
every year on groups who have visited neighbouring or more distant malaria-
endemic countries and for patients with a persistent fever who are suspected of
suffering from malaria. The area of water throughout the country within
communities or within a 3-5 km radius of them which is susceptible to
colonization by the Anopheles mosquito amounts to over 5000 hectares,
according to the certification system in force. In addition, approximately 70,000
hectares in three oblasts used for rice cultivation also provide a habitat for
Anopheles. The main malaria vector, An. messeae, is found throughout the
country: in a few areas An. hyrcanus and An. claviger are found and, in the south,
An. pulcherrimus. Data from recent years show the presence of An. superpictus,
An. plumbeus and An. algeriensis. In 1999, from data collected during systematic
observations of the phenology and seasonal variations in the number of
Anopheles at 114 observation posts, the average seasonal numerical indicators for
the mosquito imago reached a maximum of between 21 and 46.5 adult mosquitoes
per cattle shed, up to 2.7-3.3 adult mosquitoes per residential building and 30-67.3
larvae per square metre of surface water. According to the results of large scale
trapping programmes (486 communities were screened in 1999), the maximum
value of the numerical indicator was 16.8-74.1 adult mosquitoes per cattle shed
and 4.1-3.8 adult mosquitoes per residential building. In 1999, compared with
1998, the number of malarial mosquitoes detected throughout the country
declined encouragingly, or stayed at the same level, which is one of the factors
responsible for the country's favourable epidemiological situation with regard to
malaria. According to data going back many years, there has been a significant
increase in the number of mosquitoes at some observation posts in Almaty, East
Kazakhstan and Kyzlorda oblasts. There is a tendency everywhere for the
numbers of imagos detected in residential buildings to increase, which presents a
definite epidemiological risk that indigenous malaria will re-emerge if the disease
is imported into Kazakhstan from countries which suffer from it. If we consider
the species of mosquito present in the country and the temperature factor (the
number of days in the year when the average daily temperature is over 16 degrees
C), the country can be divided, on the basis of incomplete 1999 data, into zones at
very high risk of re-emergence of malaria (Almaty, Zhambyl and South
Kazakhstan oblasts), high risk (Karaganda oblasts and Almaty city), medium risk
(Aktyubinsk and Akmolinsk oblasts), and low risk (Kostanay oblast). The malaria
risk of the other oblasts has been calculated using data from earlier years (map
attached) [Translator's Note: map missing]. Preventive malaria control measures
in Kazakhstan are divided into three categories to suit three different groups of
communities. One hundred and seventy-nine communities have been allocated to
the first group, at high risk of malaria resurgence; 1377 communities to the
second group, at medium risk; and the remainder to the third group, at little or no
risk of malaria resurgence. The following factors were used to categorize
communities according to the risk that malaria might become reestablished if the
disease should be imported from elsewhere: species of malarial mosquito present;
changes in mosquito numbers and in the area of water susceptible to population
by Anopheles; temperature conditions and, consequently, the length of the malaria
transmission season and the season of effective susceptibility of the mosquito to
infection; population migration; quality of laboratory testing for the diagnosis of
malaria. Measures aimed at the destruction of mosquitoes are intended to reduce
the numbers of Anopheles in the communities most at risk of malaria resurgence,
i.e. those in group 1 above and the actual foci of malaria infection. Because of the
economic crisis and financial difficulties, fewer areas have been treated in recent
years. In 1999, 1387 hectares of water and 450,000 square metres of buildings
were treated (see Fig. 2). Measures to control biting flies in health establishments,
recreation areas, etc. Certainly also help to protect people from malarial
mosquitoes. In 1999, 12,501 hectares of water and land were treated from the
ground or the air (see Fig. 3). In the present situation, the main reasons for the
difficulties affecting the malaria control and prevention campaign are as follows.
Staff numbers in the Republic's parasitology service have been unjustifiably
reduced. For example, the number of entomologists and entomology assistants
employed is 58% and 48%, respectively, of the number laid down in Ministry of
Health directives. At the health epidemiology posts, the number of disinfectors
has been reduced to a minimum, and practically all engineer/water engineer posts
have been abolished. The country does not possess the necessary education base
for initial training or continuing education of staff for the parasitology service.
The lack of basic scientific information about the problems of malaria control and
prevention and parasitology in general. There is no research to test or introduce
the most effective, safe and low-cost malaria control products and insecticides.
The methodological literature required to use certain modern insecticides is not
available. Entomologists are not provided with specialist insect control
equipment. Entomological surveys are left incomplete because of shortages of
transport and fuel at the health epidemiology posts. Because of the economic
crisis and the high cost of the radical water engineering measures necessary to
combat malaria, these measures cannot be implemented on the scale required. The
equipment and materials stocks of the parasitology laboratories are highly
inadequate: there is a lack of modern laboratory equipment, as well as a lack of
opportunities for high-level professional training for staff. The exchange of
information between the CIS countries is unsatisfactory, and there is no common
information space: nor is there any systematic data available from other foreign
countries. In the period 2000-2003, Kazakhstan plans to carry out malaria control
activities (mosquito destruction) over an area of 2000 hectares of water and 1.5
million square metres of buildings.
Publication Types:
1445: Acta Astronaut. 1998 Jan-Apr;42(1-8):69-87.

Overview of the Neurolab Spacelab mission.
Homick JL, Delaney P, Rodda K.Collaborators (1)
Homick JL.
NASA Johnson Space Center, Houston, Texas 77058, USA.
Neurolab is a NASA Spacelab mission with multinational cooperative

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

[Archives of environmental health digital maps and their delivery by

the Internet]
Kaminuma T, Kabuyama N, Hayakawa M, Futatsuki Y.
kaminuma@nihs.go.jp
Geographic Information System is becoming a very important tool for
environmental health research. We have produced various digital maps for
different scales for different purposes. The burst of E. Coli O-157, distribution of
hazadarous chemicals in East Asia, and coastal resin pellets are some examples. It
now becomes a problem how to archive these digital maps and how to retrieve
these maps according to user's request. We have developed a computer system
that can store various types of digital maps and can retrieve them from WWW
client machines. The key concept of this archive system is to classify every digital
maps according to their region of interest.
Publication Types:
1447: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2000;(118):107-16.

[The status of NIHS Information and Computing Infrastructure

(NICI)]
Nakata K, Nakano T, Takai T, Komine K, Kaminuma T.
nakata@nihs.go.jp
From 1999 to 2000, NIHS Information and Computing Infrastructure (NICI) were
newly renovated. The purposes of the renovation are (1) the improvement of the
communication for business works in NIHS, (2) supporting for the research, (3)
supporting for the administration work. The Internet connection speed was
upgraded from 256 Kbps to 1.5 Mbps. The high quality network sever machines
and database server machines were installed. The large-scale software systems
were renewed their versions. Four experimental stations for medical plants at
Hokkaido, Izu, Wakayama and Tanegashima connected to NIHS at Tokyo or
Osaka branch by ISDN. We describe the providing information on NIHS home
page, and how to utilize NICI for our research and official works.
Publication Types:
1448: Sangyo Eiseigaku Zasshi. 2001 Jul;43(4):76-87.

[Present condition of health information control and attitudes of

occupational health professionals in collecting and utilizing health
information in workplaces]
Nakamura K, Niino N.
Department of Hygiene and Preventive Medicine, Showa University School of

Medicine.
Since the Labor Safety and Health Law of Japan provides that the employer is
responsible for taking custody of personal information obtained in periodic health
examinations, we are anxious about infringement of privacy. This study was
conducted to investigate the present condition of health information control in
each workplace and attitudes of occupational health professionals in collecting
and utilizing personal health information by means of self-administered mail
questionnaires. The numbers of respondents were a total of 549 (physicians: 237,
public health nurses: 175, nurses 122, others & unknown: 15). The major results
were as follows. 1. Percentage of workplaces in which only health professionals
can know personal health data from periodic health examinations was 24%
altogether, but it was 39% in large workplaces where full-time occupational
physicians were working. 2. More than half of the respondents were of the
opinion that the results of routine health activities could be presented in academic
conferences unconditionally or under comprehensive approval of the
representative of each workplace. 3. About a half of the respondents believed that
it was necessary to consider the intention of each examinee in utilizing blood
specimen collected at health examinations for research purposes, even though
personal identification had been erased. 4. There were many differences among
types of occupation or age groups in the attitude to changing the procedure for
health examination. And it was the majority opinion that personal health data
provided to the employer should be the minimum in order to protect individual
benefits. 5. The proportion of physicians who felt it necessity to ask about the
occupational history at the employment health examination was significantly
higher than that of public health nurses. 6. When a disease was discovered, there
were great differences among types of disease in the attitude to give the name or
condition of the disease to the employer without the consent of the patient or his
family. In view of these results, we feel that occupational health professionals are
in a dilemma in introducing modern ideas which lay stress on privacy into the
Japanese occupational health care system which is still operating on the basis of
traditional paternalism.
Publication Types:
1449: Qual Health Care. 2001 Sep;10(3):166-72.

Development of guidelines to facilitate improved support of South

Asian carers by primary health care teams.
Katbamna S, Baker R, Ahmad W, Bhakta P, Parker G.
Nuffield Community Care Studies Unit, Department of Epidemiology and Public

Health, University of Leicester, Leicester LE1 6TP, UK. sk41@le.ac.uk
BACKGROUND: Evidence based guidelines are regarded as an appropriate basis

for providing effective health care, but few guidelines incorporate the views of
users such as carers. AIM:To develop guidelines to assist primary health care
teams (PHCTs) in their work with carers within South Asian communities.
METHODS: The guidelines were drawn up by a development group consisting of
members of teams in areas with South Asian communities (Leicester and
Bradford). The teams were invited to make their recommendations based on a
systematic review of literature on minority ethnic carers and the findings of a
study of the needs and experiences of local South Asian carers. A grading system
was devised to enable the teams and a group of expert peer reviewers to assess the
quality of evidence in support of each recommendation. RESULTS: The teams
agreed seven recommendations, graded according to available evidence and
strength of opinion. External peer review supported the PHCTs' interpretation of
evidence and their recommendations. The recommendations included
consideration of communication and information for carers, coordination of care
within teams, and recognition by team members of the roles of carers and their
cultural and religious beliefs. CONCLUSION: There are particular steps that
PHCTs can take to improve their support of South Asian carers. It is possible to
develop guidelines that take users' views into account and incorporate evidence
from qualitative studies.
Publication Types:

PMCID: PMC1743443
1450: Health Policy Plan. 2001 Sep;16(3):322-5.

Newspaper reports as a source for injury data in developing

countries.
Ghaffar A, Hyder AA, Bishai D.
Health Services Academy, Ministry of Health, Government of Pakistan,

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

1451: Nippon Koshu Eisei Zasshi. 2001 Jul;48(7):551-9.
[An individual based analysis of medical expenses of outpatient

services for the elderly at one health insurance society in Fukuoka
Prefecture. Focus on multiple or redundant consultations]
Homan M, Matsuda S.
Department of Preventive Medicine and Community of Health, University of

Occupational and Environmental Health, Japan.
PURPOSE: To ascertain way to reduce medical expenses of the elderly, we

analyzed old outpatients' receipts covered by the Health and Medical Services
Law for the Aged at one health insurance society in Fukuoka prefecture. In
addition, an attempt was made to find better ways to share medical information
and construct a system of receipt analysis. SUBJECTS AND METHODS: We
used 312 receipts for 179 old outpatients in July in 1997. The number of
prescriptions was internalized into the number of outpatients' receipt. We
classified the patients as "multiple" who consulted several clinics a month and as
"redundant" who consulted several clinics for the same diseases. RESULTS AND
CONCLUSION: 1) The expenses of outpatients accounted for about 1/3 of the
total. Average values for patients were 78.3 years old of age, 7.7 diseases, 1.5
pharmacies, 1.7 clinics, 7 consulting days, and the medical expenses of 40,482
yen per month. 2) The rate of multiple including redundant consultations was
49.7% and that for those that were redundant was 9.5%. Redundant consultations
increased as the number of consultation clinics increased. 3) Factors considered to
increase medical expenses were the number of diseases, the consulting days, and
the number of consultation/prescription organizations. Multiple and redundant
consultations amounting to half of the whole fulfilled all of these criteria. 4) The
average medical expense for non-multiple and non-redundant patients was 28,314
yen, as compared with 52,786 yen for multiple and redundant and 64,306 yen for
redundant cases. If there were no multiple consultations, thirty percent of the
expenses could be avoided and if there were no redundant consultations, the
reduction might be 6%, although more detailed clinical records are necessary for
firm conclusions. To reduce excess expenditure, instructions for patients having
home doctors and passing through introductions are important. 5) Regarding the
expense of medical services, medication was accounted for 39.2% as the greatest
outlay. Cautions for suitable use of drugs are required for multiple and redundant
patients, because they tend to visit many pharmacies. Considering the rate rise of
separation of pharmacy and clinic, fixing of field division of work and the sharing
of medical information are inadequate. For example, introduction of an IC card
system might be very useful to facilitate the development of community-based
medical information system. 6) It is strongly suggested that a computerized
information system with a standardized format should be developed on the
initiative of a national organization such as the National Federation of Health
Insurance Societies.
Publication Types:
1452: J Am Med Inform Assoc. 2001 Sep-Oct;8(5):515-7.

Medical informatics and health care in Oman.
Dhar A.
Publication Types:
• Letter
PMCID: PMC131050
1453: J Health Popul Nutr. 2001 Jun;19(2):100-10.

Implementation of a medical geographic information system:

concepts and uses.
Ali M, Emch M, Ashley C, Streatfield PK.
ICDDR, B: Centre for Health and Population Research, Mohakhali, Dhaka 1212,
Bangladesh. mali@ivi.int
This paper introduces a medical geographic information system which has been
implemented to enhance public-health research by facilitating the modelling of
spatial processes of disease, environment, and healthcare systems in a rural area
of Bangladesh. In 1966, a surveillance system was implemented to record all vital
demographic events in the study area. Selected information on reproductive and
child health, socioeconomic conditions, and health and family-planning
interventions is being collected for the surveillance database. This paper discusses
the conceptual design of integrating the surveillance database with the medical
geographic information system and its use in conducting multidisciplinary health
research. The paper is intended to help those who wish to implement a health-
based geographic information system to understand the links between people and
their environments and to better meet the health needs of target communities.
Publication Types:
1454: Gerontology. 2001 Sep-Oct;47(5):254-62.

Association of comorbidity with depressive symptoms in

community-dwelling older persons.
Lee Y, Choi K, Lee YK.
Department of Preventive Medicine, Ajou University School of Medicine, Suwon,

South Korea. yhlee@madang.ajou.ac.kr
BACKGROUND: Depression in later life poses a serious threat to mental health

and well-being of older persons burdened with medical illnesses. Comorbid
medical conditions independently, as well as through interactions, may influence
the degree of depressive symptoms manifested by the elderly. Insight into the role
medical comorbidity plays in the manifestation of depression may help to better
address both physical and mental health care needs of the depressed elderly.
OBJECTIVE: To examine independent and synergistic effects of comorbid
medical conditions in the presentation of depressive symptoms among older
adults living in the community. METHODS: Data from a national survey of
community-dwelling older persons aged 60 years and over (n = 2,058) in Korea
were used. The levels of depression were assessed using an eleven-item Center
for Epidemiological Studies Depression Scale. Comorbidity was defined as the
number of chronic medical conditions and the combination of disease pairs.
Sociodemographic characteristics, self-rated health, physical functioning, history
of hospital admission in the past year, frequency of contact with friends or
neighbors, and emotional support were used as covariates. RESULTS: Overall,
persons with a medical condition compared to those without tended to show a
higher depressive symptom score. Comorbidity, in terms of the number of
medical conditions, tended to show a significant linear association with
depression, controlling for confounders. More important, independent effects of
medical conditions as well as a tendency to synergy among specific medical
conditions were found, with notable gender differences. CONCLUSION: Given
the significant but complex association of comorbid medical conditions with
depressive symptoms in aged persons, clinicians should exercise care to address
their physical and mental health needs within a common therapeutic context.
Copyright 2001 S. Karger AG, Basel
Publication Types:
1455: J Adv Nurs. 2001 Aug;35(3):393-401.

Evaluating psychosocial nursing interventions for cardiac clients

and their caregivers: a case study of the community rehabilitation
network in Hong Kong.
Holroyd E, Twinn S, Shiu A.
Department of Nursing, The Chinese University of Hong Kong, Sha Tin, New
Territories, Hong Kong. eholroyd@cuhk.edu.hk
AIM OF THE STUDY: The purpose of this exploratory study was to describe the
type and nature of psychosocial nursing interventions provided for cardiac clients
in Hong Kong's Community Rehabilitation Centres (CRNs).
DESIGN/METHODS: Using a two-phase case study design data were collected
from nurses, cardiac clients and their caregivers. The initial phase focused on
identifying the types of psychosocial interventions provided. These data were
obtained by observing nursing activities and the keeping of daily journals by the
nurses. The second phase acquired data from structured telephone interviews, that
reviewed clients' perceptions of the psychosocial interventions provided by the
nurses and face-to-face interviews with clients and their caregivers. FINDINGS:
These findings revealed that the nurses' interpersonal skills of information giving,
social support and counselling were highly valued by cardiac clients and their
caregivers. Both clients and caregivers outlined a concern about the lack of
individual care and this was reflected in the focus of the CRN on group processes.
CONCLUSION: Recommendations for psychosocial cardiac care are made for
public health nurses and nurses working in community settings.
Publication Types:
1456: Southeast Asian J Trop Med Public Health. 2000;31 Suppl 2:5-21.
Promotion of the health of rural women towards safe motherhood--

an intervention project in northeast Thailand.
Saowakontha S, Pongpaew P, Vudhivai N, Tungtrongchitr R, Sanchaisuriya

P, Mahaweerawat U, Laohasiriwong W, Intarakhao C, Leelapanmetha P,
Chaisiri K, Vatanasapt V, Merkle A, Schelp FP.
Faculty of Medicine, Khon Kaen University, Thailand.
An intervention project focusing on the health of women in the reproductive age

was conducted in three districts of Khon Kaen Province, northeast Thailand
between 1991 and 1996. Main emphasis was placed on improving reproductive
health, the nutritional status including the iron deficiency anemia (IDA) as well as
iodine deficiency disorders (IDD), and the parasitic diseases liver fluke
(Opisthorchis viverrini) and hookworm. For implementation a community based
Primary Health Care approach was used including the training of health officials
in health matters, primary health care workers and villagers as well as enhancing
health education and the dissemination of health information. The health delivery
system was encouraged to take appropriate actions such as in the treatment of
parasitic diseases and the control of IDA and IDD. Monitoring was done on a
regular basis. The outcome of the project was assessed by comparing baseline
data compiled from a random sample of the target population with the results of
the final evaluation. An attempt to compare results obtained from villages within
and outside of the project area failed most probably because of spill over effects.
A number of important indicators on family planning and mother and child health
care improved during the time the project was implemented; this included
practising family planning, and participation in antenatal care. Also the proportion
of females becoming pregnant for the first time when 20 years or older increased.
Child-raising also improved in that almost all females gave colostrum to their
babies by this time. Almost 75% of the women breast-fed their children.
Improvements occurred in the nutritional status as far as the micronutrients iron
and iodine were concerned, however the overall nutritional status of females did
not change, but a rather high proportion of females were found to be
overnourished. The project failed in reducing abortion and the proportion of
females becoming pregnant when they are 18 years old or younger. It was also not
possible to improve the usage of postnatal care. As anticipated, the results
achieved so far are most suitable in serving as a training ground and providing a
favorable example to improve family planning, mother- and child health care, and
also the general health of females in the region, particularly in neighboring
countries such as Lao PDR, Cambodia and Vietnam.
Publication Types:
1457: Sci Am. 2001 Aug;285(2):66-71.

Taming the killing fields of Laos.
Lovering D.
Publication Types:
• Review
1458: Bull World Health Organ. 2001;79(7):648-56.

Three case definitions of malaria and their effect on diagnosis,

treatment and surveillance in Cox's Bazar district, Bangladesh.
Montanari RM, Bangali AM, Talukder KR, Baqui A, Maheswary NP, Gosh
A, Rahman M, Mahmood AH.
WHO Dhaka, Bangladesh.
In countries where malaria is endemic, routine blood slide examinations remain

the major source of data for the public health surveillance system. This approach
has become inadequate, however, as the public health emphasis has changed from
surveillance of laboratory-confirmed malaria infections to the early detection and
treatment of the disease. As a result, it has been advocated that the information
collected about malaria be changed radically and should include the monitoring of
morbidity and mortality, clinical practice and quality of care. To improve the
early diagnosis and prompt treatment (EDPT) of malaria patients, three malaria
case definitions (MCDs) were developed, with treatment and reporting guidelines,
and used in all static health facilities of Cox's Bazar district, Bangladesh
(population 1.5 million). The three MCDs were: uncomplicated malaria (UM);
treatment failure malaria (TFM); and severe malaria (SM). The number of malaria
deaths was also reported. This paper reviews the rationale and need for MCDs in
malaria control programmes and presents an analysis of the integrated
surveillance information collected during the three-year period, 1995-97. The
combined analysis of slide-based and clinical data and their related indicators
shows that blood slide analysis is no longer used to document fever episodes but
to support EDPT, with priority given to SM and TFM patients. Data indicate a
decrease in the overall positive predictive value of the three MCDs as malaria
prevalence decreases. Hence the data quantify the extent to which the mainly
clinical diagnosis of UM leads to over-diagnosis and over-treatment in changing
epidemiological conditions. Also the new surveillance data show: a halving in the
case fatality rate among SM cases (from 6% to 3.1%) attributable to improved
quality of care, and a stable proportion of TFM cases (around 7%) against a
defined population denominator. Changes implemented in the EDPT of malaria
patients and in the surveillance system were based on existing staff capacity and
routine reporting structures.
Publication Types:
1459: Int J Med Inform. 2001 Jul;62(2-3):113-9.

Medical informatics--the state of the art in the Hospital Authority.
Cheung NT, Fung KW, Wong KC, Cheung A, Cheung J, Ho W, Cheung C,

Shung E, Fung V, Fung H.
Hospital Planning and Development Division, Hospital Authority, Hong Kong,

China. cheungnt@ha.org.hk
Since its inception in 1990, the Hospital Authority (HA) has strongly supported
the development and implementation of information systems both to improve the
delivery of care and to make better information available to managers. This paper
summarizes the progress to date and discusses current and future developments.
Following the first two phases of the HA information technology strategy the
basic infrastructural elements were laid in place. These included the foundation
administrative and financial systems and databases; establishment of a wide area
network linking all hospitals and clinics together; laboratory, radiology and
pharmacy systems with access to results in the ward. A major push into clinical
systems began in 1994 with the clinical management system (CMS), which
established a clinical workstation for use in both ward and ambulatory settings.
The CMS is now running at all major hospitals, and provides single logon access
to almost all the electronically collected clinical data in the HA. The next phase of
development is focussed on further support for clinical activities in the CMS. Key
elements include the longitudinal electronic patient record (ePR), clinical order
entry, generic support for clinical reports, broadening the scope to include allied
health and the rehabilitative phase, clinical decision support, an improved clinical
documentation framework, sharing of clinical information with other health care
providers and a comprehensive data repository for analysis and reporting
purposes.
1460: Int J Med Inform. 2001 Jul;62(2-3):103-11.

Data mining approach to policy analysis in a health insurance

domain.
Chae YM, Ho SH, Cho KW, Lee DH, Ji SH.
Graduate School of Health Policy and Administration, Yonsei University, CPO

Box 8044, Seoul, 120-749, South Korea. ymchae@yumc.yonsei.ac.kr
This study examined the characteristics of the knowledge discovery and data
mining algorithms to demonstrate how they can be used to predict health
outcomes and provide policy information for hypertension management using the
Korea Medical Insurance Corporation database. Specifically, this study validated
the predictive power of data mining algorithms by comparing the performance of
logistic regression and two decision tree algorithms, CHIAD (Chi-squared
Automatic Interaction Detection) and C5.0 (a variant of C4.5) using the test set of
4588 beneficiaries and the training set of 13,689 beneficiaries. Contrary to the
previous study, the CHIAD algorithm performed better than the logistic
regression in predicting hypertension, and C5.0 had the lowest predictive power.
In addition, the CHIAD algorithm and the association rule also provided the
segment-specific information for the risk factors and target group that may be
used in a policy analysis for hypertension management.

1461: Reprod Health Matters. 2001 May;9(17):118-27.
Sexual behaviour and contraceptive use among unmarried, young

women migrant workers in five cities in China.
Zheng Z, Zhou Y, Zheng L, Yang Y, Zhao D, Lou C, Zhao S.
Institute of Population Research, Peking University, 3-4, Building 22, Muxidi,

Beijing 100038, China. rkszzz@pku.edu.cn
This paper reports the results of exploratory research on reproductive and sexual
health knowledge and sexual behaviour of young, unmarried women who migrate
to cities from rural areas for work, and their access to and needs in relation to
family planning in Beijing, Guangzhou, Shanghai, Guiyang and Taiyuan, in
China. Focus group discussions were conducted with 146 young women aged 16-
25 and 58 in-depth interviews with key informants. Some of the young female
migrant workers were sexually active and living with their boyfriends, most of
whom expected to marry each other. Most of the women lacked basic information
about reproduction and contraception, and did not know where or how to obtain
contraception. There were social, psychological and economic barriers to
accessing services. Only a small proportion of those who were unmarried were
using contraception, so induced abortion was often the outcome of unprotected
premarital sex. Pleasing male partners also played an important role in
unprotected sex. The training, attitudes and approach of the entire family planning
service system in relation to unmarried and young people in China, including this
migrant population, needs to be reorientated so as to provide them with
appropriate and adequate services.
Publication Types:
1462: Bull Med Libr Assoc. 2001 Jul;89(3):287-93.

Health sciences libraries in Kuwait: a study of their resources,

facilities, and services.
Al-Ansari HA, Al-Enezi S.

Kuwait University, Khalidia.
The purpose of this study was to examine the current status of health sciences
libraries in Kuwait in terms of their staff, collections, facilities, use of information
technology, information services, and cooperation. Seventeen libraries
participated in the study. Results show that the majority of health sciences
libraries were established during the 1980s. Their collections are relatively small.
The majority of their staff is nonprofessional. The majority of libraries provide
only basic information services. Cooperation among libraries is limited. Survey
results also indicate that a significant number of health sciences libraries are not
automated. Some recommendations for the improvement of existing resources,
facilities, and services are made.
PMCID: PMC34562
1463: AIDS Care. 2001 Aug;13(4):441-56.

Promoting the positive: responses to stigma and discrimination in

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

[Detection of underlying causes of death among the deceased of

Yusho patients by linkage to the national vital statistics data]
Kaneko S, Yoshimura T, Ikeda M, Nishisaka K.
Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences,

University of Occupational and Environmental Health, Japan.
As of January 31, 1996, 292 deaths among registered patients of Yusho were
identified by three follow-up studies conducted in 1986, 1990, and 1996. In this
study, we attempted to identify underlying causes of death by linkage of the
registered data to the National Vital Statistics Data provided by the Management
and Coordination Agency of Japan, which included 15 million deaths between
1978 and 1996. The two datasets were linked by matching for six variables; birth
year/month/day, death year/month, and sex, along with a variable of death day or
death place, or both. The matched cases were 203 among 235 deaths between
1978 and 1996 (matching rate was 86%). Among the 203 deaths, 58 underlying
causes of death were newly identified, 146 causes of death were already grasped
by the follow-up studies, and 31 deaths did not have matching pair in the National
Vital Statistics data. Among the 146 deaths, 110 causes of death were concordant
with each other, however, 35 causes of death were completely discord. The reason
of the discordance and the unmatched deaths might be due to difference in
information of the matching variables in the two datasets. In order to conduct an
efficient follow-up study of Yusho patients, identification of underlying causes of
death by linkage to the National Vital Statistics Date is evitable. For that, we need
to substitute basic information in the Yusho database to those compatible to the
National civil registration system.
Publication Types:
1465: Indian J Public Health. 2000 Oct-Dec;44(4):124-8.

Diet nutrition and health profile of elderly population of urban

Baroda.
Mehta P, Shringarpure B.
Department of Foods and Nutrition, Faculty of Home Science, M. S. University,

Baroda, Vadodara-390 002.
Geriatric population forms a significant proportion of our total population. Hence,

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

A review of the epidemiological transition in dementia--cross-

national comparisons of the indices related to Alzheimer's disease
and vascular dementia.
Suh GH, Shah A.
Department of Psychiatry, Hallym University College of Medicine, Hangang

Sacred Heart Hospital, Seoul, Korea.
OBJECTIVE: To examine temporal changes in the prevalence of dementia and

associated factors. METHOD: All publications on the epidemiology of dementia
were identified using a medline search for the years 1966-1999. RESULTS:
Alzheimer's disease (AD) has become nearly twice as prevalent as vascular
dementia (VaD) in Korea, Japan, and China since transition in early 1990s. Prior
to this, in the 1980s, VaD was more prevalent than AD in these countries. In
Nigeria, the prevalence of dementia was low. Indian studies were contradictory,
with both AD and VaD being more prevalent in different studies. American and
European studies consistently reported AD to be more prevalent than VaD.
CONCLUSION: A theoretical model of transition from low incidence-high
mortality society to high incidence-high mortality society to low incidence-low
mortality society may explain these findings. Rigorous testing in prospective,
longitudinal and population-based cross-national studies using culture-fair
diagnostic instruments is required.
Publication Types:
• Review
1467: Bull World Health Organ. 2001;79(6):561-8.

Erratum in:
• Bull World Health Organ 2001;79(12):1177.
Maternal mortality at the end of a decade: signs of progress?
AbouZahr C, Wardlaw T.
World Health Organization, 1211 Geneva 27, Switzerland.
Maternal mortality is an important measure of women's health and indicative of

the performance of health care systems. Several international conferences, most
recently the Millennium Summit in 2000, have included the goal of reducing
maternal mortality. However, monitoring progress towards the goal has proved to
be problematic because maternal mortality is difficult to measure, especially in
developing countries with weak health information and vital registration systems.
This has led to interest in using alternative indicators for monitoring progress.
This article examines recent trends in two indicators associated with maternal
mortality: the percentage of births assisted by a skilled health care worker and
rates of caesarean delivery. Globally, modest improvements in coverage of skilled
care at delivery have occurred, with an average annual increase of 1.7% over the
period 1989-99. Progress has been greatest in Asia, the Middle East and North
Africa, with annual increases of over 2%. In sub-Saharan Africa, on the other
hand, coverage has stagnated. In general, caesarean delivery rates were stable
over the 1990s. Countries where rates of caesarean deliveries were the lowest--
and where the needs were greatest--showed the least change. This analysis leads
us to conclude that whereas there may be grounds for optimism regarding trends
in maternal mortality in parts of North Africa, Latin America, Asia, and the
Middle East, the situation in sub-Saharan Africa remains disquieting.
Publication Types:
1468: Eur J Cancer. 2001 Jul;37(11):1402-8.

Population-based survival from colorectal cancer in Mumbai,

(Bombay) India.
Yeole BB, Sunny L, Swaminathan R, Sankaranarayanan R, Parkin DM.
Bombay Cancer Registry, Indian Cancer Society, 74 Jerbai Wadia Road, Parel,
(Bombay), 400 012, Mumbai, India.
Survival estimates of patients registered by population-based cancer registries

reflect the average prognosis from a given cancer as they are based on unselected
patients with a wide range of natural histories and treatment patterns. In this
paper, we report the survival experience of colorectal cancer patients in Mumbai
(Bombay), India. Follow-up information on 1642 colorectal cancer patients
registered by the Bombay Population-based Cancer Registry for the period 1987-
1991 was obtained by matching with death certificates from the Bombay vital
statistics registration system, postal/telephone enquiries, home visits and scrutiny
of medical records. Cumulative observed and relative survival proportions were
calculated by Hakulinen's method. For comparison of results with other
populations, age-standardised relative survival (ASRS) was calculated by directly
standardising age-specific relative survival to the specific age distributions of the
world standard cancer patient population in 1985. The log-rank test was used to
identify the potential prognostic variables which were introduced step-wise into a
Cox regression model to identify the independent predictors of survival. The 5-
year relative survival was 36.6% for colon and 42.2% for rectal cancer. Age, site
of cancer and clinical stage of disease emerged as independent predictors of
survival. Age-specific 5-year relative survival declined with advancing age.
Survival at 5 years was 61.2% for localised colon cancer; 31.9% for regional and
9.0% for distant metastatic disease. These were 65.7, 25.6 and 4.3%, respectively
for rectal cancers. Comparison of the results with other populations revealed
significant variations, which seem to be related to differences in detection and
treatment. The prognosis from colorectal cancer in Mumbai and developing
countries, may be further improved through early detection linked with treatment.
Publication Types:
1469: Disasters. 2001 Jun;25(2):172-80.

The accuracy of mortality reporting in displaced persons camps

during the post-emergency phase.
Spiegel PB, Sheik M, Woodruff BA, Burnham G.
Johns Hopkins University, USA. pspiegel@cdc.gov
For humanitarian organisations, accurate data are essential to identify emerging

health problems and determine programme needs. We visited 45 post-emergency
phase displaced persons camps and collected three months' mortality data which
we compared with organisations' routine mortality reports. Organisations reported
612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as
the number of organisation-reported deaths divided by the number of investigator-
identified deaths, of 83 per cent. For the majority of camps which under-reported
deaths, mortality reporting ratios were significantly higher for women than men,
and for camps with central mortality registers rather than those without. In the few
camps which over-reported deaths, these occurred primarily among children
younger than five years of age, probably due to the inclusion of abortions and
stillbirths. Despite the overall under-reporting of deaths by humanitarian
organisations, the existing health information systems appear to estimate mortality
rates adequately in these post-emergency camps. However, organisations should
improve the precision and completeness with which they report the characteristics
of deaths in order to provide valuable data to target their programmes at the most
vulnerable people.
Publication Types:
1470: J Med Genet. 2001 Jul;38(7):425-9.

Cultural aspects of cancer genetics: setting a research agenda.
Meiser B, Eisenbruch M, Barlow-Stewart K, Tucker K, Steel Z, Goldstein D.
Department of Psychological Medicine, Block 4, Level 5, Royal North Shore

Hospital, St Leonards, NSW 2065, Sydney, Australia. b.meiser@unsw.edu.au
BACKGROUND: Anecdotal evidence suggests that people from non-Anglo-

Celtic backgrounds are under-represented at familial cancer clinics in the UK, the
USA, and Australia. This article discusses cultural beliefs as a potential key
barrier to access, reviews previous empirical research on cultural aspects of
cancer genetics, draws implications from findings, and sets a research agenda on
the inter-relationships between culture, cancer genetics, and kinship. METHODS:
The CD-ROM databases MEDLINE, PsychLIT, CINAHL, and Sociological
Abstracts were searched from 1980 onwards. RESULTS: Cultural aspects of
cancer genetics is the focus of an emerging body of publications. Almost all
studies assessed African-American women with a family history of breast cancer
and few studies included more diverse samples, such as Americans of Ashkenazi
Jewish background or Hawaiian- and Japanese-Americans. Our analysis of
published reports suggests several directions for future research. First, an
increased focus on various Asian societies appears warranted. Research outside
North America could explore the extent to which findings can be replicated in
other multicultural settings. In addition, control group designs are likely to benefit
from systematically assessing culture based beliefs and cultural identity in the
"majority culture" group used for comparative purposes. CONCLUSION: More
data on which to base the provision of culturally appropriate familial cancer clinic
services to ethnically diverse societies are needed. Empirical data will assist with
culturally appropriate categorisation of people from other cultures into risk groups
based on their family histories and provide the basis for the development of
culturally appropriate patient education strategies and materials.
Publication Types:
PMCID: PMC1757175
1471: Accid Anal Prev. 2001 Jul;33(4):563-5.

Safety and ergonomics evaluation of hybrid systems in Hong Kong.
Chan AH, Courtney AJ.
Department of Manufacturing Engineering and Engineering Management, City

University of Hong Kong, Kowloon Tong. alan.chan@cityu.edu.hk
This study is aimed at understanding common safety and ergonomics problems

with robot installation in Hong Kong. Information was collected through direct
observations and personal interviews with robot users from advanced hybrid
manufacturing systems. The application areas of robots and types of safety
devices employed were investigated. The ages, types of jobs, daily working hours
and working conditions of personnel were examined. Fire precaution measures,
types and varieties of training programs for users were analyzed. The results
showed that although investments were made for installation of robots for
improving production activity, limited attention was paid to the health, safety, and
ergonomics aspects in the hybrid systems. There were also cases reported where
no formal guidelines for robot manipulation and operation were provided. It
seems that management and users paid attention to robot function and capability
more than robot safety during robotization process. Conclusions were made by the
authors that efforts should immediately be made to adopt recommendations on the
safety devices and facilities and training requirements for improving users' health
and safety before fatal accidents occur.
1472: Saudi Med J. 2001 Jun;22(6):477-80.

Going beyond the curriculum to promote medical education and

practice in Saudi Arabia.
Shawky S, Soliman NK.
Department of Community Medicine and Primary Health Care, Faculty of

Medicine and Allied Health Sciences, King Abdul Aziz University, Jeddah,
Kingdom of Saudi Arabia. shshawky@hotmail.com
The foundation of health starts as early as undergraduate medical education.

Medical education in the Kingdom has always been successful in promoting the
medical profession and population health. The current issue in the Kingdom is
quality assurance in all organizations including the health field. Thus emerges the
value of evaluating the efficiency and effectiveness of the current system in
meeting health needs and expectations. The aim of this paper was to analyze the
current situation in order to design a frame for the direction of promotion of
medical education and practice that best meets health needs and expectations. In
fact, medical practice is a multidisciplinary process that is showing continuously
changing theories. It has a broad scope of serving the whole community and
improving the quality of life of all population categories. The huge quantity of
information, needed to be retained by medical professionals, necessitates the
move away from traditional methods of education to more practical and
comprehensive programs of study. Most of the recent reform in medical
education, in the Kingdom, has focused on curriculum and disregarded the
education process. The requisite for the education process is a complete model of
community-based health care, education and research. This study proposes a
design aiming to enhance medical education and promote the medical profession,
through developing the quality of medical professionals, that will foster growth of
their activity and productivity, moving them into the community where clinical
practice and experience are more relevant to the true health situation.
Publication Types:
• Review
1473: Saudi Med J. 2000 Aug;21(8):751-4.

Assessment of reporting and recording system of communicable

diseases in Jeddah Region.
Bakarman MA, Al-Raddadi RM.
Joint Program for Postgraduate Family and Community Medicine, PO Box 8252,
Jeddah 21482, Kingdom of Saudi Arabia.
OBJECTIVE: To determine the rate of reporting communicable diseases in
Jeddah region, and to compare the recording system between the governmental
and private sector. METHODS: This is a review of records study, in which the
reports of communicable diseases from all hospitals and health centers (with or
without cases) were studied, during the period of study; 1st to 25th international
weeks 1999, and the reporting rate was calculated. A simple random sample was
collected from these international weeks to evaluate the quality of recorded
information. RESULTS: The reporting rate was 74%. Private hospitals have the
highest rate in reporting (87%) and polyclinics have the least (67%). The
recording rate was above 90% for administrative data. Personal data was complete
except for patient name (76.5%), address (20%), and occupation (73%). The most
prominent defect in the disease data was found to be in recording the mode of
infection (13%), followed by previous vaccination (29%), date of symptoms
(89%), and date of diagnosis (98%). Mode of infection was recorded in (40.5%)
of cases by primary health care centers, but in polyclinics in only 1% of cases.
Previous vaccination was recorded better by governmental sectors; (29%) by
governmental hospital and (49%) by primary health care centers while in the
private sectors the rate was (21%) by polyclinic and (25%) by private hospital.
Date of symptoms was recorded in 90% of cases in all sectors except in
governmental hospitals where it was only (50%). Date of diagnosis was recorded
in more than (95%) in all sectors. The results show a statistical significant
difference between different health sectors in recording data where government
hospitals were least in recording doctor's name and in putting an official stamp in
the form (p< 0.001); primary health care centers were the best in recording patient
name and occupation (p< 0.001); polyclinics were least in recording mode of
infection and previous vaccination (p< 0.001); for recording date of symptoms
private hospitals were the best (p< 0.001). CONCLUSION: The reporting rate in
Jeddah region was 74%, but its usefulness was diminished because of the
incomplete, absent or incorrect personal and disease data.
Publication Types:
1474: Osteoporos Int. 2001;12(4):311-8.

Hip fracture incidence rates in Singapore 1991-1998.
Koh LK, Saw SM, Lee JJ, Leong KH, Lee J; National Working Committee
on Osteoporosis.
Department of Endocrinology, Singapore General Hospital, Outram Road,

Singapore 169608. leonard_koh@sgh.com.sg
In this population-based study, we determined the incidence rates of hip fracture

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

Intervention without interference: a column of Befrienders

International.
Keir N.
1476: Mil Med. 2001 Jun;166(6):475-9.

Quality of deployment surveillance data in southwest Asia.

Morrow RC, Schafer KO, Williams RL.
Navy Environmental Health Center, Norfolk, VA 23513, USA.
The Global Expeditionary Medical System (GEMS), formerly known as Desert

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

The first Israeli national health and nutrition survey (MABAT) as a

policy maker.
Kaluski DN, Goldsmith R, Arie OM, Mayer C, Green M.
1478: Radiother Oncol. 2001 Jul;60(1):81-9.

Quantitative status of resources for radiation therapy in Asia and

Pacific region.
Tatsuzaki H, Levin CV.
Applied Radiation Biology and Radiotherapy Section, International Atomic

Energy Agency (IAEA), P.O. Box 200, A-1400, Vienna, Austria.
PURPOSE: Resources for radiation therapy in Asian and Pacific countries were
analyzed to obtain a better understanding of the status of radiation oncological
practice in the region. METHODS AND MATERIALS: The data were obtained
mainly through surveys on the availability of major equipment and personnel
which were conducted through an International Atomic Energy Agency regional
project. The study included 17 countries in South Asia, South East Asia, East Asia
and Australasia. Data were related to national populations and economic and a
general health care indices. RESULTS: Large differences in equipment and
personnel among countries were demonstrated. The availability of both
teletherapy and brachytherapy was related to the economic status of the countries.
The shortage of teletherapy machines was evident in more countries than that of
brachytherapy. Many departments were found to treat patients without simulators
or treatment planning systems. The number of radiation oncologists standardized
by cancer incidence of a country did not correlate well with economic status.
CONCLUSIONS: There were significant deficiencies in the availability of all
components of radiation therapy in the analyzed countries. The deficiencies were
linked predominantly to the economic status of the country. Cognisance should be
taken of the specific shortfalls in each country to ensure that expansion or any
assistance offered appropriately match its needs and can be fully utilized. The
information on the resources currently available for radiation oncological practice
in the region presented in this paper provides a valuable basis for planning of
development aid programs on radiation therapy.
1479: Public Health. 2001 Jan;115(1):2-3.

The long march to primary health care in China: from collectivism

to market economics.
Browne D.
Medical Adviser Health Promotion, Southampton Community NHS Trust,

Southampton, UK.
1480: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 2:43-4.
International cooperation in neonatal screening: technical training

course for newborn and infant screening.
Fukushi M, Hanai J, Yamaguchi A, Mikami A, Honma K, Nomura Y, Arai

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

Using sustainable development indicators as a supplementary

measure for the integrated management of environmental
information system in Taiwan.
Chang IC, Yu YH.
Graduate Institute of Environmental Engineering, National Taiwan University,

Room 311, 71 Chou-San Road, Taipei 106, Taiwan. d2507002@ms.cc.ntu.edu.tw
Environmental Information System (EIS) transfers environmental data and

information to audiences in any field of knowledge or activity interested in
environmental problems. Currently, numerous conventional EISs or
Environmental Databases (EDs) are available in Taiwan. However, they fail to
adequately address the strong correlations among the environmental, social and
economic components. Notably, Sustainable Development Indicators (SDIs)
combine environmental, social and economic dimensions, as well as illustrate the
links among systems. Subsequently, developing a set of SDIs will provide an
excellent opportunity to systematically consolidate the information scattered
among many archives, as well as promoting an integrated EIS. This work presents
an experimental model referred to as the 'Sustainable Development Information
System of the Island Taiwan' (SDISIT). This system was developed to assist the
integrated management of either EIS or ED. The Factor Analysis Method (FAM)
is one tool that may prove useful in easing the developing process. Furthermore,
by examining the correlations between the indicators, this method can apply
existing SDIs to identify the structure of interrelationships among indicators.
Publication Types:
• Review
1482: J Environ Manage. 2001 May;62(1):93-100.

Application of the Australian river bioassessment system

(AUSRIVAS) in the Brantas River, East Java, Indonesia.
Hart BT, Davies PE, Humphrey CL, Norris RN, Sudaryanti S,

Trihadiningrum Y.
Cooperative Research Centre for Freshwater Ecology and Water Studies Centre,
Monash University, Wellington Road, Clayton 3800, Australia.
Assessment of river 'health' using biological methods, particularly those based on

macro-invertebrates, is now commonplace in most developed countries. However,
this is not the case in most developing countries, where physical and chemical
methods are used to assess water quality, with very little use of biological
assessment methods. This paper reports on a project that aimed to assess the
possible introduction of biological assessment of river condition using the
Australian River Assessment System (AUSRIVAS) into Indonesia. The paper
addresses three components of the project: (1) science--does the bioassessment
method work in this tropical region? (2) resources--are they adequate and if not
what additional resources are needed? (3) politics--what needs to be done to
convince the agencies (both central and provincial) to take up such a new
philosophy and approach? A pilot study was run in the upper Brantas River, East
Java. A total of 66 reference sites and 15 test sites were sampled and the macro-
invertebrates collected were identified to family level. A rigorous quality-control
protocol was introduced to ensure the data were reliable and reproducible. The
macro-invertebrate data were used to develop a predictive model of the
AUSRIVAS type for the upper Brantas River, and the model was then used to
assess the 'health' of sites that were presumed to be damaged in this section of the
river. A number of difficulties were experienced during the study, including:
locating reference sites sufficiently unmodified by humans; lack of skills to
identify animals collected; and a paucity of facilities required for aquatic macro-
invertebrate identification (e.g. identification keys and good quality binocular
microscopes). For resources, the major constraint to the introduction of a
bioassessment capability in Indonesia is the lack of personnel trained in the
bioassessment techniques. An 'on-the-job' training approach was adopted, largely
because of the specialist nature of this work. Six Indonesians were trained and
will now become the 'trainers' of further Indonesian scientists (we have called this
process 'training-the-trainers'). For politics, it was hoped that the AUSRIVAS
method would be suitable for introduction into the Indonesian national Clean
River Program. A strategy was developed and implemented to ensure the method
and its outputs were accepted technically by the Indonesian scientific community,
and also by the resource managers and relevant government officials. Experience
shows that if the latter do not see how the bioassessment information will be used
for management purposes they will not accept the method even if it is
scientifically sound.
Publication Types:
1483: J Allied Health. 2001 Summer;30(2):68-74.

Determinants of job satisfaction among selected care providers in

Kuwait.
Shah MA, Chowdhury RI, al-Enezi N, Shah NM.
Department of Health Information Administration, Faculty of Allied Health

Sciences and Nursing, Kuwait University, Kuwait. makhdoom@hsc.kuniv.edu.kw
The study reports job satisfaction among a sample of 370 physicians, nurses,
pharmacists, and medical laboratory technologists in the Ministry of Health
hospitals in Kuwait. Job satisfaction was measured using Dunnette's scale. The
respondents in all four categories were satisfied with all aspects of their jobs
except salary. The medical laboratory technologists were, however, dissatisfied
with professional advancement as well. The physicians were found to be most
satisfied, closely followed by nurses and pharmacists, while medical laboratory
technologists were least satisfied. Multivariate analysis was used to assess the net
effects of background and work environment characteristics on overall job
satisfaction. Introduction to job, in-service training, and monthly income had
significant positive effects on overall job satisfaction. These findings may have
serious implications for health care delivery systems that recruit expatriate care
providers.
Publication Types:
• Multicenter Study
1484: J Health Popul Nutr. 2001 Mar;19(1):6-11.

Comment in:
• J Health Popul Nutr. 2001 Mar;19(1):4-5.
Health ethics in Pakistan: a literature review of its present state.
Hyder AA, Nadeem S.
Department of International Health, Johns Hopkins University, 615 North Wolfe

Street, Suite E-8132, Baltimore, MD 21205, USA. ahyder@jhsph.edu
National literature on ethics provides an insight into the nature and development
of a dialogue on health issues within a population. This study investigated the
health ethics discourse in Pakistan. The purpose was to critically reflect on the
nature and level of such discussions with the aim of stimulating an interest in the
ethical implications of health and medicine in developing countries. The study
evaluated the literature on biomedical and health ethics published in Pakistan
during 1988-1999. Overall, there is a dearth of published discourse on healthcare
ethics in Pakistan. Values that are considered to stem from religious teachings
predominate in discussions relating to medical ethics. A lack of effective policy
and legislation concerning the ethical practice of medicine is reported to have
negative effects on the profession. Research ethics has not been captured in the
published papers in Pakistan. Consideration of ethical issues in health is at an
early stage in the country and may reflect the situation in a large part of the
developing world.
Publication Types:
• Review
1485: Comput Methods Programs Biomed. 2001 Jul;66(1):5-15.

Status of PACS and technology assessment in Japan.
Inamura K, Konishi J, Nishitani H, Kousaka S, Matsumura Y, Takeda H,

Kondoh H.
Faculty of Medicine, School of Allied Health Sciences, Osaka University,

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

A global network for the control of snail-borne disease using satellite

surveillance and geographic information systems.
Malone JB, Bergquist NR, Huh OK, Bavia ME, Bernardi M, El Bahy MM,
Fuentes MV, Kristensen TK, McCarroll JC, Yilma JM, Zhou XN.
Pathobiological Sciences, School of Veterinary Medicine, Louisiana State
University, Baton Rouge, LA 70803, USA. malone@vetmed.lsu.edu
At a team residency sponsored by the Rockefeller Foundation in Bellagio, Italy,

10-14 April 2000 an organizational plan was conceived to create a global network
of collaborating health workers and earth scientists dedicated to the development
of computer-based models that can be used for improved control programs for
schistosomiasis and other snail-borne diseases of medical and veterinary
importance. The models will be assembled using GIS methods, global climate
model data, sensor data from earth observing satellites, disease prevalence data,
the distribution and abundance of snail hosts, and digital maps of key
environmental factors that affect development and propagation of snail-borne
disease agents. A work plan was developed for research collaboration and data
sharing, recruitment of new contributing researchers, and means of access of other
medical scientists and national control program managers to GIS models that may
be used for more effective control of snail-borne disease. Agreement was reached
on the use of compatible GIS formats, software, methods and data resources,
including the definition of a 'minimum medical database' to enable seamless
incorporation of results from each regional GIS project into a global model. The
collaboration plan calls for linking a 'central resource group' at the World Health
Organization, the Food and Agriculture Organization, Louisiana State University
and the Danish Bilharziasis Laboratory with regional GIS networks to be initiated
in Eastern Africa, Southern Africa, West Africa, Latin America and Southern
Asia. An Internet site, www.gnosisGIS.org, (GIS Network On Snail-borne
Infections with special reference to Schistosomiasis), has been initiated to allow
interaction of team members as a 'virtual research group'. When completed, the
site will point users to a toolbox of common resources resident on computers at
member organizations, provide assistance on routine use of GIS health maps in
selected national disease control programs and provide a forum for development
of GIS models to predict the health impacts of water development projects and
climate variation.
Publication Types:
1487: East Mediterr Health J. 2000 Jan;6(1):25-33.

Alternative medicine and the medical profession: views of medical

students and general practitioners.
Hasan MY, Das M, Behjat S.

Department of Pharmacology, Faculty of Medicine and Health Sciences, United
Arab Emirates University, Al-Ain, United Arab Emirates.
A survey was undertaken to explore the attitudes and practices of general

practitioners and medical students in the United Arab Emirates with regards to
forms of therapy not generally accepted by conventional medicine, including
herbal medicine, acupuncture, homeopathy, spiritual therapy and
osteopathy/chiropractic. The study found that alternative medicine is in common
use to complement conventional medicine by a section of educated people within
the health care system. Our observations lead us to appreciate its role in
community health care and indicate a need to design culturally appropriate
medical curricula which incorporate information about alternative medicine.
1488: Prehosp Disaster Med. 2001 Jan-Mar;16(1):18-21.

Proceedings for the 5th Asia-Pacific Conference on Disaster

Medicine: creating an agenda for action.
De Grace M, Ericson D, Folz H, Greene W, Ho K, Pearce L.
Vancouver Hospital and Health Sciences Centre, USA.
Disaster medicine has come to the forefront and has become the focus of interest
not only in the medical community, but also in the eyes of the public. The 5th
APCDM was convened in Vancouver, Canada, 27-30 September 2000. It brought
together over 300 delegates from 32 countries to share their experiences and
thoughts regarding disaster events and how to effectively manage them. The
conference was devoted to the task of establishing priorities and creating an
Agenda for Action. From the discussions, key actions required were defined:
COMMUNICATIONS: (1) Identify existing regional telehealth groups and gather
lessons to be learned from them; (2) Form a telehealth advisory group to work
with regional groups to compile telehealth initiatives, identify international
protocols in telehealth already in existence, and solicit feedback before setting
international standards; and (3) Increase corporate partnerships in the fields of
telehealth and telecommunications, and invite corporations to send delegates to
future APCDM meetings. This should be an initiative of the APCDM, the World
Association of Disaster and Emergency Medicine (WADEM), or the European
Society of Emergency Medicine. EDUCATION AND RESEARCH: (1)
Formalize education in disaster medicine and management. The World Health
Organization and WADEM should take a leadership role; (2) WADEM is
requested to hold a conference with a focus on qualitative research; (3) WHO is
requested to continue the provision of international research teams, but to
advocate for the development of national disaster research infrastructure; (4)
Make research findings and reports available on web sites of such organizations
as WHO and PAHO; (5) Develop the translation of research for community
utilization. The WHO and PAHO are organizations that are requested to consider
this action; and (6) WADEM/APCDM are requested to focus future conferences
on applied research. INFORMATION AND DATA: (1) Create an "Information
and Data Clearinghouse on Disaster Management" to collect, collate, and
disseminate information; (2) Collect data using standardized tools, such as CAR
or Hazmat indices; (3) Analyze incentives and disincentives for disaster readiness
and establish mechanisms for addressing the obstacles to preparedness; and (4)
WADEM is requested to develop a web site providing a resource list of
interdisciplinary institutions and response activities, organized by country, topic,
and research interests. Links to other pertinent web sites should be provided.
INTERDISCIPLINARY DEVELOPMENT: (1) Focus on the interdisciplinary
nature of disaster response through more conferences encompassing grassroots
efforts and through WADEM publications; (2) Develop and apply a standardized
template of Needs Assessment for use by multidisciplinary teams. Team Needs
Assessment is essential to determine the following: (a) Local response and
international assistance required; (b) Appropriate command system; and (c)
Psychosocial impact and support necessary. PSYCHOSOCIAL ASPECTS: (1)
Incorporate relief for caregivers into action plans. This should include prime
family members who also are caregivers; and (2) Implement measures that give
survivors control over the recovery process. RESPONSE MANAGEMENT: (1)
Define relationships and roles between governments, military and security
personnel, non-governmental organizations (NGOs), and civic groups. Use an
international legal framework and liability to reinforce accountability of disaster
responders; (2) Establish a more sophisticated use of the media during disasters;
(3) Establish standards in key areas. WADEM is requested to write "White
Papers" on standards for the following areas: (a) management, (b) health/public
health, (c) education/training, (d) psychosocial, and (e) disaster plans; (4)
Establish task forces to anticipate and resolve issues around evolving and
emerging disasters (e.g., chemical and biological terrorism, landmines, emerging
infectious diseases). WADEM was again identified as the vehicle for promoting
this action. The responsibility of the next meeting of the Asia-Pacific Conference
on Disaster Medicine will be to measure progress made in these areas by
assessing how well these collective decisions have been implemented.
Publication Types:
• Congresses
1489: J Int Assoc Physicians AIDS Care. 1997 Oct;3(10):24-8.

HIV and AIDS in Germany.
Mauss S, Dressler S.
Deutsche AIDS-Hilfe, Berlin, Germany.
AIDS: While Germany is still classified as a pattern I country under the World
Health Organization (WHO) standards, meaning most new HIV infections occur
in populations at risk, trends within this broad classification are slowly changing.
Both the proportion and the absolute number of women reported as newly
infected have increased, and account for 20 percent of all new infections. The
annual number of new infections among gay men has stabilized at close to 1,000,
or 55 percent of all new infections. Immigrants and refugees from endemic areas
in Asia and Africa now comprise 17 percent of all newly reported infections. In
addition, the country's policy of making new drugs available to Germans
immediately after they are approved anywhere else in the world has created a
healthcare system in which patients have access to a broad array of exciting new
treatments, but little professional advice on treatment strategies or safety
precautions. Thus, medical professionals must work to remain abreast of new
developments in treatment. Meanwhile, organizations that have been set up to
help people live with HIV face increased economic difficulties as new treatments
lower morbidity rates.
Publication Types:
• Newspaper Article
1490: Saudi Med J. 2000 Dec;21(12):1168-72.

Study of hemoglobinopathies in Oman through a national register.
Rajab AG, Patton MA, Modell B.
Genetic Blood Disorders Unit, DGHA, Ministry of Health, PO Box 880, Muscat
113, Sultanate of Oman. drarajab@omantel.net.om
OBJECTIVES: A national register of symptomatic hemoglobinopathies has been

developed in Oman to facilitate the development of the National Program for the
control of genetic blood disorders. METHODS: The information was initially
collected retrospectively through hospital records and was refined prospectively
with data collected through a survey of pediatricians. The percentages of
heterozygotes in different population groups and geographical locations, birth
prevalence, age distribution of cases and factors determining frequencies of
Hemoglobinopathies in different regions of the country were studied from the
register. RESULTS: The register has identified 1757 cases of homozygous Sickle
Cell Anemia and 243 cases of beta-thalassemia major in a population of 1.5
million in 1995. Register based national figures of heterozygote carriers
approximate 10% for Sickle Cell Anemia and 4% for beta-thalassemia major.
CONCLUSION: Defining regional and tribal variations can assist efficient
targeting of health resources. This approach provides a simple model for other
countries or regions to follow providing there is a health care system that
facilitates registration.
1491: Health Policy Plan. 2001 Jun;16(2):193-8.

The effectiveness of patient referral in Pakistan.
Siddiqi S, Kielmann A, Khan M, Ali N, Ghaffar A, Sheikh U, Mumtaz Z.
Health Services Academy, Islamabad, Pakistan.
In Pakistan, despite an elaborate network of over 5000 basic health units and rural
health centres, supported by higher-level facilities, primary health care activities
have not brought about expected improvements in health status, especially of rural
population groups. A poorly functioning referral system may be partly to blame.
System analysis of patient referral was conducted in a district of Punjab province
(Attock) for the purpose of identifying major shortcomings, if any, in this domain.
Respondents from 225 households were interviewed. Of the households
experiencing serious illnesses less than half were taken to a nearest first-level care
facility (FLCF). Major reasons included dissatisfaction with quality of care
offered, non-availability of physician, and patients being too ill to be taken to the
FLCF. The FLCF utilization rate was less than 0.6 patient visits/person/year. The
mean number of patients referred per FLCF during the previous 3 months was 6.5
+/- 5.0. Only 15% of patients were referred on the prescribed referral form. None
of the higher-level facilities provided feedback to FLCFS: Records of higher-level
facilities revealed lack of information on either patient referrals or feedback.
There were no surgical or emergency obstetric services available at any of the
first-level referral facilities. Seventy-five percent of the patients attending the
first-level referral facilities and 44% of the patients attending higher-level
facilities had a problem of a primary nature that could well have been managed at
the FLCF. As a result of the study findings, eight principal criteria were identified
that need to be satisfied before a referral system may be considered functional.
Publication Types:
1492: Health Policy Plan. 2001 Jun;16(2):180-6.

Using costing as a district planning and management tool in

Balochistan, Pakistan.
Green A, Ali B, Naeem A, Vassall A.
Nuffield Institute for Health, University of Leeds, UK.
This paper reports on two studies in the province of Balochistan, Pakistan,

analyzing the costs of primary care facilities and district and divisional hospitals.
There are no known previous cost studies within Balochistan and the information
gained is a critical element in developing a more rational allocation of resources
within the health sector. The results demonstrate both the high level of under-
funding of primary care within the health sector and the current inefficiency of
allocation towards primary care and, within budgets, between different line items.
Medicines in particular are significantly under-funded at the expense of staffing
costs. The results are of use in developing more bottom-up budgeting systems
within a more rational resource allocation system that is being developed as an
element of the more decentralized health system towards which the province is
working.
Publication Types:
1493: Am J Trop Med Hyg. 2000 Jul-Aug;63(1-2):5-11.

Clinical, epidemiologic, and virologic features of dengue in the 1998

epidemic in Nicaragua.
Harris E, Videa E, Pérez L, Sandoval E, Téllez Y, Pérez ML, Cuadra R,
Rocha J, Idiaquez W, Alonso RE, Delgado MA, Campo LA, Acevedo F,
Gonzalez A, Amador JJ, Balmaseda A.
Division of Infectious Diseases, School of Public Health, University of California,

Berkeley 94720-7360, USA. eharris@socrates.berkeley.edu
From July to December 1998, a hospital- and health center-based surveillance

system for dengue was established at selected sites in Nicaragua to better define
the epidemiology of this disease. Demographic and clinical information as well as
clinical laboratory results were obtained, and virus isolation, reverse transcriptase-
polymerase chain reaction, and serologic assays were performed. World Health
Organization criteria were used to classify disease severity; however, a number of
patients presented with signs of shock in the absence of thrombocytopenia or
hemoconcentration. Therefore, a new category was designated as "dengue with
signs associated with shock" (DSAS). Of 1,027 patients enrolled in the study, 614
(60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were
classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic
manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%)
as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary
infection was not significantly correlated with DHF/DSS, in contrast to previous
studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a
minority due to DEN-2; both serotypes contributed to severe disease. As
evidenced by the analysis of this epidemic, the epidemiology of dengue can differ
according to geographic region and viral serotype.
Publication Types:
1494: Schizophr Bull. 2001;27(2):181-5.

Impact of the term schizophrenia on the culture of ideograph: the

Japanese experience.
Kim Y, Berrios GE.
Division of Adult Mental Health, National Institute of Mental Health, National

Center of Neurology and Psychiatry, Ichikawa, Japan. kim@ncnp-k.go.jp
The ideographic Chinese writing system (in use in Asian countries that account
for about a quarter of the world's population) directly expresses the meaning of
schizophrenia as "the disease of disorganized mind." The term directly challenges
a deeply ingrained concept of personal autonomy, and this is stigmatizing.
Japanese psychiatrists are thus reluctant to tell their patients that they are suffering
from schizophrenia, and, as a result, no more than 20 percent of sufferers actually
do know about their diagnosis. Because taking medication is based on informed
consent and the exercise of the patient's autonomy, such lack of information has
important negative effects. It is unlikely that this problem can be resolved by
education or information alone, and it may well be the case that in cultures using
ideographs, the illness will need to be renamed. This article suggests some
alternatives.
Publication Types:
1495: Isr Med Assoc J. 2001 Jan;3(1):17-20.

A four year survey of neonatal narcotic withdrawal: evaluation and

treatment.
Lifshitz M, Gavrilov V, Galil A, Landau D.
Toxicology Unit, Soroka University Medical Center and Faculty of Health

Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
matyl@bgumail.bgu.ac.il
BACKGROUND: Narcotic abuse has steadily become more prevalent in Israel

and may result in an increasing number of children exposed prenatally to
narcotics, with a consequent increase in the number of infants born with neonatal
abstinence syndrome. OBJECTIVE: To report our experience with infants born to
narcotic-addicted women between the years 1995 and 1998 at the Soroka
University Medical Center. METHODS: The medical records of 24 newborns and
their drug-addicted mothers admitted to our Medical Center for parturition were
analyzed retrospectively. A diagnosis of NAS was established on the basis of the
clinical presentation and anamnesis. The Finnegan Neonatal Abstinence Scoring
System was used to assess drug withdrawal. Urine toxicological analysis for
narcotics was done only for the year 1998. RESULTS: Of the 24 newborn infants
exposed prenatally to narcotics 23 (96%) developed NAS, and 78% (18 of the 23)
had a Finnegan score of 8 or more. These 18 infants were treated
pharmacologically (tincture of opium and/or phenobarbital) until the score was
reduced to less than 8, after which they received supportive treatment. In one
child who became lethargic after the first dose of tincture of opium, the
medication was stopped and supportive treatment alone was given. Four of the
five neonates with scores of 7 and less were given supportive treatment. One of
five infants who had a low Finnegan score at birth nevertheless received
pharmacological therapy to prevent further deterioration of his physical state since
he was born with severe dyspnea. Ten of the 24 children (42%) were followed for
lengths of time ranging from 6 to 22 months after discharge, all of whom showed
normal development. CONCLUSIONS: About three-quarters of newborns
exhibiting withdrawal syndrome required pharmacological therapy. Previous
information on maternal drug abuse is a crucial criterion for early detection and
treatment.
1496: Isr Med Assoc J. 2000 Nov;2(11):811-5.

Medical research in Israel and the Israel biomedical database.
Berns DS, Rager-Zisman B.
Chief Scientist's Office, Ministry of Health, Jerusalem, Israel.
The data collected for the second edition of the Directory of Medical Research in
Israel and the Israel Biomedical Database have yielded very relevant information
concerning the distribution of investigators, publication activities and funding
sources. The aggregate data confirm the findings of the first edition published in
1996 [2]. Those facts endorse the highly concentrated and extensive nature of
medical research in the Jerusalem area, which is conducted at the Hebrew
University and its affiliated hospitals. In contrast, Tel Aviv University, whose
basic research staff is about two-thirds the size of the Hebrew University staff, has
a more diffuse relationship with its clinical staff who are located at more than half
a dozen hospitals. Ben-Gurion University in Beer Sheva and the Technion in
Haifa are smaller in size, but have closer geographic contact between their clinical
and basic research staff. Nonetheless, all the medical schools and affiliated
hospitals have good publication and funding records. It is important to note that
while some aspects of the performance at basic research institutions seem to be
somewhat better than at hospitals, the records are actually quite similar despite the
greater burden of clinical services at the hospitals as compared to teaching
responsibilities in the basic sciences. The survey also indicates the substantial
number of young investigators in the latest survey who did not appear in the first
survey. While this is certainly encouraging, it is also disturbing that the funding
sources are apparently decreasing at a time when young investigators are
attempting to become established and the increasing burden of health care costs
precludes financial assistance from hospital sources. The intensity and
undoubtedly the quality of medical research in Israel remains at a level consistent
with many of the more advanced western countries. This conclusion is somewhat
mitigated by the fact that there is a decrease in available funding and a measurable
decrease in scholarly activity at a time when a new, younger generation of
investigators is just beginning to become productive. In closing, we wish to stress
that the collection of data for the Biomedical Database is a continuing project and
we encourage all medical researches who may not have contributed relevant
information to write to the Office of the Chief Scientist or contact the office by
email.

Healthy City Kwachon 21 Project: a community health promotion

programme in Korea.
Kim HJ.
Graduate School of Health Science and Management, Yonsei University Medical

Center, 134 Shinchon-Dong, Soedaemoon-Gu, Seoul 120-752, Korea.
Disease patterns of Koreans changed from infectious disease to non-infectious

disease in the 1970's. Even though there has been a need for a health promotion
programme, it was hard to find the programme in the community before 1985 in
Korea. In 1985, the Public Health Promotion Law was enacted and the Korean
government started to encourage local government to plan and conduct
community health promotion programs. Healthy City Kwachon 21 (HCK21) is a
health promotion programme for all residents in Kwachon, a city which has about
70,000 population and is located adjacent to Seoul, Korea. HCK21 launched in
1998 with three guiding principles: 1) programs should be accessible to all
citizens; 2) Programmes should stimulate strong community participation and 3)
Programmes should change environment and society. The long term goal of
HCK21 is to increase the healthy life span of citizens in Kwachon. HCK21 is a
collaborative project between Kwachon and the Institute for Health Promotion of
the Graduate School of Health Science and Management, Yonsei University. It
has seven components: 1) Publication of Monthly Health Newsletter; 2) Smoking
Cessation and Tobacco Prevention Program; 3) Community Nutrition Program; 4)
Maternal and Women's Health Programme; 5) Programme for Development of
District Health Management Information System; 6) Hypertension Prevention and
Control Programme and 7) Physical Activity Programme. HCK21 is now being
implemented in the third year program since the program conducted in 1998 and
1999 was successful with received support from the citizens. It is recommended
that HCK21 be a model for an integrated community-based health promotion
programme in developing countries.
1498: Nippon Ishinkin Gakkai Zasshi. 2001;42(2):75-80.

US-Japan workshops in medical mycology: past, present and future.
Dixon DM.
Bacteriology and Mycology Branch, Division of Microbiology and Infectious

Diseases, National Institute of Allergy and Infectious Diseases, National Institutes
of Health, Bethesda, Maryland 23298, USA.
The Extramural Mycology Program of the National Institutes of Health (NIH),

National Institute of Allergy and Infectious Diseases (NIAID) has organized and
implemented a five workshop series in medical mycology during a critical period
in the evolution of contemporary medical mycology (1992 to 2000;
http://www.niaid.nih.gov.ezproxy.lib.ucalgary.ca/research/dmid.htm). The goals
of the workshop series were to: initiate interactions; build collaborations; identify
research needs; turn needs into opportunities; stimulate molecular research in
medical mycology; and summarize recommendations emerging from the
workshop proceedings. A recurring recommendation in the series was to foster
communications within and beyond the field of medical mycology. US-Japan
interactions were noted as one specific example of potential information exchange
for mutual benefit. The first formal action directed at this recommendation was
the workshop Emergence and Recognition of Fungal Diseases convened under the
auspices of the US-Japan Cooperative Medical Science Program (USJCMSP;
http://www.niaid. nih.gov/dmid/us%5Fjapan/default.htm) in Bethesda, Maryland
USA on 30 June 1999 (D.M. Dixon & T. Matsumoto, co-chairs). A major goal of
the workshop was to present contemporary medical mycology to the Joint
Committee of the USJCMSP through representative research presentations in
order to make the Committee aware of current status in the field, and the potential
for scientific interactions. The second formal action is the workshop, under the
auspices of the Japanese Society for Medical Mycology Medical Perspectives of
Fungal Genome Studies scheduled for 28 November 2000 in Tokyo, Japan (T.
Matsumoto & D.M. Dixon, co-chairs). The NIAID Mycology Workshop series
recommended interactions between the following groups: academic and
pharmaceutical; medical and molecular (model systems); medical and plant
pathogens; basic and clinical; mycologists and immunologists. The first two US-
Japan workshops can be viewed as consistent with these recommendations, and
serve as a Western/Eastern gateway for exchange. The focus of the second US-
Japan workshop on genome projects for the medically important fungi provides
an excellent model for international communications. Given the tsunami of
information that is flowing from genomics and bioinformatics, it is clear that
global interactions will be essential in managing and interpreting the data.
Publication Types:
• Review
1499: Soc Sci Med. 2001 Feb;52(3):393-404.

Real world pharmacy: assessing the quality of private pharmacy

practice in the Lao People's Democratic Republic.
Stenson B, Syhakhang L, Eriksson B, Tomson G.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

bo.stenson@wanadoo.fr
The private sector is a dominant actor in the provision of pharmaceuticals,

particularly in developing countries. Private provision of drugs has been
associated with risks regarding availability, affordability, rational use and drug
quality. Ensuring an effective regulatory framework is therefore a major challenge
for governments, yet the capacity of regulatory authorities is often outstripped by
private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a
poor, landlocked country in South East Asia, the private provision of drugs has
increased dramatically since the liberalisation of the economy in the late 1980s.
This paper aims to describe the quality of the private pharmacy services in the
Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument
which serves to make the concept of Good Pharmacy Practice (GPP) operational
was developed and applied to a sample of pharmacies. Service quality, as
measured by three facility-specific indicators, showed a tendency to be lower in
the most distant districts. Poor dispensing practices were manifest by a lack of
information about drugs sold in 59% of cases, drugs not being labelled in 47%
and different drugs being mixed in the same package in 26% of cases. The prices
of four sample drugs were slightly higher in the remote districts. A 10-fold price
difference for the same drug was recorded in one district. After reporting the
findings, the paper discusses the possible influence of district and pharmacy
variables on the quality of services, and goes on to discuss the price differences. It
is concluded that further government interventions are needed in order to improve
the quality of services and to focus regulatory action on a limited number of
aspects, to ensure that drugs can be traced before trying to establish a
comprehensive regulatory system.
Publication Types:
1500: Cancer Nurs. 2001 Apr;24(2):156-61.

•
Development of a breast self-examination program for the Internet:
health information for Korean women.
Kim HS, Kim E, Kim JW.
Yonsei University, College of Nursing, Seoul, Korea.
Internet-based health information will enable us to interact with many people

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

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1301: Environ Health Perspect. 2002 Nov;110(11):1141-6.

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