His 10

1901: Int J Biomed Comput. 1995 Oct;40(2):81-3.
Related Articles, Links
Informatics in family practice--an Asia-Pacific perspective.
Kidd M.
Department of Community Medicine, Monash University, East Bentleigh,

Australia.
Recent advances in computer hardware, software and telecommunications, and

particularly in the development of the electronic medical record, mean that family
practitioners around the world now have access to a multiplicity of tools which
offer the potential for significant time savings and improved quality of health care
provision. Areas such as practice management medication management and
prescription generation, clinical record keeping, decision support, medical
research and continuing medical education can all be aided through the use of
information technology in a family practice setting. Yet family medicine, or
general practice, has largely been slow to take up the challenge of implementing
information technology in most parts of the Asia-Pacific region. This contrasts
sharply with many other areas of medicine which have been very active in
embracing this technology. This paper examines the potential advantages and the
difficulties of computerisation for general practitioners and their patients in the
Asia-Pacific region. It is hoped that the lessons already learned in some countries
in this region can be adapted and applied elsewhere.
PMID: 8847126 [PubMed - indexed for MEDLINE]
1902: Int J Biomed Comput. 1995 Oct;40(2):107-14.

The Philippine management information system for public health

programs, vital statistics, mortality and notifiable diseases.
Marte BA, Schwefel D.
Department of Health, Health and Management Information System, San Lazaro

Compound, Manila, Philippines.
Strengthening the information support for decision making has been identified as
an important first step toward improving the efficiency, effectiveness, and
equitability of the health care system in the Philippines. A Philippine-German
Cooperation is in partnership toward developing a need-responsive and cost-
effective Health and Management Information System (HAMIS). Four
information baskets are being strengthened specifically to address these needs in a
cost-effective way: public health information systems, hospital information
systems, information systems on economics and financing, information systems
on good health care management. BLACKBOX is the management information
system for public health programs, vital statistics, mortality and notifiable
diseases of the Philippines. It handles and retrieves all data that is being collected
by public health workers routinely all over the Philippines. The eventual aim of
BLACKBOX is to encourage the development of an information culture in which
health managers actively utilise information for rational planning and decision
making for a knowledge based health care delivery.
1903: Indian J Public Health. 1995 Oct-Dec;39(4):148-51.

National Iodine Deficiency Disorders Control Programme in India.
Tiwari BK, Kundu AK, Bansal RD.
DGHS, Nirman Bhavan, New Delhi.
Iodine Deficiency Disorders are one of the biggest worldwide public health
problem of today. Their effect is hidden and profound affecting the quality of
human life. An attempt has been made to describe the various aspects of the
National Iodine Deficiency Disorders control Programme (NIDDCP) being
implemented in the country. The paper also focuses about the problems associated
in implementing this national programme.
PIP: In India, 167 million people are at risk of iodine deficiency disorders (IDDs).
54.4 million people have a goiter. About 8.8 million people have IDD-related
mental/motor handicaps. IDD is a problem in every state and union territory. It is
a major public health problem in 211 of the 245 districts surveyed. Even though
IDDs cannot be cured, they can be easily prevented. Daily consumption of
iodized/iodated salt is the most effective and inexpensive way to prevent IDD. In
1962, the government of India implemented the National Goitre Control
Programme, now called the National Iodine Deficiency Disorders Control
Programme (NIDDCP). In 1982, the government made a policy decision to iodate
all edible salt in India by 1992. During 1994-1995, India's private sector produced
34 lakh metric tons of iodated salt per year. The government expects iodated salt
production to increase to 50 lakh metric tons in the near future. Iodated salt is
transported on the railways under a priority category that is second only to
defense. In 19 states and 6 union territories, the sale of noniodated salt has been
completely banned. The remaining state governments have been urged to ban the
sale of noniodated salt and to include iodated salt under the public distribution
system. Each State Health Directorate has been advised to set up an IDD Control
Cell. The biochemistry division of the National Institute of Communicable
Diseases has a national reference laboratory for monitoring of IDD, and it also
trains medical and paramedical personnel. District health officers in all endemic
states have test kits to conduct on-the-spot qualitative testing to ensure quality
control of iodated salt at the consumption level. NIDDCP provides IDD surveys,
health education, and publicity campaigns. Its information, education, and
campaign activities include video films, posters, and radio/TV spots.
1904: Regul Toxicol Pharmacol. 1995 Oct;22(2):162-71.

The development of occupational exposure limits for chemical

substances in China.
Liang YX, Gang BQ, Gu XQ.
Shanghai Medical University, People's Republic of China.
This paper presents a comprehensive review of the occupational exposure limits

(OELs) of chemical substances in China. It provides historical background on the
development of OELs in this country, with a complete list of traditionally adopted
and newly developed OELs for chemicals in workplaces. The philosophical
thoughts, the administrative system, the scientific protocols for setting and
amending health standards, with emphasis on making health a basic criterion for
setting health standards, strengthening epidemiological studies of the human
population, integrating epidemiological and toxicological studies, considering
technological and economical feasibilities, and making full use of literature
information sources are discussed. Further perspectives with respect to practical
issues of maximum allowable concentration and time-weighted average, selection
of safety factors, and establishment of biological exposure limits are also
considered, with the authors' contributions to a discussion on these topics.
Publication Types:
• Review
1905: Reprod Freedom News. 1995 Sep 29;4(17):5.

Related Articles
Women's rights advocates achieve victories as UN conference

concludes.
[No authors listed]
PIP: On September 15, 1995, government delegations finished the Platform for
Action of the United Nations Fourth World Conference on Women in Beijing,
China. In this historic document, individual governments and the international
community committed themselves to the advancement of women worldwide.
Human rights issues (violence against women and female children, and
reproductive freedom and health) were discussed and affirmed. Paragraph 2 of the
human rights section states that "the human rights of women and the girl child are
an inalienable, integral and indivisible part of universal human rights." Paragraph
9 adds "full realization of all human rights and fundamental freedoms of all
women is essential for the empowerment of women." Acknowledging "the
significance of national and regional particularities and various historical, cultural
and religious backgrounds," the document still calls for "states, regardless of their
political, economic and cultural systems, to promote and protect all human rights
and fundamental freedoms." The human rights section "reaffirms that
[reproductive rights] rest on the recognition of the basic right of all couples and
individuals to decide freely and responsibly the number, spacing, and timing of
their children and to have the information and means to do so, and the right to
attain the highest standard of sexual and reproductive health. It also includes their
right to make decisions concerning reproduction free of discrimination, coercion
and violence, as expressed in human rights documents." The platform recognizes
violence against women and girls in all societies (physical, psychological, and
sexual abuse that includes murder; systematic rape; forced pregnancy,
sterilization, contraception, and abortion; female infanticide; battering; and
trafficking in women that is perpetrated by state and nonstate actors). The section
on women and armed conflict declares that "rape in the conduct of armed conflict
constitutes a war crime and under certain circumstances it constitutes a crime
against humanity and an act of genocide." The United Nations will vote on the
Platform and Declaration during the General Assembly's fiftieth session.
1906: J Health Econ. 1995 Oct;14(4):419-41.

Optimal medical treatment under asymmetric information.
Lee C.
Department of Economics and Related Studies, University of York, Heslington,

UK.
A model is developed of patient-doctor interaction under asymmetric information.

It examines how both the probability of consulting and initial health status are
semi-endogenously determined by a potential patient determining a threshold
health level, below which he demands a consultation. It is shown that the demand
elasticity with respect to socio-economic variables is lower the more severe the
illness. The paper also offers a model of the supply side. A distinction is
established between uncertainty and asymmetric information between the patient
and the doctor. After deriving the conditions for an equilibrium of the patient-
doctor interaction, payment systems for achieving medical 'adequacy' and Pareto
efficiency are analysed.
1907: Kekkaku. 1995 Sep;70(9):537-43.

[The problems of the young tuberculosis patients in the community

tuberculosis control]
[Article in Japanese]
Hattori S.
Division of School Health and Physical Education, Aichi Prefectural Board of

Education, Nagoya, Japan.
In Japan the incidence of tuberculosis has decreased, but recently the decreasing
speed is slowed down. In young people, the phenomenon is remarkable in the
incidence for those aged 15-30 years. It will be useful to improve examinations of
tuberculosis contacts, in order to prevent spread of tuberculosis infection among
young people. This may also help effectively to identify high-risk groups for
tuberculosis. Aichi Prefecture has a unique programme that the prefectural
government can monitor and support the measures taken by the public health
centers, such as examination of tuberculosis contacts. During last three years from
1991 through 1993, 333 tuberculosis cases were reported through this system. Of
them 143 cases that were younger than 30 years have been analyzed; 65 cases
were males and 78 were females. Those aged 20-29 years occupied 58% of the
cases. More than half of the cases were diagnosed by visiting doctors. High
school and college students occupied 38% of the cases, and nurses, public health
nurses, and nursery school teachers occupied 20%. Cases whose source of
infection was known occupied less than 30%, but more than half of them had the
sources of infection in their families. This programme is very useful for
prefectural government to get the information how the public health centers
implement their measures against tuberculosis and to control them.
Publication Types:
• English Abstract
1908: Health Inf Manag. 1995 Sep-Oct;25(3):89-94.

The future is electronic.
Luxford K.
National Coding Centre.
Electronic patient records are a central feature of many national policies on health
information technology. The present article provides an overview of definitions
for various degrees of medical record computerisation and current obstacles to
implementation. A summary of progress in the areas of standards, specific
technological developments and legal issues is provided. The wide ranging
benefits of electronic patient records and the implications for health information
managers and clinical coders are discussed.
1909: Curr Issues Public Health. 1995 Aug;1(4):176-9.

Risk and vulnerability reduction in the HIV / AIDS pandemic.
Tarantola D.
PIP: An estimated 13.2 million men, 10 million women, and 2.7 million children
worldwide have been infected with HIV since the beginning of the pandemic, and
more than 10,000 people daily acquire HIV infection. 67% and 19% of these
infections have occurred in sub-Saharan Africa and Southeast Asia, respectively.
Even though the annual number of new HIV infections appears to have reached a
plateau in Western Europe and the Caribbean and may be approaching one in sub-
Saharan Africa, and the rise of new infection seems to be on the decline in North
America, Oceania, and the southeastern Mediterranean, the HIV/AIDS pandemic
has not been controlled anywhere in the world and its major impact has yet to
come. Prevention activities undertaken by individuals, communities, nations, and
international bodies have shown that the spread of HIV can be effectively
reduced. Public health interventions against HIV/AIDS emphasize risk reduction
strategies through the provision of HIV/AIDS-related information about safe
behavior and the promotion of prevention methods. Exclusive reliance upon risk
reduction strategies, however, fails to address the contextual issues in which the
pandemic is rooted. In order to significantly affect the pandemic, short-term risk
reduction interventions must be expanded considerably, adapted to local needs,
and replicated worldwide. An expanded response to the pandemic also calls for
medium- and long-term risk reduction interventions, including the linking of
HIV/AIDS prevention, care, and support work with other actions in the health and
social sector, and the remodeling of services to respond more effectively to
growing needs. Until recently, such interventions have been neglected or
misconstrued as the process of spreading thinly and irresponsibly HIV/AIDS
actions within health and social programs. The sustainability and eventual success
of HIV prevention will depend upon the capacity of health systems to integrate
HIV/AIDS-related activities with other initiatives, while retaining the ability to
track the epidemic and account for what is done about it. The influence of
contextual factors on vulnerability to HIV/AIDS is discussed.
1910: China Popul Today. 1995 Aug;12(3-4):7-8.

Related Articles
China: women benefit from the family planning programme.
Xiao Z.
PIP: This statement was made by the director of CPIRC in China. Opening
remarks focused on the admirable achievement in the reduction of births over 20
years by about 300 million, which is more than the combined populations of
Canada and the USA. Family planning programs are considered as providing the
means for couples to have fewer children and as promoting social progress and
the advancement of women. IEC programming for family planning is extensive
and country wide. Home visitation for family planning is part of programming
within the All China Women's Federation and the China Family Planning
Association. IEC programs include information about population, reproductive
health, and family planning for millions of families. The opportunity is available
for Chinese women to acquire knowledge and make decisions that balance
individual needs with social responsibility and to have access to information on
modern methods, on healthy childrearing patterns, and on maternal health.
Chinese women are considered able to have an equal say with their husbands in
determining the size and spacing of children. The maternal and child health
(MCH) and family planning network is described as including 374 MCH
hospitals, over 2800 MCH clinics and stations, 2300 county family planning
service stations, and millions of medical professionals in mobile medical teams.
Jiangsu is identified as a particularly successful province in achievement of health
and family planning. State family planning policy and related regulations are
understood within the context of integrated programs combining family planning
with economic development, poverty alleviation, popularization of modern
scientific knowledge, and betterment of social security systems. The example is
given of Henan province where girls are enthusiastic about learning and bring
productive skills as a form of dowry to the marriage. Rural women are
encouraged to participate in training, and urban women are encouraged to serve as
public role models. Family planning acceptance has not occurred evenly across
the country, and some old social traditions of son preference still prevail. China is
described as committed to programs for sustainable development, the protection
of women's rights, and the enhancement of women's status.

Informed contraceptive choice: interview with Vice Minister Li

Honggui.
Li W.
PIP: In an interview, Li Honggui, the Vice Minister of China's State Family

Planning (FP) Commission, described China's Project of Informed Choice. Li
stated that a lack of resources and the immaturity of the FP program had limited
the contraceptive choices that Chinese couples had. Therefore, in 1991, the State
FP Commission conducted field trials during which new and effective
contraceptives were introduced, services were enhanced, and informed choice was
made available to rural couples. In 1993, this program was extended into 10 cities.
This program was implemented at this time in order to meet the demand in
developed areas for contraceptives which are economical, safe, reliable and
reversible and which have fewer side effects. This program also responds to
criticism leveled at China's FP program from the international community. In the
pilot areas, the emphasis will be on improved delivery of services, and the
evaluation system will include more quality of care indices. In the pilot areas,
funding from the Rockefeller Foundation has enabled an effective IEC
(information, education, and communication) program to be launched, the FP
units to be well equipped, and the staff to receive more training. Clients also
receive follow-up services, and their records are tracked in a computer database.
While informed choice represents the future of the FP program in China, the less
developed regions currently lack the prerequisites for such a program, so
expansion will proceed cautiously.

Related Articles
Preparing for the 21st century: introducing a service approach.

He S.
PIP: While China's strong population policy remains unchanged, the State Family
Planning (FP) Commission is experimenting with innovations designed to
improve service delivery and promote gender equity. China entered demographic
transition with a large population base which obviated the luxury of achieving the
transition gradually over time. Because mortality rates have dropped dramatically
and there is a large cohort of people of reproductive age, China adds 14-15
million people to its population each year. Were it not for the FP program, China's
current population of 1.2 billion would be about 300 million higher. Economic
reform has meant that most Chinese people have their basic needs met and can
strive to improve the quality of their lives. These same reforms have weakened
the collective systems of financing reproductive health systems, however, and
new systems of local support must be found. China's Agenda 21, which sets goals
for the 21st century, cites the education of girls and women as a key step to
achieving a sustainable population size. In addition to an emphasis on
reproductive health, China is initiating programs in adolescent health, sex
education, and AIDS prevention. China's National FP Program for 1995-2000
emphasizes these changes and identifies a strong information, education, and
communication component as a priority. Innovations, such as a participatory
approach to training grassroots workers in interpersonal skills and counseling, are
being field tested as a preliminary step toward full implementation. Training
workshops are also being held to prepare FP leaders to uphold FP laws and protest
the rights of the public.
1913: Nurs J India. 1995 Aug;86(8):173-7.

Sex education for adolescents.
Handa A.
PIP: 90 boys and 90 girls from three public high schools in South Delhi responded
during 1993-94 to survey questions on their knowledge of male and female
human reproduction systems, sexual growth and development during puberty,
sociocultural aspects of sex, sexual expression and behavior, and sexual disorders
and diseases. Friends and the mass media were students' main sources of
information on human sexuality, with very few respondents learning from health
professionals, parents, and teachers. Knowledge deficits were found in all areas
surveyed, especially with regard to sexual expression, sociocultural aspects of
sex, and sexual disorders and diseases. All of the students argued the need to
teach young children about human sexuality. The sex education program
developed for the students was found to be valid and effective in increasing levels
of knowledge. Study implications and recommendations are discussed.
1914: Lancet. 1995 Jul 22;346(8969):233-4.

Comment in:
• Lancet. 1995 Sep 16;346(8977):774-5; author reply 775-6.

• Lancet. 1995 Sep 16;346(8977):774; author reply 775-6.
Natural family planning in the 1990s.
Ryder B, Campbell H.
Department of Endocrinology, City Hospital NHS Trust, Birmingham, UK.
PIP: Natural family planning (NFP) tends to be considered as a matter of chance

resulting in unplanned pregnancies and large families. A World Health
Organization (WHO) multicenter trial of the ovulation method of NFP was
undertaken during 1975-79 with the primary objective of determining what
proportion of women of many different cultures could be taught to recognize
changes in the cervical mucus around the time of ovulation. The conclusions were
that: a) irrespective of cultural, educational, or economic background, over 95%
of fertile women could recognize the mucus signs of fertility; b) the fertility rate
was 22.6 pregnancies per 100 woman years; c) the preovulatory and postovulatory
days designated by the ovulation method of NFP rules as infertile were indeed
infertile, as the pregnancies in this phase were 4 per 1000 acts of intercourse. The
knowledge gained through the WHO trial and subsequent experience has given
NFP organizations and teachers a much greater understanding of the fertile and
infertile phases, so that total pregnancy rates have been steadily falling. Of the 11
NFP studies so far reported in the 1990s, the 3 that had total pregnancy rates
greater than 5 per 100 woman years were trials of atypical NFP approaches or
teaching methods. The results can be compared with reported pregnancy rates of
between 0.18 and 3.6 for artificial contraceptive methods in well-motivated
couples. One criticism of NFP is that the necessary periods of abstinence may be
detrimental to the marital relationship. It is suggested that the sexual revolution of
the last 20-30 years has caused marital and family breakdown on a massive scale,
thus NFP might be the antidote. Since women are potentially fertile for no more
than 6-8 days in the cycle, these easily recognized symptoms empower women
through the knowledge they impart regarding their state of fertility. All women
are entitled to this simple and fundamental information.
Publication Types:
• Review
1915: AIDS Asia. 1995 Jul-Aug;2(4):2-5.

Pioneering efforts to control AIDS. Review: IHO.
Chatterji A, Sehgal K.
PIP: The Indian Health Organisation (IHO) is a nongovernmental organization

based in Bombay with more than 12 years experience in HIV/AIDS prevention
and control efforts. It has attacked ignorance and prejudice via communication
efforts. IHO has created a bond with some hospital systems of Bombay. IHO
disseminated information about HIV/AIDS in Bombay's red light districts and has
bridged the gap between the city's medical establishment and the community most
in need. IHO's aggressive street-level fighting in a sector replete with sensitive
issues has somewhat isolated it from mainstream national NGOs involved in
HIV/AIDS education and control as well as from the medical establishment and
potential partners. IHO funds have been reduced, forcing IHO to reduce
intervention programs and responses to field demands. It suffers from a high rate
of turnover among middle management staff. IHO's chief advantage is its
confidence gained over the past 12 years. IHO has clearly delineated the direction
it wants to go: care and support programs for persons affected by HIV/AIDS and
for commercial sex workers to allow them to quit prostitution, orphan care, and
development of training institutions for the education and motivation of medical
personnel on HIV/AIDS care and prevention. It plans to build a hospice for AIDS
patients and orphans and a training center. Training activities will vary from one-
week orientation programs to three-month certificate courses for medical workers,
NGOs, and managers from the commercial sector. IHO is prepared to share its
experiences in combating HIV/AIDS in Bombay in a team effort. As official and
bilateral funding has been decreasing, IHO has targeted industry for funding.
Industry has responded, which enables IHO to sustain its core programs and
approaches. IHO observations show a decrease in the number of men visiting red-
light districts. IHO enjoys a positive relationship with Bombay's media reporting
on AIDS.
1916: Psychol Dev Soc J. 1995 Jul-Dec;7(2):217-36.

Mass media and health promotion in Indian villages.
Agarwal A.
PIP: The role of mass media and other psychosocial factors in forming intentions
to acquire health-related information and promotion of actual health behaviors
was examined in a field study involving 720 male and female residents in 28
villages of Uttar Pradesh, Bihar, and Madhya Pradesh. It was found that beliefs
and attitudes toward health care, as well as some information-related needs,
contribute in the formation of intentions. More specifically, the tendency to treat
media as a source of stimulation and direction, learning, information, and tension-
reduction together with positive attitudes explain 4% of variance in intention.
Variance in actual health promotion behaviors and the use of media for health-
related information is explained by the general impact of media together with
other social factors such as social participation in community, anticipating
changes in life situations, and taking initiative by acceptors. Attitude, intention,
and behavior are related, but the link between them is mediated by other social
factors. In order for mass media to be effective, reinforcement through
interpersonal communication as well as change in environment are essential.
Excessive reliance upon mass media without the coordinated support of formal
and informal systems in the community may not be suitable for the promotion of
health behaviors in rural India.
1917: Contraception. 1995 Jul;52(1):23-34.

Comment in:
• Contraception. 1995 Nov;52(5):321-2.
IUD use and the risk of ectopic pregnancy: a meta-analysis of case-

control studies.
Xiong X, Buekens P, Wollast E.
Department of Epidemiology and Social Medicine, School of Public Health, Free

University of Brussels, Belgium
Because of inconsistent findings among case-control studies on the relationship

between IUD use and the risk of ectopic pregnancy, a meta-analysis of published
literature was conducted. From 1977 through 1994, 19 publications regarding 16
studies of ectopic pregnancy and IUD use were found by MEDLINE and manual
search. The odds ratio (ORs) of ectopic pregnancy with current and past IUD use
in each study were pooled. A quality score system was developed to assess each
study. Funnel plot was used to assess potential publication biases. For current
IUD use, when cases were compared to pregnant controls, there was an increased
risk of ectopic pregnancy (pooled OR: 10.63, 95% confidence interval (CI): 7.66-
14.74); when cases were compared to non-pregnant controls, there was no risk of
ectopic pregnancy (pooled OR: 1.06, 95% CI: 0.91-1.24). Past IUD use could
mildly increase the risk of ectopic pregnancy (pooled OR: 1.40, 95% CI: 1.23-
1.59). Selecting pregnant or non-pregnant women as controls, however, did not
affect the OR estimates of past IUD use. Current IUD use does not increase the
risk of the ectopic pregnancy. However, a pregnancy with an IUD in situ is more
often an ectopic one than a pregnancy with no IUD. Past IUD use could mildly
elevate the risk of ectopic pregnancy.
Publication Types:
• Meta-Analysis
• Research Support, Non-U.S. Gov't
1918: Jpn Hosp. 1995 Jul;14:45-50.

A study of information of emergency medical care centers.
Nobukawa M, Okawara K.
School of Medicine, Kyorin University, Tokyo, Japan.
1919: AIDS Anal Afr. 1995 Jun;5(3):14-5.

Egypt's fundamentalists say condoms immoral.
Soliman S.
PIP: The first AIDS case in Egypt was reported almost 10 years ago, yet Egypt
still does not have reliable statistics on the HIV/AIDS epidemic (officially, 513
HIV infections and 88 AIDS cases; more likely, 3000 and 10,000, respectively).
HIV/AIDS bears a stigma. The government claims that every HIV-infected
Egyptian acquired the infection through a blood transfusion while in the Gulf or
through sexual intercourse in Europe. Cultural, social, and religious norms that
discourage promiscuity may explain the low HIV/AIDS rate but these same
taboos put women at risk by making it difficult for them to protect themselves.
Islamic fundamentalist women reinforce the Islamic principle of forbidding sex
education. They consider AIDS a plague of immoral Western society. They refuse
to accept the fact that many men do not practice safer sex. These women consider
condoms immoral. They think God will curse women who refuse to have sexual
intercourse at their husbands' bidding. Many nongovernmental organizations
consider an intensive education program as the only means to avert disaster.
Egypt has yet to implement its model AIDS program. All hospitals in Cairo and
some hospitals in rural areas have equipment to test for HIV. Surveillance
systems have been limited to high risk groups. In Egypt, it is mandatory to test
foreigners for HIV. Prisoners, prostitutes, homosexuals, and blood donors are
tested randomly without their consent. Positive results are often reported to
authorities before the persons learn their HIV status. A campaign for widespread
sex education is the only action recommended so far. It includes a mass media
component and community meetings and conferences. An Egyptian physician has
found an anti-viral drug that stimulates the immune system, but his work does not
receive much coverage outside Egypt. Egyptians need to tackle their cultural
taboos about discussion of sex to curb the HIV/AIDS epidemic.
1920: J Hum Ergol (Tokyo). 1995 Jun;24(1):105-15.

Experiences of successful action programmes for occupational

health, safety, and ergonomics promotion in small scale enterprises
in Thailand.
Tandhanskul N, Duangsa-Ad S, Pongpanich C, Pungok A, Punpeng T,

Juengprasert W, Kawakami T.
Occupational Health Training and Demonstration Center, Ministry of Public

Health, Samutprakarn.
Small-scale enterprises are playing a vital role for the national economy in
Thailand, creating employment in both urban and rural areas. The improvement of
working conditions and occupational safety and health, together with improved
productivity has long been a priority. How we could practically provide owners
and workers of small-scale enterprises with opportunities for improvement action
has been our concern. In the present project, we have adopted a new programme
of action which emphasizes participation, a positive approach and locally made
solutions. The project site was in Samutprakarn province, an industrial zone near
Bangkok. Four local small-scale enterprises participated in the action programme.
They were a lead smelting, a dry-cell battery plant, a wet-cell battery plant and a
pesticides factory. The programme consisted of the following steps. 1) A
demonstration training session was conducted to motivate the enterprises'
representatives to take action. Locally invented improvement examples were
presented and small group discussion was organized for facilitating their action.
2) The participants were encouraged to use a checklist for assessing safety, health
and ergonomic risks in their own workplaces. Concrete action plans were
established based on their checklist results. 3) The improvement action started, in
which step-by-step approaches were emphasized. Advisory and supporting roles
of expert teams comprising the authors and other professionals were important to
accelerate and sustain the action at these enterprises. On the basis of this self-help
action, the participants were enabled to make many improvements at their
workplaces. These improvements developed by their own initiative were multi-
factorial. They included 1) machine and electrical safety device, 2) workstation
redesign, 3) materials handling improvement, 4) establishing new welfare
facilities such as canteens or bathrooms and 5) work environment improvement
such as better lighting or enclosure of hazardous substances. Our experiences
showed that there was a large potential to initiate local improvement actions and
duplicate them in a participatory manner. Of particular importance were the
positive attitudes towards self-help workplace action and the focus on locally
available solutions.
1921: Can Fam Physician. 1995 Jun;41:1059-60.

Health care system awry in Hong Kong.
Ketchum P.
PIP: Government-funded services in Hong Kong provide more than 90% of

hospital care and more than 90% of preventive care for young children either free
or at nominal cost. The low cost of public health care in Hong Kong, together
with the lack of gatekeeping for health care services, has led to the creation of a
wasteful, inefficient, and overburdened health care system. There is an unbearable
level of overcrowding in government hospitals. Patients wait one-three months for
appointments at specialist clinics, while pregnant women may wait five months
for their first appointment for antenatal care. Patients consult with multiple
doctors for the same episode of illness, patient data is not communicated between
doctors, and there is often poor feedback on referrals. An overemphasis upon
hospital care has driven up government health care expenditures, while abuses of
the system are rampant; there is an excessive demand for investigations, drugs,
referrals, and hospitalization for problems which could be better managed at the
community level. The health care system in Hong Kong needs to develop good
primary care; install quality gatekeeping of resources by a proper referral system,
with patients discouraged from referring themselves to specialists and hospitals;
improve the communication of patient information between attending health
professionals; and ensure high professional standards among health care
providers.
PMCID: PMC2146555
1922: Infect Dis Clin North Am. 1995 Jun;9(2):353-66.

Mass population displacement. A global public health challenge.
Toole MJ.
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Since the end of the Cold War, there has been a dramatic increase in civil
conflicts resulting in approximately 50 million refugees and internally displaced
civilians. The public health impact of these situations has been immense,
comprising high rates of communicable diseases, elevated prevalence of acute
malnutrition, and high excess mortality rates. The prevention of these adverse
public health effects includes early warning and intervention; prompt supply of
adequate food, water, and sanitation; measles immunization; effective
management of epidemic communicable diseases; and simple and timely
information systems.
PIP: The author's conclusion in this article is that the problem of population
displacement appears to be increasing and that the geographic impact is
spreading. There is a need to predict complex emergencies (civilians affected by
war or civil strike and population displacement) earlier. Effective intervention
methods will require information on the quantity and content of relief
commodities and analysis of the impact of relief on the health and nutrition of the
affected population. International relief efforts must be more than a symbol of
help. The goal should be to prevent excess mortality among the affected
populations. The public health challenge is to improve the health status of
populations caught in the cycle of war, intimidation, hunger, migration, and death.
The direct health consequences of civil strife are identified as death, injury,
disability, sexual assault, and psychological stress. The indirect health
consequences are identified as mass migration, food shortages, hunger, and the
collapse of health services. The numbers of people affected as dependent refugees
under the care of UNHCR increased from 5 million in 1980 to almost 23 million
in 1994. The total population of refugees and displaced persons is reported to
have increased between 1990 and 1994 from 30 million to 48 million. The death
rate of newly arrived refugees in Thailand, Somalia, and Sudan is estimated to be
30 times the death rate in the country of origin. Crude death rates
(deaths/1000/month) during 1990-93 are reported as ranging from 3.5 to 12 times
the rates in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe. The death rates of
children aged under 5 years are estimated to be higher than adult rates. Causes of
death are generally preventable. Common causes of death include measles,
diarrhea, malaria, cholera and dysentery, and acute respiratory infections. Public
health programs must target basic needs for shelter, food, water, and sanitation.
1923: J Epidemiol Community Health. 1995 Jun;49(3):231-3.

Rotterdam general practitioners report (ROHAPRO): a

computerised network of general practices in Rotterdam, The
Netherlands. Rotterdam's HuisArtsen Project.
Middelkoop BJ, Bohnen AM, Duisterhout JS, Hoes AW, Pleumeekers HJ,
Prins A.
Municipal Health Service Rotterdam area, The Netherlands.
STUDY OBJECTIVE--Dutch public health services are charged with collective

preventive care for the population--care that should, by law, be based on
epidemiological data. General practices potentially offer important data for this
purpose, particularly since more and more use a computer. This study aimed to
assess whether it is possible to obtain useful epidemiological data from this
source. DESIGN--In 1990, the Rotterdam Municipal Health Service, in
collaboration with the Erasmus University Rotterdam, started a computerised
sentinel practice network. The main features of this and a specific small
investigation are described. SETTING--The following institutions cooperate in
the network: Municipal Health Service Rotterdam Area; Departments of General
Practice and of Medical Informatics, Erasmus University Rotterdam; Rotterdam
District Association of General Practitioners. PATIENTS--Data are currently
collected from 20 general practitioners and > 40,000 patients. In a specific
project, the distribution of cardiovascular risk factors in different ethnic groups
was compared. MAIN RESULTS--It was possible to build up a regional
epidemiological registration system in this manner. In the cardiovascular project
we found striking differences between ethnic groups. The risk profile for Turkish
men, in particular, was less favourable. The health service also uses the system to
improve cooperation between public health and primary health care (for example,
in cervical screening, influenza vaccination). CONCLUSION--Computerised
general practices offer great possibilities for research and for preventive activities
in which public health care and general practitioners can cooperate.
PMCID: PMC1060789
1924: Tuber Lung Dis. 1995 Jun;76(3):264-70.

A national computer-based surveillance system for tuberculosis

notification in Singapore.
Snodgrass I, Chew SK.
Communicable Disease Centre, Ministry of Health, Singapore.
SETTING: The notification rate of tuberculosis (TB) among residents in

Singapore has been declining at a mean rate of 5.6% per annum, from 307 cases
per 100,000 population in 1960 to 54 cases per 100,000 population in 1992. A
National TB Notification Registry was set up in 1958 using a manual card system,
and was captured into a computer database from 1986. OBJECTIVE: To monitor
epidemiological trends of TB in Singapore with more speed, versatility and
analytical capabilities, a new microcomputer-based surveillance system was
developed in 1993. DESIGN: The main software programmes used in this system
were DBase IV (version 1.5) and Epi Info (version 5). These versions could use
base memory interchangeably and were therefore incorporated into a single
application DBase programme. Security features were incorporated into the
programme. The TB database was linked to the National HIV Notification
Registry to enhance surveillance of combined TB and human immunodeficiency
virus infection (HIV). RESULTS: The system was able to track notifications and
TB culture results, address letters and analyze data and enabled prompt
dissemination of information. CONCLUSION: The authors believe that this
system would enhance surveillance and provide timely information for national
TB control programmes. However, the effectiveness of this system is dependent
on an established notification structure with notifications for tuberculosis of
sufficient completeness.
1925: Kango. 1995 May;47(6):158-63.

[Liberation of medical service--information about medical

institutions not readily available]
Nagano M.
1926: Mil Med. 1995 May;160(5):258-63.

Comparisons of disease and nonbattle injury incidence across

various military operations.
Blood CG, Jolly R.
Medical Information Systems and Operations Research Department, Naval Health

Research Center, San Diego, CA 92186-5122, USA.
Daily rates of disease and nonbattle injury (DNBI) incidence were analyzed and
compared for four ground operations: Okinawa, Korea, Vietnam, and the
Falklands. Average daily DNBI admission rates among operations ranged from
0.99 per 1,000 strength to 4.03 for combat troops. Average daily admission rates
for support troops ranged from 0.71 to 1.15. Among combat troops, between 26
and 38% of DNBI presentations were of a nature that precluded returns to their
unit due to a medical transfer; among support troops, less than 17% were not
returned to their units due to transfers.
Publication Types:
• Comparative Study
1927: Ann Epidemiol. 1995 May;5(3):215-20.

Trends in mortality from nonneoplastic gallbladder disease.
La Vecchia C, Levi F, Lucchini F, Franceschi S.
Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland.
Trends in mortality rates from gallstones and other nonneoplastic gallbladder and
biliary tract diseases between 1955 and 1990 for 38 countries (8 from America, 3
from Asia, 25 from Europe, Australia, and New Zealand) were analyzed. Age-
adjusted mortality rates standardized on the world population were computed
from official death certifications derived from the World Health Organization
database. There were generalized and substantial declines in the rates in both
sexes and all countries considered, except for males in Czechoslovakia and
Poland. Over the calendar period considered, the average declines were over 70%
for males and over 80% for females in North America, over 60% for males and
70% for females in Latin America, although mortality remained relatively high in
Chile. The declines were 80% for both sexes in Japan and over 70% for males and
80% for females in Australia. The pattern was more heterogeneous in Europe,
with decreases of approximately 70 to 80% in northern Europe, but more modest
in central and southern Europe, with particularly moderate downward trends for
males. In several countries the decreases were rather steady over the calendar
period considered, but in a few others the decline was restricted or larger during
the most recent calendar period. The trends in gallstone and other gallbladder
disease mortality in various areas are affected by differences and potential biases
in death certification reliability, and by underlying variations and changes in the
prevalence of gallstones and gallbladder surgical removal. A likely interpretation
for the generalized decline in mortality over the last calendar period is, however,
improved diagnosis and treatment of gallstone disease.
Publication Types:
1928: Indian J Matern Child Health. 1995 Apr-Jun;6(2):31-2.

Related Articles
Health and human development.
Jaswal S.
PIP: Participants at the 1988 World Conference on Medical Education in

Edinburgh, Scotland, resolved to make the training of physicians more relevant to
the needs of the majority in their own societies. The majority of the disadvantaged
suffer from morbidity caused by malnutrition, low-quality water supplies,
unsanitary conditions, inadequate housing, and illiteracy. It is with regard to these
factors that greater interaction is needed between the medical profession and the
non-medical education, research, and extension system on the one hand and social
infrastructures on the other. The interactions may not be in general terms, but in
terms of specific ethnic groups in which they happen to practice. Researchers and
experts in the field of social science must make a concerted effort to provide a
realistic baseline of information to the medical profession about the ethno-psycho-
social environment of a given niche. The masses are apathetic, tired, and
generally do not trust governmental medical functionaries. These feelings derive
largely from poor people's necessary dependence upon poor facilities,
practitioners' inhuman attitudes toward the sick, unclean surroundings, the
widespread prevalence of unethical practices, excessive delays, and other negative
factors. People who can afford to secure care in the private sector. The author
comments on infant mortality, the concept of human development, social
development, and population growth.
1929: Philipp J Public Adm. 1995 Apr;39(2):179-200.

Status report on primary health care (1987-1993).
Bautista VA.
PIP: This article describes the legislative mandate for the development of primary
health care (PHC) in the Philippines and provides a discussion of the attempts
made to realize the goals of that mandate. Two major Department of Health
thrusts are delineated: 1) from 1986 to 1991 Under-Secretary Alfredo Bengzon
sought to deemphasize the implementation of primary health care in favor of an
approach which sought to forge partnerships with nongovernmental organizations
(NGOs) to realize a concept of "Community Health Development" and 2) from
1992 to 1995, Secretary Juan Flavier restored attention to the implementation of
PHC which would be operational under the guidance of local government units.
The difference in the two approaches is primarily a difference in their manner of
execution. Despite some problems, the first initiative achieved important goals
such as 1) implementing an information system to allow targeting of areas for
social development, 2) organizing the First National Convention of NGOs for
Health, 3) encouraging collaborative activities with NGOs, and 4) support of the
activities of Barangay Health Workers (BHWs). The second initiative involved
recognition of additional volunteer health workers; following community
organizing as a basic approach for empowerment; expanding the prior initiatives;
and making plans to identify model PHC barangays, monitor levels of PHC
implementation, and prepare a BHW operational manual. This review ends by
considering various issues and offering recommendations which include: 1)
spelling out the role of local chief executives, 2) adopting a single terminology to
describe the current approach, 3) defining the role of the BHW (multipurpose
worker or health worker), 4) adopting a convergence of efforts strategy, 5)
monitoring levels of PHC, 6) documenting the PHC implementation process, 7)
dealing with program sustainability issues, and 8) improving the management of
local health facilities.
1930: Kango. 1995 Apr;47(5):119-24.

[Kobe earthquake, nurse placement centers on line, group home for

senile elderly people]
Nakamura Y.
1931: Ann Trop Med Parasitol. 1995 Apr;89(2):135-47.

Vector control in some countries of Southeast Asia: comparing the

vectors and the strategies.
Meek SR.
Malaria Consortium, London School of Hygiene and Tropical Medicine, U.K.
The use of information on malaria vector behaviour in vector control is discussed

in relation to the area of Southeast Asia comprising Cambodia, Laos, Myanmar,
Thailand and Vietnam. The major vectors in the region are Anopheles dirus, An.
minimus, An. maculatus and An. sundaicus, of which An. dirus is the most
important. Options for vector control and the biological features of mosquitoes,
which would make them amenable to control by these measures, are listed. The
methods with the greatest potential for controlling each of the four vector species
are described. Experiences of vector control by residual spraying, insecticide-
treated nets and larva control and of personal protection against the four vectors
are outlined, and it is noted that choice of control strategy is often determined by
epidemiological, economic and political considerations, whilst entomological
observations may help to explain failures of control and to indicate alternative
strategies. Future research needs include basic entomological field studies using
the most appropriate indicators to detect changes related to rapidly changing
environmental conditions, such as loss of forest and climate change. Further
studies of the efficacy of insecticide-treated mosquito nets, with greater attention
to study design, are needed before it can be assumed that they will work in
Southeast Asia. At the same time, research to improve sustainable utilization of
nets is important, bearing in mind that nets are not the only means to control
malaria and should not drain resources from supervision and training, which
improve access to diagnosis and treatment of malaria and other diseases. Research
is needed to make decisions on whether vector control is appropriate in different
environments, and, if so, how to carry it out in different health systems.
Researchers need to play a greater role in making operational research
(entomological, epidemiological, social, economic and health systems research)
of good quality an integral component of implementation programmes.
1932: Pediatr Infect Dis J. 1995 Apr;14(4):308-14.

Erratum in:
• Pediatr Infect Dis J 1995 Jun;14(6):516.
Eradication of poliomyelitis: progress in the People's Republic of

China.
Yang B, Zhang J, Otten MW Jr, Kusumoto K, Jiang T, Zhang R, Zhang L,

Wang KA.
Ministry of Public Health, Beijing, People's Republic of China.
China and the other countries of the Western Pacific Region have a goal of
eradication of wild poliovirus by the end of 1995. In this report we examine the
progress made toward eradication through the end of 1993. We examined the
information about poliomyelitis and wild poliovirus based on the acute flaccid
paralysis surveillance system. The number of reported poliomyelitis cases
decreased from 4623 cases in 1989 and 5065 cases in 1990, which occurred
during a large nationwide poliomyelitis epidemic, to 538 cases in 1993. Mass
supplemental immunization sessions were conducted during the 1991 to 1992 and
1992 to 1993 winters. After the two rounds of supplemental immunizations in the
1992 to 1993 winter, wild poliovirus was not detected for the subsequent 21
months in 22 contiguous provinces in central and northern China, in which 980
million persons reside. In 1993 wild poliovirus was detected in only 5 provinces
in southern China and in 2 provinces in the remote Western region; these
provinces have only 14% of the total population in China. China is close to
achieving its 1995 poliomyelitis elimination goal. Mass supplemental
immunizations in children 0 to 3 years old can rapidly eliminate wild poliovirus
from large, very densely populated areas, low income rural areas and remote
mountainous areas. There appears to be no technical obstacle, even in the most
difficult areas, to achieving global eradication of wild poliovirus by the year 2000.

1933: Int Dent J. 1995 Apr;45(2):141-59.
Preregistration and post graduate practice training period. FDI

Working Group.
[No authors listed]
Working Group 14 has had formal meetings at FDI Congresses in Milan 1991,
Berlin 1992 and Göteborg 1993 and this report was approved by the Commission
at the Vancouver FDI World Dental Congress in 1994. At all stages the subject
has attracted great interest and working group meetings have been well attended.
The agreed terms of reference were: To collect information on practice training
systems. To prepare an analytical report to assist those countries that would like to
introduce a practice training period. During the early meetings it was quickly
realised that no single system could be identified as the desirable global model
and that an illustration of some systems currently operating would assist FDI
member countries contemplating the commencement of a practice training
scheme. To this extent the terms of reference have been fulfilled. This descriptive
report makes no attempt to be definitive and there are, of necessity, some
anecdotal elements within it.
1934: Harefuah. 1995 Mar 15;128(6):337-40, 400.

[Application of patient card technology to health care]
[Article in Hebrew]
Sayag E, Danon YL.
Israel Defence Forces; Children's Medical Center of Israel, Petah Tikva.
The potential benefits of patient card technology in improving management and

delivery of health services have been explored. Patient cards can be used for
numerous applications and functions: as a means of identification, as a key for an
insurance payment system, and as a communication medium. Advanced card
technologies allow for the storage of data on the card, creating the possibility of a
comprehensive and portable patient record. There are many types of patient cards:
paper or plastic cards, microfilm cards, bar-code cards, magnetic-strip cards and
integrated circuit smart-cards. Choosing the right card depends on the amount of
information to be stored, the degree of security required and the cost of the cards
and their supporting infrastructure. Problems with patient cards are related to
storage capacity, backup and data consistency, access authorization and
ownership and compatibility. We think it is worth evaluating the place of patient
card technology in the delivery of health services in Israel.
Publication Types:
1935: Glimpse. 1995 Mar-Apr;17(2):3.

Centre shares its success in family planning work with the NGOs in
the SAARC region.
[No authors listed]
PIP: In March 1995, the International Centre for Diarrhoeal Disease Research,
Bangladesh (ICDDR,B) and the government of Japan sponsored a 2-week
international workshop on Family Planning Programmes of NGOs
(nongovernmental organizations) in the SAARC Region (South Asia). The
purpose of the workshop was to share experiences with family planning and
reproductive health of the Matlab and the MCH-FP (maternal and child health-
family planning) Extension Projects in urban and rural areas with family planning
program managers from NGOs and policy and operations researchers. It also
intended to examine those family planning and reproductive health projects of the
NGOs in Bangladesh that fostered significant improvement of the national family
planning and MCH program in Bangladesh. Participants were presented with
effective family planning and MCH program design and strategies to strengthen
improved management. The workshop emphasized the emerging norms of quality
of care in family planning and reproductive health. NGOs initiated the concept of
family planning in Bangladesh in 1953, so they are considered innovators.
Accordingly, they are expected to develop designs and models for effective
service delivery systems, training, management information system, IEC
(information, education, and communication), community participation as well as
to set social norms and values for small families. At the workshop, Bangladesh
was offered as an example of how innovative NGO activities, sustained
partnership between the NGOs and the government, and technical support from
ICDDR,B lead to progress in family planning and MCH programs, despite the
great poverty and economic stagnation. Contraceptive prevalence has increased
from around 7% to almost 45% between 1977 and 1994.

1936: Southeast Asian J Trop Med Public Health. 1995 Mar;26(1):29-33.
Primary health care: the basis for malaria control in Hubei, China.
Li HF, Xu B.
Hubei Academy of Medical Sciences, Institute of Parasitic Diseases, Wuhan,

People's Republic of China.
By 1992 malaria morbidity in Hubei, China had decreased steadily to its lowest
level since 1970. Much of this achievement was through an integration of the
primary health services with malaria control activities. However, in some areas
malaria has been unstable due to weaknesses in the three tier health network. This
has particularly been at the township and village level. The future of village
doctors and appropriate measures of malaria control at the village levels are
threatened by the change to a market economy. As part of the provincial health
program, primary care services need to be improved in service provision, service
organization and service quality.
Publication Types:
1937: Stroke. 1995 Mar;26(3):399-401.

Return to work after stroke. A follow-up study.
Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T.
Department of Rehabilitation Medicine, University of Occupational and

Environmental Health, School of Medicine, Kitakyushu, Japan.
BACKGROUND AND PURPOSE: Few studies have reported the longitudinal

trend of return to work after stroke. The purpose of our study was to evaluate the
longitudinal trend of proportion of patients who return to work after stroke and
further to examine the predictors of return to work while taking follow-up periods
into consideration. METHODS: We conducted a retrospective cohort study on the
association between characteristics of stroke patients at admission and return to
work after first stroke, taking length of follow-up period into consideration (n =
183). The patients were all younger than 65 years and were working at the time of
their stroke. A follow-up questionnaire evaluated return to work and related
information. Data were analyzed using the Kaplan-Meier method for curves of the
proportion of return to work and Cox's proportional hazards model for odds ratios
of return to work. RESULTS: The curve of proportion of return to work had two
steep slopes, and the proportion was at a maximum at 18 months from patient
admission. The adjusted odds ratios of return to work for patients with normal
muscle strength versus severe weakness, without apraxia versus with apraxia, and
with white-collar versus blue-collar occupations were 5.16 (P < .05), 4.16 (P <
.05), and 1.43 (.05 < P < .10), respectively. CONCLUSIONS: The increase of
proportion of return to work after stroke was nonlinear, and this trend was
referable to the social security systems available to the patients included in this
study. Normal muscle strength and absence of apraxia were significant predictors
of return to work after stroke. White-collar occupation showed a tendency to
promote return to work.
1938: J Hum Lact. 1995 Mar;11(1):11-5.

Breastfeeding practices in Chengdu, Sichuan, China.
Guldan GS, Zhang M, Zeng G, Hong J, Yang Y.
Barriers to increased breastfeeding rates in Chengdu, Sichuan were investigated in

1992 and 1993. Responses of focus groups showed that ignorance about
breastfeeding and belief that the mother's milk was inadequate, and lack of
support from their families, places of employment, and the health system acted as
barriers to the women's breastfeeding their infants up to the age of four to six
months. Subsequently, 363 mothers of 4- to 12-month-old Chengdu infants were
surveyed. Although most mothers in both studies said breastmilk was the best
food for their infant up to age of four to six months, only about half of the
mothers breastfed for longer than one month. Both studies showed that infants
who roomed with their mothers after birth were more likely to have been put to
their mother's breast earlier, fed colostrum, breastfed somewhat longer, and
exclusively breastfed for a somewhat longer period, although their mothers' infant
feeding knowledge did not differ. The researchers conclude that Chengdu health
workers should teach parents and parents-to-be more about breastfeeding, and that
rooming-in be expanded in Chengdu hospitals.
PIP: In China in 1992, a focus group was conducted of 4-9 mothers at eight
different places of employment in Chengdu, Sichuan (total mothers, 55), to learn
their attitudes, beliefs, concerns, knowledge, and preferred channels of receiving
infant feeding information. During April 1993, interviews were conducted with
363 infant-caretaker pairs from each of Chengdu's five districts to examine infant
feeding practices. 88% of infants were ever breast fed. Even though almost 73%
of the caregivers thought that breast milk was the best food for the first six
months, only 32% of infants 4-6 months old were currently being breast fed. The
targeted breast feeding rate of the National Action Programme for Child
Development in China is 80%. Only one 7-month-old infant was currently
exclusively breast fed. The findings of the survey corroborated those of the focus
groups. Mothers tended to have little knowledge about breast feeding, to believe
their breast milk was inadequate, and to have no support from their families,
employers, and the health system. Knowledge on infant feeding of mothers whose
infants roomed with them after delivery and that of mothers whose infants did not
room with them after delivery was similar. Infants who roomed with their mothers
after delivery tended to have first been breast fed earlier (p 0.0001), to have been
given breast milk as their first food (; 0.0001), to continue to have been breast fed
when the mothers thought that their breast milk was inadequate (p = 0.0003), to
have received colostrum (p = 0.003), to have been breast fed longer (p = 0..0002),
and to have been exclusively breast fed longer (p 0.0001). These findings led to
three recommendations to encourage breast feeding in Chengdu: health workers
should consider breast feeding important and should educate parents about infant
feeding and nutrition; more hospitals in Chengdu need to practice rooming-in; and
a study should be conducted to determine whether health workers have adequate
knowledge about breast feeding.
Publication Types:
1939: Stud Fam Plann. 1995 Mar-Apr;26(2):101-6.

The sisterhood method of estimating maternal mortality: the Matlab

experience.
Shahidullah M.
Maternal and Child Health-Family Planning Extension Project (Rural),

International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
This study reports the results of a test of validation of the sisterhood method of
measuring the level of maternal mortality using data from a Demographic
Surveillance System (DSS) operating since 1966 in Matlab, Bangladesh. The
records of maternal deaths that occurred during 1976-90 in the Matlab DSS area
were used. One of the deceased woman's surviving brothers or sisters, aged 15 or
older and born to the same mother, was asked if the deceased sister had died of
maternity-related causes. Of the 384 maternal deaths for which siblings were
interviewed, 305 deaths were correctly reported, 16 deaths were underreported,
and the remaining 63 were misreported as nonmaternal deaths. Information on
maternity-related deaths obtained in a sisterhood survey conducted in the Matlab
DSS area was compared with the information recorded in the DSS. Results
suggest that in places similar to Matlab, the sisterhood method can be used to
provide an indication of the level of maternal mortality if no other data exist,
though the method will produce negative bias in maternal mortality estimates.
PIP: The results are reported of a test to validate the sisterhood method of
measuring the rate of maternal mortality using data from a Demographic
Surveillance System (DSS) operating since 1966 in Matlab, Bangladesh. The
records of maternal deaths that occurred during 1976-90 in the Matlab DSS area
were used. One of the deceased woman's surviving brothers or sisters, 15 years or
older and born to the same mother, was asked if the deceased sister had died of
maternity-related causes. The respondents of the field survey came from 3 groups.
In the first group respondents were individuals with a sister who had died of
maternity-related causes during the period. The second group consisted of siblings
of women of reproductive age who had died of nonmaternity-related causes. The
third group comprised respondents of both sexes who did not have a sister who
died of maternal or nonmaternal causes. Of the 384 maternal deaths for which
siblings were interviewed, 305 (79%) deaths were correctly reported, 16 deaths
were underreported, and remaining 63 (16%) deaths were misreported as
nonmaternal deaths. 70 (18%) of the 384 deaths were attributed to induced
abortion, 17 (4%) to spontaneous abortion, 214 (56%) to direct obstetric causes,
and 79 (21%) to indirect obstetric causes. 354 (92%) of the 384 deaths were to
ever-married women and the remaining 30 (8%) to never-married women. Of 70
deaths related to induced abortion, only 35 were reported to ever-married women,
and no such deaths were reported as occurring to never-married women.
Information on maternity-related deaths obtained in a sisterhood survey
conducted in the Matlab DSS area was compared with the information recorded in
the DSS. Findings suggest that in places similar to Matlab, the sisterhood method
can be used to provide an indication of the level of maternal mortality if no other
data exist, although the method will produce negative bias in maternal mortality
estimates, especially on deaths related to induced abortion.
Publication Types:
1940: Am J Health Promot. 1995 Mar-Apr;9(4):261-8.

Erratum in:
• Am J Health Promot 1995 Jul-Aug;9(6):435.
A debunking of the myth of healthy Asian Americans and Pacific

Islanders.
Chen MS Jr, Hawks BL.
Department of Preventive Medicine, Ohio State University, Columbus 43210,

USA.
PURPOSE. To present evidence that the model of healthy Asian Americans and
Pacific Islanders (AAPIs) stereotype is a myth. SEARCH METHOD. The authors
retrieved literature from the National Library of Medicine's compact disk
databases (Cancerlit, CINAHL, Health, and MEDLINE), and examined pertinent
federal government publications supplemented by the authors' knowledge of other
published materials. IMPORTANT FINDINGS. This review paper presents three
reasons why AAPIs are underserved: (1) the population growth rate has been
unusually rapid and recent; (2) data regarding the health status of AAPIs are
inadequate; and (3) the myth that AAPIs are model minority populations in terms
of their health status was promulgated. MAJOR CONCLUSIONS. The
conclusions are as follows: (1) AAPIs are heterogenous with respect to
demographic factors and health risk factors; (2) because the current databases on
the health status of AAPIs include small sample sizes, both the quantity and
quality of these data need to be improved with respect to appropriate gender and
ethnic group representation; (3) Risk factor and mortality data for AAPIs suggest
that the burden of certain preventable diseases, namely, tuberculosis, hepatitis-B,
liver cancer, and lung cancer may be higher than those of any other racial and
ethnic population. The model healthy AAPI stereotype is a myth.
Publication Types:
• Review
1941: J Psychosoc Nurs Ment Health Serv. 1995 Feb;33(2):13-8.

Cultural influences on depression in Korean Americans.

Kim MT.
College of Nursing, University of Arizona, Tucson 85721, USA.
This article does not intend to simplify the emotional world of KAs, nor to
generate a stereotype of cultural knowledge about KAs. A practice based on
stereotypical knowledge often does more harm than good (Brigham, 1971).
Cultures are not indefinitely static systems. Cultural subgroups and the dominant
culture in which they reside exchange influences, which results in changing
cultural pattern (DHHS, 1993). Consequently, a wide range of individual
differences exists in terms of educational status, language sufficiency,
acculturation status, and personalities. Although clinicians should acknowledge
and be sensitive to a client's cultural background, they need to base clinical
decisions on awareness of individual differences. Nevertheless, an understanding
of how cultural and social forces affect the vulnerability to depression should
guide practitioners in designing and implementing culturally relevant treatment
regimens for all clients (Weiss, 1988). Unfortunately, critical questions, such as
what specific therapies are necessary for effective treatment of Korean-American
clients, has not been found in current research. Systematic and accurate data-
based information about KAs are lacking. Future research into the mental health
needs of KAs should include assessments of needs in order to provide a basis for
planning the prevention and intervention programs to adequately meet Korean
Americans' mental health needs.
Publication Types:
1942: IHRIM. 1995 Feb;36(1):10-2.

Standardization of paperless health records.
Mogli GD.
Ministry of Health Planning, Sultanate of Oman.
1943: AIDS Wkly. 1995 Jan 2:8-9.

Size of Pakistan government AIDS grant criticized.
[No authors listed]
PIP: The World Health Organization (WHO) states that there are between 20,000
and 50,000 HIV cases in Pakistan. Although the country's AIDS Prevention and
Control Program was initiated in 1987, it is only being pursued aggressively now
after being integrated with the overall health care system. Critics have stated that
Pakistan has no program to screen HIV high-risk groups. The biggest challenge
before the government is to educate people about AIDS and its consequences.
This task is, however, complex in a conservative Islamic country which has a
40% national literacy rate, 67% rural population, and where sex is not openly
discussed. Health officials are planning to involve the Islamic clergy to
disseminate information about HIV/AIDS through sermons in the mosques.
However, it is not yet known if the idea will be accepted by the clergy. Experts
warn that urgent steps need to be taken to prevent the HIV situation from
developing into an advanced epidemic.
1944: Newsl Macro Syst Inst Resour Dev Demogr Health Surv. 1995;7(2):1-2.
Related Articles
Computer-aided field editing in DHS: the Turkey experiment.
[No authors listed]
PIP: A study comparing field editing using a Notebook computer, computer-aided

field editing (CAFE), with that done manually in the standard manner, during the
1993 Demographic and Health Survey (DHS) in Turkey, demonstrated that there
was less missing data and a lower mean number of errors for teams using CAFE.
6 of 13 teams used CAFE in the Turkey experiment; the computers were equipped
with Integrated System for Survey Analysis (ISSA) software for editing the DHS
questionnaires. The CAFE teams completed 2466 out of 8619 household
questionnaires and 1886 out of 6649 individual questionnaires. The CAFE team
editor entered data into the computer and marked any detected errors on the
questionnaire; the errors were then corrected by the editor, in the field, based on
other responses in the questionnaire, or on corrections made by the interviewer to
which the questionnaire was returned. Errors in questionnaires edited manually
are not identified until they are sent to the survey office for data processing, when
it is too late to ask for clarification from respondents. There was one area where
the error rate was higher for CAFE teams; the CAFE editors paid less attention to
errors presented as warnings only.

1945: Indian J Matern Child Health. 1995 Jan-Mar;6(1):11-3.
Determinants of breast feeding practices in rural community of

Wardha.
Kishore S, Garg BS, Mathur JS, Nayar S.
PIP: In 4 villages of Wardha District in Maharashtra State, India, interviews were

conducted with 200 mothers of at least 1 child younger than 12 months so
researchers could identify determinants of breast feeding. Most mothers were
younger than 25 years (73.5%). The proportion of mothers who initiated breast
feeding within 1 hour of childbirth and within 5 hours of childbirth increased as
educational level increased. 52.2% of all women initiated breast feeding within 6
hours. Primiparous mothers were less likely to wait 24 hours before breast feeding
than multiparous mothers (16.9% vs. 34.5%). Multiparous mothers were more
likely to be illiterate than primiparous mothers, which may explain this delay in
initiation of breast feeding. As income increased, the likelihood of feeding
colostrum to newborns also increased (66.7% for Rs 150, 80% for Rs 200-299,
and 85.2% for Rs 300). 28.5% of all women discarded the colostrum. Multiparous
mothers were more likely to breast feed for more than 1 year than primiparous
mothers (68.5% vs. 31.5%). These findings suggest that increasing the
educational level and socioeconomic status of mothers as well as improving the
maternal and child health care system by supporting an IEC (information,
education, and communication) component in child survival and safe motherhood
program will promote breast feeding.
1946: Popul Educ Asia Pac Newsl Forum. 1995;(42):8.

Cambodia. Programmatic approach to IEC on reproductive health.
[No authors listed]
Various UNFPA-funded population programs are now in place in six provinces

and the capital and some more are in the pipeline. The ones currently being
implemented include projects on maternal and child health and birth spacing,
national population census, improvement of family health of displaced persons,
and socio-economic research. Those in the pipeline are population education in
the school system, gender and population issues, and population and environment.
All the programs mentioned have implications for information, education and
communication (IEC). To implement these programs effectively, UNFPA and the
government realized the need for IEC support. To provide a coherent, integrated
and holistic approach to the provision of IEC support to all the UNFPA-funded
population activities, a programmatic approach to IEC was developed with the
assistance of CST adviser on population communication, Mr. Francisco Roque.
The IEC program will basically support the government policy of providing
voluntary birth spacing services as a means to promote better maternal and child
health through IECM activities; and to provide adequate information to selected
target groups required to bring about desired behavioral changes in responsible
reproductive decision-making and lifestyle. The target groups to be reached
include: service providers and health workers, policymakers and administrators,
women of reproductive age, men, and the adolescents aged 15-19 as well as
teachers and trainers. The IEC interventions hope to create awareness of the
benefits of birth spacing, introduce population concepts in curricula and
appropriate health/teaching materials in selected medical schools and secondary
schools, reduce misconceptions, provide proper counseling, and sustain
government's interest and commitment to the population program. full text
1947: Yakushigaku Zasshi. 1995;30(2):75-90.

Related Articles
[Historical sketch of modern pharmaceutical science and technology

(Part 4). Post World War II 50 years]
Yamakawa K.
Faculty of Pharmaceutical Sciences, Science University of Tokyo.
A short history of the pharmaceutical science and technology, postwar 50 years is

divided into nine sections for the purpose of discussion. 1. Japan's postwar
rehabilitation, Japanese pharmaceutical industries and newly developed
pharmaceutical sciences and technologies. In 1945, the Japanese pharmaceutical
industry was reconstructed. Production of penicillin was carried out with the
strong support of the U.S. Occupation Forces. New sciences in pharmacy
(biochemistry, biopharmacy, pharmacology, microbiology, physical chemistry,
etc.) were introduced in this period. 2. Introduction age of foreign new drugs and
technology (1951 to 1960s). Japan gained independence in 1951. Japanese
pharmaceutical companies imported many new drugs and new pharmaceutical
technologies from the U.S.A. and European countries in this period. Then, these
companies were reconstruction rapidly. However, consequently Japanese
pharmaceutical companies were formed as an imitation industry. 3. Rapid
economic growth period for pharmaceutical companies (1956 to 1970s). In this
period, many Japanese pharmaceutical companies grew rapidly at an annual rate
of 15-20% over a period of 15 years, especially with regard to the production of
active vitamin B1 analog drugs and some OTC (public health drugs). Some major
companies made large profits, which were used to construct research facilities. 4.
Problems for the harmful effects of medicines and its ethical responsibility. In the
1970s, many public toxic and harmful effects of medicines were caused,
especially SMON's disease. In this time, many pharmaceutical companies
changed to its security got development of ethical drugs. 5. Self development of
new drugs and administration of pharmaceutical rules (1970s). During the 1970s,
many pharmaceutical laws (GLP, GCP, GMP, GPMSP etc.) were enacted by the
Ministry of Health and Welfare. In 1976, the Japanese Pharmaceutical Affairs
Law was revised, which set forth standards regarding the efficacy and safety of
ethical drugs and re-evaluation of drugs. Many facilities were built for the
purpose of ensuring efficacy and safety, as shwon in Table 1. 6. Problems of
Intellectual Property and followed the revisionist line of research and
development for new ethical drugs. In 1976, Japanese pharmaceutical companies
ceased to be an imitation industry, and increased research for the development of
new drugs. 7. Pharmaceutical science and technology innovation (After 1985).
Many of the pharmaceutical innovations during this period were as follows: 7.1)
Technology innovation for evaluation of drug efficacy; 7.2) 1st to 3rd medical
diagnostic technology innovations; 7.3) medical analytical methods and
spectrometry technologies; 7.4) Computer-aided drug-design technology and drug
information technology innovation; and 7.5) Drug delivery system and treatment
drugs. 8. Recent research and development of new ethical drugs in Japan (1970 to
1995). Cephalosporine type beta-lactams (cefazolin, cefametazole, furomoxef,
cefdinir), new quinolones (norfloxcin, ofloxacin, tosfloxcin), H1-Blockers
(famotidine), Ca-antagonists (diltiazem, nicardipine), and other new drugs
(pravastatine, taclolimus, leuprine) etc. came onto the market. 9. International
Harmonization Age and Review toward 21 century. The rapid development and
globalization of the pharmaceutical market has promoted international
harmonization and rationalization of pharmaceutical regulatory affairs. In 1990,
the Japan Pharmaceutical Manufacturers Association published a report toward 21
century, which described practical plans.
Publication Types:
• Historical Article
1948: Asia Pac J Public Health. 1995;8(3):162-6.

HIV/AIDS surveillance system and reported cases of human

immunodeficiency virus infection and acquired immunodeficiency
syndrome in Japan (1983-1993).
Miyazaki M, Naemura M.
Water Supply and Environmental Sanitation Department, Ministry of Health and

Welfare, Japan.
The Ministry of Health and Welfare forms the AIDS Surveillance Committee,
which publishes HIV infection at two-month intervals. As at December 1993, the
Ministry of Health and Welfare reported 267 AIDS cases and 1,143 HIV infection
cases. Epidemiological data in Japan showed a rapid increase of cases of
transmission through heterosexual contact since 1991, before which cases of
transmission due to homosexual contact were relatively large in number according
to reports. Sporadic cases of mother-to-child transmission and some cases due to
injection of drug use were also reported. However, others/unknown cases were
449 (31.8%). Although the reported number of AIDS cases and HIV infection
cases in Japan is still small, a rapidly increasing HIV epidemic is feared. It is
predicted that the primary mode of transmission will be heterosexual contact and
that another epidemiological characteristics will be diversified modes of
transmission. Therefore, the present surveillance should continue and actively
track the epidemic and provide useful information for planning prevention
strategies in Japan.
1949: Seiroka Kango Daigaku Kiyo. 1995;21:1-13.

[A study on health and caregiving status of the elderly over age 75

living in urban Tokyo--comparing 1987 with 1993]
Sato R, Iida S, Noji A, Murasima S, Kondo Y.
The purpose of this study is to propose the improvement of the community care
service and caregivers' support system. A questionnaire was sent to the elderly
over age 75 living in Chuo Ward of Tokyo, on their living place, previous illness,
health status, degree of assistance needed, and their caregivers. The same kind of
surveys were made in 1987 and 1993, and the health status and home care were
compared and changes in caregiver services were examined. Valid responses of
3,294 (response rate of 81.3%) in 1987 and 3,409 (response rate of 76.3%) in
1993 were analyzed and compared with each other. The results are following; (1)
The total number of bedridden elderly persons decreased from 214 (6.5% of the
total) in 1986 to 61 (1.8% of the total) in 1993. The number of elderly over age 75
with high health status increased. (2) The rate of the elderly who stay only
indoors, although physically non-handicapped and in good health, was 20%. (3)
The statistic of caregivers' concern about care services in the answer to open
ended questions showed the increase of the desire for the supply of information,
and the fact of more suitable pieces of advice having been given about the
resources for care, care-give service, and family adjustment. It is necessary to
establish the system to support and develop home care in the community in the
future. Social support will also be necessary not only for infirm or handicapped
elderly people, but also for demented, living in solitude, or non-social withdrawn
healthy aged people to make use of community care service, counseling of care
service and short stay at nursing homes. Especially the importance of community
care service to prevent the elderly from being bedridden was suggested.
Moreover, general broad support is necessary, such as social education, income
guarantee and housing measure as well as that from the point of view of health
and welfare.
Publication Types:

Knowledge, attitudes and perceptions related to drug abuse in

peninsula Malaysia: a survey report.
Low WY, Zulkifil SN, Yusof K, Batumalai S, Aye KW.
Faculty of Medicine, University Malaya, Kuala Lumpur.
Given the magnitude of drug addiction in Malaysia, the government has given top
priority to this issue. It is timely that an assessment of knowledge, attitudes and
perceptions related to drug abuse and drug dependents among the general public
be carried out. Thus, a nationwide survey was undertaken. A representative
sample of 2,591 respondents aged 13 years and above from households were
surveyed throughout the 11 states and the Federal Territory of Kuala Lumpur in
Peninsula Malaysia. The results revealed that the respondents are moderately
knowledgeable on drug abuse, especially information pertaining to treatment,
rehabilitation and aftercare services, including education to families against drug
abuse. The public possess a negative attitude towards drug dependents. Majority
felt that drug addicts do not have the will power to rid themselves of drugs and
they also lack a supportive family network system. Many believe that the most
vulnerable group are the adolescents. Respondents were aware of the type of
drugs commonly abused, although they failed to realise their long-term effects.
Respondents do not attribute low education, large family and marginal income to
the background of drug dependents. The findings showed gaps and
misconceptions in terms of knowledge, attitudes and perceptions of the public.
Accurate knowledge on, and right attitudes and perceptions towards drug related
issues would certainly benefit the public in timely prevention of drug abuse.
Publication Types:
1951: Int Anesthesiol Clin. 1995 Fall;33(4):1-14.

Health care quality management: a status report.
Vorhaus CB, Enthoven AC.
Health Servives Management, Stanford University, CA, USA.
Publication Types:
• Review
1952: J Med Liban. 1995;43(1):17-22.

Most common diseases treated in primary health care facilities in

Lebanon.
Adib SM, Nuwayhid I, Hamadeh GN.
Department of Epidemiology, American University of Beirut (AUB), Lebanon.
The Lebanese Ministry of Health has requested public health experts to assess the
most common health problems seen in Primary Health Care (PHC) facilities. This
paper presents the results of this assessment conducted in a convenience sample
of PHC centers. The assessment aimed at identifying areas of strength and gaps in
the current system. Data were drawn from 23 PHC centers in various regions of
Lebanon, in addition to an 8-year review of the experience of the Department of
Family Medicine at the American University Hospital. In general, 46% of all
visits to PHC centers did not include any kind of diagnosis. Most centers provided
data on large categories of diseases without breakdown into specific entities. The
most commonly identified health problems were hypertension, diabetes and
asthma, in addition to eye and ear diseases, cardiologic conditions, and
dermatologic problems. Other health problems included ill-defined signs and
symptoms associated most likely with mental distress. Dental caries, skin and hair
parasites, and respiratory tract infections topped the health problems among
children. A qualitative synopsis of all data is presented. The paper highlights the
limitations of the current health information system in Lebanon, and suggests
corrective measures. It also presents a number of recommendations regarding the
optimal use of PHC centers for health education and promotion and for disease
prevention.
1953: J Electrocardiol. 1995;28 Suppl:110-20.

The state of body surface mapping in Japan.
Watanabe Y.
Department of Internal Medicine, Fujita Health University School of Medicine,

Aichi, Japan.
In Japan, body surface mapping (BSM) started in 1974. A huge amount of data
has been accumulated regarding basic researches and clinical applications. Recent
work on BSM in Japan is summarized here, with the goals of establishing a
normal database and diagnostic criteria by using the standardized mapping
system. The standard systems used in Japan are the HPM-7100 and the VCM-
3000, manufactured by Fukuda-Denshi (Tokyo, Japan) under the supervision of a
committee of the Japanese Circulation Society. The number of leads in this
system is 87 (59 on front, 28 on back). As a basic study, a computer simulation
was carried out on bundle branch block with myocardial infarction (MI), on late
potentials in MI, and finally, on the solution of the inverse problem. The database
of 606 normal subjects was established regarding age and sex, and a "departure
index" (the grade of deviation from normal: the difference between a patient's
data the normal mean divided by the normal SD) was proposed. Using the
departure index, diagnostic criteria were proposed for the ischemic site, MI site,
hypertrophic site of the ventricle, etc. The origin of the ventricular premature
contractions was determined by the site of minima and maxima of the QRS and
QRST isointegral maps. The site of accessory pathways was determined by the
site of minimum less than -0.15 mV on the BSM. For the prediction of patients
prone to ventricular tachycardia (VT), several approaches were tried such as
multipolar patterns of QRST isointegral maps, Wigner distribution, late potentials
with relation to endo- or epicardial delayed potentials, body surface distribution of
specific frequency band (25-50 Hz) obtained from fast Fourier transform analysis,
and nondipolarity of the QRST isointegral map. To improve the ablation
procedure of VT, the author developed a technique to determine the precise
location of the VT focus in pace mapping using a correlation matrix between VT
and pace maps. To ensure the longevity of the BSM, a reduction of the number of
leads has been proposed. The usefulness of BSM has been confirmed and the
technique accepted in Japan for daily clinical diagnosis.
1954: Medinfo. 1995;8 Pt 2:1603-7.

Health informatics from theory to practice: lessons from a case

study in a developing country.
Jayasuriya R.
Department of Public Health and Nutrition, University of Wollongong, New

South Wales, Australia.
Implementation of IT in developing countries has had successes and failures. The

theory of successful implementation has mainly been researched in developed
countries. There is now evidence that there are other issues that are of importance
to developing country health systems. Case studies allow us to identify pitfalls
that implementors can fall into. The implementation of a computerized Field
Health Information System in the Philippines provides insight into some factors
of importance. While there are similarities to issues in developed countries, there
are also many differences.
1955: Medinfo. 1995;8 Pt 2:1549-52.

Measuring the success of implementation of information system for

health center.
Chae YM, Kim SI, Lee BH, Choi SH, Kim IS.
Department of Preventive Medicine, Yonsei University College of Medicine,

Seoul, Korea.
The purpose of this study is to analyze the effects of the Health Management
Information System (HMIS) on the productivity and adoption process of health
center staff as well as the satisfaction with the services provided by the Kwonsun
health center located in Suwon city as a study subject. Three surveys were
conducted to measure the changes in productivity and adoption process
(knowledge, persuasion, decision, implementation, and confirmation) of health
center staffs over time. In addition, the effects of HMIS on the level of
satisfaction with the services perceived by the visitors were also measured by
comparing the satisfaction level between the study health center and a similar
health center as a control group. The results suggest that HMIS increased
productivity and satisfaction of staffs but did not increase persuasion and decision
level, and that it succeeded in increasing the satisfaction with the services for the
visitors.
1956: Medinfo. 1995;8 Pt 2:1535-7.

Regional medical information network using optical memory cards

and integrated services for digital network.
Ogushi Y, Misawa T, Hayashi Y, Ohta Y, Suzuki S, Horie M, Sakashita Y.
Department of Medical Informatics, Tokai University School of Medicine, Japan.
Since 1986, we have been developing a regional health and welfare system using
optical memory cards. We have expanded the system and performed model
experiments and evaluations this time. There are approximately 3000 card-holders
and 23 card-reader terminals in use. They cover 50 percent of the medical
facilities in the city of Isehara. Two medical clinics within neighboring cities have
joined our project. Standard Deviation Index (SDI) has been introduced to
standardize the numeric results of examinations. The terminals are connected with
Integrated Services for Digital Network (ISDN) allowing remote access to the
optical memory cards. This enhanced connectivity has allowed greater
cooperation in delivering quality medical services.
1957: Medinfo. 1995;8 Pt 2:1528.

Delivering health information databases on World Wide Web at the

National University of Singapore.
Lun KC, Tan TW, Gopalakrishnakone P, Loh S.
Department of Community, Occupational, and Family Medicine, National

University of Singapore.
The National University of Singapore (NUS) is one of the first medical schools in
Asia to exploit the use of the World Wide Web on the Internet for the delivery of
health information databases. Its WWW server was established in 1993 by the
NUS Biocomputing Research and User Support (BRUS) technology group in
collaboration with the Computer Resource Planning committee of the Faculty of
Medicine. As a result of the early recognition of the powerful platform on which
health information services can be delivered worldwide, the NUS effort has been
accredited with a number of Internet firsts in the area of health informatics. The
following are some of the NUS achievements: NUS-NCI CancerNet on the Web.
The NUS developed and implemented the first WWW version of the popular
CancerNet database offered by the National Cancer Institute, NIH, USA. Health
Info-Com Network Medical Newsletter. The NUS developed and implemented
the first WWW version of the medical newsletter, MEDNEWS which is edited by
Dr. David Dodell, USA. It is now mirrored by the University of Pennsylvania in
the United States and De Montfort University, U.K. Poisons Information
Database. This first WWW implementation of a database on known plant, snake
and other animal toxins with directories of antivenoms, toxinologists and poisons
control centers around the world is offered by the NUS Venom and Toxin
Research Group. HistoNet. This is a large collection of histology specimens from
the NUS Department of Anatomy. MEDISTAT. This is the first WWW
implementation of a Health and Population Statistical Database which contains
information for Singapore, selected Asian countries and aggregate data for world
regions. The Singapore Biotechnology Database. This database features
companies and organizations involved in biotechnology and related activities in
Singapore. Efforts are continuing to offer more value-added health information
databases on the NUS WWW server and to link the server with other top-class
information centers worldwide. Our mission is to identify the National University
of Singapore as a global health information hub on the Internet.
1958: Medinfo. 1995;8 Pt 2:1265-9.

On the foundation and structure of medical informatics.
Li Z, Mitchell J, Tian A, Rikli A.
Medical Informatics Group, University of Missouri-Columbia, Columbia, MO

65211, USA.
The authors from China and the United States take medical informatics from
theory to practice by improving its research, application, and dissemination and
by expanding its educational potential. We built a theoretical model and discussed
its definition, approach, foundation, principles, and structure. Medical informatics
is the interdisciplinary study of information science applied to medicine and
health care. Its developing approach is transplantation. The foundation of medical
informatics has "building blocks" of knowledge. They are: information procedure
models; information classification principles; information processing
methodologies; and functional hierarchical principles of information systems. The
structure of medical informatics includes the main knowledge branches and their
logical relations. There are four big branches: computer tools and systems
methods; engineering equipment and methods; medical fields information
systems; and health care management systems. Based on the investigation of the
professional status (its theory and application, and its forms and the contents) of
medical informatics, it can be seen that this new discipline is becoming mature.
1959: Medinfo. 1995;8 Pt 2:1255-9.

Reorganization of the information technology program at a United

States medical school: is there a lesson for academic medical
informatics in Japan?
Inoue Y, Beck JR.
Office of Information Technology, Baylor College of Medicine, One Baylor

Plaza, Texas Medical Center, Houston, Texas 77030, USA.
Reorganization of the information technology program at Baylor College of

Medicine commenced with the goal of obtaining a client-focused organization
instead of a classically departmental structure. Legacy organizations
independently established by request or serendipity had gaps and overlaps in
services and could no longer respond to new issues, such as integration of several
hospitals, resource sharing of health care delivery, administration of a shared
library, and an academic informatics program. The renewal of the information
technology program has led to departments of Telecommunications, Enterprise
Services, Client Services, and Medical Informatics, and has also allowed cross-
departmental projects led by a technology architect. In contrast with that of
Baylor, the approach of the Yamaguchi University School of Medicine in Japan
may be construed as economic efficiency at the cost of client services. Effective
client services by friendly and efficient staff groups is the most important factor
for an academic information technology program, if the goal is to reorganize in
anticipation of future challenges to the medical center.
Publication Types:
• Research Support, U.S. Gov't, P.H.S.
1960: Medinfo. 1995;8 Pt 1:581-5.

An experimental study on home health care support information

system construction.
Ishikawa K, Sekita Y, Yamanaka T, Hosaka H, Inada H.
Department of Medical Systems Management, Kagawa Medical School, Japan.
The need for home health care has been increasing in Japan and the expectation is
to apply advanced technology to home health care in order to promote it. We
already studied the development of a home care support information system using
a personal computer and a telephone set with multifunction. In the present study a
new system using a new telephone terminal was developed in order to increase
flexibility. To work out the concrete social system in the near future, a model of a
PHD (Personal Health Data) management system was constructed and tested.
Experimental studies were conducted by physicians and public health nurses. The
model system would be useful for daily monitoring of home patients in the
chronic stage of a disease and for dealing with their emergency states.
1961: Medinfo. 1995;8 Pt 1:484.

Development of a health administration system for inhabitants in

local community without abnormal findings by health examination.
Nakano M, Nojiri M, Sato Y, Utsumi K, Honda M, Iwai Y.
Department of Health Science, School of Nursing, Chiba University, Chuo-ku,

Japan.
This study was to establish practical methods to apply to the community health
promotion program the data obtained by surveys in a fishing village, under "The
Health and Medical Services Law for the Aged." This data, together with
guidelines on health counseling for inhabitants in the local community with less
abnormal findings on health examination, could be used for developing a health
promotion support system. In 1990, a questionnaire survey was carried out on
lifestyle such as diet, exercise, and rest, of 1,497 inhabitants (557 males, 940
females) attending for a health examination under "The Health and Medical
Services Law for the Aged," at Nishiizu district, Shizuoka Prefecture, Japan. The
questionnaire inquired about the subjects' health behavior and consciousness, i.e.,
on their dietary intake and preferences, dietary habits, regular exercise, exercise
habits, and rest, both in fact as well as in perception. In 1991, a survey was also
carried out on the daily physical activity and exercise of 1,737 inhabitants (620
males, 1,117 females) attending for a health examination under the law in the
same district. The items measured were the daily physical activity, the exercise
intensity, and the frequency score derived from several exercises. The relationship
to the exercise score was made on the basis of the sex, age, daily physical activity,
and the findings of the health examination as well as the self-evaluation of health.
In 1992, based on these results and also on the know-how about the software
made for similar purposes, "The Health Promotion Support System" for the
personal computer was developed in order to help public health nurses perform
health counseling for the local community. By means of this system, the answers
concerning the health examination findings, habits, health conditions, etc.,
enabled us to obtain information about the appropriate amount of exercise needed
for health, and of the total exercise time needed in a week at the level of 40%
maximum oxygen intake. In order to ascertain the quality and effect of the
program, the system was applied practically by the public health services, both at
Nishiizu district and at Maruyama, Chiba Prefecture, Japan. A questionnaire
survey was also conducted in Chiba Prefecture, the subjects were seven public
health nurses. The results of this survey showed that the system was successfully
applied to the people who received less care because of not having abnormal
findings on the health examination.
1962: Medinfo. 1995;8 Pt 1:358.

Integrating a health IC card system into a hospital information

system.
Chen TS, Chao CM, Cheng CC, Shih YS, Lin HC.
Department of Engineering Science, National Cheng Kung University, University

Road, Tainan, Taiwan.
As an experiment, a health IC card has been linked into the hospital information
system of the National Cheng Kung University (NCKU) Hospital. The NCKU
Hospital Information System (NCKU-HIS) services all the procedures for patient
registration, billing, prescriptions, and the processing and storing of test results.
The health IC card system provides good quality information to the doctors, the
hospital, the patients, and the insurance organizations. For a fully comprehensive
system, it is essential to integrate the health IC card system into the operational
NCKU-HIS, the communication protocols, and the national insurance procedures.
The experiment was designed to see if the development of such a system was
feasible, and the results have been impressive. It has proved possible to operate
the health IC card system, linking into different machines under different
computing environments. A single computer system to store all the data of all the
patients and to process all the nation's healthcare information would require
almost unlimited mainframe processing power and unlimited storage. It would be
very difficult to construct such a large computerized information system. All the
hospitals would be required to use the same data format to process their
information, and a large national healthcare network would have to be built,
making the collection and storage of personal medical information very difficult
and probably inefficient and unsatisfactory. Even if it was possible, it would be a
very costly and time-consuming task. An IC card is cheap and easy to use, and
offers an alternative solution to the problem of handling the nation's healthcare
information. The original healthcare IC card experiment (started in 1990) was
limited to the NCKU Hospital and the Taiwan Government Employees' Clinic.
The experimental system was designed to be fully integrated into the NCKU-HIS
and has been widely accepted by the users, especially the IC card-holding
patients. It is also well-suited to the management of healthcare insurance. An
expanded healthcare IC card system was implemented from the end of 1993 and
covers six clinics and six hospitals in Penghu County. The operation of the
registration and billing subsystems are supported by PC workstations in a
client/server network as these subsystems are used very frequently. Some of the
other computerized functions in the NCKU-HIS are supported by the mainframe
TANDEM computer system. The interfaces with the communication protocols
and application software provide for the effective two-way transfer of data and
programs. For future use, consideration is being given to the employment of the
Health Level Seven (HL/7) protocol for electronic data interchange. National
standards such as Chinese information processing, the use of standard codes, the
authorization of the content of the IC card, and communication protocols are
already incorporated in the system.
1963: Stud Fam Plann. 1995 Jan-Feb;26(1):22-32.

Beliefs and practices regarding delivery and postpartum maternal

morbidity in rural Bangladesh.
Goodburn EA, Gazi R, Chowdhury M.

United Nations Population Fund, Cambodia.
Most maternal deaths occur in the puerperium and most maternal morbidities
probably also arise at that time. Maternal morbidities occur much more frequently
than maternal deaths, but very little is known about their magnitude or causes.
This study uses focus-group discussions to explore the experiences of childbirth
and postpartum illness among rural Bangladeshi women. The women's beliefs
about disease causation, and their use of traditional health care, are explored. The
significance of the findings for the training of traditional birth attendants and for
programs of postpartum care is discussed.
PIP: In August 1991 in rural central Bangladesh, researchers conducted focus

group discussions with mothers of all ages and trained and untrained traditional
birth attendants (TBAs) to examine the experiences of childbirth, postpartum
morbidity, local beliefs, and practices. They intended to use the information to
design a prospective study of postpartum morbidity and its relation to delivery
practices. Postpartum morbidity was common. Most frequently described
postpartum conditions were breast problems, perineal problems, infections, and
prolapse. Participants mentioned a wide range of local treatments, but few
mentioned antibiotics as a treatment for infections. They believed in supernatural
causes of disease. Training did not substantially change the belief systems or
practices of TBAs. Harmful traditional practices included internal manipulations
and massage, introduction of oils into the vagina, use of fundal pressure or tight
abdominal bands during labor, pulling on the umbilical cord, choking or inducing
vomiting in the mother to facilitate placental delivery, and not using uterine
massage to prevent and treat postpartum hemorrhage. Beneficial practices were
adopting an upright position and walking during labor, squatting for delivery,
noninterferring with the membranes, having psychological support from
attendants, and being in familiar surroundings. The custom of seclusion was a key
obstacle to health-care seeking after delivery. Thus, home visits during the first
two weeks after delivery are needed. Relatives rather than TBAs performed many
deliveries. Food taboos were not as significant as earlier believed. These
discussions revealed that the preventive aspect of modern prenatal care has not
been incorporated into the women's belief system. They also suggest that the need
for health care is not being addressed.
Publication Types:
1964: Prev Med. 1995 Jan;24(1):85-8.

Establishment of an occupational diseases surveillance system to
monitor blood lead levels in Taiwan.
Wu TN, Shen CY, Yang GY, Liou SH, Ko KN, Chiang HC, Lai JS, Ho CK,
Chang PY.
Ministry of Health, Taiwan, ROC.
BACKGROUND. Occupational diseases share many common characteristics with

infectious diseases. However, the successful approach of using surveillance
systems to eradicate infectious diseases has never been applied to the control and
prevention of occupational diseases. METHODS. On the basis of a nationwide
survey of blood lead levels in the general population in Taiwan, we (the Ministry
of Health, Taiwan) have developed an obligatory surveillance system for blood
lead. RESULTS. This government-administered system, which uses laboratory
data as its source of information, enrolls all workers whose blood lead level
exceeds regulation points (40 microgram/dl for men and 30 micrograms/dl for
women). A Group of Health Promotion of Lead-using Workers (GHPLW) has
been organized to be responsible for conducting epidemiological investigations to
locate exposure sources in the workplace and to improve the working
environment of cases and other workers with the same exposure.
CONCLUSIONS. We emphasize that the accomplishment of the GHPLW's task
depends not only on "curing" the case, but also on eradicating the lead exposure
source and decreasing the blood lead level of workers in the workplace during
long-term follow-up. The system aims to upgrade occupational disease control to
the stage of specific prevention and health promotion. The establishment of this
system is a historic step in industrial hygiene and occupational disease prevention
in Taiwan.
1965: World Health Forum. 1995;16(3):305-11.

Informatics: the key to efficiency.
Indrayan A.
Division of Biostatistics and Medical Informatics, University College of Medical

Sciences, Delhi, India.
In India a computer-based national health management information system is

being implemented by linking more than 450 districts on a network. This and
other actions in the field of informatics technology could significantly raise the
efficiency of the country's health sector by making decisions more logical,
speeding them up and monitoring their impact, and could help to improve the
utilization of scarce resources.
1966: J Nerv Ment Dis. 1994 Dec;182(12):685-91.

Utilization of mental health services by minority veterans of the

Vietnam era.
Rosenheck R, Fontana A.
Evaluation Division of the National Center for PTSD, Yale University, New
Haven, Connecticut.
This study sought to identify differences in utilization of mental health services

among members of five minority groups who served in the military during the
Vietnam era. Data on utilization of mental health services from five different
types of provider (Veterans Affairs [VA] and non-VA mental health providers,
nonpsychiatrist physicians, clergy, and self-help groups) were obtained from a
national survey of Vietnam era veterans (the National Vietnam Veterans
Readjustment Study) along with information on sociodemographic characteristics,
health status, income, and health insurance coverage. Chi-square tests and
multivariate logistic regression analyses were used to compare use of various
services among whites, blacks, Puerto Rican Hispanics, Mexican Hispanics, and
others. Black veterans and Mexican Hispanic veterans were significantly less
likely than white veterans to have used non-VA mental health services or self-
help groups, after adjusting for health status and other factors. There were no
differences between ethnocultural groups in use of VA mental health services, or
services provided by nonpsychiatrist physicians or clergy, even after adjustment
was made for health and economic factors. Although military service during the
Vietnam conflict may have alienated many minority veterans from the federal
government, the reluctance of minorities to use non-VA mental health services
does not extend to the VA system. Further studies are needed to clarify the
reasons for less non-VA service use among some minority groups.
1967: Gaoxiong Yi Xue Ke Xue Za Zhi. 1994 Dec;10 Suppl:S94-101.

Framework for application of geographic information system to the

monitoring of dengue vectors.
Su MD, Chang NT.
Department of Agricultural Engineering, National Taiwan University, R.O.C.
In a successful management program of dengue vectors, not only health

education, source reduction or insecticide application should be conducted, but all
basic information should also be manipulated properly and efficiently. This
information includes the surveys of species, dispersal and dynamics of vectors, as
well as the detection of breeding sources, and the records of dengue cases and
epidemic periods. Most of the above information expressed as regionalized
variables always varies spatially and/or temporally. However, due to the
deficiency of topological information, the conventional database management
system cannot efficiently analyze those dengue related data. Thus, we have
applied the geographic information system (GIS) to the monitoring of dengue
vectors. The purpose of this report is to introduce the basic concepts of GIS, to
describe the framework of the prototype dengue vector monitoring system which
was built using data collected from the Sanmin area, Kaoshiung city, Taiwan, and
to indicate the possibility of using this system to manipulate spatially correlated
data and support decision making in the control of dengue disease.
Publication Types:
1968: J Med Syst. 1994 Dec;18(6):335-42.

Hospital information system and patterns of cancer screening.
Nasseri K, Bastani R, Bernstein S, Breslow L.
Jonsson Comprehensive Cancer Center, Division of Cancer Control, University of

California, Los Angeles, USA.
Relative ease, implied accuracy, and unprecedented possibilities of computerized

health care information systems, is very tempting for researchers. Attempts at
determining the referral patterns for cancer screening at a large county hospital
through the use of computerized administrative and clinical files, and some of the
problems encountered is reported here. Only 17% of women over 18, and 16% of
women over 50 who visited this hospital were referred and received screening for
cervical and breast cancer, respectively. Pap testing was concentrated at clinics
dealing with reproductive health, and women with higher visit frequencies had a
higher referral rate. Major problems encountered were lack of uniformity in
capturing information for similar variables in different files, inconsistency in
capturing data elements, and partial coverage. To enhance capabilities of
computerized health information system, following principles must be
incorporated in the designs: complete coverage, uniform collection of data across
time and files, and inclusion of linking capabilities.
Publication Types:
1969: Isr J Med Sci. 1994 Nov;30(11):805-10.

A 10 year survey on Mycobacterium tuberculosis isolates in Israel

and their drug resistance.
Lavy A, Mates A.
Mycobacterium Reference Laboratory, A. Felix Public Health Laboratories, Tel

Aviv, Israel.
An increased incidence of tuberculosis has been observed in Israel in 1985, 1986

and since 1990--years of large waves of immigrations. A very similar trend of
disease was observed in the Mycobacterium Reference Laboratory of Israel, and
consequently a survey was undertaken among the 1,181 bacteriologically
confirmed tuberculosis cases newly registered there in 1983-92. The overall
percent distribution of drug-resistant Mycobacterium tuberculosis during this
period was 12.6% (7.3% resistant to one drug and 5.3% (multiple drug
resistance). The highest percent distribution of drug-resistant bacilli was found
among immigrants from the former Soviet Union (37.3%) and Ethiopia (16.2%).
The highest incidence of disease was found in males and in patients aged > 30.
Pulmonary disease was the most common form for all patients: among the
extrapulmonary cases, the most frequently involved site was the genitourinary
system in Israelis and the lymph nodes in Ethiopians. Most isolates fit into one
variant by biochemical analysis, indicating the need for a more sensitive method
to type M. tuberculosis for epidemiological purposes. The data included in this
survey provide information useful for a national tuberculosis program.
1970: Isr J Med Sci. 1994 Nov;30(11):801-5.

Overview of research in the medical sciences in Israel: institutions,

investigators and funding.
Berns DS, Silbermann M.
Israel Ministry of Health, Jerusalem.
1971: Indian J Matern Child Health. 1994 Oct-Dec;5(4):88-94.

Related Articles
Health systems research in maternal and child health challenges,

problems and prescriptions.
Deodhar NS.
PIP: Health services or health systems research (HSR) helps to select the best
course of action when complex administrative issues make solutions difficult to
realize. HSR research should be carried out to: 1) identify the problems in the
promotion and development of maternal-child health (MCH) services and its
accessibility; 2) search for alternatives, seek cost-effective solution, and develop
interventions; and 3) develop mechanisms for effective application of available
knowledge, technology, and research results. The major challenges of improving
the quality of life women and children comprise: information, education, and
communication (IEC); program implementation and management; health
management information system; intra- and inter-sectoral coordination and
collaboration; the status of women, the education of girls, and income generation;
medical audit and rationalization of the procedures; and the environment. Some of
the problems in promoting health systems research suggest that the governmental
system is impervious to ideas and research findings. Bureaucracies are rigid and
bound to rules, which is not conducive to promoting research and improving the
delivery of health care. Hardly any research for health development takes place in
the states in India, and trained personnel in HSR are not easily available. Field
studies often reveal damaging information about the health staff and the
institutions. Health service information and information on births and deaths,
maternal mortality, and demography are poor at the district, primary health care,
and village levels. The remedy lies in the extensive use of HSR; the need for
demystification of HSR; attitude building and commitment for health authorities
and medical school teachers; innovative approaches, as tested by the
nongovernmental organizations; the encouragement of health officers and
voluntary organizations to undertake HSR; the training of manpower for HSR;
HSR especially at the district level; HSR as an integral par of health
administration; organizational change; and recognition and awards.
1972: Int J Health Plann Manage. 1994 Oct-Dec;9(4):341-8.

Implementing health management information systems: measuring

success in Korea's health centers.
Chae YM, Kim SI, Lee BH, Choi SH, Kim IS.
Yonsei University College of Medicine, Seoul, Korea.
This article analyses the effects that the introduction and adoption of a health
management information system (HMIS) can have on both the productivity of
health center staff as well as on user-satisfaction. The focus is upon the service
provided by the Kwonsun Health Center located in Suwon City, Korea. Two
surveys were conducted to measure the changes in productivity and adoption
(knowledge, persuasion, decision, implementation and confirmation) of health
center staff over time. In addition, a third survey was conducted to measure the
effects of HMIS on the level of satisfaction perceived by the visitors, by
comparing the satisfaction level between the study health center and a similar
health center identified as a control. The results suggest that HMIS increased the
productivity and satisfaction of the staff but did not increase their persuasion and
decision levels; and, that is also succeeded in increasing the levels of visitors'
satisfaction with the services provided.
Publication Types:
1973: Int Dent J. 1994 Oct;44(5 Suppl 1):553-60.

Global results: 15 years of CPITN epidemiology.
Pilot T, Miyazaki H.
WHO Collaborating Centre for Oral Health Services Research, University of

Groningen, The Netherlands.
The general acceptance and use of the CPITN system worldwide has provided, in
a very short time, a vast amount of data on periodontal diseases. This data has
been entered into the WHO Global Oral Data Bank, from which, after analysis,
much valuable information has been derived. Overall the CPITN system is seen as
having more than fulfilled the initial hopes invested in it. It has provided a simple
yet effective method for measuring and monitoring the magnitude, prevalence and
severity of periodontal diseases throughout the world, as well as helping in our
understanding of the disease process.
1974: Integration. 1994 Sep;(41):8-11.

Yielding impressive results. The Egyptian experience in family

planning communication campaign has been an exemplary model
for many developing countries.
Wafai M.
PIP: In Egypt the current use of family planning methods nearly doubled from
1980 to 1992. The toughest obstacles to the promotion of family planning are the
deeply rooted pronatalism, the high rate of illiteracy, and low use of print media.
The early efforts of the 1960s through the 1970s helped raise people's awareness
of the problem, but traditional attitudes to family planning persisted. The
Information, Education and Communication (IEC) Center established in 1979 in
the State Information Service (SIS) of the Ministry of Information spearheaded
the IEC efforts for family planning throughout the country. The Egyptian
Contraceptives Prevalence Survey conducted in 1984 showed that the current use
of family planning methods had increased 6.1% from the 1980 level, and that
56% of married women wished to stop having children, but were afraid of side
effects of contraceptive use. The SIS/IEC Center launched a creative mass media
campaign using TV spots and dramas. It also pioneered community-based public
communication activities on population and family planning by organizing
population communication forums. The local communication work is
implemented by each of the 60 regional offices of SIS. Other government
agencies, such as Health Insurance Organization, also launched IEC campaigns
promoting their own services. Non-governmental organizations (NGOs) such as
the Family of the Future and the Clinical Service Improvement Project also
engaged in social marketing of contraceptives. The use of family planning
methods mounted between 1980 and 1992 from 24% to nearly 48%, and the
method of choice shifted from the pill to the IUD. The country's crude birth rate
declined steadily from 40 per 1000 population in 1985 down to 29/1000 in 1992.
The six major factors for success included an innovative communication program,
religious support, political commitment, an improved service delivery system,
involvement of NGOs, and the economic influence. The Egyptian experience in
family planning IEC has been an exemplary model for many developing
countries.
1975: Integration. 1994 Sep;(41):4-7.

We will solve the problem. An interview with Population and Family

Welfare Minister Prof. Maher Mahran.
Rakia N.
PIP: The success of Egypt in confronting the population problem can be attributed
to three main factors: 1) the strong political commitment of the government; 2)
the population policy was formulated in 1973 on the basis of rapid population
increase, high population density, and unsatisfactory levels of education and
health; 3) policies must be within the framework of the religions of Egypt, of
culture, heritage and morality. The sharp increase in the rate of family planning
practice from 38% in 1988 to 47% in 1992 could be attributed to the IEC program
with convincing family planning messages, particularly to the effective use of
television since the illiteracy rate is still high in Egypt (37% among males and
66% among females in 1990). The Ministry of Health's System Development
Project has upgraded family planning service delivery in 21 governorates during
the period of 1987-1993. Medical facilities that belong to the private institutes,
factories are also encouraged to provide family planning services. Proper family
planning programs can actually reduce the maternal mortality rate by nearly 30%
in Egypt. One of the reasons why the contraceptive prevalence rate was only 24%
in 1992 in rural Upper Egypt is the insufficient number of family planning clinics
within walking distance for villagers. Therefore, the mobile clinic was introduced
in collaboration with the Japan International Cooperation Agency. Accordingly,
the number of couples practicing family planning has rapidly increased in the
pilot villages. 18 training centers have also been established all over the country
for doctors, nurses and other paramedics. Injectables are also well received by
Egyptian women because of their contraceptive effectiveness that lasts as long as
six months. Norplant will be introduced very soon. More than 10,000 Egyptian
women have tried the contraceptive on an experimental basis by participating in
contraceptive effectiveness research. Egypt can help other countries with support
of big donors including the United States and Japan.
1976: Integration. 1994 Sep;(41):28-31.

Client satisfaction. An interview with Dr. Moshira El Shaffie,
undersecretary for family planning, Ministry of Health.
Mann R.
PIP: The Egyptian family planning program has been successful in that it has
rapidly improved its service delivery system. In 1993 the Ministry of Health
(MOH) had 3492 facilities providing family planning services in 21 governorates,
and 10,714 physicians and 12,638 nurses took part in the program. As a result,
716,000 clients obtained family planning services from the MOH facilities, 15%
more than in 1992. The achievements have been brought about by the System
Development Project (SDP) that was started in 1987 which has upgraded the
MOH family planning service delivery system in 21 out of 26 governorates. The
initial goal of the SDP was to reduce the birth rate from 38/1000 population in
1986 to 35/1000 in 1993. The birth rate in 1994 is estimated to have dropped to
30/1000. New and improved IEC materials were designed and distributed. The
clinics were reequipped for improved services. Training was conducted for
doctors and nurses. Technical guidelines were developed in order to provide high
quality service. Because injectables contain a hormone that causes amenorrhea in
80 to 85% of women, they might not be as popular as the IUD. In the end
injectables and Norplant will be more popular in Upper Egypt than in Lower
Egypt. Condoms are available throughout the country. Pills are available in clinics
and also can be bought at any of around 18,000 pharmacies. At the impact of the
family planning program the fertility level has been falling. The total fertility rate
was 5.3 in 1979-1980. By 1994 it had dropped to 3.7 (2.9 in the urban areas and
4.9 in the rural areas). Infant mortality decreased by half between 1972 and 1992.
More young women are using contraception for spacing rather than for limiting
the number of children after having obtained the desired family size.
Nevertheless, according to the Egypt Demographic and Health Survey 1992, the
current family planning services have not reached one in five married women
wishing to use family planning.
1977: Parasitology. 1994 Sep;109 ( Pt 3):373-87.

The evaluation of potential global morbidity attributable to

intestinal nematode infections.
Chan MS, Medley GF, Jamison D, Bundy DA.
WHO Collaborating Centre for the Epidemiology of Intestinal Parasitic

Infections, Department of Biology, Imperial College, London, UK.
This paper presents a method of estimating the potential global morbidity due to
human intestinal nematode infections (Ascaris lumbricoides, Trichuris trichiura
and hookworms), based on the observed prevalence of infection. The method
relies on the observed relationships between prevalence and intensity of infection,
and between worm burden and potential morbidity. This approach is shown to be
sensitive to the precision of the original prevalence estimates and, in particular, to
the degree of spatial heterogeneity in levels of infection. The estimates presented
here indicate that several tens of millions of children are likely to suffer
developmental consequences from infection, and suggest that the global disease
burden of geohelminthiasis may be significantly greater than was supposed.
Publication Types:
1978: Mil Med. 1994 Sep;159(9):590-5.

The battle for Hue: casualty and disease rates during urban
warfare.
Blood CG, Anderson ME.

Research Center, San Diego, CA 92186-5122.
Renewed nationalism with the ending of the Cold War has precipitated numerous
conflicts between regions or countries that were formerly united. Hostilities
between some ethnic and nationalistic factions have reached the point where
regional security is threatened and United Nations-sanctioned military operations
may be required. Because some U.N. operations could require the forcible
removal of an entrenched faction from an urban setting, the present investigation
seeks to determine the levels of medical casualties that might be sustained during
urban warfare. Casualty rates and illness incidence were examined for U.S.
Marine forces participating in the retaking of the city of Hue during the Tet
offensive in 1968. The casualty rates were analyzed for different phases of the
urban assault and contrasted with a different period of the Vietnam Conflict, and
with the high intensity battle for Okinawa during World War II. Rates of
casualties during the retaking of Hue were highest during the two phases of the
operation that required close-quarter fighting. The house-to-house fighting south
of the river yielded a wounded rate of 37.9 per 1,000 strength per day, while the
fighting in the inner city yielded a rate of 44.4. Rate of wounded during the
"mopping-up" phase was 5.8. The rate of illness incidence was stable over the
month-long operation and showed no concomitant increase with battle intensity."
1979: China Popul Today. 1994 Aug;11(4):9-11.

Related Articles
Integration of population with development: China's practice.
Xiao Z.
PIP: The director and professor of the China Population Information and Research
Center discussed the determinants of fertility decline in China as due to political
commitment, integration of population with social and economic development,
timely effective technical services, voluntary participation of the public, and
extensive information, education, and communication (IEC). There has been
broad national and international acknowledgement of the success of family
planning programs since the 1970s in bringing about rapid fertility decline in
China. Integrated social and economic development has varied within the country,
and population growth is still high in poverty-stricken areas, ethnically inhabited
areas, and landlocked areas. Successful integration means meeting the
population's basic needs for food and clothing, promoting the notion of an
improved quality of life, and providing the opportunity for common prosperity.
The national target is to contain population at 1.3 billion by the year 2000 by
improving the quality of human resources and instituting a compulsory 9 years of
education. National laws have been passed to facilitate fertility decline, but family
planning regulations must be applied locally due to disparities in level of
development. The national population plan includes strategies for controlling
growth in over 2000 specific counties. There is the political integration of family
planning agencies and plans within the Central Committee of the Communist
Party and the State Party. Local family planning groups have been established in
29 provinces. The integrated strategy has been successful in changing people's
ideas about marriage and childbearing, promoting the improvement in women's
status, improving educational status, and establishing a social security system.
However, China has not yet completed its fertility transition. There is agreement
between Chinese leaders and the population that population growth issues are
development issues, and the solution is to increase production and simultaneously
implement the family planning program. A comprehensive and committed
approach to growth and environmental protection will contribute to sustainable
development. All social and economic policies should support fertility decline.
Family planning implementation must respect the basic rights of individuals and
couples while stressing social responsibility and duties. IEC should be used
instead of coercive practices.
1980: JOICFP News. 1994 Aug;(242):7.

Related Articles
Japanese respond to campaign.
[No authors listed]
PIP: A unique campaign launched by JOICFP in August 1993 had by the end of
June 1994 netted US $41,200 to support activities of the integrated Project (IP) in
developing countries. Under the campaign, the public, institutions, organizations,
and businesses have been sending in used prepaid cards for sale to collectors in
Japan and abroad. Prepaid cards are widely used throughout Japan for phones,
subways, railways and highways. Nippon Telegraph and Telephone Corporation
(NTT) alone issues 20 million cards annually. The campaign, which has been
widely featured in the media, has proved effective for drawing attention to
JOICFP and to population and family planning issues. Gaining the understanding
of the Japanese public about population issues has grown in importance since the
government's announcement of the new Global Issues Initiative (GII). Word about
the campaign was carried by radio, television, newspapers, and magazines
nationwide. The number of cards sent in escalated with the attention. By the end
of June, JOICFP had received around 700,000 cards, of which 550,000 have been
exchanged for cash. The funds generated by the card sales have been allocated to
support grassroots IP activities and encourage the self-reliance of projects in
China, Ghana, Guatemala, Nepal, Tanzania, and Zambia. Responses to the
campaign have come from individuals as well as local governments, hospitals,
enterprises, and educational institutions. Many of these have initiated their own
card-collection system and information-dissemination activities to support
JOICFP. Over 5000 different organizations are now collaborating with JOICFP
for the campaign, including Tenmaya Department Store in Okayama City.
1981: New Horiz. 1994 Aug;2(3):404-12.

Cost containment: the Pacific. Japan.
Tajimi K, Shimada Y, Nishimura S, Sirio CA.
Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo,
Japan.
The Japanese healthcare system is structured to provide universal healthcare
access to the entire Japanese population via a constitutional guarantee. Increasing
costs within the Japanese healthcare system are largely attributable to the
country's rapidly aging population. Intensive care services are provided primarily
in large tertiary care hospitals by a relatively small cadre of dedicated critical care
physicians. Triage pressure is high in many Japanese hospitals due to a relatively
small proportion of ICU beds. As a result, few patients are admitted to the ICU at
low risk of adverse outcome or monitoring. Costs associated with providing
critical care are poorly understood because of current hospital cost accounting
systems. Critical care costs have only recently become an area of concern.
Nevertheless, critical care physicians are taking steps to more fully understand
severity of illness, clinical outcome, and utilization of resources in order to
effectively guide healthcare policy and resource allocation decisions impacting
Japanese critical care.
Publication Types:
1982: J Trop Med Hyg. 1994 Aug;97(4):199-204.

Quality evaluation in the management of child sponsorship

programmes.
McDonnell WA, McDonnell TP.
Programme evaluation tactics for child sponsorship programmes have historically

concentrated on quantitative analysis of service units, amount of money invested,
number of countries served, the number of projects, and number of children in
each project. While these are valuable measures of programme variables, they do
not assess the impact of programmes on the lives of the children sponsored.
Outcome measures designed to assess programme impact add greatly to the
information available to child welfare professionals. This study collected data
about the impact of the programme on the lives of the children. The Child
Welfare League's Child Well-Being Scales (CWBS) were used to assess
programme impact. Twelve scales were chosen as directly related in type to the
programmes administered by Children International, a traditional and well
established child sponsorship organization located in Kansas City, Missouri. A
thirteenth scale was suggested by field workers in India as particularly relevant to
Third World populations. The scales were translated into languages appropriate to
each population in the programme countries. Social workers in each country were
trained to administer and score them. This analysis used the emerging data
technology becoming available to programmes in Third World countries. The
system enables administrators in the Third World to evaluate, enhance and
summarize their programmes in a way understandable across borders. Epi Info
(Dean et al., 1990) was customized to provide the framework for the analysis. The
population for this study was selected by a 5% random sampling of children
currently enrolled as sponsored children (180,000+ worldwide). These were
compared with a waiting-list control group selected randomly from lists of
children who have applied for sponsorship but have not yet been receiving
services (n = 50 from each project).(ABSTRACT TRUNCATED AT 250
WORDS)
1983: Jpn J Med Sci Biol. 1994 Aug;47(4):221-39.

Epidemics of aseptic meningitis due to echovirus 30 in Japan. A

report of the National Epidemiological Surveillance of Infectious
Agents in Japan.
Yamashita K, Miyamura K, Yamadera S, Kato N, Akatsuka M, Hashido M,

Inouye S, Yamazaki S.
Department of Epidemiology, National Institute of Health, Tokyo.
Two rages of epidemic of aseptic meningitis (AM) due to echovirus 30 (E30) in

Japan were analyzed with respect to two sources of information, AM incidence
and E30 isolation, both gathered through the National Epidemiological
Surveillance of Infectious Diseases. The first E30 epidemic spread throughout
Japan in 1983 and ceased within the year. The second epidemic, starting in 1989,
continued for the three successive years, and in the last year, 1991, the total E30
reports numbered 4,061, the largest number of a single virus type ever reported.
Although the epidemic showed temporal and geographical shift and lasted for one
or two years in some areas, most laboratories reported the largest number of E30
isolation in 1991. Among E30-yielding cases with clinical information during
1982-1992, the associating frequency with AM was as high as 82.5%. Other
central nervous system involvements such as encephalitis, myelitis,
encephalomyelitis and/or paralysis were reported in 36 E30-yielding cases and
their monthly and age distributions were different from those of AM cases. The
proportion of such disease among E30-yielding cases (0.60%) was close to that of
other enteroviruses (0.56%). During the epidemics, E30 was isolated more
frequently from cerebrospinal fluid than was E4 or E9 which prevailed
coincidentally. E30 was most frequently isolated from cases of 4-7 years of age,
sharing the common characteristic pattern of age distribution with other
enteroviral meningitis. E30-yielding cases, however, involved a large number of
older age groups than those of other enterovirus infections, and this tendency was
the most pronounced in the first epidemic year, 1983. The contribution of these
E30 epidemics on the yearly trend of clinically reported AM incidence and on the
shift of its age distribution was also analyzed.
1984: MMWR CDC Surveill Summ. 1994 Jul 22;43(2):7-19.

Dengue surveillance--United States, 1986-1992.
Rigau-Pérez JG, Gubler DJ, Vorndam AV, Clark GG.
Problem/Condition: Dengue is an acute, mosquito-transmitted viral disease

characterized by fever, headache, arthralgia, myalgia, rash, nausea, and vomiting.
The worldwide incidence of dengue hemorrhagic fever (DHF) and dengue shock
syndrome (DSS) increased from the mid-1970s through 1992. Although dengue is
not endemic to the 50 United States, it presents a risk to U.S. residents who visit
dengue-endemic areas. Reporting Period Covered: 1986-1992. Description of
System: Dengue surveillance in the 50 United States and the U.S. Virgin Islands
relies on provider-initiated reports to state health departments. State health
departments then submit clinical information and serum samples to CDC for
diagnostic confirmation of disease among U.S. residents who become ill during or
after travel to dengue-endemic areas and among residents of the U.S. Virgin
Islands. In Puerto Rico, an active, laboratory-based surveillance program receives
serum specimens from ambulatory and hospitalized patients throughout the island,
clinical reports on hospitalized cases, and copies of death certificates that list
dengue as a cause of death. Laboratory diagnosis relies on virus isolation or
serologic diagnosis of disease (i.e., IgM or IgG antibodies against dengue
viruses). Results: In 1986, the first indigenous transmission of dengue in the
United States in 6 years occurred in Texas; from the time of that incident through
1992, however, no further endemic transmission was reported. During 1986-1992,
CDC processed serum samples from 788 residents of 47 states and the District of
Columbia. Among these 788 residents, 157 (20%) cases of dengue were
diagnosed serologically or virologically. Of the 157 patients, 71 (45%) had visited
Latin America or the Caribbean; 63 (40%), Asia and the Pacific; seven (4%),
Africa; and nine (6%), several continents. All four dengue virus serotypes (DEN-
1, DEN-2, DEN-3, and DEN-4) were isolated from travelers to Asia and the
Pacific; however, travelers to the Americas acquired infections with only DEN-1,
DEN-2, or DEN-4. Even though the number of laboratory-diagnosed dengue
infections among travelers was small, severe and fatal disease was documented.
In the U.S. Virgin Islands and Puerto Rico, three serotypes (DEN-1, DEN-2, and
DEN-4) circulated during 1986-1992. In Puerto Rico, disease transmission was
characterized by a cyclical pattern, with peaks in incidence occurring during
months with higher temperatures and humidity (usually from September through
November). The highest incidence of laboratory-diagnosed disease (1.2 cases per
1,000 population) occurred among persons < 30 years of age; rates were similar
for males and females.(ABSTRACT TRUNCATED AT 400 WORDS)
1985: Asia Pac Obs. 1994 Jul-Sep;1(2):1-2.

Related Articles
China's demographic dilemma.
[No authors listed]
PIP: China's population policies should take into account that further population
declines between 1992 and the year 2000 will result in reducing the proportion of
young people and increasing by two times the number of elderly over the age of
65 years. The aged population which was 1.2 billion in 1994 is expected to
increase to 12.9% of total population. The expected increases in the elderly would
make China the only country in the world, beside Japan with an expected elderly
population comprising 20% of total population by 2025, ever to have such a high
proportion of aged. China must decide whether it is more important to reduce
population growth or secure a favorable ratio of working age persons to elderly
dependents. With a high proportion of elderly in a population, there would be a
need for social support from children for the elderly and increased expenditures
for pensions, public health services, social welfare, and social relief. Griffith
Feeney and Yuan Jianhua of the Beijing Institute of Information and Control in
1994 examined data from a 1992 national survey and found that fertility declined
from 2.04 children per woman in 1990 to 1.65 children per woman in 1991, which
is replacement level fertility. The reliability of the survey results has been
questioned by Chinese demographers because of the change in national birth
planning policy to the responsibility system among local, regional, and national
political and administrative heads for family planning use. The study researchers
conclude that, even with underreporting of 10% to 20%, the survey results
indicate attainment of Chinese replacement level fertility. If policy continues to
press for fertility decline, there would be unprecedented number of elderly and a
tremendous population imbalance. Demographically, this form of age structure
imbalance has never been experienced historically. The 1992 State Family
Planning Commission survey results were substantiated by surveys conducted
between 1982 and 1990 as showing "very low, but generally declining levels of
fertility." Both the international and the national community of scholars have
recognized the high quality of these surveys.
1986: J Pharmacol Exp Ther. 1994 Jul;270(1):414-23.

Interindividual variations in human liver cytochrome P-450

enzymes involved in the oxidation of drugs, carcinogens and toxic
chemicals: studies with liver microsomes of 30 Japanese and 30
Caucasians.
Shimada T, Yamazaki H, Mimura M, Inui Y, Guengerich FP.
Osaka Prefectural Institute of Public Health, Japan.
Interindividual variations in the level and activity of cytochrome P-450 enzymes

were investigated in the liver microsomes of 30 Japanese and 30 Caucasian
patients. The P-450 enzymes used in this study included P-450 1A2, 2A6, 2B6,
2C, 2D6, 2E1 and 3A, and the monooxygenase activities determined were 13
typical P-450 substrates and 9 procarcinogens. Although the total P-450 content
was higher in Caucasian (mean, 0.43 nmol/mg of protein) than in Japanese
populations (mean, 0.26 nmol/mg of protein), the relative levels (percent of total
P-450) of individual forms of P-450 determined immunochemically were not very
different except that P-450 2A6 and 2B6 levels were higher in the Caucasians.
About 70% of liver P-450 could be accounted for by P-450 1A2, 2A6, 2B6, 2C,
2D6, 2E1 and 3A proteins, and P-450 3A (about 30% of total P-450) and 2C
(about 20%) enzymes were found to be the major forms. Considerable levels of P-
450 1A2 (about 13%) and 2E1 (about 7%) could be determined, whereas the P-
450 2A6 (about 4%), 2D6 (about 2%) and 2B6 (< 1%) were the minor P-450
forms. Differences in some of the P-450 1A2-, 2A6-, 2D6-, 2E1- and 3A4-
dependent activities were observed in Japanese and Caucasian populations. No
clear sex-related differences in individual P-450 contents and drug- and
carcinogen-metabolizing activities were detected in 60 human samples, except
that P-450 1A2-dependent activities were found to be higher in mean than in
women in the Caucasian population only. A single neonate sample tended to be
lower in P-450 1A2-, 2A6- and 2E1-dependent activities. In contrast to rat
counterparts, we could not detect apparent developmental changes in P-450
content and activity in humans between 12 and 73 years old. Thus, the results
presented in this study provide useful information for the study of drug
biotransformation in humans and for the basis of drug toxicities, carcinogenesis
and teratogenesis.
Publication Types:


1987: Med War. 1994 Jul-Sep;10(3):183-94.
Desert Storm syndrome: sick soldiers and dead children?
Doucet I.
Medical Educational Trust, London.
Ill-health has been reported by many soldiers and others deployed in the Persian
Gulf during the Gulf War of 1991. Iraqi children have also been reported as
suffering from an undiagnosed wasting disease. Little conclusive information has
come to light; this paper reviews what is known at present, largely from anecdotal
reports. Symptoms reported differ from post-traumatic stress syndrome as
reported after previous conflicts; some are suggestive of a direct effect on the
immune system. Various possible causes are examined, including post-traumatic
stress disorder, infection, prophylactic medication, exposure to chemical and
biological warfare agents, exposures resulting from oil spills and fires, and
exposure to depleted uranium ammunition. The latter was used extensively for the
first time in the Gulf War, and is manufactured and test-fired in Britain. The
passive role of the British government in following up such reports is noted, in
contrast with the more active official responses in the United States. It is
suggested that Desert Storm Syndrome is one example of multiple assault upon
the body's immune system.
1988: J Audiov Media Med. 1994 Jul;17(3):117-20.

Development of a health information service using a videotex

system.
Dzulkifli AR, Aishah AL, Ch'ng HS, Rose A, Rahmat A, Isa AM, Baidi BM,
Abas H, Abu Bakar AM, Samsinah H.
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang.
A number of health databases is now available in Malaysia, but few are accessible
to the general public. However, recently a service was launched nationwide via a
videotex system to also target the Malaysia public. This service is provided by the
School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM) in
collaboration with several Malaysian Government ministries and agencies. Access
to health information via videotex, be it medical, pharmaceutical or environmental
is viewed as an effective means of on-line information dissemination. It provides
not only rapid retrieval but is also economical and interactive, particularly suitable
for a developing country.
Publication Types:
1989: Jpn Hosp. 1994 Jul;13:65-78.

A study of Japan's emergency medical care system--emergency

transportation and medical care service areas for tuberculosis
patients.
Nobukawa M.
Since 1988, there has been a noted increase in the use of emergency transportation
by tuberculosis patients in Japan. Therefore it is necessary to build a suitable
emergency medical care system for these patients. We evaluated the present
emergency medical care system available to them in Tokyo. We also studied
emergency medical care service areas (MCSAs) to further aid in the revision of
the emergency medical care system for tuberculosis. We used data from
tuberculous patients who required the use of the emergency medical care system
in Tokyo. The data was collected by the Tokyo Fire Department's emergency care
information system from 1978 to 1990. We investigated and analyzed data
regarding transportation and patient data. We also analized transportation data
from the point of view of municipal districts (wards, cities, towns, villages),
MCSAs and the Tokubetsuku region. We concluded that the number of
emergency transports for tuberculosis patients has gradually been increasing and
that the currently MCSA regions were not ideal for use in developing a
transportation system for these patients. Using larger areas such as Tokubetsu-ku
and Tokyotoka would be more practical emergency medical care system for
tuberculosis patients in Tokyo, it will be necessary to take into account the
Tokubetsu-ku area, the vagrant population within it, and the time required to
transport the patients from this area to the Tokyotoka area.
1990: Jpn Hosp. 1994 Jul;13:59-64.

Related Articles
Development of total medical material distribution management

system.
Uto Y, Kumamoto I.
Kagoshima University Hospital.
Since September 1992, attempts have been made at Kagoshima University

Hospital to develop the Medical Material Distribution Management System which
helps to realize optimal hospital management as a subsystem of the Total Hospital
Information System of Kagoshima University (THINK). As this system has been
established, it has become possible for us to have an accurate grasp of the flow
and stock of medical materials at our hospital. Furthermore, since September
1993, the Medical Material Distribution Management System has been improved
and the Total Medical Material Distribution Management System has been
smoothly introduced into the site of clinical practice. This system enables
automatic demands for fees for treatment with specific instruments and materials
covered by health insurance. It was difficult to predict the effect of this system,
because no similar system had been developed in Japan. However, more
satisfactory results than expected have been obtained since its introduction.
1991: Jpn Hosp. 1994 Jul;13:25-31.

Related Articles
Hospital administration with medical information management--

case study of a government-owned hospital under private
management.
Oka M.
Osaka Kosei-Nenkin Hospital, Japan.
1992: J Occup Med. 1994 Jun;36(6):609-15.

United States military casualty comparison during the Persian Gulf

War.
Helmkamp JC.
Division of Safety Research, National Institute for Occupational Safety and
Health, Morgantown, West Virginia.
The United States undertook an extensive mobilization of military forces in

Southwest Asia after the invasion of Kuwait by Iraq in August 1990. With this
massive buildup and the short duration of the Persian Gulf War, an
epidemiological comparison of military casualties was of interest. Information
extracted from the Worldwide Casualty System maintained by the Department of
Defense was used to describe the casualties. Of the 219 (212 men and 7 women)
US casualties, 154 were killed in battle and 65 died from nonbattle causes. Thirty-
five of the battle deaths were a result of friendly fire. Eighty-three percent of all
casualties were white and the mean age at death for all casualties was 26.9 years.
The Army had the highest proportion of both battle (58%) and nonbattle (71%)
casualties and the Marine Corps had the highest battle casualty rate (0.52 per 1000
personnel) and nonbattle casualty rate (0.31).
1993: J Hum Ergol (Tokyo). 1994 Jun;23(1):7-26.

A model of ergonomics intervention in industry: case study in

Japan.
Chavalitsakulchai P, Ohkubo T, Shahnavaz H.
Department of Human Work Sciences, Luleå University, Sweden.
This paper presents the results of an ergonomics survey in four different Japanese
work places. The survey consisted of two parts. In the first part, the physical and
psycho-social problems of the female workers were investigated. Questionnaire
techniques were used to assess musculoskeletal disorders in various parts of the
body and of psycho-social stress at work as well as in the daily life situation.
Furthermore, work posture analysis, task analysis, simple clinical tests and
flexibility tests were conducted. In the second part, the ergonomics intervention
practices in different types of Japanese work places were examined. Three
different questionnaires were developed and used to collect information from
representatives of employees, management and responsible governmental agents
of the Department of Industrial Safety and Health, Ministry of Labor, with regard
to ergonomic interventions at work places. Management, employees, and
government representatives expressed desire for cooperation and participation for
arrangement of the ergonomics intervention program. A model for appropriate
ergonomics intervention in industry is developed with regard to physical and
psycho-social problems at work. Factors influencing worker participation and the
establishment of a dynamic system of ergonomics intervention at work places are
discussed. Practical ways for improving the working conditions of female workers
are: (i) cooperation between managers, workers, and government officers is
regarded as vital for the ergonomics intervention program, (ii) worker
participation, (iii) appropriate training course with regard to ergonomics
education, and (iv) managerial support.
1994: Popul Headl. 1994 May;(230):7.

Indonesia: population central to development.
[No authors listed]
PIP: The Indonesian representative to the 50th session of the Economic and Social
Commission for Asia and the Pacific (ESCAP) reiterated the issue of population
as being central to sustainable development. Indonesia recognizes that quality of
life, which can be improved with education, health, skills, productivity, self
reliance, and resiliency, has an impact on the process of development. Without
quality improvements, large numbers of people become a burden. Population
programs must aim to reduce population growth rates simultaneously with
enhancing the quality of life. Women's improvement in education, health, and
employment opportunities must be accomplished because of women's important
role in national development. The goals of sustainable development are to
maintain a balance between human needs and desires of the population and
available resources and the environment. Sustainable development is necessary
for present and future generations. The Fourth Asian and Pacific Population
Conference was held in Bali in August 1992, at which time the Bali Declaration
was affirmed. At the January 1994 meeting of officials regarding the
implementation of the Bali Declaration held in Bangkok, Thailand, the Indonesian
representative stressed the importance of the vigorous involvement of the ESCAP
secretariat in planning and implementing population programs in the region.
Recommendations included in the Bali Declaration are related to the issues being
addressed at the International Conference on Population and Development to be
held in Cairo in September 1994. The secretariat was also asked by the Indonesian
representative to disseminate information on the implementation of the Bali
Declaration through regular publications and other appropriate venues.
Comprehensive data collection and information systems were needed on the links
between population, development, and resources.
1995: Methods Inf Med. 1994 May;33(2):234-6.

An information network for community medical care.
Sorachi K.
Himeji Medical Association, Hyogo, Japan.
An information network for community medical care was established by the

Himeji Medical Association in 1987. The network interconnects through public
telephone a central computer located at the office of the Medical Association with
personal computers installed in the offices of members of the Association. An
overview of the network, which is in full operation, is given, and current problems
and future directions are discussed.
1996: Contraception. 1994 May;49(5):527-41.

Maintaining technical quality of care in the introduction of

Cyclofem in a national family planning program: findings from
Indonesia.
Lubis F, Fajans P, Simmons R.
Yayasan Kusuma Buana, Jakarta, Indonesia.
This paper discusses the technical dimensions of "quality of care" in contraceptive

service delivery in both the Cyclofem Introductory Trial, as well as in routine
service delivery of other injectables in Indonesia. Although the quality of care in
the Cyclofem trial was generally acceptable, substantial weaknesses in screening,
clinical technique, the management of side-effects, and knowledge concerning re-
injection time frames were identified in the provision of injectable contraceptives
in routine service delivery. The findings suggest that in order for Cyclofem and
other injectables to be delivered in the routine program with an adequate standard
of care, considerable managerial adaptation and strengthening of providers'
technical capabilities would be necessary prior to actual introduction. This would
include providing training and updated technical guidelines concerning both
Cyclofem and other contraceptives to providers, with an emphasis on technical
issues including contraceptive indications and contraindications, re-injection time
frames, maintenance of asepsis and the management of side-effects.
Strengthening the existing management information system and logistics systems
to facilitate differentiation between injectable contraceptives provided by the
program so as to ensure sufficient supplies of both contraceptives and associated
materials such as needles and syringes will also be necessary.
PIP: The aim was to examine the implications for service delivery in Indonesian
national family planning programs introducing a new method, the injectable
Cyclofem. Observations were made in 28 clinics and with in-depth interviews in
Jakarta, West Java, and West Sumatra. The clinics included introductory trial
clinics, nontrial health centers, community-based health posts, and private sector
settings. Observations focused on the logistics of clients moving through the
clinic and on all methods provided. In-depth interviews were conducted among
national leaders, provincial and district program managers, public and private
providers of services, community leaders, and clients. Quality of care issues
focused on indications and contraindications, clinical technique, management of
side effects, and appropriate follow-up in service delivery. Observations revealed
that the clinical record form K-IV was not used very well for ascertaining client's
needs for spacing methods. The form also did not differentiate between
injectables and oral pills. Screening for contraindications was limited. Several
patterns emerged on use of syringes and needles, including single use and
multiple use. All used alcohol to swab the injection site, but one center reused
cotton swabs. Hands were rarely washed before providing services. Many service
centers were without running water in the service area. Gloves were reused
without disinfection. Insertion instruments for IUDS were not properly sterilized.
Written materials were only in one language. Side effects discussions were taken
out of context and used to motivate clients. When symptoms were reported,
complaints were dismissed, and assessment of the seriousness of bleeding or
amenorrhea was not made. Clients were told to come back on a specific day.
Mistiming of returns for injection resulted in mistiming of injections and a variety
of inappropriate responses for assurance of contraceptive coverage. Most clients
were responsible and returned on the appointed date. There were management
problems that interfered with quality of care delivery: supply shortages,
inadequate knowledge by staff of the importance of asepsis and technical
information, heavy case loads, provider fears of discussing side effects with
clients, lack of technical supervision, and general lack of attention to quality of
care issues. Recommendations were to provide technical guidelines and
instructions that are periodically updates, training for all service providers, written
manuals or guidelines, a functional supervisory system, revision of reporting
forms, refinement of logistics to assure one syringe and needle per client, and
balanced staff and equipment for case load management.
Publication Types:
• Clinical Trial

Contraceptive introduction and the management of choice: the role

of Cyclofem in Indonesia.
Simmons R, Fajans P, Lubis F.
Department of Population Planning and International Health, School of Public

Health, University of Michigan, Ann Arbor 48109-2029.
This paper presents a programmatic perspective on the relationship between the

introduction of new contraceptive technology and expanding contraceptive
options, using the example of Cyclofem in Indonesia. Past approaches to
contraceptive introduction have considered only the characteristics of the new
method in the decision-making process. In assessing whether the introduction of a
new method actually expands contraceptive choice for women and whether the
program has the managerial capabilities to assure quality of care in this process,
the authors argue that consideration must be given to all methods within a
delivery system and how new technology relates to the management of
contraceptive choice. Using this perspective, the authors suggest that choice
would not necessarily be expanded with scaled-up service delivery of a new once-
a month injectable in the Indonesian public sector context.
PIP: After observation and in-depth interviews within the Indonesian Family
Planning Service Delivery System, it was concluded that the introduction of new
contraceptives such as the injectable Cyclofem administered once a month would
be advantageous only if changes were made in operations and program
management. Changes were needed in counseling and information provision,
technical provision of care, training of staff, supervision, record keeping, logistics
and supplies, and policy support. Informed choice was jeopardized in the prior
introduction of the new method Norplant, and wide scale introduction of
Cyclofem would stretch the ability of the system to respond with assurances of
quality of care. Expanding the method mix would be appropriate in settings where
the service delivery system is stronger, where injectables are not currently
available, and where Cyclofem could replace high-dose injectables already
dispensed. This study included observations of 241 individual provider-client
interactions and 107 in-depth interviews among national leaders, provincial and
district program managers, public and private sector providers, community
leaders, and clients in Cyclofem trial and non-trial areas. Promotional activities
were not performed for Cyclofem. The introduction of Cyclofem expanded
women's options and in a way that included additional information not usually
provided. Cyclofem has the advantage of easy reversibility, regular bleeding
patterns, and high efficacy. This method, however, was not promoted as a spacing
method, in part because spacing methods are generally promoted within the
service delivery system. The system already provide two other injectables, DMPA
and NET-EN, with very different side effects. The policy and management
obstacles to planned expansion of choice in the public sector of the Indonesian
Family Planning Program included the following: the emphasis on long-acting
methods, charges for injectables and limited supplies, the lack of identification of
specific injectables in the record-keeping system, inadequate information
dissemination and counseling, and the added burden to staff time. The private
sector is more suitable for introduction of all injectables.
Publication Types:
1998: Comput Methods Programs Biomed. 1994 May;43(1-2):85-91.

Technology assessment of PACS in Osaka University Hospital.
Inamura K, Satoh K, Kondoh H, Mori Y, Kozuka T.
Osaka University, School of Allied Health Sciences, Faculty of Medicine, Japan.
This paper describes a methodology of PACS technology assessment and gives

examples of the results of measurement of 24 items of PACS-related situations of
image diagnosis systems in Osaka University Hospital before a PACS is installed.
These data are to be compared with the data which will be measured after PACS
is installed in the new Osaka University Hospital, in order to complete our
technology assessment. We propose common variables, units, and conditions of
measurement, in order to establish a standard method of data comparison between
before and after PACS installation in hospitals at large. We designed our PACS
taking technology assessment into account. We do not stop the technology
assessment at the efficacy evaluation, because PACS must be more than a tool for
radiological practice. We extend the technology assessment into the effectiveness
evaluation, so that PACS is a part of radiological practice itself, and diagnostic
accuracy, economy and efficiency are the results of PACS operation.
1999: Comput Methods Programs Biomed. 1994 May;43(1-2):3-8.

Round table discussions: standardisation and its role in PACS and

medical imaging.
Saranummi N, Inamura K.
VTT Information Technology, Tampere, Finland.
The round table discussions dealt with standardisation and its role in PACS and
medical imaging, and with the assessment of medical imaging and targeting R &
D based on that. Two approaches to enable image files to be transferred were
discussed in the standardisation sessions. Firstly, the standardisation efforts in
Europe, USA and Japan which all focus on a single standard on image transfer
and file format were discussed. A plea was made to merge these three approaches.
It was also noted that the Japanese IS&C standard is essentially a standard for off-
line PACS. Secondly, an argument was raised that as several i age file formats are
already in existence (because of the different computer platforms in use), what is
needed are converters between these de-facto formats instead of striving towards
one common standard. The round table on assessment focused on the changes in
the radiological practices which are already emerging following the introduction
of new digital imaging modalities. It was argued that PACS will cause further
organisational changes because a hospital-wide PACS enables images to be
viewed everywhere. The radiology meetings have been the mechanism for
discussing difficult cases. In the PACS world their role may change. However,
PACS will only diffuse when it offers clear advantages over the present
procedures. This means that PACS, digital imaging and radiology practices
evolve in parallel and incrementally.
2000: Nagoya J Med Sci. 1994 May;57 Suppl:195-202.

Vibration exposure and prevention in Japan.
Futatsuka M, Ueno T, Yamada S.
Department of Public Health, Kumamoto University School of Medicine, Japan.
Working conditions of vibration exposure have generally improved, but many

difficult problems must be solved such as (1) hygienic improvements in a variety
of vibrating tools; (2) improving working conditions, for example, by limiting the
time of operation in spite of economic difficulties such as those faced by those
who work on a piece rate basis; (3) gathering more complete information about
the risk population because of the large number of self-employed in informal
employment sectors; and (4) finding work places after rehabilitation for patients,
particularly in mountainous rural areas or in small scale industries. Historical
observation of vibration and preventive measures in Japanese national forests was
presented on the basis of the results of a retrospective cohort study in Kyushu,
Japan. Prevalence rate of VWF remarkably changed from 58.4% in the groups
that began to operate chain saws in 1960 to only a few cases in the groups who
started the operation after 1971. When we compare the relationships between the
results of long term cohort study and the consequences of preventive measures of
vibration syndrome, the most important factor is the decrease of vibration
exposure (improvement in chain saws plus the time restriction system). The
comprehensive prevention system used in Japanese national forests consists of the
following: (1) Health care system; (2) Work regulation system; (3) System for
improving mechanized tools; (4) Warming system to protect against cold
conditions; and (5) Education and training system.
Publication Types:
• Review
PMID: 7708102
2001: J AHIMA. 1994 May;65(5):70-2.
Opportunity for application of information technology: a case study

of Kuwait.
Shah MA, Choudury MH, Westberg J.
Faculty of Allied Health Sciences and Nursing, at Kuwait University.
2002: China Popul Today. 1994 Apr;11(2):17-9.
UNFPA-funded component projects in China.
[No authors listed]
PIP: Brief summary descriptions are given for 16 projects funded by the UN
Family Planning Association in China. The largest project pertains to a joint effort
in training doctors in 300 of the poorest counties and education of local
government personnel about maternal and child health and family planning
programs. The contraception production project is devoted to self-sufficient
production of effective and safe contraceptives and eliminating production of the
stainless steel IUD and other ineffective contraceptives. Basic research is being
funded at Beijing, Tianjin, and Chengdu research institutes on safe and acceptable
fertility regulation methods for Chinese people. Family planning personnel at
Nanjing Population College will receive strengthened training, while maternal and
child health and family planning professionals at the National Training Center
will have management skills upgraded. Both programs will have short term
courses and long term diploma programs. 23 provincial subcenters and 2 regional
centers in Beijing and Shanghai will receive help in better maintenance of
equipment. 20 pilot training centers in 19 provinces will be targeted for improved
training of family planning workers. Population education will be expanded to
2000 middle schools in 25 provinces, farmer's schools, and junior middle schools.
A population information program will be established to collect, store,
disseminate, and publish population information in the Population Information
and Research Center (CPIRC) within China and abroad and to publish and
analyze within the State Statistical Bureau 1990 Census data. CPIRC will be
developing an information processing system. Research by the Chinese Academy
of Social Sciences will be directed to women' status and the household economy
and fertility. Policy personnel will receive training. Demographic research will be
conducted by the Research Center for the Rural Economy. Family planning field
workers will receive training at the National Demographic Center at the People's
University of China, and a master's degree in population science will be offered at
the Institute of Population Research of Peking University. Income generation will
be the focus of projects in 34 counties in 10 provinces. Population aging will
receive research funding. The Department of International Relations will have
support for national execution of UNFPA projects.
2003: Health Millions. 1994 Apr;2(2):12-4.
A health profile of tribal India.
Basu SK.
PIP: There were 67.76 million persons belonging to scheduled tribes in about 74
distinct groups in India in 1991, or 7.95% of total population, usually living in
remote and ecologically diverse climates and areas. Modern medicine has not
been accepted in most tribal areas, where magico-religious health care systems
prevail. Health conditions in tribal areas have been described as deficient in
sanitary conditions, personal hygiene, and health education. Common diseases are
sexually transmitted ones and genetic abnormalities such as sickle cell anemia and
Glucose-6 Phosphate Enzyme Deficiency (G-6-PD). Disease incidence for sickle
cell anemia has been estimated at more than 19% among 35 tribal population
groups. 5 million are estimated to be carriers. G-6-PD shows a genetically carried
deficiency in a blood enzyme; persons commonly reject antimalarials, antibiotics,
and analgesics. The population estimated to have the deficiency is about 13
million, primarily residing in Madhya Pradesh, Maharashtra, Tamil Nadu, Orissa,
and Assam states (15%). The incidence is high in malaria zones. Screening kits
are needed by health workers, so that identified people can be tattooed and high
risk families counseled accordingly. The Onges, Jarawas, and Shompens of
Andaman and Nicobar Islands are facing extinction due to endemic diseases,
venereal diseases, and a shortage of women. Health workers need information on
the folklore related to health of these and other tribal groups, in order to provide
appropriate health and sanitary practices and to document indigenous herbs for
medical use. Malnutrition is pervasive among tribals. Deficiencies have been
detected in gross amounts of calcium, vitamin A, vitamin C, riboflavin, and
animal protein. Southern tribes are known for their caloric and protein
deficiencies. Those in rice-eating belts tend to have had higher protein intake. The
workload of tribal women is heavy, long, and increasing. Maternal mortality is
due to unhygienic conditions and inappropriate tribal practices. Interventions must
focus on tribal culture, medical training of indigenous people, a health care
delivery system catering to the community needs, and more research.
2004: J Epidemiol Community Health. 1994 Apr;48(2):182-7.
Gastric cancer screening programme in Japan: how to improve its

implementation in the community.
Wang B, Yanagawa H, Sakata K.
Department of Public Health, Jichi Medical School, Tochigi, Japan.
STUDY OBJECTIVE--The aim was to investigate which factors in the operating

procedure of the gastric cancer screening programme carried out by local
Japanese municipalities affect the participation rate. DESIGN--This was a cross-
sectional study. Data were mainly obtained by questionnaire completed by the
person in charge of health in each municipal council. Information was sought on
screening motivation, screening programme organisation, payment for the
examination, the scheduling and filing system, and community manpower. Data
on the participation levels were obtained from the health data service system
published by the Ministry of Health and Welfare in 1991. SETTING--All of
Japan's 3268 local municipalities were sent the questionnaire. Altogether 2795
municipalities responded (85.5% response rate). SUBJECTS--The local
municipality was regarded as the study unit. The municipalities were classified
into two groups--small municipalities, those with < 10,000 population aged 40
years and over, and large municipalities, those with > 10,000 population aged 40
years and over. MAIN RESULTS--The participation rate in the screening
programme varied according to the municipality population size and age. Small
municipalities had higher participation rates. The rate in people aged 60-69 years
was highest and that in those aged 70+ years was lowest. The participation rate
was positively associated with factors related to the operating procedure before
(for example, giving information about screening), during (for example, assisting
the screening staff), and after (setting up the relevant filing systems) the gastric
examination. CONCLUSIONS--The results suggest that personal motivation,
manpower in local residents' organisations, scheduling time for convenience, and
a basic filing system for individual data, especially for people who have not
participated in the programme for a few years, are important in increasing
participation.
PMCID: PMC1059931
2005: Integration. 1994 Mar;(39):48-50.
Training: more user friendly.
Horibe N.
PIP: China launched its family planning program in 1971 by initially focusing on
public information campaigns and providing services to married couples
nationwide. It eventually instituted programs to improve maternal and child
health/family planning (MCH/FP) through better quality service. Such programs
introduced interpersonal communication and counseling to improve quality
service. In 1990, with help from UNICEF and the United Nations Population
Fund [UNFPA], the Ministry of Public Health (MOPH) implemented a project to
improve MCH/FP in 300 of China's poorest counties. Its training activities are
chiefly for physicians and emphasize safe motherhood, breast feeding, diarrhea,
case management of acute respiratory infection, and FP. Interpersonal
communication and counseling has been included in each of these areas. Also
with UNFPA assistance, the State Family Planning Commission (SFPC) began a
project in 1991, targeting township and village family planning workers, which
concentrates on interpersonal communication and counseling in its service
delivery system. MOPH and SFPC are China's 2 vertical service delivery systems
and they do not cooperate at the central level. At the lower level, however, they
work together in interpersonal communication and counseling training. The
training uses the participatory training method, which encourages two-way
communication. The curriculum addresses motivation; education and counseling;
perception, values, and misconceptions; verbal and nonverbal communications;
interviewing and listening skills; and how to help the client's decision making.
Feedback is very important. The participatory method training class should not
exceed 50 participants, but financial constraints make this difficult in China.
Short-term benefits of the training are: inspiration to trainers, increased sensitivity
to the clients' needs and feelings, and exposure to an international professional
work ethic and practice.
2006: Disasters. 1994 Mar;18(1):58-75.
Post-emergency epidemiological surveillance in Iraqi-Kurdish

refugee camps in Iran.
Babille M, De Colombani P, Guerra R, Zagaria N, Zanetti C.
Istituto Superiore di Sanità, Rome, Italy.
In 1991 a computerized, comprehensive epidemiological surveillance system was

developed to monitor health trends in approximately 25,000 acutely displaced
Kurds in Nowsood and Saryas refugee camps, Bakhtaran region, Northwestern
Iran. In addition, community-based surveys offered information unobtainable
from health facilities. Weekly population movements, attack rates, point-
prevalence estimates, and case fatality ratios were calculated, and the data were
analysed and compared. The overall crude mortality rate (CMR) in the camps
under study was still 9 times higher than the reported CMR for Iraq. Health
problems with very low rates (less than 1.0/1,000 population/week) included the
triad of measles, meningitis and tetanus. However, morbidity for the most
common conditions (acute respiratory infections, diarrhoea, skin infections, eye
diseases and, finally, typhoid fever) was shown to increase at the end of the
intervention, highlighting that the pressure of repatriation on refugees made them
progressively worse. This article concludes that epidemiological surveillance
systems should be implemented during mass-migrations in developing countries
also in post-emergency settings. Furthermore, surveillance appears to be
indispensable in order for the international agencies to keep abreast of events and
to safeguard human rights when international attention subsides.
2007: Int J STD AIDS. 1994 Mar-Apr;5(2):124-9.
Patterns of risk behaviour for patients with sexually transmitted

diseases and surveillance for human immunodeficiency virus in
Kuala Lumpur, Malaysia.
Lye MS, Archibald C, Ghazali AA, Low BT, Teoh BH, Sinniah M, Rus SC,
Singh J, Nair RC.
Institute for Medical Research, Kuala Lumpur, Malaysia.

A study was conducted to determine the feasibility of establishing a sentinel
human immunodeficiency virus (HIV) surveillance system involving patients with
sexually transmitted diseases attending private clinics and a government sexually
transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk
behaviours for HIV infection were also collected. A total of 84 female and 91
male patients were interviewed and tested for HIV infection; 41.7% of the women
reported working as prostitutes, other occupations included masseuses,
hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The
most common diagnosis was gonorrhoea. Other diagnoses included non-specific
genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3%
of the women had a hundred or more sex partners during the previous month;
99% had 6 or more sex partners. Only 4.8% of female patients had their male
partners using condoms most of the time, 11.9% hardly used condoms at all. Of
the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had
between 6-20 different partners in the previous year. 78.0% of them had
prostitutes as their sex partners most of the time. 41.8% had experiences in
Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used
condoms rarely. Although all patients were tested negative for HIV antibodies, lot
quality assurance sampling methods indicate that the upper limits of prevalences
for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The
study has shown that it is feasible to carry out a sentinel surveillance programme
among STD patients and provided useful baseline data for future
comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: The authors interviewed and tested 91 male and 84 female sexually
transmitted disease (STD) patients for HIV infection to determine the feasibility
of establishing a sentinel HIV surveillance system involving patients with STDs
attending private clinics and a government STD clinic in Kuala Lumpur,
Malaysia. 77.3% of the women were aged 20-34 years and 7.1% under age 20.
Information was collected on risk behaviors for HIV infection. 41.7% of the
women reported working as prostitutes, while others worked as masseuses,
hairdressers, waitresses, salesgirls, receptionists, factory workers, and in other
capacities. 58.3% of the women had 100 or more sex partners during the
preceding month and 99% had six or more sex partners. Only 4.8% of the women,
however, had their male partners use condoms most of the time, while 11.9%
hardly used condoms at all. Gonorrhea was most commonly diagnosed, while
nonspecific genital infections, pelvic inflammatory disease, genital herpes, and
syphilis were also diagnosed. Among the males, 93.3% were heterosexual and
6.7% bisexual, with 41.1% having 6-20 different partners in the previous year.
78.0% had prostitutes as their sex partners most of the time, 41.8% had
experiences in Thailand and the Philippines, 73.6% never used condoms, 19.8%
used condoms rarely, and 6.6% used condoms most of the time. Despite such
behavior, all tested negative for antibodies to HIV. Lot quality assurance
sampling methods did, however, indicate that the upper limits of prevalences for
females and males were 3.5% and 3.3% respectively, at a 5% type I error. An
HIV prevalence of several percent could therefore exist. While offering useful
baseline data for future comparisons, this study found it feasible to carry out a
sentinel surveillance program among STD patients.
2008: Southeast Asian J Trop Med Public Health. 1994 Mar;25(1):37-44.
Epidemiologic characteristics of drivers, vehicles, pedestrians and

road environments involved in road traffic injuries in rural
Thailand.
Swaddiwudhipong W, Nguntra P, Mahasakpan P, Koonchote S, Tantriratna

G.
Department of Community and Social Medicine, Mae Sot General Hospital, Tak,
Thailand.
This report presents descriptive epidemiology of vehicle-related crashes that

caused severe injuries in a defined geographical area in northern Thailand,
conducted to determine the nature of injuries and factors that contributed to the
crashes. In each incident, the driver and other victims were identified and
interviewed by a trained public health worker using a standard investigation form.
During 1991, 286 single-vehicle crashes (66.4%), 117 crashes with other vehicles
(27.1%), and 28 crashes involving pedestrians (6.5%) occurred in the area. These
crashes injured 581 persons (551 vehicle occupants and 30 pedestrians), of whom
36 (6.2%) died. The vehicles involved in the crashes included 11 bicycles (2.3%),
371 motorcycles (78.6%), and 90 other motor vehicles (ie, pick-up trucks, lorries,
and cars) (19.1%). Motorcycle-related crashes accounted for the majority of
injuries and deaths. Driver risk factors for traffic injuries, such as alcohol
consumption, lack of a valid driving licence, limited driving experience, and
being a teenage driver, occurred more commonly among drivers of motorcycles
than of other motor vehicles. Poor vehicle conditions and road environments
reported in some incidents may have posed additional risks. Pedestrian factors,
including young and old age, and alcohol use, may also have contributed to the
occurrence of pedestrian injuries. Our system of data collection using an
investigation form can provide relevant information, leading to the development
of appropriate accident prevention programs for the community.
2009: Safe Mother. 1994 Feb;(13):9.

Mother's death means baby is likely to die too.
Abdulghani N.
PIP: A study by Dr. Nagiba Abdulghani, conducted for the University of London
School of Hygiene and Tropical Medicine, reports that in almost 2/3 of the cases
of maternal death during childbirth in North Yemen, the children died within 1
year of their mothers. The maternal mortality ratio in North Yemen is 753 per
100,000 live births. The study included 224 maternal deaths in 10 hospitals
between May, 1987, and April, 1989. 9 out of 10 mothers who died were
illiterate. Only 1/5 had received prenatal care. The inaccessibility of health
services, the poor quality of care and facilities, and a lack of faith in a system that
humiliates women were given as reasons for failure to seek medical care. Causes
of death in order of frequency were hepatitis, hemorrhage, infection, and toxemia.
3/4 of the women died postpartum. 1/5 of the babies were stillbirths. 1/5 of the
mothers had a history of maternal complications. 1/5 had chronic disease. 2/3 of
the women had begun their pregnancies within 1 year of their last childbirth. 1/2
of the women had symptoms ranging from vomiting and fatigue to jaundice and
vaginal bleeding. Recommendations of the study included: 1) programs to prevent
and treat hepatitis and; 2) an information, education, and communication (IEC)
community campaign on the signs of maternal complications. Personnel should
also continue their training and research activities.
2010: China Popul Today. 1994 Feb;11(1):2-4.

Related Articles
Minister Peng on population situation and major experiences of

family planning implementation.
Peng P.
PIP: Minister Peng Peiyen of the State Family Planning Commission delivered a
speech at the 6th National Symposium on Population Science and the Conference
of the Population Association of China. Population programs should be an
integral part of economic and social development and a priority for the
Communist Party and at all levels of government. Full responsibility for
implementation should be taken by top Party organizations and government.
Achievement in family planning should be based on the target responsibility
system. Family planning policy should be evenly implemented throughout the
country. Family planning quotas are preferred as strict and effective controls on
births. Traditional ideas about childbearing should be challenged through
information, education, and communication [IEC]. Grassroots level networks
should be strengthened for effective program management. Family planning
should better serve and be integrated with the socialist agenda of economic
development. Large numbers of family planning workers need to be trained in a
systematic way. Self-management, self-education, and self-service should be
encouraged among the population. The family planning program is still unevenly
developed in the country, and there are still a large number of annual births,
which puts pressure on socioeconomic development, natural resources, and
ecology. The most important task for China is the control of population growth,
which also involves improving the quality of human resources and readjusting the
population structure. The practice of family planning is a policy decision, which is
required for attainment of the 2nd and 3rd strategic goals for economic
development. There is a need for demographic research to guide program
implementation. Research should focus on controlling population growth,
improving the quality of human resources, and expanding the scope of inquiry.
2011: Indian Pediatr. 1994 Feb;31(2):239-44.
Utility of growth monitoring: its relevance in the promotion of child

health.
Kapil U, Joshi A, Nayar D.
Department of Human Nutrition, All India Institute of Medical Sciences, New

Delhi.
PIP: Growth monitoring (GM) in India is a strategy to detect early growth

retardation, promote optimum growth, create awareness about growth among
mothers, enhance delivery of primary health care, and identify those at risk of
malnutrition. Anthropometric measures include weight, height, mid-upper arm
circumference, chest circumferences, and the ratio of chest to head circumference.
Weight-for-age is the recommended measure of growth, because of the measure's
sensitivity to change. In developing countries preventive growth charts are used.
In developed countries curative growth charts are used and require decimals of
age and the ability to use graphs. The weight measure is sensitive to changes due
to malnutrition. Maternal maintenance of a growth card provides a visual
reminder about the nutrition and health of her child, an immunization record,
feeding patterns, and child spacing. Growth monitoring programs involved
weighing, maintaining growth charts, promoting health advice among mothers,
following-up by health workers, arranging mothers' meetings, maintaining home
visits by health workers, and supplying other health care services such as
immunization, birth spacing promotion, and oral rehydration information and
supplies. Growth monitoring and growth surveillance are different but
complementary. Growth monitoring is not just periodic nutritional assessment.
Growth monitoring involves improving interactions between mothers and the
community, educating about nutrition, and improving child health. 33% of India's
administrative blocks (2600 blocks) are involved in the Integrated Child
Development Services (ICDS), which promote child health and nutritional status.
The "anganwadi" worker serves as the main functionary for an area of about 1000
total population. Slowness of growth has been reported as disregarded in favor of
attention to severe malnourishment. Success of growth monitoring was
determined to be contingent on early identification of growth faltering, being part
of the primary care system, having adequate supplies of weighing equipment,
providing nutrition and health education, having community support, and
providing referral services. Deficits in selected ICDS programs were lack of skills
to use growth charts. Quality of programs varied widely. Recommendations were
made for future improvements.
2012: Indian J Soc Sci. 1994;7(3-4):265-84.
Issues of poor rural self-employed women.
Jumani U.
PIP: Most Indian women are low income and self-employed, but women's studies
have not focused on this large population. In order to fill in the gap in the
literature on women's employment in India, a study was conducted in 1985 among
800 women from 5 "talukas" in Ahmedabad district. This article describes the
common social and economic issues faced by poor, rural, self-employed women.
Most of the sample belong to lower caste groups. The caste system contributed
largely to their poverty, exploitation, and lack of access to facilities. The Harijans
are treated the worst and many villages consider them untouchables. The Vaghris
and the Dehgam are considered low caste but not untouchables. These groups are
not treated much better than the Harijans. Relations between various castes are
often strained. In many villages access to information about government programs
is controlled by the Sarpanch and Talati and denied to the lower castes. Women's
division of labor is determined by caste. The response to the demands of survival
among low-income women is to adopt a "contingency" approach to life. These
women are mobile, travel with few belongings, and seek shelter anywhere.
Children are not sent to school. Many are untrained even in a caste-based
occupation. The poor are generally landless and without assets. Work skills are
acquired from family or neighbors. Women and poor people lack access to loans
and lack awareness of detailed procedures. Cash payment does not usually go to
women. Women work in caste-based occupations in addition to two or three
seasonal agricultural labor jobs. Development programs do not address the current
situation of the poor.
2013: Plan Parent Chall. 1994;(1):28-30.
Exploring new paths to service delivery in Palestine.
[No authors listed]
PIP: From 1963 to 1987, the Palestinian Family Planning (FP) and Protection
Association (FPA) set up 11 urban clinics and branches. As the result of a needs
survey in 1985, the FPA was planning to provide more services in rural areas. The
political situation and the 1987 start of the Intifada, however, made delivery of
even existing services more difficult and helped create a pronatalist atmosphere
which was fueled by religious opposition to FP. In order to continue its work, the
FPA took advantage of interagency cooperation with the nongovernmental
organizations which had existing health clinics and which agreed to provide
contraceptives in exchange for a percentage of the sales revenue. The role of the
FPA was to provide the supplies and to train staff in service provision. The FPA
also used this cooperative system to funnel FP information, education, and
communication to women's groups. Through these efforts the FPA reached 60%
more new clients in 1992 than it had in 1991. This successful cooperative method
had its roots in the efforts the FPA had made since the 1970s to provide FP
services in the maternal and child care clinics for refugees set up by the UN Relief
and Works Agency (UNRWA). In 1993, the FPA received funding to open its
own clinic in Gaza (where 75% of the people are refugees). The FPA is also
actively seeking the involvement of religious leaders in discussions about the
incorporation of FP in refugee health programs. Meanwhile, in 1990, the
UNRWA began to offer FP as part of its maternal health program and to refer
clients to the FPA where they were served free of charge. When the UNRWA
began to provide FP services directly, the FPA provided the training for the
UNRWA personnel. By remaining flexible, the FPA has been able to use
appropriate channels to deliver its own expertise to women in need. Creative new
approaches will continue to be called for to reach the thousands of women who
remain in need of FP services.
2014: Popul Educ Asia Pac Newsl Forum. 1994;(40):13.

IEC strategy in support of family planning evaluated.
[No authors listed]
PIP: A final project evaluation report was released in April 1994 as PHI/89/PO9,
Strengthening IEC Management among Thailand Family Planning Programs. The
project is described as a function of the Department of Health's five year plan.
The project aim is to increase the capacity for planning, supervising, and
implementing IEC activities, designing and evaluating an evaluation system,
developing and producing IEC materials, and training and mobilizing workers in
IEC. The evaluation reveals that objectives have been met and teams are set up at
all levels. Recommendations are made to develop an integrated and
comprehensive family planning plan with major IEC components, to subcontract
out activities where personnel skills are inadequate, to introduce operations
research and integrate the results into operations, to strengthen staff capability,
and to test the viability of and expand IEC teams at the local level. The report also
indicates that there is a need for centrally produced IEC materials. Materials were
needed on methods and how to handle misconceptions about methods. There is a
need to secure the services of a private agency for production of materials. Family
planning and IEC distribution systems need to be strengthened at the local
government level. A training skills session is necessary for development of
interpersonal communication skills on how to use and maximize use of IEC
materials. Communications training in general required a longer investment in
training time. Communications training methods would be improved through use
of videos on family planning counseling and practical field exercises.
2015: Glob AIDSnews. 1994;(2):1-2.
Pakistan launches media blitz on AIDS.
Lynn W.
PIP: In March 1994, the National AIDS Prevention and Control Programme in
Pakistan launched its media campaign. Staffers have had to work within Islamic
principles to inform the public about the risk of HIV infection and to encourage
the public to adopt behavior to prevent its transmission. The media messages are
not sexually explicit. They call for Pakistanis to call a hotline for or to ask
medical professionals about more detailed information on AIDS. The hotline
number is memorable (123). The 2 hotlines in Islamabad receive 250-300
calls/day. These hotlines deliver a recorded message with information on the
significance of condoms in AIDS prevention and allows callers an opportunity to
leave a telephone number or address if they want information. Staff advise callers
who are concerned that they may be infected with HIV to obtain a test at 1 of 30
sites and to attend the National Institute for Health in Islamabad for more testing
and counseling if the first test is positive. The hotline system will soon expand to
all other major Pakistani cities. The program receives 300-400 letters/week asking
for specific information. The program had workshops for journalists as its first
wave of increasing AIDS awareness. The journalists followed with thoughtful
articles on AIDS. Program staff spent much energy to obtain support from Islamic
leaders. More media professionals have joined efforts to disseminate information
through various media forums to encourage people to seek treatment for sexually
transmitted diseases. The program's goal is a 55% increase in the number of
people who can name at least 2 correct ways to prevent HIV transmission and an
increase in condom use from 1% to 70%. The program eventually would like to
increase outreach efforts by working with nongovernmental organizations and by
developing videos and short stories.
2016: Mothers Child. 1994;13(1):1-3.
Combatting anemia in adolescent girls: a report from India.
Kanani S.
PIP: In a study on anemia in adolescent girls living in slum areas, 105 girls, aged
10 to 18, participated in qualitative (focus group discussions; open ended, in depth
interviews) and quantitative (structured survey and hemoglobin estimation)
research activities before and after intervention. Perceptions of mothers were also
surveyed. The qualitative methods were used on selected subsamples in order to
represent all age and ethnic groups and geographic areas of the slum. Quantitative
methods were used on all 105 girls. The prevalence of anemia was 98%. The
patterns of responses were similar for the focus groups, interviews, and surveys.
Mothers and their daughters believed the girls were healthy (" one who ate well,
worked without tiring easily and did not fall sick often"). There was no major
connection made between menstruation and health, or between present and future
health. Most of the girls were unaware of the Gujarati term for anemia, pandurog,
which is used in awareness campaigns. The girls described symptoms (weakness
= kamshakti) associated with anemia and knew these could be remedied with
green leafy vegetables, fruit, milk, meat, tonics from the doctor, and iron tablets
(shakti ni goli). Based on these results, a puppet show, using local terms and
events, was developed that covered the causes, symptoms, treatment, and
prevention of anemia. The term, pandurog, was introduced and reinforced. The
girls were encouraged to have their blood tested and to take iron tablets. The
hemoglobin levels of the girls were taken after the show and after an iron
supplement program lasting three months. Compliance with the supplementation
program was monitored biweekly. Group discussions with flash cards reinforced
the information in the puppet show. Results from the last hemoglobin level
showed a significant increase; however, the prevalence of anemia was 87%.
About half of the girls consumed at least 60% of the tablets; one-fifth consumed
80%. Forgetfulness and fasting during Ramzaan were cited as reasons for
noncompliance. There was a significant increase in awareness of the term,
pandurog; the symptoms of anemia; the importance of diet in preventing
pandurog; and the role of menstruation in increasing iron needs and contributing
to pandurog.
2017: AIPLA Q J. 1994;22(1):27-64.
Patents and the Human Genome Project.
Smith GK, Kettelberger DM.
2018: Eisei Shikenjo Hokoku. 1994;(112):138-42.
[Important points and references for the description of hazard

information in MSDS]
Yamamoto M, Kaminuma T.
The preparation of MSDS (material safety data sheets) began in Japan in April
1993 with the notice of three Ministries, the Ministry of Health and Welfare, the
Ministry of International Trade and Industry and the Ministry of Labor. MSDS
are designed to provide chemical information to protect human health and the
environment from chemical hazards. Important points in describing hazard
information in MSDS are explained as well as references which are useful for
preparation of MSDS. Problems for further discussion are also pointed out.
Publication Types:
• Review
2019: Taehan Kanho. 1994;33(1-2):80-91.
[Study of home nursing care needs and implementation of self care

of chronically ill patients]
[Article in Korean]
Woo SH, Oh HS.
This study was done to gather the basic information needed to identify how the
home nursing care needs and implementation of self care is being carried out for
chronically ill patients. The subjects of the study were 294 from chronically ill
patients in a general hospital, a university hospital and seven primary health care
center and the data was collected by a nurses, public health nurse practitioners
using questionnaires from July 30 to September 30, 1993. The data were analyzed
using percentage, mean, and T-test, ANOVA. Our objectives were to understand
basic nursing information general characteristics, implementation of self care,
home nursing care needs, implementation of self care depend on general
characteristics. The results of the study were as follows 1) General characteristics
of subjects. The majority of subjects are female (54.8%); 66.7% of residence are
fishing and agrarian villages. 20.1% of disease are neurologic system (backache,
neuralgia, HIVD, C.V.A). 2) Environmental offord reveals high point in
implementation of self care (2.76 +/- 1.37); 3) B.P check reveals high percentage
in home nursing care needs. (84.7%); 4) Implementation of self care depend on
general characteristics reveals significantly different by sex*, educational level**,
monthly income**, number of family*, disease*, and reason of untreatment** (*
< 0.05, ** < 0.01). In conclusion the study requires efforts of nurse practitioners,
and the support of useful resources by government.
Publication Types:
2020: Adv Intern Med. 1994;39:305-55.
Human immunodeficiency virus and acquired immunodeficiency

syndrome: an update.
Schnittman SM, Fauci AS.
Division of AIDS, National Institute of Allergy and Infectious Diseases, National

Institutes of Health, Bethesda, Maryland.
Research progress in the understanding of HIV and its effects on the human
immune system continues at a rapid pace. Such research is yielding new ideas for
chemotherapeutic agents, immunologic stimulators and modifiers, and potential
vaccines. Clinical trials to test these approaches are under way. Despite the
accomplishments, the epidemic progresses unchecked, resulting in continued
suffering and death and enormous demands on the health care system of many
nations. Clinicians have had to deal with new and difficult opportunistic
infections. Yet advances in the treatment and prevention of these illnesses have
benefited many AIDS victims. In the United States, the AIDS epidemic is now
concentrating in the inner cities, involving injection drug users, minorities,
heterosexuals, women and their offspring. In the developing world, AIDS
continues to be predominantly a heterosexually transmitted disease, where more
than one third of prostitutes in central African cities are infected. The major
burden of the AIDS epidemic in the remainder of this and the next century will be
in India and Southeast Asia, again predominantly via heterosexual spread. A great
deal is now understood concerning the life cycle of HIV. More light has been
shed on the interaction of HIV and CD4+ T cells, the cellular and viral factors
involved in viral expression vs. latency, the function of the viral regulatory and
structural proteins and the role of cytokines in regulation of HIV expression. Our
understanding of the precise mechanisms whereby HIV causes a loss of CD4+ T
cells remains incomplete. The direct infection and cell killing of CD4+ T cells is
important and is supported by recent evidence demonstrating a high viral burden
in these cells in the lymphoid tissue of patients. Over the last 1 to 2 years, there
has been new evidence for indirect mechanisms of CD4+ T-cell depletion and/or
dysfunction including: autoimmune reactions, perturbations of specific V beta T-
cell receptor populations, infection of T-cell precursors in bone marrow and
thymus, immunosuppression and dysregulation by viral proteins, possible super-
antigen effects, and antigen-induced apoptosis or programmed cell death. New
information has come forth in our understanding of B-cell abnormalities in HIV
pathogenesis, including the putative role of IL-6 in B-cell activation and the
identification of EBV in B-cell lymphomas in the CNS of patients with AIDS. It
is expected that these and future discoveries concerning immunopathogenesis of
HIV infection will help steer the therapeutic effort. Major strides continue to be
made in the therapeutic arena for HIV infection and its
complications.(ABSTRACT TRUNCATED AT 400 WORDS)
Publication Types:
• Review
2021: Int J Biomed Comput. 1994 Jan;34(1-4):357-61.
Workstation network system which enables international exchange

of characters and images at the University of Tokyo Hospital.
Kaihara S.
Hospital Computer Center, University of Tokyo Hospital, Japan.
The circumstances when physicians want to exchange information are analyzed

and the necessary requirements for workstations are discussed. Although there are
many requirements, it will not be necessary to incorporate every requirement onto
a single workstation. In the international setting, the capability of handling non-
alphabetic characters is also important. The requirements for image display
should be classified for those physicians who make their diagnosis primarily on
the basis of images and those who use images as additional diagnostic
information. On the basis of these discussions, the system of the University of
Tokyo Hospital, which is now being implemented, is described. The system will
be a network of approximately 300 workstations with one mainframe computer.
2022: Bull World Health Organ. 1994;72(3):409-22.
Improving vaccination coverage in urban areas through a health

communication campaign: the 1990 Philippine experience.
Zimicki S, Hornik RC, Verzosa CC, Hernandez JR, de Guzman E, Dayrit M,

Fausto A, Lee MB, Abad M.
Center for International, Health, and Development Communication, Annenberg

School for Communication, University of Pennsylvania, Philadelphia 19104-
6220.
From March to September 1990 the Philippine Department of Health, with the
assistance of the HEALTHCOM Project, carried out a national mass-media
communication campaign to support routine vaccination services. The essential
elements of the campaign strategy were as follows: focusing on measles as a way
to get mothers to bring their children to the health centre; emphasizing logistic
knowledge in the mass-media messages, in particular popularizing a single day of
the week as "vaccination day" and giving clear information about the age for
measles vaccination; and focusing on urban areas, which had lower vaccination
rates than rural areas. Evaluation of the effects of the campaign indicates an
increase in vaccination coverage and a substantial increase in the timeliness of
vaccination that can be attributed to improvement in carers' knowledge about
vaccination. Furthermore, most of the observed increase in knowledge was related
to exposure to the mass-media campaign. There was no evidence of any
programmatic change that could account for the increase in vaccination or
evidence that increased health education efforts at health centres could account
for the change in knowledge. These results indicate that when countries meet
certain conditions--a high level of access to the media, sufficient expertise and
funds available to develop and produce high-quality radio and television
advertisements, and a routine system that is able to serve the increased demand--a
mass communication campaign can significantly improve vaccination coverage.
PIP: The Philippine Department of Health conducted a national mass media

communication campaign during the period March-September 1990 to support
routine vaccination services. The campaign focused upon measles as a way to get
mothers to bring their children to the health center, emphasized logistic
knowledge in the mass-media messages, and focused upon urban areas with lower
vaccination rates than rural areas. Examples of logistic emphasis include
designating one day per week as vaccination day and giving clear information
about the age for measles vaccination. An increase in vaccination coverage and a
substantial increase in the timeliness of vaccination were observed which may be
attributed to the improvement in carers' knowledge about vaccination. Most
observed increase in knowledge was related to campaign exposure. There was no
evidence of any programmatic change which could account for the increase in
vaccination or evidence that increased health education efforts at health centers
could account for the change in knowledge. These results indicate that when
countries meet certain conditions, a mass communication campaign can
significantly improve vaccination coverage. Conditions include access to media,
expertise, and funds to produce and air high quality television and radio spots, and
a routine system capable of handling the increased demand.
Publication Types:

• Research Support, U.S. Gov't, Non-P.H.S.
Winners show the way to good management in health care.
Schwefel D, Pons MC.
Philippine-German Health and Management Information System Project, German

Agency for Technical Cooperation (GTZ), Manila, Philippines.
To stimulate resourcefulness in the health care services of the Philippines, the

German Agency for Technical Cooperation (GTZ) organized a competition to
discover and publicize examples of good management. The results provide a rich
fund of new ideas.
PIP: In August 1990, the Health and Management Information System project of
the German Agency for Technical Cooperation hosted a nationwide competition
in the Philippines to discover, award, and publicize examples of good
management (increased effectiveness, efficiency, and equity) in the field of health
care. 102 entries were obtained from nongovernmental organizations and
governmental agencies in all 12 regions of the Philippines and in 52 of the 75
provinces. Site visits were made to 70 projects, 50 were found to merit support,
and 12 of these were considered outstanding. The final selection committee chose
3 projects for gold medals, 8 for silver medals, and 38 for bronze medals;
accompanying monetary prizes ranged from US $1000 to $9000. Projects
awarded gold medals were a voluntary diabetics' association which conducts
monthly testing and training and provides support for sufferers, a drugstore
cooperative run by a group of poor garbage collectors, and a network of mothers'
clubs which emphasizes activities to improve self-reliance. The silver medal
projects included a program to provide field experience for medical students, a
series of health committees which advocate using health care as a catalyst for
community empowerment in remote areas, a program offering community-
development experience for students of social work, a university-based testing
and development program for herbal medicines, a medical clinic for the urban
poor, a radio broadcasting program on health topics, a maternal and child health
care program, and a herbal medicine production and marketing program. The
winning projects showed an intelligent and creative use of previously untapped
human and material resources. Flyers summarizing ideas from all of the winning
projects are being disseminated to spark participation in a second contest
scheduled for 1994.
Health consequences of vasectomy in India.
Tripathy SP, Ramachandran CR, Ramachandran P.
Indian Council of Medical Research, Ansari Nagar, New Delhi.
Vasectomy acceptance has been declining in India during the past 20 years. Even
if the risk of prostate cancer is marginally higher in vasectomized men, this risk in
India has to be assessed against the immediate safety and other possible long-term
benefits of this procedure. The Indian Council of Medical Research has launched
a case-control study, which is unlikely to be time-consuming or beyond the
available means and resources, in order to obtain definitive data on this problem.
Meanwhile, vasectomy remains an excellent procedure for the couple seeking
permanent methods of contraception, and specific efforts to promote its
acceptance must continue in India.
PIP: The prevalence and acceptance of vasectomy in India has fallen from 74.2%
(proportion of all sterilizations) in 1970 to 4.2% in 1992. Barriers in the
organizational structure and poor access to services may contribute to the
decrease in vasectomies. A review by the Indian Council of Medical Research
(ICMR) has concluded that there is no consensus about an increased risk of
prostate cancer among vasectomized men. The overall morbidity and mortality
rates due to cancer in vasectomized men are equal to or lower than those of
community-matched controls. Conflicting time-trends in the same study and
differences between studies in the same country make it difficult to determine
whether or not vasectomy decreases the risk of cardiovascular and
cerebrovascular diseases. No studies have looked at an association between
vasectomy and these diseases in India. WHO has asked the ICMR to participate in
a multicountry study on prostate cancer. ICMR's Scientific Advisory Groups
suggested that ICMR should also conduct a comprehensive case control study
among men who are at least 50 years old who underwent vasectomy at least 10
years earlier. This ICMR-funded 2-year study, which has already begun, measures
the risk of cardiovascular disease, cerebrovascular disease, and cancers other than
prostate cancer. It will allow ICMR to weigh all the long-term risks and benefits
of vasectomy in India against its short-term safety. The findings will provide
potential clients information on the relative risk of prostate cancer and other
diseases in vasectomized men in India, so they can make an informed choice. In
the meantime, based on its immediate safety, low cost, and feasibility in a primary
health care system, efforts to promote vasectomy acceptance in India must
proceed, especially targeting couples wanting permanent contraception.
Pooling academic resources for public health.
Michael JM, Hayakawa JM.
University of Hawaii, Honolulu 96822.
PIP: In January 1984, the Asia-Pacific Academic Consortium for Public Health
(APACPH) was established, bringing together 5 schools of public health with the
objectives: to raise the quality of professional education in public health; to
enhance the knowledge and skills of health workers through joint projects; to
solve health problems through closer links with each other and with ministries of
health; to increase opportunities for graduate students through curriculum
development; and to make child survival a major priority. The Consortium now
comprises 31 academic institutions or units in 16 countries, and is supported by
UNICEF, The World Health Organization, the China Medical Board of New
York, and the governments of Japan and Malaysia. During 1985-1992, it also
received major support from the United States through the US Agency for
International Development and the University of Hawaii. During the past 10
years, APACPH has carried out such activities as setting up a data bank on the
programs of its members, assessing public health problems, designing new
curriculum and systems for service delivery, facilitating information and faculty
exchanges, and running workshops for academic administrators. It has also
organized conferences on the impact of urbanization on health, aging, child
survival, AIDS, and occupational health. Since 1987 it has published the Asia-
Pacific Journal of Public Health, the only English language journal on public
health issues in the Asia and Pacific region, which will feature work being done
by non-English-speaking researchers. Emphasis in the coming years will be
placed on setting common standards for teaching and research, so that members
can make more use of each other's programs. It is hoped that membership of the
Consortium will continue to expand. A particular concern will be to focus more
resources on preventive care rather than curative.
2026: Med Inform (Lond). 1994 Jan-Mar;19(1):21-36.
Current assessment and proposed improvement to emergency

medical information systems in Japan.
Nagai M, Yamamoto M, Numata T.
Department of Engineering, Nagoya Institute of Technology, Japan.
Most prefectural governments in Japan have been implementing, or planning to

implement, emergency medical information systems that take advantage of
advanced information-related technologies such as computers and communication
systems, in order to improve their emergency medical care systems. We studied
the emergency medical information systems to analyse their present status, clarify
their purpose, and present the ideal system, in view of community health care
requirements. Here the results of the research are examined, and there is a
discussion of what is needed to improve the system in the future. The emergency
medical information system in Aichi prefecture is taken as an example, to closely
survey its present situation and analyse the evaluation of the system by the
residents who are the major beneficiaries of the system.
Health practices and indices of a poor urban population in

Indonesia. Part I: Patterns of health service utilization.
Kaye K, Novell MK.
Health/Population/Nutrition Offie, Save the Children, Westport, Connecticut

06880, USA.
This first section in a two-part study of health indices and practices among
residents living in a Jakarta slum describes the use of public and private primary
health care services in relation to socioeconomic and health status. As problems
associated with urban poverty rapidly increase in developing countries, it is
important to study the ethnic and economic diversity which exists in slums and
shanty towns: results of such studies should inform the development of effective
strategies for outreach and service delivery. Through a survey of 690 mothers and
593 children, we found that 1) poorer residents were more likely than relatively
affluent ones to rely on local government clinics (posyandus) for primary health
care; 2) regular posyandu users were more likely than non-users to be fully
immunized and to use ORT correctly; 3) delivery in hospital was common among
all residents, but especially among the more affluent; and 4) prevalence of
contraception was high and not associated with socioeconomic status or type of
primary health care service used. Strengthening primary health care services at the
government's local health posts could benefit all groups in the community if
wealthier residents participated more in the posyandus. Standards of care in the
private sector should also be improved.
PIP: A study conducted in two urban slum communities in Indonesia--Duri Utara

and Jelambar Baru--found that the newly established government primary health
care posts (posyandus) are having a beneficial impact on child health status, yet
are not being utilized by more affluent residents. Selected from residents enrolled
in the Save the Children Health Information System were 375 mothers who had
used the posyandu for the care of all their children in the 12 months preceding the
study and 305 non-users, most of whom obtained care from the private sector.
33% of the Duri Utara sample and 19% of the Jelambar Baru were classified as
poor (US$50/month), while 16% and 30%, respectively, were categorized as rich
(US$115/month). 68% of poor mothers compared with 30% of rich mothers were
regular posyandu users. Regular users were significantly more likely than non-
users to know how to prepare oral rehydration solution (90% versus 77%), to use
this during their children's diarrhea episodes (79% versus 68%), and to have
children under-three years old who were completely immunized (83% versus
65%). There were no significant differences according to posyandu use or
socioeconomic status in contraceptive prevalence (74% overall). Recommended
are interventions aimed at either improving the quality of preventive health care
services in the private sector or attempts to encourage more affluent residents to
utilize posyandu services.
Health practices and indices of a poor urban population in

Indonesia. Part II: Immunization, nutrition, and incidence of
diarrhea.
Kaye K, Novell M.
Save the Children Health Unit, Westport, Connecticut 06880, USA.
This second section in a two-part study of health indices and practices among a
poor urban population in Indonesia focuses on problems related to immunization,
nutrition, and incidence of diarrhea. Through a survey of 690 mothers and 593
children in two slum communities in Jakarta, we found that 1) 65% of the
children were mildly to severely malnourished according to Gomez criteria, with
malnutrition most prevalent among the poorest; 2) 75% of the mothers reported
exclusive breastfeeding of their infants during the first four months after birth, but
breastfeeding decreased sharply with increasing socioeconomic status; 3) of the
19% of one- to three-year-old children who were incompletely immunized, most
were likely to be missing their measles and DPT3 immunizations; and 4) 28% of
the mothers reported that at least one of their under-three-year-old children had
diarrhea in the last month, with frequency of reporting highest among poor
mothers and those using water from vendors. We concluded that selective
interventions should be accompanied by development of a comprehensive health
infrastructure that permits uninterrupted service delivery and follow up of those
identified as high risk. Such a comprehensive primary health care system should
be part of a multisectoral development strategy.
PIP: A study conducted in two Indonesian slum communities--Duri Utara and

Jelambar Baru--in 1991 revealed alarmingly high levels of child malnutrition,
diarrhea, and incomplete immunization. Selected for inclusion in the survey were
690 mothers and 593 of their children under 36 months of age. Respondents were
drawn from a Health Information System maintained by Save the Children. The
mean percentage of median weight-for-age was 85%; however, this statistic
ranged from 80% for poor children (family income under US$50/month) to 93%
for rich children (family income over US$115/month). On the basis of Gomez
malnutrition categories, 44% of children were classified as mildly malnourished,
22% were moderately malnourished, and 3% were severely malnourished. 37% of
poor children, compared to 19% of middle class and rich children, were in the
moderately to severely malnourished groups. The incidence of child diarrhea in
the past month was 36% in poor families and 20% in rich families. Both
nutritional status and diarrhea incidence were less favorable for children who
received their health care from the government-run primary health care post. 42%
of families who purchased water (generally the poor) reported diarrhea compared
to 30% of those who used hydrants and 17% of those who had indoor taps. Only
77% of children 12-36 months of age were fully immunized. 75% of mothers who
had a live birth in the year preceding the survey breast fed exclusively for the first
four months; this statistic was 83% for poor women compared to only 54% for
rich women. The persistence of child health problems in these communities,
despite the existence of a comprehensive primary health care center, confirms the
need for a multisectoral approach that addresses poverty-related issues such as
water services and nutrition education.
Publication Types:
2029: Cancer Surv. 1994;19-20:369-92.
Brain and other nervous system tumours.
Muir CS, Storm HH, Polednak A.
Cancer Registration in Scotland, Information and Statistics Division, Edinburgh.
Interpretation of time trends in incidence rates for cancers of brain and other and
unspecified parts of nervous system is complicated by variation in registration
efficiency over time and place, statistical instability of rates, changes in the ICD
classification of the tumours, variation in registration practice for the benign and
unspecified tumours over time and changes in methods of diagnosis. The reader
will undoubtedly have the impression that in this chapter there are too many
differences in the content of the data over time and place to have confidence in
any of the conclusions drawn. To derive a well documented and sustainable
assessment on secular trends will require an international collaborative study
collecting incidence data for the malignant, benign, uncertain and unspecified
tumours of the brain and other parts of the nervous system by histology and by
method of diagnosis. By providing a separate rubric for the meninges, the 10th
Revision of the ICD (WHO, 1993) should--combined with the morphology
rubrics of the second edition of the International Classification of Diseases-
Oncology (Percy et al 1990)--make such an endeavour somewhat easier. The data
presented above nevertheless suggest that, as for several other cancer sites, on the
whole there has been a slow overall increase in the incidence of brain and other
and unspecified nervous system neoplasms on the order of 1-2% per year over the
past 30 years. Increases appear to have been greater in older people. The extent to
which these increases are due to the unquestioned improvements in methods and
precision of diagnosis is not clear. Birth cohort data suggest that in recent years,
this influence may have been greatest for those birth cohorts born prior to 1900,
and this effect is unlikely to disappear until cohorts born about 1910-1920 have
passed on. There is currently little evidence to support the contention that the
recent increase in older people cannot be largely explained by improvements in
diagnostic methods, wider access to medical care and more intensive
investigation. Further work is needed.
2030: Int J Epidemiol. 1993 Dec;22(6):1146-53.
Factors affecting immunization coverage levels in a district of India.
Balraj V, Mukundan S, Samuel R, John TJ.
Department of Virology, Christian Medical College Hospital, Tamilnadu, India.
Immunization coverage is measured to assess the performance of the Expanded

Programme on Immunization. In 1988 we conducted a coverage survey among
12-23 month-old children in the North Arcot District (population 5,007,746) in
southern India. In each of the 12 towns a 30-cluster sample survey was conducted.
In the 35 rural blocks with 1590 panchayats, 159 were selected systematically and
all children (n = 7300) were surveyed. In the towns, coverage ranged for measles
vaccine from 29 to 53%, BCG from 65 to 91% and OPV and DPT third dose from
just over 60% to just over 80%. In the rural areas, coverage ranged for measles
vaccine from 10.8 to 19.3%, BCG 25.1-34.1%, DPT third dose 42.2-50.4% and
OPV third dose 39.6-48%. In the towns, 25, 66, 67 and 59% of BCG, DPT, OPV
and measles vaccines had been provided by private agencies showing that
availability of vaccines throughout the week and easy access even in payment
terms played an important role in achieving higher levels of coverage compared
with rural areas where all vaccines are given by Government agencies, free of
charge. In the rural areas, significantly large variations in coverage were seen
among panchayats--large and peri-urban panchayats had significantly better
coverage than small and more rural panchayats. Within any given block (the
population unit consisting of 30-40 panchayats served by a Primary Health
Centre), there were large variations in the levels of immunization coverage
between panchayats.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: The authors report findings from an immunization coverage survey in 1988
among 12-23 month old children in the North Arcot district of southern India
conducted to assess the performance of the Expanded Program on Immunization.
All 7300 children in 159 of 1590 systematically selected panchayats were
surveyed. In the towns, coverages for measles vaccine ranged 29-52%, BCG 65-
91%, and OPV and DPT 3rd dose 60-80%. Coverages in the rural areas were the
following: measles vaccine, 10.8-19.3%; BCG, 25.1-34.1%; DPT 3rd dose, 42.2-
50.4%; and OPV 3rd dose, 39.6-48%. In the towns, 25%, 66%, 67%, and 50% of
BCG, DPT, OPV, and measles vaccines, respectively, were provided by private
agencies. The higher coverage levels achieved in towns point to the importance of
making vaccines available and easily accessible throughout the week.
Government agencies provide all vaccines free of charge in rural areas. Further,
large and peri-urban panchayats in rural areas had significantly better coverage
than small and more rural ones, while large variations were found between
panchayats in the levels of immunization coverage within any given block of 30-
40 panchayats. The authors argue that variations in coverage levels in urban and
rural areas and within rural areas may be due to varying efficiencies of different
immunization delivery systems or responsible staff serving each region. In
closing, neither the district nor block is a satisfactory unit for coverage surveys.
Information should instead be collected from each geographical area served by a
health worker to best detect poorly immunized areas. Coverage surveys should
also ultimately be replaced with the auditing of immunization and disease
surveillance.
Publication Types:
2031: Acta Paediatr Jpn. 1993 Dec;35(6):579-82.
JICWELS' MCH training program in the Aiiku Institute: Asian

MCH workshop.
Hirayama M, Oyama O, Asano M.
Nippon Aiiku Research Institute for Maternal and Child Health and Welfare,
Tokyo, Japan.
Taking a form of Official Development Aid (ODA), the Japan International

Cooperation of Welfare Services (JICWELS) and Imperial Gift Foundation,
Boshi-Aiiku-Kai (Aiiku Association for Maternal and Child Health and Welfare)
have extended a study program on maternal and child health (MCH) since 1989
on the commission of the Ministry of Health and Welfare. 'Community
participation' is the key to the first international study program focused solely on
MCH. The purpose of the program is to help to improve the planning and
administration in the field of MCH. Through this, the information and experience
attained in Japanese MCH activities are introduced especially by participation in
community-level activities of 'Aiiku-Han' in which local citizens play a major
role. The operation system of the Asian MCH Workshop, contents of the
workshop, evaluation and future prospects are discussed.
PIP: The Japan International Cooperation of Welfare Services and the Imperial
Gift Foundation, Boshi-Aiiku-Kai, operate an international study program on
maternal and child health (MCH), which focuses on community participation. The
program aims to help public health officials (physicians) improve planning and
administration of MCH services. The training program emphasize primary health
care, study on the theory and actual application of community participation and
IEc programs (health planning), and discussion. So far, the program has invited
delegates to its ASIAN MCH Workshop from Indonesia, Malaysia, Nepal, the
Philippines, and Thailand. Delegates make field trips to Aiiku-Han activities in
Japan. Delegates especially appreciate the home visits they make with the Aiiku-
Han-Ins. Aiiku-Han-Ins are volunteer housewives in the community, organized
since 1933, who promote health and welfare of pregnant women, infants, and the
elderly, and prevention of diseases afflicting mothers and children, through home
visits and discussions. The Aiiku-Han (group of Aiiku-Han-Ins) is organized as
follows. The volunteer reports to a community active worker, who is in charge of
10 volunteers. The community active worker reports to the community unit
leader, who is in charge of 5-6 community active workers. The unit leader reports
to the community leader, who is in charge of 10-20 unit leaders. The community
leader conveys information to public health officials. Both workshop participants
and staff evaluate the workshops. High evaluation scores are usually the norm for
the workshop. High evaluation scores are usually the norm for the workshop. The
training program distributes newsletters to past participants, keeping them up-to-
date. It would like to become an international MCH information center. It would
like to expand training to field workers, including public health nurses, midwives,
and nurses.
2032: Acta Paediatr Jpn. 1993 Dec;35(6):559-66.
Maternal and child health in Indonesia.
Okamoto A.
Department of Pediatrics, Aiiku Hospital, Tokyo, Japan.
AIIKU-HAN activity was initiated by the Imperial Gift Foundation BOSHI-

AIIKU-KAI in Japan in 1936 and has been introduced and accepted to
community-based maternal and child health development in Indonesia through the
international cooperation project conducted by Japan International Cooperation
Agency (JICA) in order to encourage community health activities carried out by
Indonesian women volunteers. As AIIKU-HAN activity in Japan and Dasa
Wisma health activity in Indonesia have much in common, transferring concepts,
methods and experiences met less obstacles when Indonesian community health
volunteers learned AIIKU-HAN activity. Experience gained while developed
countries were less developed can be transferred by shifting the time-scale of
history in developed countries.
PIP: The government of Japan provided technical assistance to the government of

Indonesia to implement The Project for Community-Based Family Planning and
Maternal and Child Health (MCH) in Central Java in November 1989. Project
activities included training of Indonesian counterpart personnel, health and family
planning workers, and community leaders; dissemination of information and
educational materials on family planning and MCH; development of monitoring
and evaluation strategy of Posyandu (health service unit provided by the
community for the community supported by health center staff) activities. The
Japan International Cooperation Agency provided long term and short term
specialists, medical equipment, and IEC (information, education, and
communication) equipment to Central Java. As of early 1993, more than 10,000
participants have received training through the project. The Family Welfare
Movement (PKK) members conduct most community development efforts (e.g.,
community health) in Indonesia. Ten households or families comprise a unit of
self-reliant welfare (including health) system (Dasa Wisma). Dasa Wisma
workers remind women to visit the Posyandu for well-baby and well-mother
exams. A community health development project (AIIKU-SON) developed in
Japan in the 1930s for villages is similar to the PKK movement in Indonesian
villages. The AIIKU-SON activities of monthly home visits and learning through
discussion (i.e., monthly meeting in each level) were introduced to PKK and
health center staff in Central Java, which were easily accepted by the Indonesian
people. Visiting cards are used to record and monitor the health situation of
families. More than 6000 midwives and Dasa Wisma cadres have undergone
training. This project exemplifies how experiences of Japan, a developing country
through the 1950s, can be transferred to help current developing countries.
2033: Hosp Community Psychiatry. 1993 Nov;44(11):1095-7.
Comment in:
• Hosp Community Psychiatry. 1994 May;45(5):499-500.
Benefits of a structured format for paper and computerized

psychiatric case records.
Rabinowitz J, Modai I, Valevski A, Zemishlany Z, Mark M.
School of Social Work, Bar Ilan University, Ramat Gan, Israel.

Publication Types:
2034: Hosp Community Psychiatry. 1993 Nov;44(11):1091-5.
Comment in:
• Hosp Community Psychiatry. 1994 May;45(5):499-500.
Why and how to establish a computerized system for psychiatric

case records.
Modai I, Rabinowitz J.
Gehah Psychiatric Hospital, Petah Tiqva, Israel.
Based on experience with successful implementation of an on-line computerized

psychiatric case record system in a psychiatric hospital in Israel, the authors
discuss the advantages of such systems and outline the process of converting
paper records to computerized records. Computerized records can save time by
automatically issuing routine reports, improve clinical practice, simplify quality
assurance, and ease collection and analysis of data for research. The process of
converting paper records to computerized records can begin with analysis of the
hospital's reporting requirements and creation and pilot testing of structured paper
forms with a multiple-choice format that is eventually incorporated into the
computer program. The authors recommend an on-line computerized record
system with direct input of data because such a system can be used for case audits
and can generate reports, treatment plans, and medication orders without
removing records from circulation. Other advantages include the system's
usefulness in electronic communication within and outside the hospital.
2035: Am J Epidemiol. 1993 Nov 1;138(9):723-34.
Use of surnames to identify individuals of Chinese ancestry.

Choi BC, Hanley AJ, Holowaty EJ, Dale D.
Occupational and Environmental Health Unit, Faculty of Medicine, University of

Toronto, Ontario, Canada.
The objectives of this study were to develop and test surname lists for identifying
Chinese ancestry. The Ontario all-cause mortality database for the period 1982-
1989 was randomly split into source and test data sets. Frequencies by birthplace
were compiled for each surname in the source data set, by sex, and the surnames
were weighted based on their positive likelihood ratios. Lists of Chinese surnames
were then assembled based on varying cutoff levels, and screening performance
indicators for each list were calculated, including sensitivity, specificity, positive
and negative predictive values, post-test odds, positive likelihood ratio, and yield.
The internally generated lists were evaluated in the test data set. Results indicated
that surnames have a good potential to identify individuals of Chinese origin. In
the source data set, at a cutoff level of 100 for males (217 surnames) and females
(210 surnames), both sensitivity and the positive predictive value of the surname
lists for males and females were very high, above 80%, and the positive
likelihood ratio was above 600. In the test data set and using the same surname
lists, the sensitivity, positive predictive value, and positive likelihood ratio
remained at a high level: 73%, 81%, and 603, respectively, for males; and 73%,
84%, and 772, respectively, for females. Various scenarios and their
methodological implications are discussed.
Publication Types:
2036: Indian J Matern Child Health. 1993 Oct-Dec;4(4):118-21.
CHILD - to - child: the programme in survival and development of

children.
Mohapatra SC, Sankar H, Mohapatra P.
PIP: This study examined the effectiveness of training programs during October
1986 and September 1987 for elder children who reared younger siblings in rural
villages in India. The study population came from Bariasanpur, Rustampur, and
Khanpur for the experimental group and from Narayanpur, Kodopur, and
Ledhupur for the matched control group. Baseline information and interviews
were collected for 280 families and 1745 persons: 136 experimental group
families and 144 control group families. 46 children in the experimental group
and 30 children in the control group were selected for the training sessions.
Training was conducted over a four-day period for groups of 15 children. Pictures
were used for illiterates to depict illness and treatment. Topics included injury,
fever, diarrhea, and food hygiene. Assessment was made after seven days using
an instrument and scales developed by Guilbert and methods suggested by Siegel.
48.57% of families used a child-to-child system of care at some point. 70.54% or
86 families in areas where training was available agreed to have their elder
children trained. Child care by elder children involved about 26 days per month.
Only 3-6% of the families had toys for children. Younger children were fed about
three times a day in either group. There were significant differences in knowledge
between the control and experimental groups. Skills were also improved in the
experimental group. 53.6% of families were lower caste, and 44.3% were middle
caste. The mean per capital income was Rs. 77.90 +or- 31.33. 97 of 144 families
involved maternal caretakers. Good quality of care was provided by 75% of
mothers on food hygiene, 82.1% on diarrhea, 50% on fever, and 64.3% on
accidents. 10.7% of grandparents provided good quality care.
2037: Am J Epidemiol. 1993 Sep 1;138(5):310-7.
Mortality-discriminating power of some nutritional,

sociodemographic, and diarrheal disease indices.
Bairagi R, Koenig MA, Mazumder KA.
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
This study compared the predictive power of selected nutritional

(anthropometric), socioeconomic, and diarrheal disease morbidity variables for
subsequent childhood mortality over a 1-year period. The data consisted of
observations of approximately 1,900 children aged 6-36 months obtained from a
longitudinal demographic surveillance system located in a rural area of
Bangladesh in 1988-1990. The results suggested that weight-for-age (%) was the
best predictor of subsequent mortality over a 1-year period, followed by weight
velocity (monthly weight gain or loss in grams). Standardization of weight
velocity by the US National Center for Health Statistics standard did not improve
the mortality-discriminating power of this variable. Reported diarrheal morbidity
was also a useful criterion for predicting mortality. Neither maternal education
nor sex of the child had significant mortality-discriminating power.
PIP: The predictive power of selected nutritional (anthropometric),

socioeconomic, and diarrheal disease morbidity variables for subsequent
childhood mortality were compared over a 1-year period. The data were obtained
from the Sample Registration System of the International Centre for Diarrhoeal
Disease Research, Bangladesh, located in a rural area of Bangladesh in 1988-90.
In 1988 the weights of approximately 1900 children aged 6-36 months were
measured to the nearest 100 gm on a bar scale to assess the impact of the flood on
the nutritional status of children in the area. The weights of the children were
measured again after 3 months for examination of any changes in nutritional
status. Information on diarrheal disease during the previous 24-hour period and
also during the previous week, including the day of the interview/weight
measurement, was also collected. Measurements for 1874 children were available
from the 1st weight measurement, and measurements for 1900 children were
available from the 2nd weight measurement. The 1664 children for whom
measurements were available from both time periods were included in this study;
27 of these died during the 12-month period following the last weight
measurement. Below a threshold point of 70% mortality increased very sharply
for weight-for-age (percent) and around 70 gm month for the weight velocity
index. The sensitivity and specificity curves weight-for-age (percent) appeared to
be superior to the weight velocity index as a predictor of mortality. Weight
velocity was a weaker predictor than was weight-for-age (percent), and the power
of the weight velocity index was lower than that of weight velocity. Neither
maternal education nor sex of the child had significant mortality-discriminating
power. The discriminating powers of the variables of diarrhea on the day of
assessment and diarrhea during the previous week were significant (p 0.05).
Publication Types:
2038: Mil Med. 1993 Aug;158(8):542-5.
Debriefing: a therapeutic intervention.
FitzGerald ML, Braudaway CA, Leeks D, Padgett MB, Swartz AL, Samter
J, Gary-Stephens M, Dellinger NF.
Walter Reed Army Medical Center, Pediatric Consultation Liaison Service,

Washington, DC 20307-501.
An injured soldier may not have the benefit of the mental health interventions
available to other combatants. A team of psychiatric liaison nurses report on the
therapeutic effects of debriefing in the treatment of the traumatically injured
soldier. Debriefing not only affords an opportunity for the patient to share
thoughts and feelings about the trauma, but provides additional data regarding
effective coping mechanisms. This information also assists the health care team to
identify individuals at risk for developing post-traumatic stress disorder. Patient
teaching can then be directed toward helping each individual recognize the signs
and symptoms of stress unique to him/her and mobilize a plan for obtaining
assistance. Debriefing also assists the treatment team in identifying a soldier's
specific information deficits regarding the system, i.e., medical boards and
convalescent leaves.
2039: Mil Med. 1993 Aug;158(8):508-12.
A descriptive analysis of wounds among U.S. Marines treated at

second-echelon facilities in the Kuwaiti theater of operations.
Leedham CS, Blood CG, Newland C.

Medical data from 120 U.S. Marine Corps trauma admissions to second-echelon
facilities during Operation Desert Shield/Storm were examined. Sixty-five percent
of the admissions occurred between February 22 and February 28, the time frame
corresponding to the ground war and the preliminary mobilization period.
Penetrating wounds were the most prevalent types of injury, followed by
lacerations, open fractures, and closed fractures. The most frequent anatomical
regions sustaining injuries were the leg, head, hand, and arm. Fragments were the
causative agent of 63% of the admissions that had this variable recorded, while
gunfire was the cause in 20% of the cases. The median injury-to-admission
interval increased from 0.67 hours in the non-ground war period to 4.41 during
the ground war.
Publication Types:
2040: J R Soc Health. 1993 Aug;113(4):184-6.

Factors associated with awareness and knowledge of cervical cancer

in a community: implication for health education programmes in
developing countries.
Dhamija S, Sehgal A, Luthra UK, Sehgal K.
Institute of Cytology and Preventive Oncology (ICMR), Maulana Azad Medical

College Campus, New Delhi, India.
An attempt has been made to study the correlates of knowledge of cervical cancer
in a community. The survey undertaken is a part of Knowledge, Attitude and
Practice (KAP) study prior to initiation of cytological screening. Total women
interviewed by KAP survey were 1411 selected through 2 stage stratified random
sampling. Subjects for the present analysis consisted of a group of women who
had reported previous gynaecological problems related to cervical cancer. The
study brought out that younger women had better awareness and knowledge about
cervical cancer and related information. Literacy status for education and
exposure to family planning was influential in creating awareness about cervical
cancer. Lastly, the earlier episodes of gynaecological problems, and treatment
seeking behaviour lead to higher awareness (efforts may be made to innovate
ways to reach older and illiterate women at risk of cervical cancer for better
awareness in the community.
PIP: Data were collected from a community-based cytological screening program

tested by Maulana Azad Medical College (MAMC), Delhi, India, in order to
utilize the health infrastructure for prevention, detection, and management of
cancerous lesions of the cervix and to establish a community referral system for
control of cervical cancer. The Alipur Primary Health Center field practice area of
MAMC provides health care to 65,000 people in 27 villages. 609 (42.2%) of the
total of 1411 women interviewed reported previous incidence of gynecological
problems, but only 281 had sought treatment. 36.3% of those who reported earlier
gynecological problems and 40.2% of those who sought treatment, as compared
to 30.8% of all the women interviewed, were aware about cervical cancer in
general. The literacy status and ever use of family planning was significantly (p
.05) associated in all groups with the awareness of cervical cancer, earlier
episodes of gynecological problems, and seeking treatment. Among women aged
less than 35 years, who were informed about cervical cancer, there were
statistically significant differences (p .5); these were 31.1% of all the women
interviewed, 33.8% of those who reported earlier gynecological problems, and
43.9% of those who sought treatment for earlier gynecological problems
compared to women aged 35 years and above (P 0.05). Only 114 out of 221, who
were informed and who reported gynecological problems, sought treatment
(acceptors). Non-acceptors of treatment in this group lacked correct knowledge
about cervical cancer. 34.5% of acceptors knew about the age of onset, 11.4%
about early symptoms, and 24.8% about the method of early detection compared
to 30.6%, 0.0%, and 3.7% of non-acceptors, respectively. 68.5% of the non-
acceptors had obtained information regarding cervical cancer from relatives,
neighbors, and friends, while the acceptors had obtained the information from
hospitals and mass media also. 60.2% of acceptors were exposed to family
planning compared to 50.9% of non-acceptors.
Publication Types:
2041: Gaoxiong Yi Xue Ke Xue Za Zhi. 1993 Jul;9(7):410-7.
The effect of shift system on sleep quality, sleep quantity,

psychological disturbance, and family function of workers in
Taiwan.
Chang CJ, Wang SY, Liu HW.
Department of Family Medicine, Kaoshiung Medical College, Taiwan, Republic

of China.
This study was designed to examine whether there were any differences in sleep
quality and quantity between rotating shift workers and permanent day workers.
The subjects of this study consisted of 419 rotating shift workers and 468
permanent day workers. The Chinese Health Questionnaire (CHQ-12) and Family
APGAR Index were used to collect information concerning psychological
disturbances and family dysfunctions. The results showed that, compared to the
permanent day workers, sleep quality and quantity were poorer for the rotating
shift workers. The rotating shift workers often had more psychological
disturbances and family dysfunctions than permanent day workers.
Publication Types:

2042: Chronobiologia. 1993 Jul-Dec;20(3-4):269-75.
Chronobiologic perspective of international health care reform for

the future of children.
Halberg F, Cornélissen G, Carandente A, Bakken E, Young E.
Chronobiology Laboratories, University of Minnesota, Minneapolis.
The realization of the implications of splitting the atom ended a tragic war. The
nuclear age ensued. Likewise, a devastating escalation of health care costs could
be ended by realizing the implications of splitting the normal range. Our currently
disease-cure-oriented health care system does too little too late. Chronobiology
could change this status quo into a system that recognizes risk early; it would gain
new information from the resolution of predictable variations that take place
within the physiologic range. Investment into vaccinations leads to returns in the
form of savings in suffering and cost. A relatively modest investment into a
'Blood Pressure Health Start', pursued while chronobiology is being taught as an
integral part in primary, secondary, higher and continued education, may not only
drastically and in some respects promptly reduce the health care bill, but it would
help the economy of the country that invests into the development of
instrumentation for a chronobiologic systems approach. On the one hand,
reducing the number of cases of catastrophic diseases, via improved diagnosis (to
start with) of the blood pressure status, is likely to substantially reduce the budget
deficit by reducing the legitimate and essential costs of care (to start with, of
strokes and heart attacks, that kill more people than all other diseases combined
and that have blood pressure disorders as their major risk factor). On the other
hand, by implementing a novel health care system which also involves new
technology that can become in demand worldwide, any trade balance will be
improved.(ABSTRACT TRUNCATED AT 250 WORDS)
2043: Jpn Hosp. 1993 Jul;12:63-5.

Related Articles
The research trend of life sciences in Japanese universities based on

literature database search.
Odaka T, Akazawa K, Sakamoto M, Kinukawa N, Kamakura T, Nishioka Y,

Itasaka H, Watanabe Y, Nose Y.
Faculty of Medicine, Kyushu University, Fukuoka, Japan.
We searched literature databases regarding the four Japanese universities that

published the highest number of life science papers. The databases used in this
study were MEDLINE and EMBASE. As a result, there was a 30% difference in
the number of papers among the four universities.
Publication Types:
2044: Int J Epidemiol. 1993 Jun;22(3):457-62.
Patterns of infant mortality from Armenian parish records: a study

from 10 countries of the diaspora, 1737-1982.
Armenian HK, McCarthy JF, Balbanian SG.
Department of Epidemiology, Johns Hopkins University School of Hygiene and

Public Health, Baltimore, MD 21205.
Using parish records from 10 different countries with small Armenian

communities, this study compared patterns of infant mortality in these countries
over a period of 245 years. Deaths registered as aged < or = 1 year were used to
estimate the numerator for the infant mortality rates (IMR) while the denominator
was estimated from births in the same year based on baptisms in the appropriate
registers. To check on the validity of using the baptisms as the denominator for
the IMR, records of infant deaths were linked with the baptismal records. Thus,
from a sample of 273 infant deaths 78.4% had a baptismal record in the registers
of the same church in which the death was recorded. Of the deaths 60% had a
recorded cause of death. Over the past 245 years, IMR have fallen substantially in
all parishes. However, there were notable exceptions to this general pattern of
declining IMR over time. For example, the IMR was tripled in Palestine during
the decade of the First World War, possibly as a result of the influx of refugees
deported from Turkey. A study of the seasonal occurrence of the deaths revealed
peaking of deaths between May and August, a pattern influenced by the relative
importance of gastroenteritis as a cause of death during the summer months in
Egypt where the majority of these infant deaths were recorded. A review of the
most important causes of death helped identify an outbreak of undetermined cause
in Belgrade in 1737 and an outbreak of dysentery deaths in Alexandria, Egypt, in
1909.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: The use of parish records of the Armenian infant mortality rate (IMR)
illustrates the trends of IMR over time and among Armenian population in
different countries, and indicates the overall health of the population at different
stages of development. The data from parish records collected by the Armenian
Genealogical Society is reasonably valid as a whole, but suffers from
misclassification bias reporting in the cause of death. Cause of death was reported
in only 60% of cases. Coding of specific causes was based on List B of the List of
50 Causes from the ICD, 8th Revision. Heaping may occur at age 1, but mortality
both above and below age 1 was rounded and may minimize this bias. Bias is
reporting neonatal deaths is possible, but 78.4% of deaths were linked to
baptismal records. Uniformity of recording systems were established by the
Armenian church after 1863. IMR data span a period of 245 years (1737-1982)
and includes information from 10 countries having long standing Armenian
communities: Singapore, Burma, Bangladesh, Indonesia, India, Egypt, Palestine,
Cyprus, Greece, and Belgrade, Yugoslavia. Baptismal records were used to
calculate births for the denominator in the IMR. Tabulations were made by the
church, which showed variations in the proportion of successful matches of births
and deaths. Data were available by age, sex, and geographical distribution and
varied through time and seasons. In the analysis of time trends, it was revealed
that IMR declined continuously but varied for all countries. In India and the Far
East, IMR was consistently lower that the IMR from the Middle East parishes.
Greece and Cyprus also had somewhat low IMR. The large settlements of
Armenians had the highest IMR; these large communities also were communities
with low socioeconomic status. Between 1910 and 1919, IMR from Palestine
parishes increased; this may have been due to the refugees fleeting persecution
and genocide in Armenia and those deported from Turkey. Economic and health
conditions among refugees were known to be poor. Neonatal deaths were higher
in countries with low IMR. Peak deaths occurred during the months of May and
August. Gastroenteritis was a primary cause of death. The most important causes
of death were due to diarrhea and respiratory infections. Neonatal deaths were
primarily due to congenital anomalies. Many of the death clusters occurred during
peak epidemics.
Publication Types:
2045: Harefuah. 1993 Jun 1;124(11):715-6.

[Compliance with recommended periodic examinations of workers

in Israel]
[Article in Hebrew]
Green MS.
Occupational Health Institute, Ra'anana.
Initial design and subsequent improvement of health education and health

promotion programs should be based on reliable, current data on the health-
related habits of the target population. Various organizations in the Israeli health
system conduct campaigns encouraging the general population to undergo
periodic blood pressure and blood cholesterol measurements. In addition, regular
examination of the breast and uterine cervix are recommended for women.
However, there is no systematic on-going monitoring of compliance with these
recommendations. Health promotion programs in the work-place are regularly
conducted by the national Occupational Health Institute (affiliated with the
General Labor Federation Health Insurance Institute). To obtain basic information
on such health-related behavior, a survey was conducted in April 1992 in a
sample of 1,042 employees at 6 places of work. The results indicate relatively low
compliance with recommended periodic health examinations and demonstrate the
need for regular studies of this kind in representative population samples. In this
way decision-makers in public health service would be provided the data essential
for determining optimal allocation of resources to health promotion programs.
Publication Types:
2046: Kekkaku. 1993 Jun;68(6):407-18.
[A study of knowledge, attitude and health behavior toward

tuberculosis among non-immigrant Korean people in Japan]
Matsuba T.
Department of Hygiene, Juntendo University School of Medicine, Tokyo, Japan.
Knowledge, attitude and health behavior toward tuberculosis among Non-

immigrant Korean people in Japan was researched by using questionnaire because
of increasing the number of the tuberculosis patients among those group. The
Korean member of protestant churches in Tokyo were subjects for the survey.
Immigrant Korean people and their descendants were excluded. The questionnaire
form was written in Korean language under the guidance of native Korean
tuberculosis specialists. Proportion of Response was 53.1%, or 251 among 473
from 10th January to 30th June in 1992. The knowledge of tuberculosis among
them was revealed to be higher than among ordinary native Korean people. It was
different statistically by generation, namely, younger subjects aged less than 40
years old tended to answer that tuberculosis was a minor illness. The mass
screening system in Japan was well known by the subjects, as shown by the fact
that 72.4% of them answered that they knew about it. But only 56.6% of them
replied that they actually took the mass screening. The source of its information
was different statistically by sex, occupation, and generation. As for their health
behavior, nearly two third (63.7%) of them visited the hospital or dispensary
quickly when they fell sick. A small number of them answered that they could not
visit a doctor because of their problems with the Japanese language. More than
80% of them possessed a National Health Insurance certificate. This proportion
varied according to the period of stay in Japan. That is to say, The group which
stayed in Japan less than one year was significantly the lowest because they were
limited in their ability to enter National Health Insurance.
Publication Types:
2047: Intern Med. 1993 Jun;32(6):441-4.
The prognosis of idiopathic portal hypertension in Japan.
Ichimura S, Sasaki R, Takemura Y, Iwata H, Obata H, Okuda H, Imai F.
Department of Public Health, Aichi Medical University, Japan.

To clarify the factors relating to the prognosis of patients with idiopathic portal
hypertension (IPH), we followed 171 patients with IPH until the end of 1990, who
were registered in the database among those with abnormal portal circulation as of
1985 in hospitals of Japan. During the follow-up period, twenty patients died; 6
from gastro-intestinal tract bleeding, 5 from hepatic insufficiency and 9 from
other causes. Cox's proportional hazard model suggested that male patients
(hazard ratio 4.85, 95% confidence interval 1.82-12.94), with a disease onset at
less than 40 years of age (H.R.3.94, 95% C.I. 1.31-11.57), and/or with varices
(H.R.2.86, 95% C.I. 1.05-7.77) generally had poorer prognoses.
Publication Types:
2048: Regul Toxicol Pharmacol. 1993 Jun;17(3):262-81.
Comparing regulatory regimens for pesticide control in 22

countries: toward a new generation of pesticide regulation.
Schmidt-Bleek F, Marchal MM.
Umweltbundesamt, Berlin, Germany.
Some historical developments of chemical control legislation are being traced,

from specialized laws, such as pesticide acts, to the 1970/1980 generation of
generalized legal instruments involving all commercial chemicals. It is then
argued that from an environmental protection point of view, a "cradle-to-grave"
assessment will henceforth be necessary. Ecological guidelines and indicators for
the assessment of the life-cyclewide environmental impact intensity of economic
outputs are presented. The international implications of the worldwide trade in
pesticides are being considered. As the use of pesticides has invariably
transfrontier effects and since unilateral import restrictions due to environmental
quality requirements constitute nontariff barriers to trade, a high degree of
international harmonization is desirable. This point is also of some importance
with a view to the GATT negotiations and the chances for exporting chemicals
from developing and postsocialist countries into industrialized hard currency
areas in the future. The results of a comprehensive review in 1990/1991 of the
regulatory pesticide management regime in 22 countries are presented,
comprising countries from Central and Eastern Europe as well as the
industrialized Western countries. The review is based upon the returns to a
questionnaire which had been designed jointly by the International Institute of
Applied Systems Analysis (IIASA) and the Regional Office of the WHO in
Copenhagen. The information received was subsequently validated by the
competent authorities. Taking all observations into consideration, the framework
of an advanced prototype legislative framework for pesticides management is
proposed.
Publication Types:
• Review
2049: Mil Med. 1993 May;158(5):340-4.
The relationship between battle intensity and disease rates among

Marine Corps infantry units.
Blood CG, Gauker ED.

Disease and non-battle injury (DNBI) rates were examined in conjunction with
casualty rates across two Marine Corps operational scenarios, the assault on
Okinawa and the Korean War. DNBI rates increased significantly with battle
intensity among Marine infantry battalions involved in both operations. Highly
significant positive correlations (p < 0.001) were evidenced between DNBI rate
and wounded-in-action (WIA) rate, DNBI rate and killed-in-action rate, and
DNBI rate and the preceding week's WIA rate among infantry units in both
Okinawa and Korea. The severity of wounds and DNBI rate were also
significantly correlated.
Publication Types:

2050: IDRC Rep. 1993 Apr;21(1):14-6.
Threads of common knowledge.
Icamina P.
PIP: Indigenous knowledge is examined as it is affected by development and

scientific exploration. The indigenous culture of shamanism, which originated in
northern and southeast Asia, is a "political and religious technique for managing
societies through rituals, myths, and world views." There is respect for the natural
environment and community life as a social common good. This world view is
still practiced by many in Latin America and in Colombia specifically. Colombian
shamanism has an environmental accounting system, but the Brazilian
government has established its own system of land tenure and political
representation which does not adequately represent shamanism. In 1992 a
conference was held in the Philippines by the International Institute for Rural
Reconstruction and IDRC on sustainable development and indigenous knowledge.
The link between the two is necessary. Unfortunately, there are already examples
in the Philippines of loss of traditional crop diversity after the introduction of
modern farming techniques and new crop varieties. An attempt was made to
collect species, but without proper identification. Opposition was expressed to the
preservation of wilderness preserves; the desire was to allow indigenous people to
maintain their homeland and use their time-tested sustainable resource
management strategies. Property rights were also discussed during the conference.
Of particular concern was the protection of knowledge rights about biological
diversity or pharmaceutical properties of indigenous plant species. The original
owners and keepers of the knowledge must retain access and control. The
research gaps were identified and found to be expansive. Reference was made to a
study of Mexican Indian children who knew 138 plant species while non-Indian
children knew only 37. Sometimes there is conflict of interest where foresters
prefer timber forests and farmers desire fuelwood supplies and fodder and grazing
land, which is provided by shrubland. Information and research priorities will be
examined and an action plan developed in future months.
2051: Bioethics. 1993 Apr;7(2-3):263-70.
Artificial reproductive technologies: the Israeli scene.

Heyd D.
KIE: In 1991, the Israeli Minister of Health and the Minister of Justice jointly
nominated a commission to consider the subject of IVF in all its aspects. Heyd
summarizes the commission's recommendations on the following issues as put
forth in an interim report: access to fertility treatments, financing of treatment,
counseling, the definition of parenthood, donation of genetic material, freezing of
embryos, surrogacy, and experimentation with embryos.
2052: Rinsho Byori. 1993 Apr;41(4):435-40.
[The present situation of the computer system for the clinical

laboratory in Japan]
Ohota H, Hasimoto K, Inaba N, Sakurabayasi I, Kasii A.
Department of Clinical Laboratories, Jichi Medical School, Ohomiya Medical

Center.
We report the present situation of the computer system utilization for the Clinical
Laboratory in Japan. For this studies, the data were calculated to our purpose from
the materials for statistics published by the Ministry of Health and Welfare, Japan
Society of Medical Technologist, and so on. The results were as follows, 1)
computer systems were used on the 85% of all hospitals, and the most of them
were used for the medical office work included the payment office. At clinical
laboratory, there was very few use the computer systems, which account for 25%.
2) In the field of the clinical laboratory, there was mostly used at clinical
chemistry, next field was hematology, serology, urinalysis, and microbiology,
respectively. 3) Total system for the hospital, including ordering system were
used only 0.06% (208 cases) of all hospitals in Japan. We calculated the number
of beds with a hundred thousand population, the spread of the computer system,
the number of the out-patients, in-patients, and the utilization ratio of beds, then
we compared with that data for all of the prefecture included Tokyo, Osaka and
Kyoto. As a result of the calculation, the prefecture which the number of bed with
a hundred thousand population was much more than another zone were the
utilization ratio of beds was less than another area, and there was worth at the
spread of computer system. We think there areas had the smaller hospitals than
that of having highly spread of computer system.
Publication Types:
2053: Methods Inf Med. 1993 Apr;32(3):192-4.
Checkup interval and cancers in automated multiphasic health

testing and services.
Hinohara S, Takahashi T, Uemura H, Noto T, Shinozuka T, Kinoshita H,

Matsuyama M, Suzuki S, Osamura Y, Oogushi Y.
School of Medicine, Tokai University, Kanagawa, Japan.
The purpose of this study was to disclose which types of cancer and how many
persons with cancer were detected among the AMHTS examinees of our AMHTS
center by using the hospital information retrieval system, and to study the
relationship between cancer and the number of examinees, checkup intervals, and
frequency in AMHTS. The examinees who had checkups more than twice were
divided into three groups based on their checkup intervals: within one year, one to
two years, and over two years. The relationship between cancer ratios and
checkup intervals was evaluated in each group of examinees. In those having
checkups within one year and from one to two years the cancer rate was 2.9
patients per 1,000 persons. However, in those having checkups after a two-year
period or longer, the cancer rate was 4.3, clearly greater than the rate of the other
two groups.
2054: Singapore Med J. 1993 Apr;34(2):157-63.
The Singapore Renal Registry: an overview.
Woo KT.
Singapore Renal Registry, Department of Renal Medicine, Singapore General

Hospital.
The Singapore Renal Registry (SRR) is created to collect and analyse information
on incidence, prevalence, morbidity and mortality of End Stage Renal Disease
(ESRD) in Singapore. Its objectives include the implementation of a consolidated
renal disease data system, report on incidence and trends over time of renal
disease, analyse aggregate data on effect of various modalities of therapy, identify
problems and opportunities for special studies and research. The framework of the
Registry encompasses the following areas: incidence, demographics and causes of
ESRD, utilization of treatment modalities, institutions providing treatment,
morbidity and survival rates of various treatment modalities, the paediatric sector,
the private sector, international comparisons and research areas. This overview
will present whatever existing data and renal statistics that are currently available
on a regional or national basis. The collection of nationwide statistics will provide
a database to formulate national averages of individual renal statistics. Statistics
can also be collected to provide valuable data for planning and projection for
future needs.
2055: Indian J Public Health. 1993 Apr-Jun;37(2):48-53.
Socioeconomic factors and prevalence of endemic goitre.
Joshi DC, Mishra VN, Bhatnagar M, Singh RB, Garg SK, Chopra H.
P&T Dispensary, Aligarh.
The present study was conducted on 2611 school children of a rural area of
Meerut, with the objectives to find out the prevalence and distribution of endemic
goitre and the socioeconomic variables associated with the distribution of the
endemic goitre. Grading of goitre was done as per the criteria laid down by the
WHO-1979 (1). The overall prevalence rate of endemic goitre was 50.1%, the
prevalence was more among females (55.1%) as compared to males (47.2%).
Maximum number of goitre cases were having grade Ia enlargement (46.9%)
followed by grade Ib (34.1%), grade 2(15.0%) and grade 3 (4.0%). Prevalence
increased with increase in age. Statistically significant differences were found in
the prevalence of endemic goitre in relation to different religions and caste
groups, different occupations of the parents/guardians of children and types of
houses used for the purpose of living.
PIP: Most studies of goiter show a link with lower socioeconomic status. Goiter is
endemic in areas with environmental iodine deficiency or diets high in certain
foods which interfere with iodine utilization by the body. This study aims to
examine the extent of goiter and the socioeconomic factors associated with its
appearance among 2611 school children in a rural areas of Meerut, India. The
student population was selected from 22 schools in the Primary Health Center
Machhra Area between April 1989 and March 1990. Prevalence of goiter was
clinically determined and graded according to the World Health Organization's
1979 criteria. Information was obtained on type of housing, occupation of parents,
religion, and caste. 1308 children (50.1%) had goiter (55.1% of females and
47.2% of males). The largest number of cases involved an enlarged goiter
palpable when the neck was extended (46.9%) followed by visible enlargement
when the neck was extended (34.1%). 4.0% had a grade 3 goiter (visible at a
distance). Prevalence increased with increased age. The largest percentage of
cases appeared in the age group 12-14 years (53.8%) and the fewest in the age
group 6-8 years (45.3%). Females had higher rates in all age groups; differences
by age and gender are statistically significant. Goiter prevalence was lowest
among Brahmins (29.8%) followed by Guijars (38.3%), 43.8% among Jats, and
53.5% among Kumhars. 53.6% of scheduled caste members had goiter. The
highest percentage of goiter cases occurred among children of laborers (56.4%)
followed by children of businessmen (51.2%). 45.1% of children of farmers and
37.0% of children of service workers had goiter. Differences are statistically
significant. 62.1% of children living in Kuchha housing and 62.6% of children
living in mixed housing had goiter as opposed to only 33.1% of children living in
pucca housing. Low socioeconomic status is clearly related to the prevalence of
goiter.
2056: Int Rev Educ. 1993 Mar;39(1-2):37-51.
[Teaching materials for population education]
[Article in French]
Valerien J.
PIP: A discussion of the changing objectives of teaching materials for population

education is illustrated with 5 examples of materials prepared in response to the
new trends. Adequate teaching materials are a vital component of population
education since most teachers have not been specifically trained in the content of
population education or in the multidisciplinary and participatory methods basic
to population education, which strives to promote acquisition of new attitudes and
behaviors as well as of knowledge. The strategic importance of teaching materials
explains the great effort devoted to their production since population education
was first introduced. The 25 Asian nations cooperating in the PROAPS regional
program have generated more than 5000 documents in the past 15 years. Early
teaching materials in population education concentrated on sex education and
were regarded as somewhat doctrinaire. With experience, the objectives of the
teaching materials became more clearly defined. The emphasis shifted from trying
to convince teachers of the need for population education to an effort to identify
their needs in order to develop more useful teaching materials. Integration of
population education into the elementary school curriculum is eased by the fact
that elementary teachers are generalists who remain with their classes all day. The
challenge for secondary teacher is not to add new content but to show the
relationship between existing curricular materials and population problems.
Teachers require mastery of new techniques involving class participation.
Teaching materials should include activities to be done in class. A survey of
available teaching materials shows that great attention has been given to
constructing a recognized body of scientific concepts and information for
population education. Population education is no longer focused exclusively on
dynamics on the quality of life in various areas such as resource availability,
development and employment, health and environmental protection.
Methodological guides to participatory teaching strategies and techniques have
been prepared, including innovative pilot materials prepared by CRESALC
beginning in the 1980s. The survey of teaching materials indicates that in the
great majority of cases, population education has been integrated into existing
programs. Interesting attempts have been made to condense the context and
objectives of population education into a single manual covering several grade
levels for school systems lacking the resources to acquire a greater array of
materials.
Publication Types:
2057: Integration. 1993 Mar;(35):40-1.

Related Articles
South-South cooperation. Leaders of 108 non-aligned countries have

decided to hold a ministerial-level conference on population as soon
as possible.
Samuel N.
PIP: In September 1992, the Non-Aligned Movement (NAM) called for integrated
efforts to slow down the population growth of an already crowded world of 5.4
billion. According to the State of World Population 1992 published by the United
Nations Population Fund (UNFPA), the global population will increase by an
average of 97 million/year until the end of the 20th century, 90 million/year until
2025, and 61 million/year until 2050. The UNFPA report predicts that by 2050
world population will almost double, and 97% of the increase will be in
developing countries. State or government leaders who participated in the Tenth
Conference of the Non-Aligned Countries held in Jakarta, Indonesia, expressed
deep concern over the pressures on their strained economic, social, and
environmental systems. The final documents adopted stressed that improvements
in education, health, and employment, the role of women in society, and access to
family planning services are crucial. The leaders recognized South-South
cooperation as vital for development and reduction of dependence on the North.
The Summit participants also said that in order to provide technical assistance in
population and family planning, the NAM leaders have decided that a ministerial-
level meeting on population should be held to intensify the exchange of
information regarding population policies and family planning programs; to
organize South-South technical cooperation schemes on education, safe
motherhood, and family planning programs; and to establish cooperative schemes
for the production of medical supplies for family planning programs. Japan has
made a financial commitment to support Indonesia's South-South cooperation
programs in family planning are appreciated by recipient countries in Asia,
Africa, and other parts of the world. As they become more familiar with the
appropriateness of the scheme, many traditional donors will gradually assist
South-South cooperation programs.
2058: Integration. 1993 Mar;(35):37-9.

Related Articles
Consensus on demographic targets.
Seewald M.
PIP: In an interview, Dr. Nibhon Debavalya of the Population Division, Economic

and Social commission for Asia and the Pacific (ESCAP), explained the
significance of the Bali Conference as well as other population-related issues in
the region. ESCAP's Population Division receives its mandate from the
Committee on Population and Social Development. ESCAP's population concerns
are handled under the Committee on Poverty Alleviation through Economic
Growth and Social Development which will have its 1st meeting in 1993. The
Population Division carries out 1) collaborative research, 2) technical assistance
and advisory services 3) human resources development, and 4) population
information and dissemination. In collaborative research, studies are carried out
on aging of the population, consequences of population change, planning of small
towns and rural human resources development, the accessibility of contraceptives
and improving family planning and maternal and child health, and management
information systems. The Bali Declaration on Population and Sustainable
Development provides practical guidelines for developing the infrastructure for
sustainable development within the region. It will be the basis of related policies
and their implementation. The countries of the ESCAP region have set population
goals: to reduce rates of population growth, countries should adopt strategies to
attain replacement level fertility of 2.2 children per woman by the year 2010. The
Declaration also encourages countries to reduce the level of infant mortality to 40
per 1000 live births or less during the same period. It states that in countries with
high maternal mortality efforts should be made to reduce it by at least half by the
year 2010. Major concerns also relate to the low level of male involvement in
contraceptive usage, the high fertility in some countries, the issue of aging East
Asia, and international migration. So far, the Asia-Pacific region is the only
region that has come up with a consensus on its demographic targets.
2059: Integration. 1993 Mar;(35):22-3.

Related Articles
"We will not rest." Filipino women want a fertility management

program that respects women's dignity, women's bodies and
women's choices.
Alvarez RO.
PIP: The program officer for the Institute for Social Studies and Action presents
1) her views on women's fertility management under different political
administrations in the Philippines, 2) the political postures of influential groups,
3) the goals of women's and health groups, and 4) the actions taken by Filipino
women. Under Ferdinand Marcos, the official family planning (FP) program
emphasized reduction of population growth and established a quota system and
incentives for the number of new acceptors. Women, as a result, became victims;
e.g. IUDs were inserted without prior knowledge, and inadequate information and
follow-up were provided on oral contraceptive use. Efforts were criticized for
treating women as program targets and not as individuals capable of making
choices. Under Corazon Aquino, the Roman Catholic hierarchy dominated and
would have banned all forms of artificial contraception had women's and health
groups not blocked the effort. Only in 1989 did President Aquino finally
announce that multiple methods of family planning (FP) would be promoted.
There was a transition in program services during the transfer to the Department
of Health. Currently the government promotes FP within the safe motherhood and
child survival context, but adolescents and unmarried women and couples are
excluded from FP services. Population control advocates believe FP is a health
issue. The Roman Catholic Church accepts only natural methods and believes
artificial methods interfere with the natural processes of procreation. Anti-FP
groups promote only natural FP methods and wage campaigns to discredit
contraceptive methods. Women's and FP groups contend that it is a woman's right
to regulate her own fertility. Safe abortion should be made available to those who
need it. Women's networks are mobilizing to talk about the issues, to hold public
activities to change laws and policies and to encourage women's involvement in
decision making affecting their lives, and to conduct research specific to women's
views. Women's organizations will be active until safe, affordable, accessible, and
appropriate fertility management is available to all women.
2060: Sangyo Igaku. 1993 Mar;35(2):88-97.
[Health care of work stress: a review]
Araki S, Kawakami N.
Department of Public Health, Faculty of Medicine, University of Tokyo.
In order to clarify the health effects of work stress and possible strategy for its
prevention and treatment, we reviewed the literature on work stress as follows: 1)
Review was made on 12 major psychosocial work stressors, 4 acute reactions to
stress, disease outcome of work stress, measurement methods of those variables,
and theoretical models of work stress. 2) Epidemiological studies of the effects of
work stressors on cardiovascular diseases, psychological distress and mental
disorders in Japan were reviewed. Also, work stress in specific occupations such
as software engineers, nurses and female researchers was reviewed. 3) The
following strategies for the prevention and treatment of the health effects of work
stress were reviewed: i) surveillance of work stress, ii) improvement of
psychosocial work environment, iii) education and information dissemination, and
iv) reinforcement of occupational mental health services. Finally, the need for
further investigation on the health effects of work stress and on the possible
programs for the prevention and treatment in occupational health care system was
discussed.
Publication Types:
• Review
2061: Child Care Health Dev. 1993 Mar-Apr;19(2):71-88.
Prevention of childhood disability in the People's Republic of China.
Chen J, Simeonsson RJ.
Frank Porter Graham Child Development Center, University of North Carolina,

Chapel Hill 27599-8180.
With a dramatic decrease in infant mortality, an emerging challenge facing

modern medicine in China is chronic disabling conditions in infants and young
children. According to the results of a national sampling survey in 1987, it is
estimated that there are over 51 million people of all ages with disabilities, which
accounts for 4.9% of the total population. One out every five families in China
has a member who is disabled. For children under 14 years of age, the overall
prevalence rate of disability is 2.66%. The prevalence rate of mental retardation is
1.8% which accounts for 66% of all disabled children. Mental retardation is the
most frequent childhood disability. Research on factors contributing to disability
indicates the complexity of the problem. The etiology of 47% of cases is
unknown, 21% of cases result from damage prenatally, 3% are due to perinatal
factors, 29% are acquired during infancy and early childhood. Efforts to prevent
developmental disabilities among children can be classified in terms of primary,
secondary and tertiary activities. The most important primary prevention activities
consist of genetic counselling, immunization programmes, improved prenatal,
perinatal and postnatal health care, and legislation. On the secondary preventive
level, focus is primarily on prenatal diagnosis and newborn screening. Tertiary
preventive efforts include special education and comprehensive rehabilitation
services. While these prevention efforts have been established, they are
insufficient to meet the needs of disabled children and their families. In the
context of the one child per family policy in China, much more is needed, much
more can be done to reduce childhood disability. In addition to strengthening
prevention efforts at all 3 levels, special emphasis should be placed on (a)
integration of existing primary health care systems with early intervention
programmes, (b) public education and information, (c) personnel preparation, and
(d) research and evaluation.

2062: Soc Sci Med. 1993 Mar;36(5):585-96.
Developing a primary health care management information system

that supports the pursuit of equity, effectiveness and affordability.
Husein K, Adeyi O, Bryant J, Cara NB.
Department of Community Health Sciences, Aga Khan University, Karachi,

Pakistan.
A key set of goals of primary health care (PHC) includes equity, effectiveness and
affordability. By equity, we mean universal coverage and care according to need;
by effectiveness, that the system has a favorable impact on mortality and serious
morbidity; by affordability, that the system is within the budgetary reach of
government and communities. There are other requirements of PHC as well: that
the system be socially and culturally acceptable, and that communities are active
participants in the development and implementation of the system. Further, the
PHC system should be compatible with larger system of a region or country, and
possibly serve as a prototype for the development of larger health systems. With
these requirements in mind, the Aga Khan University has developed a series of
community-based, urban PHC systems, each serving a population of about
10,000, in the katchi abadis (squatter settlements) of Karachi. These communities
are severely deprived, with high infant, child and maternal mortality rates. The
PHC systems are designed to achieve equity, effectiveness and affordability, and
within 3-5 years have advanced substantially toward those goals. A key factor in
those developments has been the management information system (MIS), which
has served as a basis for planning, managing and evaluating the PHC systems.
Central questions about such an MIS are: What kind of MIS design is necessary to
support the pursuit of those goals? What problems arise in the MIS as such a
system is implemented? What kinds of changes and adaptations need to be
considered in the MIS as the PHC system itself matures? What does the PHC
system cost, and what part of the total cost of the PHC system is attributable to
the MIS? How practical is this kind of MIS, developed in small prototype PHC
systems, for replicability in larger health systems? What are the possibilities and
requirements for simplification in order to be used in health systems that are less
intensively managed? The experience of AKU in Pakistan in the development of
PHC systems, with associated management information systems, helps to answer
these questions.

2063: Ann Acad Med Singapore. 1993 Mar;22(2):237-41.
Poisons information in Singapore.
Chao TC, Tay MK, Bloodworth BC, Lim KH.
Poisons Information Centre, Institute of Science and Forensic Medicine,

Singapore.
The Poisons Information Centre (PIC) provides viral and timely information to
prevent and manage poisoning episodes. Comprehensive information on
household, agricultural and industrial chemicals, natural toxins, pharmaceuticals,
local antidote stocks and local poisons experts is retrieved from the Centre's
computerised information system and printed literature. Public subscribers can
obtain poisons information through Teleview.
Publication Types:
• Case Reports
2064: Ann Acad Med Singapore. 1993 Mar;22(2):129-33.
Quality assurance in medicine: research and evaluation activities

towards quality control in Singapore.
Emmanuel S.
Research and Evaluation Department, Ministry of Health, Singapore.
Quality assurance and medical audit requires a good Health Management

Information System (HMIS) to support it. In Singapore, there is a well developed
HMIS built on the routine reporting of utilisation and activity statistics from
public sector and private sector hospitals, government clinics and support
services. In addition, there is a computerised national surveillance system for
disease monitoring, which includes the disease condition, operations done and the
physician and surgeon responsible for managing any inpatient or day case
admitted into any hospital in Singapore. This forms the basis for the computerised
national health system known as Medinet. Supplementing this are ad hoc surveys
on quality of service, medical audit studies and supplementary information
systems such as the Births and Deaths registration system and the Census of
Population. Such a well developed HMIS greatly facilitates medical audit in
Singapore. Indicators for audit can be generated from existing health databases,
which point to areas requiring further inquiry and investigation. The use of a
unique National Registration Identity Card (NRIC) for every Singaporean enables
healthcare utilisation at all levels to be linked, further enhancing the capability for
medical audit here.
2065: JOICFP News. 1993 Feb;(224):6.

Related Articles
Lao women make do with less.
[No authors listed]
PIP: The implementation of the Sustainable Community-based Family Planning

(FP) and Maternal and Child Health (MCH) Project with Special Focus on
Women in Laos was begun this year. The project is a by-product of JOICFP
mission activities; JOICFP will maintain cooperative ties to the project along with
the UNFPA. The JOICFP mission met with government officials and international
agencies in December, 1992 as part of an effort to understand the conditions of
women, the availability and quality of FP services, and population issues.
Meetings were also held with officials of the Lao Women's Union. A profile of
the country's health system (central, provincial, district, and village) was
constructed. Obstacles to effective service delivery were the lack of clearly
defined roles for each level, severe shortages of equipment and supplies and
trained personnel particularly at the district and village levels, and travel
difficulties. The result is that patients tend to seek care at the higher levels or to
seek traditional healers and use private pharmacies for services and supplies.
Travel can be difficult in Laos. Laotian policy emphasizes FP as a means of birth
spacing in order to improve MCH. MCH receives 70% of the total public health
budget. Shortages of trained staff and lack of supplies were the most pressing
problems identified by the mission. In border areas with Thailand and China,
there was a strong demand and a high level of awareness of FP. In general,
however, there was a lack of correct information on reproductive health among
Laotian women. A major strategy in the new FP and MCH project is to strengthen
district level health care by strengthening trust at the local level. The project will
be implemented initially in 2-3 districts. Project sustainability is expected to be
assured through a fee charging system. The notion of paying for contraceptives
and drugs has already been established, and it is expected that payment will be
forthcoming if quality and constant supplies are assured. The free contraceptives
provided by the government are in short supply and not usually available outside
urban areas.
2066: Dirasat Sukkaniyah. 1993 Jan-Mar;15(77):49-76.

Related Articles
Testing the cost-effectiveness of three alternative teams in

implementing the Regional Center for Training (RCT) follow-up
system in satellite centers.
Heda Z, Khalid M, Osman M.
PIP: The Regional Training Center (RTC) was established at the OB/GYN
Hospital, Ain Shams University, to overcome the shortage of trained service
providers in the Egyptian family planning program. Over the past three years,
RTC has successfully met the training needs for family planning services in
Egypt. As part of the RTC's efforts, nine Satellite Training Centers (STCs) were
established to provide quality training for service providers in nine governorates
in Egypt. The RTC role in family planning activities is described. A study was
conducted to test different teams in the implementation of the RTC follow-up
system in three governorates in upper Egypt. The study was a cost-effectiveness
analysis designed to determine which team best implements the follow-up system,
with the ultimate goal of providing policymakers and program administrators with
a better understanding of the role of the follow-up of trainees in providing high
quality family planning services. The study was conducted during May-December
1991 using a sample of three STCs. The study produced valuable information for
improving training logistics, clinical training, use of audiovisual equipment,
record keeping, and overcoming training problems at STCs. The information
clearly showed the importance of the follow-up system in providing
administrators and decisionmakers with information needed to assess the
operations and performance of STCs. Furthermore, the strengths and weaknesses
of training at the STCs were revealed, giving useful insights for quality
improvement. The use of RTC staff is the most cost-effective approach to follow-
up at the STCs.
Streamlined records benefit maternal and child health care.

Kumar R.
Department of Community Medicine, Postgraduate Institute of Medical Education

and Research, Chandigarh, India.
In order to simplify the collection, recording and reporting of information on

maternal and child health care in a rural area of India, a home-based mother and
child card and a tally sheet were introduced. This has made it possible for the
community to evaluate the services provided.
PIP: A sample survey of households in 5 primary health districts in India showed

that health center records grossly underreported birth and infant mortality rates
(18/1000 reported vs. 34.4/1000 actual and 20/1000 reported vs. 51/1000 actual,
respectively). Therefore, the data collection and reporting system was reviewed
with input from the health workers who maintained the system. The system was
found to be too cumbersome and time-consuming, with similar entries often
required in several registers; all records were incomplete. To correct this situation,
a simplified record keeping system was devised using a home-based mother and
child health card and a tally sheet and retaining the family register, diary of visits,
and registers of patients and stocks from the old system. Separate family registers
were made for each village and were alphabetized by head of household.
Information from the diaries of house visits and patients registered was entered in
the family register and tally sheets in a daily basis. The tallies were used in
monthly reports for submission to the primary health centers. After 6 months, 14
health workers reported improvement in the system; however only 7 family
registers were up-to-date and, although the tally sheets were properly completed,
workers continued to underreport vital events showing a (24.4/1000 birth rate and
22.5/1000 infant mortality rate). This system, nevertheless, has the advantage of
reducing needless duplication of reporting. Its main advantage, however, is the
fact that the mothers now have an information card detailing the services they
have received. This allows information to flow into the community, not just to the
major health centers, and eases the coordination of efforts of various providers of
maternal and child health services. The card reminds mothers about services
needed and services as a check list for health workers. Vital events remained
grossly underreported because senior administrators were more interested in
service statistics, particularly family planning services, and gave workers the
impression that it was not important to spend time detailing vital statistics.
Commitment by supervisors is necessary to improve data collection further.
Harnessing health information in the Third World.

Coghlan SE, Khan MS.
The provision of technical information on health in developing countries is

discussed, with particular reference to the Diarrhoeal Diseases Information
Services Centre in Bangladesh. Progress towards meeting the pressing needs of
the Third World in this field can undoubtedly be made by increasing the use of
micrographic, computer and videodisc technologies and by reorganizing and
promoting the facilities on offer.
PIP: The provision of health information in developing countries is hampered

unless librarians act as facilitators for information-seekers. Awareness of the
needs of users, of new technologies to meet these needs, of techniques of
information retrieval, and of the necessity to provide access to information for all
members of the health community is vital for the growth of viable health systems.
Good examples of information dissemination at work are 1) the International
Nutrition Centre in Central American and Panama filling 900 requests for
information on child survival each year; 2) the Organisme de Recherches sur
l'Alimentation et la Nutrition Africaines in Dakar, Senegal, publishing a list every
3 months of recent acquisitions in the field of nutrition and management of
diarrhea; 3) the USAID-funded center to support health planning in
Ouagadougou; 4) a multisectoral documentation center for the Sahel in Mali; 5)
the International Water and Sanitation Centre in The Hague dispensing
information on water and sanitation in developing countries; 6) the Center
International de l'Enfance in Paris providing information on child health in 3
languages; 7) the Asian Institute of Technology in Bangkok coordinating for the
Environment Sanitation Information Center; and 8) the Appropriate Health
Resource sand Technologies Action Group publishing newsletters on health
topics in 8 languages for 650,000 readers. Good sources of information on
diarrheal disease are the Department of Community Medicine of Godjah Mada
University in Indonesia and the Information Center on Diarrheal Disease of the
Philippine Department of Health. An especially important information source is
the Diarrheal Disease Information Services Center in Dhaka, Bangladesh.
Established in 1982, this center is known for its regional and international
networking. Funding from the Canadian International Development Research
Centre permitted the purchase of computers; the publication of a quarterly journal
on diarrhoeal disease, bibliographies, a directory of Asian specialists, and a
review of research projects; as well as the development of a documents library.
Additional funding, received in 1988 from the Swiss Development Cooperation,
supported new programs including the acquisition of CD-ROM databases and the
technology to create specific bibliographies on demand. Modern micrographic,
computer, and videodisc technologies, allow developing countries to meet their
communication needs while bypassing conventional methods. In large regions
which lack adequate information facilities, politicians and administrators must be
convinced of the importance of health literature services. Such service should be
integrated at the national level and be brought to the attention of the local health
community and the population at large.
Publication Types:
2069: Med Law. 1993;12(1-2):153-63.
A look at court appointed psychiatric evaluations in Israel with

special reference to criminal liability.
Durst R, Jabotinsky-Rubin K, Ginath Y.
Talbieh Mental Health Center, Jerusalem, Israel.
This article presents the data collected from 128 court appointed psychiatric
evaluations (CAPEs) and their analysis. Issues addressed are: the link between
type of criminal offence and mental disorder; rate of recidivism; efficacy of the
early detection and follow-up systems; inherent psychiatric dilemmas;
unacceptable lacuna in information recorded in the CAPEs; and the babel of legal
and psychiatric terms. We advocate that a combined effort be made by the legal
and psychiatric fraternities to create a uniform and standardized CAPE.
The worldwide magnitude of protein-energy malnutrition: an

overview from the WHO Global Database on Child Growth.
de Onís M, Monteiro C, Akré J, Glugston G.
Scientist, Nutrition unit, World Health Organization, Geneva, Switzerland.
Using the WHO Global Database on Child Growth, which covers 87% of the total
population of under-5-year-olds in developing countries, we describe the
worldwide distribution of protein-energy malnutrition, based on nationally
representative cross-sectional data gathered between 1980 and 1992 in 79
developing countries in Africa, Asia, Latin America, and Oceania. The findings
confirm that more than a third of the world's children are affected. For all the
indicators (wasting, stunting, and underweight) the most favourable situation--low
or moderate prevalences--occurs in Latin America; in Asia most countries have
high or very high prevalences; and in Africa a combination of both these
circumstances is found. A total 80% of the children affected live in Asia--mainly
in southern Asia--15% in Africa, and 5% in Latin America. Approximately, 43%
of children (230 million) in developing countries are stunted. Efforts to accelerate
significantly economic development will be unsuccessful until optimal child
growth and development are ensured for the majority.
Evaluation of the home-based maternal record: a WHO

collaborative study.
Shah PM, Selwyn BJ, Shah K, Kumar V.
Division of Family Health, World Health Organization, Geneva, Switzerland.
Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal,

Sri Lanka, Democratic Yemen and Zambia) participated in the WHO
collaborative study to evaluate the home-based maternal record (HBMR). The
evaluation showed that use of the HBMR had a favourable impact on utilization
of health care services and continuity of the health care of women during their
reproductive period. When adapted to local risk conditions, their cut-off points
and the available resources, the HBMR succeeded in promoting self-care by
mothers and their families and in enhancing the timely identification of at-risk
cases that needed referral and special care. The introduction of the HBMR
increased the diagnosis and referral of at-risk pregnant women and newborn
infants, improved family planning and health education, led to an increase in
tetanus toxoid immunization, and provided a means of collecting health
information in the community. The HBMR was liked by mothers, community
health workers and other health care personnel because, by using it, the mothers
became more involved in looking after their own health and that of their babies.
Apart from local adaptation of the HBMR, the training and involvement of health
personnel (including those at the second and tertiary levels) from the start of the
HBMR scheme influenced its success in promoting maternal and child health
care. It also improved the collection of community-based data and the linking of
referral networks.
PIP: An evaluation was made of the home-based maternal record (HBMR) as an

impetus to improved continuity of care and to improved education of women
about their health status. The study involved Egypt, India, Pakistan, Philippines,
Senegal, Sri Lanka, Democratic Yemen, and Zambia. THe HBMR is a system for
recording risk factors and early signs of complications, referrals, and treatment of
the mother and infant. Data entry comes from a variety of sources, including the
mother and other health personnel. Previous experience with home-based
recording systems was reviewed. The WHO record was developed in 1982 and a
set of guidelines was developed to evaluate the objectives and explore the
functions. The evaluation was conducted between 1984 and 1988 in the 13
countries previously indicated with pre- and post-intervention designs and with
controls, where possible. HBMRs were given to mothers during the second
through the eight month of pregnancy, and those identified at risk were referred
for appropriate care. Study populations ranged from 14,000 to 250,000 and female
literacy ranged from 15% to 91%. Sample populations ranged from 75 to 819.
Evaluation and results were provided for each of 6 objectives: 1) to encourage
continuity of care from pregnancy through interpregnancy periods; 2) to
encourage early identification of at-risk women and newborns; 3) to promote
referral suitable to women and encouraging self-care; 4) to promote initiation of
appropriate care suitable to needs; 5) to provide a useful and practical record of
care; and 6) to provide a focus for health education about risk and health care
during pregnancy and the interpregnancy period, and for the neonatal period. The
findings revealed that HBMR was an important asset in increasing the quality and
quantity of prenatal, postnatal, and interpregnancy care of mothers. There was
also improved neonatal health care. Mother's knowledge about helpful practices
was improved. Other improvements were evident in early identification of risk
factors both before and after pregnancy, referrals of at-risk persons, initiation of
care, registration of mothers and infants at health centers, vaccination with tetanus
toxoid, and provision of useful health information. Continuity of care was
improved when compared with baseline and control data. The HBMR was found
to be suitable for use with all women regardless of childbearing age.
Publication Types:
• Multicenter Study
2072: Eur J Cancer. 1993;29A(16):2305-14.
Large-scale, population-based prospective studies in Japan.
Watanabe S.
National Cancer Center Research Institute, Tokyo, Japan.
Large scale, population-based prospective studies have increasing importance for

the study of common cancers in view of the possibility of advancing the
understanding of different risk factors in the initiation, promotion and progression
phases during what is thought to be the long process of human carcinogenesis.
The permanent registration system in Japan ("Koseki") simplifies the follow-up of
registered participants of such cohorts. The population-based cohort studied by
Hirayama and the cohort of the atomic bomb survivors started during the 1960s
are examples of such possibilities in Japan. Rapidly changing patterns of disease
and lifestyles during the last 30 years require new population-based prospective
studies focusing on a different set of exposures and with increased detail of
exposure assessment. We have established a new population-based prospective
study, the "Koseisho" cohort, between 1990 to 1992, following a cross-sectional
study, using various biomarkers in five health centre districts. The Koseisho
cohort comprises approximately 170,000 people aged 40-59 or 40-69 in 12
different health centre districts. The data are linked with the mass screening
program registry data every year, and the sera and buffy coats collected at the
beginning of the study will be stored at -80 degrees C for at least 10 years. We
intend to integrate various sources of information about health conditions for the
prevention of chronic diseases in these cohort areas. Nutritional practices are one
of our main interests, and repeated surveys by different methods are planned.
Although all death certificates are collected through the health centres, disease
registration committees were established in each district to register incident cases
of both cancer and certain cardiovascular diseases. Representative population-
based prospective studies in Japan are briefly reviewed and introduced.
Publication Types:

• Review
2073: China Popul Today. 1992 Dec;9(6):14-5.
Shanghai takes action to reduce abortions.
[No authors listed]
PIP: Efforts are underway in Shanghai, China, to reduce the number of induced
abortions. A seminar on this topic was conducted in August, 1992, and a survey
was conducted by the Shanghai Family Planning Committee. The seminar
participants stressed that the focus should be on reproductive health and efficient
family planning (FP) program implementation. A publicity and public education
program was formulated. There were 10 specific measures proposed having to do
with content of publicity and educational programs and with the methodology for
measuring program effectiveness. 1) There was a need for puberty education in
the middle schools, which should be universally administered. 2) All unmarried
men and women aged 18 years and older should receive premarital education. 3)
When registering for marriage, couples should receive information on deferred
marriage and deferred childbearing. Contraceptives should be provided at the
premarital checkup for those seeking to defer childbearing. 4) Postpartum follow-
up should be conducted with a visit to breast feeding women and provision of
advice on practicing contraception. 5) Women who are planning to have an
abortion should have access to health and FP education. Follow-up visits should
be made in order to provide guidance on health and FP. 6) A Shanghai school and
branch schools should be established to educate people about marriage and child
bearing. The schools would operate daily and provide basic knowledge about
population and FP in a systematic fashion. 7) Women who are breast feeding and
using contraceptives should have FP services available. 8) Knowledge about
contraception should be transmitted through every possible channel of
communication with a variety of means, in order to popularize the concept. 9)
Workers with experience in publicity and education need to be provided with FP
training. 10) The FP target management system should include a strategy for
reducing induced abortions and for implementation of a publicity and education
campaign.
2074: Clin J Pain. 1992 Dec;8(4):317-23.
Chronic low back pain patients around the world: cross-cultural

similarities and differences.
Sanders SH, Brena SF, Spier CJ, Beltrutti D, McConnell H, Quintero O.
Pain Control and Rehabilitation Institute of Georgia, Decatur 30030.
OBJECTIVE: The current study sought to determine whether there were any
significant cross-cultural differences in medical-physical findings, or in
psychosocial, behavioral, vocational, and avocational functioning, for chronic low
back pain patients. DESIGN: Partially double-blind controlled comparison of six
different culture groups. SETTING: Subjects were selected from primarily
ambulatory care facilities specializing in treating chronic pain patients.
PATIENTS-SUBJECTS: Subjects consisted of 63 chronic low back pain patients
and 63 healthy controls. Low back pain patients were randomly selected from six
different culture groups (American, Japanese, Mexican, Colombian, Italian, and
New Zealander). Ten to 11 were gathered per culture from a pool of patients
treated at various pain treatment programs. Likewise, 10 or 11 control group
subjects were obtained from each culture from a pool of healthy support staff.
MAIN OUTCOME MEASURES: The Sickness Impact Profile and the Medical
Examination and Diagnostic Information Coding System were used as primary
outcome measures. RESULTS: Findings showed that (a) low back pain subjects
across all cultures had significantly more medical-physical findings and more
impairment on psychosocial, behavioral, vocational, and avocational measures
than controls did; (b) Mexican and New Zealander low back pain subjects had
significantly fewer physical findings than other low back pain groups did; (c) the
American, New Zealander, and Italian low back pain patients reported
significantly more impairment in psychosocial, recreational, and/or work areas,
with the Americans the most dysfunctional; and (d) findings were not a function
of working class, age, sex, pain intensity, pain duration, previous surgeries, or
differences in medical-physical findings. CONCLUSIONS: It was concluded that
there were important cross-cultural differences in chronic low back pain patients'
self-perceived level of dysfunction, with the American patients clearly the most
dysfunctional. Possible explanations included cross-cultural differences in social
expectation; attention; legal-administrative requirements; financial gains;
attitudes-expectations about usage, type, and availability of health care; and self-
perceived ability and willingness to cope.
Publication Types:
• Clinical Trial
2075: Int J Epidemiol. 1992 Dec;21(6):1043-9.
Surveillance for equity in primary health care: policy implications

from international experience.
Taylor CE.
School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD

21202.
Experience around the world shows that health agencies can promote community-
based surveillance for equity to focus low-cost interventions on priority needs.
Social inequities which have seemed intractable can be resolved if care responds
directly to demonstrated need. The concept of promoting equity as a basic
principle of primary health care has an interesting psychological twist. The ethical
imperative of equity can strengthen services when linked with the practical
management tool of surveillance. Moral conviction in applying this social justice
norm can facilitate action which is made efficient by the realism of statistically
based methods of surveillance. If international agencies condition their aid on
surveillance for equity their assistance will more likely go to those in greatest
need. This is a more efficient and effective way of tracking their money than the
previous tendency to set up vertical programmes which generally have poor
sustainability. Surveillance helps mobilize political will and community
participation by providing practical data for local, district and national decision-
makers. The many field demonstrations of successful surveillance for equity tend
to have been brushed off by development experts who say they are difficult to
replicate nationally. The Model County Project in China shows how a systematic
extension process can test procedures in experimental areas and adapt them for
general implementation. Surveillance can help bureaucracies maintain capacity
for flexible and prompt response as decentralization promotes decision-making by
local units which are held responsible for meeting equity targets. Surveillance for
equity provides a mechanism to ensure such accountability.
PIP: Epidemiological methods of surveillance allow public health officials to use

equity indicators (fertility, mortality, and causes of death) to improve health care
for the poor, thereby achieving an effective and efficient primary health care
system and a moral objective. The indicators should be simple and measurable.
Each community is responsible for monitoring its members and should begin with
registering all families. Simple retrospective verbal autopsy methods should be
used initially. Continuous data collection (e.g., rapid assessment procedures and
simple demographic surveys) should monitor high risk subgroups. Surveillance
provides feedback so health workers and community leaders can discuss how to
address health problems. Interventions should be simple and inexpensive and
attack only priority demonstrated needs. Development specialists have discredited
many field demonstrations of successful surveillance for equity, claiming they
cannot be reproduced at the national level. The Model County Project in China is
an example of how ideological commitment to equity can improve health care.
Between the early 1960s and late 1970s, it used barefoot doctors to monitor the
health of and provide health care to neighbors. Local health cooperatives and the
barefoot doctors promoted preventive measures and equitable distribution of food.
The Project's activities resulted in a sizable reduction of infant mortality (275-50).
In the 1980s, however, China shifted to privatization which reversed the earlier
priority of equity. It has since realized the effects of this shift and now
reemphasizes equity. In the Punjab, India, village-based auxiliary nurse-midwives
conducted effective continuous epidemiological surveillance, focusing on the
most needy families, and provided health care. This Narangwal Project improved
both equity and cost effectiveness. Other effective surveillance projects were in
rural Haiti (affiliated with the Schweitzer Hospital), the Kakamega Project in
Kenya, and in Jamkhed, India.
Publication Types:
• Review
2076: MMWR Morb Mortal Wkly Rep. 1992 Dec;41 Suppl:111-22.
Disease surveillance in China.
Chunming C; Centers for Disease Control (CDC).
In the past 10 years in China, because social conditions have been stable and the
public health infrastructure has been well developed, the disease surveillance
network has substantially improved. A computerized reporting system for
notifiable diseases has been established that links China's 30 provinces,
autonomous regions, and municipalities. Mechanisms for providing timely
feedback to units that report data and for systematically assessing the quality of
those data are important attributes of this system. During this period, data from
the surveillance system have become more representative, and, simultaneously,
more effective use of data has been promoted. Data collected through the disease
surveillance network serve as the basis for formulating health policies and
devising strategies for preventing disease.
2077: Isr J Med Sci. 1992 Dec;28(12):878-80.
Emergency admission to hospital: the family physician as

gatekeeper. Results of a 4-year prospective community-based study.
Furst A.
Department of Family Medicine, Hebrew University, Hadassah Medical School,

Jerusalem, Israel.
2078: Isr J Med Sci. 1992 Dec;28(12):868-77.
Standardized mortality ratios for Israel, 1983-86.
Ginsberg GM.
Department of Data Analysis, Ministry of Health, Jerusalem, Israel.
Standardized mortality ratios (SMRs), standardized by age, sex, continent of birth,

and religion are presented by cause and region for the period 1983-86. Regional
SMRs ranged from 90.6 in Jerusalem to 107.6 in Ramla. These differences may
be due to direct and indirect occupational, environmental and socioeconomic
effects as well as to possible health service differences. SMRs can be used to
indicate regions where further in-depth epidemiological investigations are called
for in order to ascertain the reasons for elevated disease specific SMRs. In
addition, SMRs could be used as a global measure of all effects in order to adjust
any regional budgetary allocation formula, based on capitation.
2079: Nippon Koshu Eisei Zasshi. 1992 Nov;39(11):873-8.
[A study on personal information system using movable media for

effective welfare services]
Matsubara I, Naruse Y, Sokejima S, Yamagami T, Kagamimori S.
Department of Community Medicine, Faculty of Medicine, Toyama Medical and

Pharmaceutical University.
A data system which enables utilization of individual patient data by public health
nurses, physicians and home helpers, is required both for the continuous and
comprehensive monitoring of the various needs of the aged receiving care
services at home in the local district and for facilitating welfare services.
Therefore, an experimental and comprehensive system for public health, medical
services and welfare was put into practice for district public health services for the
aging society. The results of this trial system shows that this system is useful
indeed for the welfare services, though it also has several problems.
Publication Types:
2080: Environ Res. 1992 Oct;59(1):175-88.

Chronic liver injury in phenoxy herbicide-exposed Vietnam
veterans.
Tamburro CH.
Department of Medicine, University of Louisville, School of Medicine, Kentucky

40292.
Reports of hepatotoxic injury in Vietnam veterans exposed to phenoxy herbicides

(mainly, 2,4-D and 2,4,5-T) initiated a retrospective cohort study of veterans self-
reporting exposure to Agent Orange (AO) while serving in Vietnam from 1962 to
1971. Historical, medical, and laboratory information was obtained in a subcohort
of 100 randomly selected veterans from a pool of 350 registrants. An occupational
work exposure ranking system was designed to estimate individual exposure to
phenoxy herbicide and its contaminant, dioxin (TCDD). Job classifications were
determined by military job codes. Military application of the herbicides used in
Vietnam were derived from the National Research Council Report based on the
Herbs tapes. Health examination included tests of body systems affected by
TCDD and similar agents, e.g., hemopoietic system, cholesterol/lipid metabolism,
hepatic function, and skin lesions. Skin rash was utilized as a marker disease,
since no case of true chloracne was found among the cohort. The cohort was
divided into those with (R) and without (NR) a reported rash during or after the
Vietnam tour. The R group had higher frequency (31%) of abnormal liver studies
of all types than the NR group (18%). Of the 14 Vietnam veterans with persistent
serum transaminase elevations, 86% reported a rash. Abnormal liver functions
correlated with herbicide exposure index in both groups, but was more prominent
in the R group. Study of the exposure index components showed that the liver
abnormalities were related to the months of exposure and not to job classification
or exposure rank. Viral hepatitis and alcoholism among both groups accounted for
the association between liver abnormalities and cumulative exposure to AO.
These data provide strong supportive evidence that chronic liver abnormalities
among Vietnam veterans applying to the AO Registry are mainly due to viral or
alcoholic causality and not to herbicides and their TCDD contaminant.
2081: Med Inform (Lond). 1992 Oct-Dec;17(4):279-91.
MCHS: an application software for family welfare programmes.
Moidu K, Singh AK, Boström K, Wigertz O, Trell E, Kjessler B.
Department of Medical Informatics, Faculty of Health Sciences, University of

Linköping, Sweden.
At the level of first contact, a primary health care centre, information management
is an unwieldy task, therefore health information systems are reported to be
inadequate and weak. Microcomputers could improve information management at
this level, but there is little success due to a lack of specialized application
software. In this paper we describe software developed after a multi-centre
systems analysis study, on an essential data set, to support the delivery of the
public health programmes for family welfare, i.e. maternal health care, family
planning and immunization programmes. The modular approach was taken to
develop a common application software for information management use at
multiple sites. The software is tested in a laboratory mode by retrospective data
entry from sites in Sweden and in India. All the information could be entered and
site-specific reports that were generated are compared. The software provided a
common data collection format, an essential platform for outcomes research.
2082: Mil Med. 1992 Sep;157(9):444-6.
Medical limitations of gas masks for civilian populations: the 1991

experience.
Golan E, Arad M, Atsmon J, Shemer J, Nehama H.
Israeli Defence Forces, Medical Corps.
Using a gas mask (GM) may involve considerable inconvenience, impairment of

respiration and communication, and serious psychological reactions. The medical
literature is primarily focused on the occupational aspects of using the GM by
young and healthy workers. In contrast, there is hardly any information
concerning the use of GMs by large, unselected populations, including children,
the elderly, and the sick. Issuing GMs to all residents of Israel prior to Operation
Desert Storm created an urgent need to define the populations whose health might
be jeopardized by using the standard GM. Adding an active air supply system
(AASS) to a standard GM may ease the burden on this high-risk group. We
evaluated the physiological aspects of breathing with a GM, with and without
AASS, in respect to pathophysiology of diseases, and reached a set of criteria for
identifying those who may be endangered by a GM and are expected to benefit
from the AASS. The method used to sort and identify those entitled to the AASS
is described.

2083: Int Nurs Rev. 1992 Sep-Oct;39(5):145-8.
Development of a PHC nursing information system in Korea.
Lee WH, Kim E, Cho WJ, Oh K, Yoo JS, Storey MJ.
Yonsei University College of Nursing WHO Collaborating Centre for Research

and Training for Nursing Development in Primary Health Care, Korea.
WHO has established collaborating centres at educational institutions throughout

the world to assist with WHO research. In 1988 a WHO Collaborating Centre was
inaugurated at Yonsei University College of Nursing in Korea. Since then two
important research projects have been completed for establishing a data bank of
human resources of nursing for primary health care (PHC) in Korea. Both projects
strengthen the PHC nursing information systems in Korea and, as such, are
beginning to develop PHC networks throughout Korea, passing on information to
an international network system. Below, the rationale behind the two projects, the
methodology and the results.
Publication Types:
2084: Southeast Asian J Trop Med Public Health. 1992 Sep;23 Suppl 4:23-8.
Malaria in Cambodia.
Denis MB, Meek SR.
Centre National de Malariologie, Phnom Penh, Cambodia.
There are around half a million cases of malaria with 5-10,000 deaths per year in
Cambodia. Incidence rates vary in different parts of the country. Malaria control
is hampered by multiple drug resistance of Plasmodium falciparum,
inaccessibility to the major vector, poor security in most malarious areas, and lack
of resources. The control strategy emphasises improvement of clinical
management and provision of prompt and accurate diagnosis in order to reduce
morbidity and to prevent mortality. In addition health information and drug
distribution systems are being improved. The use of pyrethroid-treated mosquito
nets and health education are being promoted. Particular attention is given to
returning refugees as they settle into the country.
Publication Types:
• Review
2085: Integration. 1992 Aug;(33):44-5.
Policies and strategies. Bangladesh.
Huq N.
PIP: Bangladesh has a population of nearly 108 million on a landmass of 143,998

sq km. The rate of population growth peaked at around 35 in the 1960s. The
population increased from about 43 million in 1951 to 68 million in 1970 and to
about 90 million in 1981. In 1976 a national policy for population control and
family planning (FP) was announced which employed thousands of full-time field
workers, and developed information, education, and motivation activities. The
implementation strategy entailed the integration of health and FP, maternal child
health (FP/MCH) service delivery systems at subdistrict (upazila) levels with a
wide choice of contraceptive methods and expanded good quality services.
Greater emphasis on MCH services included immunization, oral rehydration, and
training of traditional birth attendants. Even if the goal of net reproductive rate of
1 is achieved by 2005, the population will rise to about 137 million by 2000. The
Fourth 5 year Plan (1990-95) seeks to lower the growth rate from 2.15 in 1990 to
1.8% by 1995; to cut the crude birth rate of 34.5 live births/1000 people in 1990
to 30.1/1000 by 1995; and to reduce the crude death rate of 13.6/1000 population
in 1990 to 11.9/1000 by 1995. The reduction of the total fertility rate from 4.30 in
1990 to 3.40 by 1995 would require increasing the contraceptive prevalence rate
of 40% in 1991 to 50% in 1995. It is also planned to raise the number of the
continuous users of contraceptives from 8.8 million in 1991 to 12.3 million
acceptors by 1995. The government has been providing continuous institutional
support to a network of FP clinics in rural areas which the Family Planning Board
started to operate in 1965. The present field structure is composed of the division
level (4 divisions in the country), district level (64 districts), upazila level (460
upazilas), and union level (4500 rural unions).
2086: Integration. 1992 Aug;(33):34-7.
Serve the unmet needs.
Nahariya R.
PIP: The Philippine Family Planning Program component of the UN Population

Fund (UNFPA) defines the demand for family planning (FP) as the desire of
couples to space or limit their children, and reduce the risks of pregnancy and
childbirth. Although the teachings of the Catholic Church oppose FP, at the local
level priests do not enforce this strict code. Funding is relatively sufficient, but the
public support of legislators is lacking, and implementation is problematic.
Nongovernmental organizations (NGOs) are instrumental in delivering 38% of FP
health care service focusing on comprehensive reproductive health concerns of
low- and middle-class women in urban areas exclusive of the very poor. The
reporting system is ill-functioning, perinatal deaths often go unreported, and in
remote areas underreporting is the rule. The collected data are not used for
management or in the communities and municipalities. The prevalence of FP is
42-44%, but only 22-24% of it consists of effective methods. 23% of women aged
15-44 have unmet needs of FP. The program could be improved significantly in
view of a 90% female literacy rate in 1991, an independent streak in women in
urban areas, and a less male-oriented culture. The program of the UNFPA is on a
5-year cycle, and from 1993 the support of USAID, the World Bank, the German
government, and the Japan International Cooperation Agency is expected.
2087: Health Millions. 1992 Aug;18(4):12-5.
Women's health as empowerment: towards a holistic experience.
Khanna R.
PIP: The Women's Health Programme of the nongovernmental organization

Social Action for Rural and Tribal Inhabitants of India (SARTHI) serves women
living in the Santrampur taluka of Panchmahals district in Gujarat State, India.
The program, which has been operating since July 1988, addresses gynecological
and psychological health and issues of violence and exploitation. It incorporates
traditional health practices and modern allopathic health practices. SARTHI
provides gynecologic services via illiterate women health workers (barefoot
gynecologists). They also counsel the rural and tribal women and mobilize them
for collective action. The 1st phase of the program was training local women in
maternal and child health care which included nutrition education and aseptic
deliveries. It moved into its 2nd phase due to the realization that it was imposing
an external health system on the local women. So the program undertook a
research project to verify locally used traditional medicines. Training of the
barefoot gynecologists marked the beginning of the 3rd phase. These women
health workers soon realized that their main objective was empowerment of the
local women. The program provides women with information to empower them to
deal with their problems. Training is the key to the program's success. it designed
training in phases to build upon knowledge. It begins with an 8-day training
program followed by 3-day modules each month. Training includes technical
health information and empowerment and leadership building. Content depends
on the current situation of the women. Methodologies include role playing, songs,
question-answer sessions, and reviews.
2088: Isr J Med Sci. 1992 Aug-Sep;28(8-9):526-33.
Sentinel markers for industrial disasters.
Deutsch PV, Adler J, Richter ED.
Unit for Occupational and Environmental Medicine, Hebrew University-Hadassah

School of Public Health and Community Medicine, Jerusalem, Israel.
Workers, managers, and occupational health and safety inspectors can be trained
to detect or recognize and promote action to correct sentinel markers for industrial
disasters. A sentinel marker is defined as a pre-disaster warning sign of
impending failure in prevention. Administrative sentinel markers are: a weak
occupational health and safety program; lack of spontaneous access to top
management; failure to accept responsibility for subcontractors; the absence of
written disaster plans and drills for emergency response in the factory and the
adjacent community; noninvestigation of prodromal leaks, exposures, spills or
injuries; punishment of "troublesome" individuals reporting such prodromal
events; nonuse or misuse of data on illness, injury and absenteeism; and
suboptimal work conditions and supervision of shift workers. Information sentinel
markers include absence of worker and community right-to-know programs,
nonuse of data on earlier mishaps from similar technologies, and failure to
provide toxicologic data to hospitals in the pre-disaster phase. Technological
sentinel markers are: absence of fail-safe controls, interlocks and automated alarm
systems driven by real-time monitoring. Transportation sentinel markers include
suboptimal vehicle standards, and drink, drugs and fatigue in drivers. Preventive
programs based on identification of all sentinel markers by workers are suggested
to be more effective than selective action based on risk assessment analysis.
Publication Types:

• Review
2089: Popline. 1992 Jul-Aug;14:4.
Distribution system in Bangladesh spurs decline in growth.
[No authors listed]
PIP: Fertility reductions in Bangladesh have contributed to a reduction in

population growth from 2.5% between 1981 and 1991 to 2.3% in 1991. The
average density of 800 persons/sq. km means competition for resources in a
subsistence level economy. There is scarcity of land, food shortages, and an
abundance of labor. Rapid socioeconomic development is not possible even with
an average annual economic growth rate of 3.7% because of population growth.
Birth control has doubled to 18.6% in 1991. Sterilization is no longer the primary
means of contraception. Contraceptive usage increases are more widespread
among young women who are spacing births. A recent study reports that fertility
declines are due to increases in the expansion of family planning field workers
over the past decade. Home distribution is considered compatible with
sociocultural traditions. In 1990, there was 1 field worker/856 married women of
reproductive age. 120 private voluntary organizations and the government provide
contraceptive services. In 1989, 40% of pill and condom users obtained their
supplies from commercial channels. This is possible because of the successful
social marketing available through 130,000 commercial retail outlets.
Nongovernmental organizations have also been given the freedom to operate
independently from government programs. The International Center for Diarrheal
Disease Research contributed to the contraceptive effort by field testing in
Matlab, Aboynagar, and Sirajganj the introduction of door-to-door injectable
contraception services and the building of satellite clinics. The information,
education, and communications (IEC) activities also contributed to the 95.4% of
women knowledgeable about at least 4 methods of contraception. Kantner and
Noor reported that 14.4 million births were averted due to an increase in marriage
age (from 16.3 years in 1974) to (17.7 years in 1989). Program efforts are being
accelerated because of the 45% of the population that is presently under 15 years
of age but will be reaching reproductive age shortly. This acceleration is needed
to just maintain the total fertility rate of 4.6 live births/woman. The target is to
achieve 50% contraceptive use by 1997 from its present level of 40%, which
means 21.9 million averted births. 70% contraceptive use is needed for
replacement level fertility. International donor support is still needed.
2090: Bull Med Libr Assoc. 1992 Jul;80(3):294-9.
The medical libraries of Vietnam--a service in transition.
Brennen PW.
Medical College of Wisconsin Libraries, Milwaukee 53226.
The medical libraries of Vietnam maintain high profiles within their institutions
and are recognized by health care professionals and administrators as an
important part of the health care system. Despite the multitude of problems in
providing even a minimal level of medical library services, librarians, clinicians,
and researchers nevertheless are determined that enhanced services be made
available. Currently, services can be described as basic and unsophisticated, yet
viable and surprisingly well organized. The lack of hard western currency
required to buy materials and the lack of library technology will be major
obstacles to improving information services. Vietnam, like many developing
nations, is about to enter a period of technological upheaval, which ultimately will
result in a transition from the traditional library limited by walls to a national
resource that will rely increasingly on electronic access to international
knowledge networks. Technology such as CD-ROM, Integrated Services Digital
Network (ISDN), and satellite telecommunication networks such as Internet can
provide the technical backbone to provide access to remote and widely distributed
electronic databases to support the information needs of the health care
community. Over the long term, access to such databases likely will be cost-
effective, in contrast to the assuredly astronomical cost of building a comparable
domestic print collection. The advent of new, low-cost electronic technologies
probably will revolutionize health care information services in developing
nations. However, for the immediate future, the medical libraries of Vietnam will
require ongoing sustained support from the international community, so that
minimal levels of resources will be available to support the information needs of
the health care community. It is remarkable, and a credit to the determination of
Vietnam's librarians that, in a country with a legacy of war, economic deprivation,
and international isolation, they have somehow managed to provide a sound basic
level of information services for health care professionals.
Publication Types:
PMCID: PMC225670
2091: Health Serv Manage Res. 1992 Jul;5(2):107-14.
Policies and practices related to information system adoption in

hospitals owned by Ministries of Health in the Arab Gulf.
Nabali HM.
Department of Health Services Administration, American University of Beirut.
This is a discussion paper based on the findings from a study of the factors
affecting the adoption of computer-based hospital information systems (CBHIS)
in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain,
Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as
visits to ministries of health in these countries. The focus of this paper is on the
adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of
the main role that ministries of health play as providers of health care in the
Region. Prior to describing CBHIS adoption practices, an overview of the Region
in terms of its economic development and its health care delivery systems is
presented. Next, the research setting along with the major findings are briefly
described followed by a discussion of the advantages and disadvantages of
centralized CBHIS adoptions. Finally, management guidelines related to the
adoption of CBHIS by multi-hospital institutions are proposed.
2092: Jpn Hosp. 1992 Jul;11:33-41.

Related Articles
A study of evaluation methods for hospital medical care systems.
Nobukawa M, Eussen ME.
When we seek to evaluate hospital medical care services, we first collect data
regarding the existing system in order to gather information and to develop a
method of analysis that we can use for evaluation. We took the OPD system as an
example, taking into account systematic OPD services based on queuing theory
and computer simulation. As a result of the computer simulation model based on
experimental conditions, we were able to offer recommendations for
modifications of the present system that could improve patient service. The
hospital manager can use this information to aid him in the decision making
processes concerning the hospital. A study of the methods for the evaluation of
hospital medical care services is important. It is necessary to develop a regional
medical care information system as well as a hospital medical care information
system.
2093: Pop Sahel. 1992 Jun;(17):25-8.
[Stimulating demand for and promoting health services. Infant

nutrition and child survival]
[Article in French]
Traore B.
PIP: The child morality rate has fallen in the large African capitals. Maternal and
child health (MCH) services focusing on improving health and reducing mortality
are partially responsible for this reduction. The reduction in child mortality in
sub-Saharan Africa (SSA) has slowed in the last decade, however. For example,
there was a 16% reduction in child mortality in SSA between 1965 and 1979
compared to a 10% reduction between 1978 and 1987. Both Latin America and
Asia had a greater reduction than did SSA (24% and 19%, respectively) during
1965-1979 and during 1978-1987 (35% and 28%, respectively). During the first
period, North Africa and SSA had almost the same reduction in child mortality
(27% and 21%, respectively) while North Africa had a much greater reduction
during the second period than did SSA (46% vs. 10%). SSA has the highest infant
and child mortality rates in the world. Health programs and structural adjustment
programs reflect the socioeconomic situation in SSA. A reorientation of health
programs and a progressive responsibility of the social elite in implementing
structural adjustment programs in Africa would improve the socioeconomic
situation. The nature of data does not allow one to say what part of health
programs improves child survival. Progress in child survival has been achieved in
some parts of SSA. For example, during 1983-1987, there was a 33% reduction in
child mortality. The prevalence of AIDS in children is having a negative effect on
child survival. In the future, development or strengthening of health information
systems as well as registration systems will help governments realize changes in
child survival. Promotion of exclusive breast feeding for the first six months and
prolonged breast feeding with appropriate supplements thereafter as means to
prevent diarrhea, postpartum family planning programs, improvement in female
education, improved access to modern child health care, increased birth intervals,
and promotion of and stimulation of demand for MCH services would improve
child survival in SSA.
Publication Types:
2094: Asia Pac POPIN Bull. 1992 Jun;4(2):18-9.

Related Articles
China POPIN.
Li Y, Zhou H.
PIP: China's POPIN is an information network established in September 1986 in

order to maintain the flow of information between 10 population information
centers and over 49 members in institutes and schools. The goal was to enhance
family planning program implementation to provide assistance to policymakers,
to strengthen the population sciences, and to avoid duplication of effort. A
working committee was established in April 1989 to reinforce cooperation and
coordination between members and to assemble a basic set of information.
Cooperative activity is concentrated on resource sharing, information research,
and dissemination of information. In 1990 documentation of resources in member
organization collections was begun. Annual meetings are a forum for discussing
national standards for coding, classification, cataloguing, and using the
bibliographic database of the network. On line retrieval has been made easier with
a standard book classification system and unified subject headings. POPIN also
holds annual meetings to discuss research findings and future research plans.
Research findings are compiled and distributed annually. In June 1991, a
professional working group was set up to edit and publish population information.
Each member published 2-5 articles or documents/year. The group disseminates
information in a systematic, comprehensive, and timely fashion for policymakers,
family planning personnel, and researchers. International exchange of population
data and information is promoted. Foreign experts in demography have been
engaged to train staff members and exchange information. China POPIN is a
member of global POPIN and Asia-Pacific POPIN and has participated in special
seminars, conferences, and training sessions. China POPIN has interchanges with
170 related worldwide organizations. A cooperation arrangement with ESCAP
has resulted in translation of more than 40 ESCAP monographs into Chinese and
in population information directories. POPIN members are independent and with
the authority and ability to conduct population information work separate from
Beijing.
2095: Asia Pac POPIN Bull. 1992 Jun;4(2):13-7.

Related Articles
Networking of networks: a 1990s approach to information for

development.
[No authors listed]
PIP: The ability to access and use information is increasingly becoming a crucial
determinant of a country's ability to achieve sustainable socioeconomic
development. Countries which are able to manage and utilize data and
information have a competitive advantage over other nations. Countries which fail
to tap into the growing global knowledge base, develop a complementary local
knowledge base, promote the dissemination and use of knowledge, and invest in
institutional and technical human capital will, however, simply remain or fall
behind the competition. Many developing countries lack appropriate strategy,
financial support for information centers and networks, timely adoption and use of
new technology, adequate telecommunications infrastructure, and coordination at
national and regional levels. Further, telecommunications services are costly,
research on user group behavior is inadequate, few technically skilled people are
available, and governments fail to recognize the importance of joining
international information networks. Policy development, maternal-child health
and family planning, and information, education, and communication are 3 of the
most significant population issues worldwide. To best address these issues,
international development agencies are urged to veer from providing capital and
to directly support greater access to information and enhanced knowledge leading
to sustainable national development. Thus far the UN has helped create global
information systems in certain areas, and regional cooperative information
systems are being developed. ESCAP has taken the lead in Asia and the Pacific.
Gradually, population libraries and information centers are becoming
computerized. Greater effort is recommended to recover costs for services and
products. Further, donors and country organizations should stress that information
is only useful as far as it is used.
2096: Soc Sci Med. 1992 Jun;34(12):1385-97.
Health-seeking behavior and the meaning of medications in

Balochistan, Pakistan.
Hunte PA, Sultana F.
Department of Anthropology, University of Connecticut, Storrs 06268.
A wide variety of health care options--home-based, indigenous, and

cosmopolitan--exists in northern Balochistan, Pakistan. This paper examines
health-seeking behavior in the area of mother and child health for villagers in this
pluralistic medical setting. The analysis of a specific series of illness episodes
shows that the majority of cases obtain treatment from different medical systems
for a single episode. Interest in medications takes precedence over practitioners,
and the meaning the villagers attach to such substances is explored. Long-
established patterns of behavior relating to indigenous medicine continue to occur
when cosmopolitan medicine is utilized. Information presented here helps to
explain problems in utilization of cosmopolitan pharmaceuticals and delineates
areas for future health programme activity.
2097: MMWR Morb Mortal Wkly Rep. 1992 May 22;41(20):362-7.
Cigarette smoking among Chinese, Vietnamese, and Hispanics--

California, 1989-1991.
Centers for Disease Control (CDC).
Although cigarette smoking causes 434,000 premature deaths annually in the

United States (1), information characterizing smoking behaviors generally lacks
specificity for racial/ethnic groups and subgroups (2). To characterize smoking
and other risk behaviors more fully for program planning efforts at the local level,
three California communities and the California Department of Health Services
developed culturally adapted versions of CDC's Behavioral Risk Factor
Surveillance System (BRFSS). These surveys were administered to selected
Chinese (3), Vietnamese (4), or Hispanic populations in California. This report
summarizes information about smoking from these surveys during 1989-1991.
Acceptability of Norplant-2 rods as a method of family planning.
Singh K, Viegas OA, Ratnam SS.
Department of Obstetrics and Gynaecology, National University Hospital,

Singapore.
The Norplant-2 rod system consists of two silastic rods in which levonogestrel has
been incorporated with the polymer. The continuation rate at the end of five year
was 62%. No accidental pregnancies occurred throughout the five years of use.
The post-removal conception rate in women desiring pregnancy was 70.8% at the
end of two years. The majority of acceptors were happy with the rods and 86.8%
expressed the desire to have another set of implants inserted following removal of
the first set. The study shows the Norplant-2 rod system to be a well accepted
method of family planning.
PIP: Physicians from the National University Hospital, Singapore enrolled 100
women between December 1985-March 1986 in a 5 year study of the efficacy,
acceptability, and reversibility of Norplant-2 rods. They examined them at 1, 3, 6,
and 12 months and 2 times each year thereafter. All women returned. No one had
an unintended pregnancy. The leading reason for removal was planning a
pregnancy (24 of 38 removals). The 8 removals for menstrual problems occurred
during the 1st 2 years. Of the 24 women, 6 changed their minds about having
another child and used other family planning methods. 58.3% of the 24 women
(77.7% of the 18 women who still wanted to conceive) were pregnant within 3
months after removal. At the end of 2 years, only 1 woman did not become
pregnant (70.8% of 24 and 94.4% of 18) probably because she was experiencing
subfertility since she was 44 years old. All 17 women gave birth vaginally to
healthy full term infants. The physicians removed the rods from the 62 women
who still had a Norplant-2 system at the end of 5 years. 87.1% (52) found the
Norplant-2 system very favorable. No woman said it was not favorable. Further
all 62 women were satisfied with all the information they received about the
Norplant-2 system. 74.2% thought Norplant-2's ease of use/convenience was its
best attribute and 24.2% said it was the low risk of pregnancy. Moreover 48.4%
did not think negatively about Norplant-2. The least liked attribute was menstrual
pattern changes (35.5%). 4 women complained about the removal procedure
being painful, yet 3 requested a 2nd set of Norplant-2 rods. In fact, 86.8% of the
women who intended to use contraception after removal chose Norplant-2 rods.
Of the 9 women who did not plan to use contraception, 7 planned to conceive and
2 were widowed. In conclusion, Norplant-2 system is safe and efficient. Further it
has an advantage over the Norplant-6 system--ease of insertion and removal.
Publication Types:
2099: Comput Methods Programs Biomed. 1992 May;37(4):319-25.
Current status of Image Save and Carry (IS&C) standardization.
Ando Y, Hashimoto S, Ohyama N, Inamura K.
Department of Radiology, School of Medicine, Keio University, Japan.
Image Save And Carry (IS&C) was planned to be an off-line information system
for transmission and exchange of medical images and information between a
medical facility's different divisions as well as between other hospitals. The IS&C
committee defines file format for magneto-optical disk, the data format and
representation, media compatibility and data security and technological
assessment. A 'zone management method' which contributes to a rapid access of
data in the recording media is used for IS&C file management. The IS&C
standard holds as much conformation as possible in order to coordinate with
ACR-NEMA (American College of Radiology-National Electrical Manufacturers'
Association) and MIPS (Medical Information Processing Systems) standards. The
IS&C data format is based upon the ACR-NEMA/MIPS standard. A major
difference between the ACR-NEMA/MIPS standard and IS&C standard is that the
IS&C standard is expected to serve for recording all kinds of medical information
(e.g., diagnostic reports, endoscopic images and electrocardiograms), including
X-ray images. Applications to PACS, teaching files, personal electronic health
and medical records are promising. The booklet of IS&C standard will be
published in the spring of 1992 by the IS&C committee.
2100: Kekkaku. 1992 Apr;67(4):319-29.
[Surveillance of tuberculosis epidemics in Aichi Prefecture]
Ikari A.
Department of Health, Aichi Prefectural Government, Japan.
A survey was done on the conditions of the tuberculosis surveillance system used
for extraordinary examination in high tuberculosis prevalence areas in Aichi
Prefecture during the period from 1981 to 1989. The results were as follows: 1) A
total of 25 health centers provided information to 456 cases in specific groups
known as "danger groups" and 227 cases within a furniture company. Information
was most frequently provided when the index cases had been diagnosed bacillary
positive. 2) Extraordinary examinations were performed on 222 cases for nine
years, one case a year per each health center. The frequency of extraordinary
examination was never high. A total of five epidemic cases (2.3%) and 30
microepidemic cases (13.5%) were discovered. 3) Coordination among health
centers to make examinations was required in 81 cases (36.5%). 4) In index cases
in which extraordinary examinations were performed, 43 preventable cases
(19.4%) were found. It is therefore important to thoroughly enforce family-
contact examinations. In order to complete extraordinary examinations, the
importance of not only the systematic collection of information and the action of
examination about specific groups but also the establishment of a surveillance
system for extraordinary examinations is vital.
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1901: Int J Biomed Comput. 1995 Oct;40(2):81-3.

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