His 3

401: Soc Sci Med. 2007 Apr;64(7):1536-47. Epub 2007 Jan 17.
Related Articles, Links
Intimate partner violence among Afghan women living in refugee

camps in Pakistan.
Hyder AA, Noor Z, Tsui E.
Johns Hopkins Bloomberg School of Public Health, and Center for Injury
Research & Policy, USA. ahyder@jhsph.edu
The purpose of this paper is to explore events and factors that lead to conflict in
the home in the Afghan refugee setting, and the current status of the health
sector's ability to respond to evidence of conflict. Qualitative interviews were
conducted with 20 women of reproductive age and 20 health workers serving
these women in an Afghan refugee camp near Peshawar, Pakistan, during the
summer of 2004. In particular, this paper analyses women's explanations of how
various marriage traditions may be linked to conflict in the home and how the
interactions of different family members may be related to conflict. The
relationships of women with their parents-in-law and husbands are highlighted in
particular, and a model developed to explore the choreography of their
relationships and the ways in which these dynamics may encourage or inhibit
violence. The perspectives of health workers on the ways in which the health
system responds to family conflict and violence are also presented. Finally, this
paper provides information that helps to frame the issues of family violence and
conflict in long-term refugee populations for intervention designers and those who
are working to craft a health sector response to this problem.
Publication Types:
• Research Support, Non-U.S. Gov't
PMID: 17234316 [PubMed - indexed for MEDLINE]
402: Environ Res. 2007 Mar;103(3):424-31. Epub 2007 Jan 17.

Diurnal temperature range and daily mortality in Shanghai, China.
Kan H, London SJ, Chen H, Song G, Chen G, Jiang L, Zhao N, Zhang Y,

Chen B.
Department of Environmental Health, School of Public Health, Fudan University,
Shanghai, China. kanh@niehs.nih.gov
Although the relationship between temperature level and mortality outcomes has
been well established, it is still unknown whether within-day variation in
temperature, e.g. diurnal temperature range (DTR), is a risk factor for death
independent of the corresponding temperature. Moreover, DTR is a
meteorological indicator associated with global climate change which may be
related to a variety of health outcomes. We hypothesized that large diurnal
temperature change might be a source of additional environmental stress and
therefore a risk factor for death. We used daily weather and mortality data from
Shanghai, China to test this hypothesis. We conducted a time-series study to
examine the association between DTR and mortality outcomes from 2001 to
2004. A semi-parametric generalized additive model (GAM) was used to assess
the acute effect of DTR on mortality after controlling for covariates including
time trend, day of the week (DOW), temperature, humidity, and outdoor air
pollution. We found a strong association between DTR and daily mortality after
adjustment for those potential confounders. A 1 degrees C increment of the 3-day
moving average of DTR corresponded to a 1.37% (95% CI 1.08-1.65%) increase
in total non-accidental mortality, a 1.86% (95% CI 1.40-2.32%) increase in
cardiovascular mortality, and a 1.29% (95% CI 0.49-2.09%) increase in
respiratory mortality. The effects of DTR on total non-accidental and
cardiovascular mortality were significant on both "cold" (below 23 degrees C)
and "warm" (at least 23 degrees C) days, although respiratory mortality was only
significantly associated with DTR on "cold" days. This study suggests within-day
variation in temperature may be a novel risk factor for death.
Publication Types:
• Comparative Study
• Research Support, N.I.H., Extramural
• Research Support, N.I.H., Intramural
• Research Support, U.S. Gov't, Non-P.H.S.
403: Int J Technol Assess Health Care. 2007 Winter;23(1):138-45.

Cost-effectiveness analysis of prenatal diagnosis intervention for

Down's syndrome in China.
Chen Y, Qian X, Li J, Zhang J, Chu A, Schweitzer SO.

National Key Laboratory of Health Technology Assessment, School of Public
Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, P.R. China.
yychen@shmu.edu.cn
OBJECTIVES: The cost-effectiveness of prenatal diagnosis intervention for

Down's syndrome (DS) in China was assessed and evidence-based information
for policy makers and providers is presented. METHODS: Based on field surveys
in four selected cities in China and a literature review, the economic evaluation of
prenatal diagnosis for DS from a societal perspective is conducted by cost-
effectiveness analysis. RESULTS: In current clinical practice, for a cohort of
10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus
sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of
age and older (maternal age screening strategy) can detect .67 DS births. The
strategy that offers the diagnostic test after maternal serum screening with alpha-
fetoprotein and human chorionic gonadotrophin (maternal serum screening
strategy) can detect 1.41 DS births. The cost per prevented DS birth by the
maternal age screening strategy and maternal serum screening strategy is US$
13,091 and US$ 56,048, respectively. Sensitivity analysis shows that the maternal
serum screening strategy can be cost-effective if uptake rate of CVS or AC for
patients with positive serum tests increase while the cost of serum screening
decreases. CONCLUSIONS: Although, in general, serum screening has been
found to be more cost-effective than maternal age screening, this appears not to be
the case in China. The reasons appear to be low uptake rate of the maternal serum
strategy, low uptake rate of CVS or AC, and the high price of serum screening.
Our findings are that health system factors concerning technology utilization are
important determinants of the technology's efficiency.
Publication Types:
404: Shokuhin Eiseigaku Zasshi. 2006 Dec;47(6):268-76.

[Identification of fungi using DNA sequences: an approach to

identify Fusarium species isolated from domestic unpolished rice]
[Article in Japanese]
Sakai A, Ozeki Y, Sasaki Y, Suzuki C, Masui Y, Aihara M, Kikuchi Y,

Takatori K.
National Institute of Health Sciences, 1-18-1, Kamiyoga, Setagaya-ku, Tokyo
158-8501, Japan.
Molecular approaches are being developed to provide for the rapid and objective
identification of fungi. We attempted the identification of Fusarium species by a
genetic analysis to validate practically the utility of a molecular approach for
fungal identification and to reveal its limitations, and sequenced three regions, the
5' end of the 28S rRNA gene (D2 region) and the internal transcribed spacer 1 and
2 (ITS1 and ITS2) regions, in the rRNA genes. The DNA sequences of 38
Fusarium strains isolated from domestic unpolished rice were compared for
similarity with entries in the GenBank. Based on this comparison, it was
estimated that all these three regions, as a minimum, must be compared with the
database to identify Fusaria at the species level. According to the combinations of
sequences in the three regions, the 38 isolates were classified into 13 groups. Out
of the 13 groups, 6 groups (20 isolates in total) could be identified as definite
species based only on the sequence data. For the other 6 groups (17 isolates in
total), candidate species were limited on the basis of the sequence similarity, and
then the isolates were identified at the species level with the aid of morphology.
Only one isolate could not be identified. These results verified that DNA
sequence comparison with the GenBank database is useful for the identification of
Fusarium species.
Publication Types:
• English Abstract
405: J Public Health (Oxf). 2007 Mar;29(1):62-9. Epub 2007 Jan 16.
Analysis of news of the Japanese asbestos panic: a supposedly

resolved issue that turned out to be a time bomb.
Takahashi Y, Miyaki K, Nakayama T.
Department of Health Informatics, Kyoto University School of Public Health,

Yoshida Konoe, Sakyo, Kyoto, Japan 606-8501.
BACKGROUND: Asbestos-linked public health problems were widely reported

in Japan, in 2005. The objective is to apply text mining with network analysis to
characterize these problems. METHODS: Text mining with network analysis of
newspaper headlines including the word 'asbestos' published in 1987 and 2005
was conducted. Outcome measures are occurrence of the words and simultaneous
occurrence of two words in the newspaper headlines. RESULTS: In 36 headlines,
which contained the word 'asbestos' in 1987, the word 'pollution' (40%) appeared
most frequently, followed by 'removal' (31%) and 'campaign' (29%). For
combinations of words, the following occurred most frequently: 'campaign and
expulsion' (26%) followed by 'removal and campaign' (14%). Of 293 headlines in
2005, the following words appeared: 'hazard' (31%), 'person' (16%) and 'death'
(13%). For combinations, the following appeared: 'person and death' (9%).
Asbestos pollution and removal campaigns were reported in 1987, but the death
of citizens was reported in 2005. CONCLUSIONS: Text mining with network
analysis, which presents one of the methods for visualization of text data, suggests
the following insight. Insufficient steps against asbestos had been taken for 20
years, which is compatible with the latency period. It has resulted in widespread
exposure to asbestos and more severe asbestos-related public health problems
among citizens. This methodology suggests that analyzing text data by this
method can serve future surveillance and efficient use of epidemiological
knowledge.
406: J Public Health Dent. 2006 Fall;66(4):285-7.

Specific caries index: A new system for describing untreated dental

caries experience in developing countries.
Acharya S.
Bhagyashree, Kunjibettu, UDUPI - 576102, Karnataka State, India.

shashidhar_acharya@yahoo.com
OBJECTIVES: To develop a reproducible surface-specific caries index that

provided qualitative and quantitative information about untreated dental caries,
that could be used in conjunction with the DMFS index and would provide
information on not only the caries prevalence but also the location and type of
caries lesion in an individual based on clinical examination. METHODS:
Untreated carious lesions were divided into six types based on the location of the
lesions. 339 rural school children in the age group of 12-15 years were examined
for dental caries using both the DMFS index and the Specific Caries Index.
RESULTS: Type 1 and 2 were found to be the most common type of caries
lesions. The reproducibility of the Specific Caries Index was also found to be
good. CONCLUSIONS: Encouraging indications about the validity and
reproducibility of this new caries index was found, suggesting the need for further
studies to test its applicability in larger and different populations.

407: Osteoporos Int. 2007 Jul;18(7):923-9. Epub 2007 Jan 16.
Hormonal profiles and biochemical indices of bone turnover in

Indian women.
Desai Meena P, Khatkhatay MI, Bhanu Prakash KV, Savardekar LS, Shah
RS, Ansari Z.
Department of Molecular Immunodiagnostics, National Institute for Research in

Reproductive Health, Parel, Mumbai, India.
immunodiagnostic_nirrh@rediffmail.com
SUMMARY: The study establishes Indian referent database for bone turnover
markers. The levels of markers decreased across the four quartiles of BMD
showing a negative correlation with BMD. The study depicts that levels of
hormones and bone turnover makers can aid in identifying women at risk for
osteoporosis. INTRODUCTION: Biochemical markers of bone turnover reflect
changes in bone metabolism earlier and aid in the management of osteoporosis.
Since a referent database for Indian women is lacking, the study was initiated to
establish the same and suggest that hormonal profiles and markers of bone
turnover can aid in identifying women at risk for osteoporosis. METHODS:
Osteocalcin (OC), bone specific alkaline phosphatase ((BSAP), C-terminal
crosslinking telopeptide of type-I collagen (CTX-I), deoxypyridinoline (DPD),
follicle-stimulating hormone (FSH) and estrone glucuronide (E(1)G) were
measured in 365 Indian women (20-70 years) and correlated with BMD
measurements by dual energy absorptiometry (DXA) using one way analysis of
variance (ANOVA). RESULTS: The mean levels of bone resorption markers;
CTX-I and DPD increased significantly across the age showing a negative
correlation with BMD. The increase in levels of CTX-I and DPD was
significantly higher (p < 0.0001) as compared to the femoral and spinal BMD,
which dropped only 30-36%. The levels of bone turnover markers and FSH
decreased across the four quartiles of spinal and femoral BMD showing a
negative correlation whereas E(1)G levels increased across the four quartiles.
CONCLUSION: The bone turnover markers were comparatively low in cohort of
Indian women studied.
Publication Types:
408: Indian J Med Ethics. 2006 Jul-Sep;3(3):93-4.

The cloning controversy.
Nandakumar S.
Suryodaya Centre for Health Information Pvt Ltd., Prashanthi, 11 Sivaganga

Road, Nungambakkam, Chennai 600 034, India. saranya@rediffmail.com
Stem cell research has captured the imagination of many, including the scientific
and medical community. But the medical community received a wake-up call
early this year when a well-known researcher publicly confessed to deception.
While the core question relates to honesty and integrity, it is equally necessary to
examine the system that made such deception possible.
409: J Egypt Public Health Assoc. 2002;77(1-2):143-58.

Mortality stastistics as indicators of quality of hospital care.
Gabal MS, Salem KA.
Dept. of Comm., Environ. and Occup. Medicine, Ain Shams University.
Death rates have always been important information for hospitals to provide a
solid base for the evaluation of the quality of their medical care. This study was
carried out to find out the gross death rate (GDR) as well as net death rate (NDR)
in King Fahad hospital, Jeddah, Kingdom of Saudi Arabia (KSA) in the period
from 1994-2000 and also to find out demographic characteristics of deaths in the
year 2000 according to ICD-10 as indicators of quality of hospital care. Medical
records of discharged patients including deaths during the year 2000 were
reviewed (13386). Complete data about deaths were obtained. Results of the
studied hospital showed gradual decrease in GDR from 5.8% to 4.5% (1994-
1998) then slight increase from 4.9% to 5.0% (1999-2000) but still below the year
1994 (5.8%) and also there is gradual decrease in NDR from 4.6% to 3.6% in the
studied period. GDR in different departments of the hospital during the year 2000
showed that Medical ICU was the highest (24.5%) followed by Surgical ICU
(17.9%) followed by Cardiac ICU (14.3%) while GDR in the Medical department
was found to be (12.9 %) of the discharged subjects. According to nationality;
proportional mortality rate (PMR) of Saudis represented 62% of total deaths
followed by Yemenis (8.2%) meanwhile Egyptians represented 3.7% of total
deaths in the studied year. As concerned to age groups; the highest PMR was
found among those aged 65-74 years (21.9%) while the lowest PMR was found
among those aged 13-24 years (4.2%). The highest PMR of deaths during the
studied year was reported in March (10.4%) followed by April (9.7%) then
February (9.4%) which are the months of pilgrimage season while the lowest
frequency was found in December (6.9%). Also PMR was found to be higher
among females (57%) compared to males (43%). According to International
Classification of Diseases (ICD-10); diseases of the circulatory system were
found to be the commonest underlying cause of death in the studied year. It
represented 35.5% of all deaths followed by neoplasms (11.2%) while the lowest
cause reported was mental and behavioral disorders (0.1%). In conclusion,
combination of the previous indicators and comparing the results with other
hospitals in different countries indicates good quality of medical care in the
studied hospital.
410: Isr Med Assoc J. 2006 Dec;8(12):865-9.

The use of medical informatics as a management tool for community

health services during the 2006 Israel-Lebanon War.
Kokia ES, Marom R, Shalev V, Jan Y, Shemer J.
Maccabi Healthcare Services, Tel Aviv, Israel. kokia_e@mac.org.il
BACKGROUND: During war the health management organizations have

tremendous difficulty monitoring members' needs according to geographic spread.
OBJECTIVES: To describe how an HMO used its health information technology
in a way that enables its management to receive updated online information on the
needs of the insured, according to their distribution throughout the country during
the time of the war in Lebanon in July-August 2006. METHODS: Data were
derived from the computerized medical records of Maccabi Healthcare Services--
the second largest HMO in Israel, providing care to more than 1.7 million
members nationwide. Data on healthcare utilization by northern members were
compared to the geographic distribution of clinics. RESULTS: The war was
characterized by the massive evacuation of citizens southwards. During this
period there was an abrupt decline in the utilization of medical services by
northern members in the northern region. This decline returned to normal 10 days
after the ceasefire. A reciprocal increase was noted in the use of health services by
citizens from the north in other regions. This increase returned to normal after the
war. No such pattern was noticed during the same period in 2005.
CONCLUSIONS: Real-time surveillance of trends in consumption of health
services by citizens in times of regular daily living as well as during emergencies
and wars is a vital management tool for medical directors responsible for
providing health services.
411: J UOEH. 2006 Dec 1;28(4):431-8.

[The preparatory education of electronic patient record for nursing

students before practical nursing training]
Nagamatsu Y, Kanayama M, Yoshioka M, Anan A, Takeyama Y, Kubo Y,

Shibata H, Kawamoto R.
Department of Clinical Nursing, School of Health Sciences, University of

Occupational and Environmental Health, Yahatanisi-ku, Kitakyusyu 807-8555,
Japan.
Preparatory education has been provided for both nursing students and teachers to
understand the electronic patient record (EPR) since 2004 when EPR was
introduced to the hospitals where students are allocated to undertake their work
experience. First, the training and management board contacted our medical
information department for an appointment and sent us a working group. They
taught the nursing training staff how to use EPR and how to assign students to the
proper patient record in the EPR system. Second, as preparatory education for the
students, they explained the procedure for the use of EPR and the protection of
personal information. Students practiced with training in the EPR system,
focusing on the functions which are used frequently in practical tasks. As a result
of this preparatory education, students understood the protection of personal
information very well, although their understanding of the operation and
management of the equipment was relatively poor and adversely affected their
practice. We need to review our education contents more often. We also need to
examine the present state of understanding of EPR and the problems of teaching
in practical nursing training.
Publication Types:
412: Ying Yong Sheng Tai Xue Bao. 2006 Oct;17(10):1918-22.

[Urban greenbelt eco-service value of Hangzhou City under effects
of land use change: an evaluation with CITYgreen model]
[Article in Chinese]
Zhang K, Zhang J, Chen Y, Zhu Y.
College of Environment and Resource Sciences, Zhejiang University, Hangzhou,

China. zk1130@gmail.com
Based on the Landset TM information of land use/cover change and greenbelt

distribution in Hangzhou city in 1994 and 2004, and by using CITYgreen model,
this paper estimated the eco-service value of urban greenbelt in the city under the
effects of land use change and economic development. The results showed that in
the 10 years from 1994 to 2004, the greenbelt area in the city decreased by 20. 4%
, while its eco-service value increased by 168 million yuan. The annual increment
of greenbelt eco-service value and GDP was 111.92% and 5. 32% , respectively.
Suitable adjustment of land use pattern in the city harmonized the relationships
between urban economic development and urban eco-function, and achieved
higher eco-service efficiency of land utilization.
Publication Types:
413: Trop Med Int Health. 2007 Jan;12(1):25-36.

Trial participation and vaccine desirability for Vi polysaccharide

typhoid fever vaccine in Hue City, Viet Nam.
Kaljee LM, Pham V, Son ND, Hoa NT, Thiem VD, Canh do G, Thoa le TK,
Ali M, Ochiai RL, Danovaro-Holliday MC, Acosta CJ, Stanton B, Clemens J.
Department of Pediatrics, School of Medicine, University of Maryland, Baltimore

MD, USA. lkaljee@peds.umaryland.edu
OBJECTIVES: To identify demand for Vi typhoid fever vaccine for school-age

children; obstacles and enabling factors for vaccine delivery; and socio-
behavioural factors associated with trial participation and possible predictors of
future vaccine acceptance, in Hue City, Viet Nam. METHODS: Pre- and post-trial
surveys of randomly selected households with children aged 6-17 years. Simple
multinomial logistic analyses for ratios of relative risks (RRR) and significance
on trial participation by demographics and variables related to typhoid fever,
vaccination, and pre-trial experiences with information and consents. Multiple
logistic regressions to assess differences in participation based on child's
characteristics. RESULTS: As many as 62.6% of households let all school age
children participate, 10.2% let some participate, and 26.8% let none of their
children participate in the trial. Factors associated with all children participating
included past use of healthcare facilities (RRR, 0.45; 95% CI, 0.24-0.83),
knowledge of vaccines (RRR, 0.17; 95% CI, 0.03-0.86), and perceived causes of
typhoid fever (RRR, 0.90; 95% CI, 0.81-0.99). Factors associated with some
children participating included utilization of healthcare facilities (RRR, 0.08; 95%
CI, 0.01-0.66) and perceived severity of typhoid fever (RRR, 0.64; 95% CI 0.46-
0.88). Participation was associated with satisfaction regarding pre-vaccination
information and consent procedures. Children and adolescents were active
decision-makers. Only 14 of 461 (2.2%) respondents would not use the Vi
vaccine in the future for their child(ren). CONCLUSIONS: Inter-related factors
contribute to participation in a clinical vaccine trial, which may differ from desire
to participate in a public health campaign. Educational campaigns need to be
targeted to children and adolescents, and consideration for assent procedures for
minors. Obtaining informed consent may affect trial participation within a social
and political system unaccustomed to these procedures.
Publication Types:
414: Health Policy. 2007 Sep;83(1):73-83. Epub 2007 Jan 3.

Reorienting Health Ministry roles in transition settings: capacity

and strategy gaps.
Fritzen SA.
LKY School of Public Policy, National University of Singapore, Singapore.

fritzen@nus.edu.sg
Health authorities in developing countries must often cope with rapid changes in
the administrative, policy and socioeconomic contexts in which they work.
Changes in this external environment have important implications for the roles
that health planners can effectively play and the leverage they exercise throughout
the system. This paper examines the challenges associated with reorienting
ministry roles from administrative fiat to overall orchestration and strategic
steering, using health workforce management in transitional Vietnam as a
backdrop. Decentralization, commercialization of services and rising inequalities
have reduced the efficacy of the administrative controls and standardized strategy
on which Vietnam's Ministry of Health has traditionally relied. Reorientation, in
Vietnam and elsewhere, depends on bridging significant capacity and strategy
gaps, notably in the strengthening of information, planning and accountability
systems that respect both the limitations of central control and the diversity of
local conditions.
415: Indian J Public Health. 2006 Jan-Mar;50(1):24-7.

Geomatics and public health.
Jaishankar R, Jhonson CP.
Indian Institute of Information Technology and Management, Kerala,

Thiruvananthapuram. jrnair@iiitmk.ac.in
Geomatics technology has tremendous potential to address public health issues

particularly under the present circumstances of global climate change and climate
or technology induced human migration, which result in an increase in the
geographical extent and re-emergence of vector-borne diseases. The authors
present an overview of the science of geomatics, describe the potential impacts of
climate change on vector-borne diseases and review the applications of remote
sensing for disease vector surveillance.
Publication Types:
• Review
416: Diabetes Care. 2007 Jan;30(1):120-7.

Comment in:
• Diabetes Care. 2007 May;30(5):e40; author reply e41.
Minimum waist and visceral fat values for identifying Japanese

Americans at risk for the metabolic syndrome.
Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY.
Epidemiologic Research and Information Center, Veterans Affairs Puget Sound

Health Care System, Seattle, Washington, USA.
OBJECTIVE: Japanese American is an ethnic group with a high risk for type 2
diabetes, which is linked to the metabolic syndrome. Central adiposity is
considered to play a key role in the metabolic syndrome. Not known are the
optimal cut point values for central and visceral adiposity to identify Japanese
Americans at risk for the metabolic syndrome. RESEARCH DESIGN AND
METHODS: Study subjects included 639 Japanese Americans. The nonadipose
variables of the metabolic syndrome were defined using modified International
Diabetes Federation criteria, and the accuracy of identifying at least two of these
by intra-abdominal fat area (IAFA) as measured by computed tomography and
waist circumference was cross-sectionally assessed using area under receiver
operating characteristic (ROC) curves. The values for IAFA and waist
circumference that resulted in maximizing the Youden index were defined as
"optimal." RESULTS: The area under the ROC curve for IAFA exceeded that for
waist circumference (men 0.787 vs. 0.686; women 0.792 vs. 0.721). For women,
the optimal cut points for IAFA and waist circumference were 51.5 cm(2) and
80.8 cm (age < or = 56 years) and 86.3 cm(2) and 89.0 cm (age > 56 years). For
men, the optimal cut points for IAFA and waist circumference were 88.6 cm(2)
and 90.0 cm (age < or = 57 years) and 96.1 cm(2) and 87.1 cm (age > 57 years).
CONCLUSIONS: These results argue that current Japanese waist circumference
cut points for the metabolic syndrome need to be revised. Moreover, the waist
circumference and IAFA cut points should be age specific, especially in women.
Appropriate waist circumference cut points are from 80 to 90 cm in women and
from 87 to 90 cm in men.
Publication Types:

417: Int J Gynaecol Obstet. 2007 Jan;96(1):57-61. Epub 2006 Dec 21.
Cesarean births in Taiwan.
Hsu CY, Lo JC, Chang JH, Chen CP, Yu S, Huang FY.
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei,

Taiwan. hsu4426@ms4.hinet.net
OBJECTIVE: To evaluate the use of cesarean delivery in Taiwan by comparing

local clinical indications with those in international cohorts. METHODS: In-
patient claims from the National Health Insurance (NHI) in Taiwan were
analyzed. Indications for cesarean delivery were evaluated with primary diagnosis
codes and procedure codes from the NHI dataset. To produce a stable numerator
for cesarean section, 3 years (1998-2000) of claims for cesarean delivery were
abstracted and annualized. RESULTS: Rates ranged between 27.3% and 28.7%
for primary cesarean delivery and were below 5% for vaginal birth after a
cesarean section (VBAC). Compared with rates in other countries, rates for
overall and primary cesarean section as well as for VBAC were significantly
higher in medical centers in Taiwan (P<0.001). However, the clinics contributed
the most to the difference in both overall and primary cesarean rates. The most
common indication for cesarean section was prior cesarean section (43.3%-
45.5%), followed by malpresentation (19.6%-23.4%). The proportion of fetuses
with malpresentation delivered by cesarean section in Taiwan was 7.9%, almost
twice the upper limit expected for all pregnancies as indicated in international
studies. CONCLUSION: It is important to use appropriately documented data and
to compare them with international data when monitoring local obstetric
practices. The disproportionately high cesarean delivery rates in Taiwan may hold
major lessons for the many countries contemplating or having universal health
insurance coverage with a similar mix of providers.
418: Environ Health Perspect. 2006 Dec;114(12):1847-52.

Arsenic exposure and age and sex-specific risk for skin lesions: a
population-based case-referent study in Bangladesh.
Rahman M, Vahter M, Sohel N, Yunus M, Wahed MA, Streatfield PK,

Ekström EC, Persson LA.
ICDDR, B: Centre for Health and Population Research, Mohakha, Dhaka,

Bangladesh. mahfuzar@icddrb.org
BACKGROUND: The objective of this population-based case-referent study in
Matlab, Bangladesh, was to assess the susceptibility to arsenic-induced skin
lesions by age and sex, in a population drinking water from As-contaminated tube
wells. METHODS: Identification of As-related skin lesions was carried out in
three steps: a) screening of the entire population > 4 years of age (n = 166,934) by
trained field teams; b) diagnosis of suspected As-related cases by physicians; and
c) confirmation by experts based on physicians' records and photographs. A total
of 504 cases with skin lesions were confirmed. We randomly selected 2,201
referents from the Matlab health and demographic surveillance system; 1,955
were eligible, and 1,830 (94%) were available for participation in the study.
Individual history of As exposure was based on information obtained during
interviews and included all drinking-water sources used since 1970 and
concentrations of As (assessed by atomic absorption spectrophotometry) in all the
tube wells used. RESULTS: Cases had been exposed to As more than referents
(average exposure since 1970: male cases, 200 microg/L; female cases, 211
microg/L; male referents, 143 microg/L; female referents, 155 microg/L). We
found a dose-response relationship for both sexes (p < 0.001) and increased risk
with increasing socioeconomic status. Males had a higher risk of obtaining skin
lesions than females (odds ratio 10.9 vs. 5.78) in the highest average exposure
quintile (p = 0.005). Start of As exposure (cumulative exposure) before 1 year of
age was not associated with higher risk of obtaining skin lesions compared to start
of As exposure later in life. CONCLUSIONS: The results demonstrate that males
are more susceptible than females to develop skin lesions when exposed to As in
water from tube wells.
Publication Types:

PMCID: PMC1764143
419: J Nurs Scholarsh. 2006;38(4):352-7.

A cross-cultural analysis of dignified dying.
Doorenbos AZ, Wilson SA, Coenen A.
School of Nursing, University of Washington, Seattle, WA, USA.

doorenbo@u.washington.edu
PURPOSE: To describe the characteristics of dignified dying and other
terminology nurses used to describe this phenomenon in Ethiopia, India, Kenya,
and the United States (US). DESIGN: A cross-sectional descriptive survey with a
convenience sample of nurses who cared for dying patients in Ethiopia (n=14),
India (n=229), Kenya (n=36), and the US (n=281). Data were collected between
2002 and 2004. METHODS: Nurses were recruited to complete the ICNP
Dignified Dying survey, which consists of demographic information, 2 open-
ended questions, and 14 questions about characteristics of dignified dying.
FINDINGS: The 14 characteristics on the dignified dying scale reliably measured
dignified dying, with a Cronbach's alpha coefficient of .91. All characteristics
were rated as representative of dignified dying, with content validity scores
ranging from .62 to .77. Factor analysis yielded a two-factor solution, which
accounted for 53% of the variance. CONCLUSIONS: Findings of this study
contribute to the ongoing development of the International Classification of
Nursing Practice (ICNP) regarding the nursing phenomenon of dignified dying.
The ICNP a unified nursing language system, is used to promote and facilitate
scholarly exchange among nurses across countries.
Publication Types:
420: Health Policy Plan. 2007 Jan;22(1):49-59. Epub 2006 Dec 19.
The distribution of net benefits under the National Health Insurance

programme in Taiwan.
Huang N, Yip W, Chou YJ, Wang PJ.
Institute of Public Health, National Yang Ming University, Taipei, Taiwan.

wyip@hsph.harvard.edu
The redistributive effects of a social insurance programme are determined by how

the programme is paid for-who pays and how much do they pay?-and how the
benefits are distributed. As a result, the redistributive effects of a social health
insurance programme should be evaluated on the basis of its net benefit-the
difference between benefits and payment. Among the rich body of empirical
analysis on equity in health care financing, however, most studies have relied on
partial analysis, assessing equity by source of financing while ignoring the benefit
side, or looking at equity in benefits but ignoring the funding side. Either
approach risks misleading findings. In this study, therefore, the primary objective
was to assess the distribution of net benefits across income groups under Taiwan's
National Health Insurance (NHI) programme. This study observed a nationally
representative sample of 74 012 NHI enrolees from 1996 to 2000. The unique
NHI databases in Taiwan provide comprehensive enrolment and utilization
information, and allowed linkage to each enrolee's income tax files. In addition to
crude estimates, two-part models and ordinary least-square models were used to
adjust inpatient and outpatient benefits for health care needs (age, sex, major
disease status and physical disability). After adjusting for health care needs, the
distribution of net benefits showed an apparent pro-poor pattern, with the lowest
income group receiving the highest net benefits (NT$3353) and the top income
group receiving the lowest net benefits (-NT$3072) in 1996. Although a clear pro-
poor pattern was observed among those enrolees who paid wage-based premiums,
this vertically equitable pattern was less evident among the enrolees who paid
fixed premiums. Overall, a trend of increasing net benefits was observed in all
income groups between 1996 and 2000, and all the NHI enrolees can be
considered better off over time. In addition to contributing to the limited literature
on equity in net benefits, the study provides an important policy reference to
developing countries with large underground economies and relatively small
populations of regular wage-earners as it indicates that using fixed premiums as a
major financing scheme may pose a serious equity concern and policy challenge.
Publication Types:
421: Am J Prev Med. 2006 Dec;31(6 Suppl 2):S240-2.

International experience in stroke registry: Japanese Stroke

Databank.
Kobayashi S; Japan Stroke Scale Registry Study Group.
Shimane University, School of Medicine, Shimane, Japan.

skdr3nai@med.shimane-u.ac.jp
422: J Water Health. 2006 Dec;4(4):463-77.

Rural communities' preferences for arsenic mitigation options in
Bangladesh.
Ahmad J, Goldar B, Misra S.
The World Bank, 1818 H. St. NW, Washington DC, 20433, USA.
In the context of arsenic contamination of groundwater in Bangladesh, this paper

analyses rural people's preferences for arsenic-free drinking water options. A
particular focus is on rural households' willingness to pay for piped water supply
which can provide a sustainable solution to the arsenic problem, and how the
preference for piped water supply compares with that for various other
household/community-based arsenic mitigation technologies. The analysis is
based on data collected in a survey of over 2700 households in rural Bangladesh.
Six arsenic mitigation technologies were selected for the study: three-kolshi
(pitcher) method, activated alumina method (household-based and community-
based), dugwell, pond sand filter and deep tubewell (handpump). The survey
results indicate that, after taking into consideration the initial and recurring costs,
convenience, associated risks and the advantages and disadvantages of each
selected technology, the preference of the rural people is overwhelmingly in favor
of deep tubewells, followed by the three-kolshi method. The analysis reveals a
strong demand for piped water in both arsenic-affected and arsenic-free rural
areas, and scope of adequate cost recovery. Between piped water and other
arsenic mitigation technologies, the preference of the rural people is found to be
predominantly in favor of the former.
Publication Types:
423: Am J Trop Med Hyg. 2006 Dec;75(6):1223-31.

Urban farming and malaria risk factors in a medium-sized town in

Cote d'Ivoire.
Matthys B, Vounatsou P, Raso G, Tschannen AB, Becket EG, Gosoniu L,

Cissé G, Tanner M, N'goran EK, Utzinger J.
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel,

Switzerland.
Urbanization occurs at a rapid pace across Africa and Asia and affects people's
health and well-being. A typical feature in urban settings of Africa is the
maintenance of traditional livelihoods, including agriculture. The purpose of this
study was to investigate malaria risk factors in urban farming communities in a
medium-sized town in Côte d'Ivoire. Two cross-sectional surveys were carried out
among 112 households from six agricultural zones. First, the heads of households
were interviewed on agricultural land use, farming practices, water storage,
sanitation facilities, and socioeconomic status. Second, a finger prick blood
sample was taken from all household members and examined for the occurrence
and density of Plasmodia. Geographic coordinates of houses, farming plots, and
potential mosquito breeding sites were recorded and integrated into a geographic
information system. Predictors of Plasmodium falciparum parasitemia were
assessed using non-random and random effects Bayesian regression models. The
overall prevalence of P. falciparum was 32.1%. In children < 15 years of age, risk
factors for a P. falciparum infection included living in a specific agricultural zone,
close proximity to permanent ponds and fish ponds, periodic stays overnight in
temporary farm huts, and low socioeconomic status. Our findings indicate that
specific crop systems and specific agricultural practices may increase the risk of
malaria in urban settings of tropical Africa.
Publication Types:
424: Lepr Rev. 2006 Sep;77(3):210-8.

Leprosy control activities in India: integration into general health

system.
Pandey A, Patel R, Uddin MJ.
Regional Leprosy Training and Research Institute, Lalpur, Raipur, Chhattisgarh,

India. rltri@sify.com
Integration of leprosy control into the general health system is an essential

element of a leprosy elimination strategy. In India, the process has been
undertaken with the assistance of World Bank in a phased manner. In the first
phase (2001-2002), 24 low/moderately endemic provinces for leprosy were
targeted. Operational research was undertaken in these low/moderate endemic
provinces to assess the progress of integration of leprosy control in general health
system using defined categories, viz. structural integration, training status,
availability of MDT and recording/reporting of cases. Selection of nine provinces,
18 districts, 86 health facilities and 108 sub-centres was performed using
multistage stratified random sampling technique. Data were collected by
interviewing GHS/vertical staff, scrutiny of records and spot checking of MDT
stock by Health officers of three leprosy institutions of the Government of India.
The result showed that district leprosy nuclei had formed in 16 of 18 districts. In
56% of health facilities vertical staff were redeployed for delivering general
health care. Forty-five percent of medical officers, 71% of health supervisors and
75% of multipurpose workers were trained in leprosy. MDT treatment was
available in >80% of health facilities. In only 2% of health facilities 3 months
MDT stock of all types was present. Forty-four percent of sub-centres were
delivering subsequent doses (second dose onward) of MDT. Reporting through a
simplified information system was universal. This study emphasizes the need for
reorientation training of Medical Officers, better MDT stock management and
decentralized management of cases up to sub-centre level.
Publication Types:
• Multicenter Study
425: Environ Monit Assess. 2007 Aug;131(1-3):163-76. Epub 2006 Dec 14.
The valuation of health effects caused by stationary sources-related

SO2 emissions: the adaptation of impact pathway approach in
Taiwan.
Lin SL, Lin KH.
Department of Environmental Engineering and Management, Chaoyang

University of Technology, 168 Gifeng E. Rd., Taichung County, Taiwan, Taiwan,
413, Republic of China. sllin@cyut.edu.tw
This paper presents the externalities of sulfur dioxide (SO(2)) in the Taichung
metropolitan, Taiwan. The human effects of SO(2) from stationary sources are a
key element for local air quality management. A methodology to evaluate those
effects in monetary term had been adapted and applied. This method was
modified from the EU-based impact pathway approach link to the skill of
geographic information systems. The studied area was divided into 66 districts
and the quantity of SO(2) was allocated to each district. Then, the ambient
concentration of SO(2) was estimated by using the ordinary kriging method. A
risk analysis was employed to characterize the health impacts caused by SO(2).
Finally, a monetary transfer approach based on the European data was conducted
to estimate local damage costs per ton of SO(2). Health impacts, especially acute
mortality, dominate in term of costs. The calculation showed that damage costs
ranged from 0.56 to 7.38 USD/kg SO(2) based on the 2002 emission data. The
results could be used in the internalization of SO(2) externalities and management
of the stationary sources in the studied area. This paper also concludes that the
externalities caused by stationary-related SO(2) emissions are some 28.5 million
US dollars in Taichung metropolitan (Taiwan) in 2002.
Publication Types:
426: J Prev Med Pub Health. 2006 Nov;39(6):499-504.

[The socioeconomic cost of diseases in Korea]
[Article in Korean]
Jung YH, Ko S.
Korea Institute for Health and Social Affairs. yhjung@kihasa.re.kr
OBJECTIVES: The aim of the study was to estimate the annual socioeconomic
cost of diseases in Korea. METHODS: We estimate both the direct and indirect
costs of diseases in Korea during 2003 using a prevalence-based approach. The
direct cost estimates included medical expenditures, traffic costs and caregiver's
cost, and the indirect costs, representing the loss of production, included lost
workdays due to illness and lost earnings due to premature death, which were
estimated based on the human capital theory. The cost estimates were reported at
three different discount rates (0, 3 and 5%). RESULTS: The cost of diseases in
Korea during 2003 was 38.4 trillion won based on 0% discount rate. This estimate
represents approximately 5.3% of GDP. The direct and indirect costs were
estimated to be 22.5 trillion (58.5% of total cost) and 15.9 trillion won (41.5%),
respectively. It was also found that the cost for those aged 40-49 accounted for the
largest proportion (21.7%) in relation to age groups. The cost of diseases for
males was 23.5% higher than that for females. For major diseases, the total
socioeconomic costs were 16.0, 13.4, 11.3 and 11.19% for neoplasms, and
diseases of the digestive, respiratory and circulatory systems, respectively.
CONCLUSIONS: This study can be expected to provide valuable information for
determining intervention and funding priorities, and for planning health policies.
Publication Types:
427: Hu Li Za Zhi. 2006 Dec;53(6):5-13.

[The strategy and prospects of suicide prevention in Taiwan]
Lee MB, Tai CW, Liao SC, Chiang HC.
Natonal Taiwan Suicide Prevention Center, Taiwan, ROC. mingbeen@ntumc.org
Suicide mortality rates have been steadily rising in Taiwan, and suicide has been
among the top ten causes of death for the last consecutive eight years. In response
to this situation, the Taiwan Department of Health assigned the Taiwan
Association Against Depression the task of setting up the Taiwan Suicide
Prevention Center. The mission of the Center, suicide prevention, is advanced by
its establishment of efficient networks nationwide capable of delivering related
care services. Suicide prevention strategies can be categorized, based on
coverage, as universal, selective or indicated interventions. The Center also plans
to standardize the national suicide report format and care delivery system,
improve mental health service quality, and organize community support networks.
It pursues an encompassing health care mechanism model, where clients are
considered the first priority, the family a fundamental supporting unit, and the
community a solid foundation. The Center will offer a helping hand for
individuals who have attempted suicide by maintaining a spirit of positive values
and achieving mutual benefits.
Publication Types:
428: Nippon Rinsho. 2006 Dec;64(12):2194-200.

[Epidemiology of Basedow disease and other thyroid diseases]
Ashizawa K.
Department of Clinical Studies, Radiation Effects Research Foundation.
Basedow disease is one of several representative thyroid diseases. According to

information from Japan's Ministry of Health, Labour and Welfare, it is estimated
that there were a total of about 130,000 patients (32,000 male 98,000 female, sex
ratio of 1 : 3) of thyrotoxicosis in Japan during 2002. This number accounts for
about 0.1% of the entire population of Japan. Several reports based on data from
medical examinations provide higher prevalence rates. A survey of subclinical
thyroid diseases is now in progress. There are reports of cases of progression from
subclinical status to overt status, which suggests that the number of affected
individuals becomes higher. Epidemiological data are still insufficient. Disease
registry systems and medical examination data should be further improved.
Publication Types:
• Review
429: Kekkaku. 2006 Nov;81(11):693-707.

[New era in molecular epidemiology of tuberculosis in Japan]
Takashima T, Iwamoto T.
Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for

Respiratory and Allergic Diseases.
Molecular epidemiology of tuberculosis (TB) is a science to study TB

transmission dynamics and to enhance our understanding of the epidemiology of
TB by utilizing molecular typing methods as an adjunct to classical
epidemiological approach. Before the era of molecular epidemiology, it was quite
difficult to ascertain the source of the infections since M. tuberculosis is spread by
air-borne droplets of respiratory secretions expelled by an infectious person to a
susceptible host and it can remain latent as an asymptomatic infection for years.
Now a day, our understanding of TB transmission dynamics has been refined by
genotyping of M. tuberculosis strains. The methods of molecular epidemiology,
especially IS6110 RFLP of M. tuberculosis, were first introduced to outbreak
investigations and then gradually been expanded its application to population-
based study in Japan. IS6110 RFLP is obviously a powerful tool for strain
differentiation of M. tuberculosis but its labor-intensiveness limits the achievable
throughput and makes it less useful for long-term prospective studies. Recently,
apart from IS6110 RFLP, DNA amplification-based method, i.e., variable number
of tandem repeats (VNTR) has appeared as a substitute for or adjunct to the
IS6110 RFLP. In this symposium, we have invited four opinion leaders in
molecular epidemiology of TB from different fields: Mycobacterium reference
center, basic science, clinical practice, and public health practice. We, as the
chairpersons of this symposium, hope that this symposium would trigger the
development of molecular epidemiological network of TB in Japan. 1.
Achievement and problem of molecular epidemiologic study with IS6110-RFLP
analyses of tuberculosis in Okinawa: Shinji MAEDA (Mycobacterium Reference
Center, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis
Association) The long-term RFLP analyses of tuberculosis in Okinawa showed
that endemic M. tuberculosis might be present. This is one of the achievements of
our project study. On the other hand, for more effective examination of contact
persons, information of molecular epidemiology should be used actively.
Therefore because the analysis report needs to be sent back quickly, the PCR-
based VNTR method should substitute for the RFLP analysis. 2. Basic knowledge
and application of Variable Numbers of Tandem Repeats: Kei NISHIMORI
(Department of epidemiology, National Institute of Animal Health) Genomic loci
of Variable Numbers of Tandem Repeats (VNTR loci) in Mycobacterium
tuberculosis complex and Mycobacterium avium, the history of analysis of VNTR
loci, the hypothetical mechanisms of increase or decrease of number of repeats,
the structures of the loci, and the necessity of standardizing the VNTR typing
were introduced. 3. Clinical application of VNTR: Tomoshige MATSUMOTO,
and Hiromi ANO (Department of Clinical Research and Development, Osaka
Prefectural Hospital Organization Osaka Prefectural Medical Center for
Respiratory and Allergic Diseases) Tuberculosis genotyping was first introduced
to outbreak investigations and population-based studies. The advent of Variable
Numbers of Tandem Repeats (VNTR) can be applied to clinical fields of not only
Mycobacterium tuberculosis but also of Mycobacterium avium. In Osaka
Prefectural Medical Center for Respiratory and Allergic Diseases, clinical
application of VNTR was first introduced in Japan to determine whether
Mycobacterium tuberculosis or avium disease was caused by reactivation or
reinfection when relapsed. We showed some examples about usefulness of the
clinical application of VNTR. 4. Molecular epidemiology of tuberculosis to
improve TB prevention and control activities: Tomotada IWAMOTO
(Department of microbiology, Kobe Institute of Health), Riyo FUJIYAMA,
Noriko TANAKA, Yasuto KAWAKAMI (Kobe City Public Health Center),
Chika SHIRAI (Hyogo-ku Health and Welfare Department, Kobe) M.
tuberculosis isolates in Kobe have been characterized as: a) Beijing family strains
are highly prevalent (77%), b) two major MIRU profiles in Beijing family were
found, one is globally pandemic genotype and the other is locally prevalent
strains, c) six strains belonged to T3-Osaka family, and d) Manila family strains
made cluster consisting of 3 strains. Kobe VNTR Database which consists of 12-
loci MIRU and 9 additional VNTR loci has been developed. The basis for the
selection of these supplemental 9 VNTR loci and the application of VNTR
database in TB control program were introduced.
Publication Types:
• Review
430: Ann Saudi Med. 2006 Nov-Dec;26(6):429-32.

Erratum in:
• Ann Saudi Med. 2007 Jan-Feb;27(1):54.
Towards evidence-based medical education in Saudi medical

schools.
AlFaris E, Abdulgader A, Alkhenizan A.
Department of Family and Community Medicine, College of Medicine, King

Saud University, Riyadh, Saudi Arabia. eiad@ksu.edu.sa
(EBME) [corrected] is an attitude of mind that entails the creation of a culture in

which teachers think critically about what they are doing, look at the best
evidence available and on this basis, make decisions about their teaching practice,
and subsequently, undertake the necessary revision and change. More medical
schools have opened in Saudi Arabia in the last few years than have existed over
the last three decades. Currently, the education of health professionals is based on
assumption and traditions and rarely on research findings. Medical teaching has
evolved from being opinion-based to evidence-based and the art of teaching is
rapidly becoming the 'science' of teaching. The need for evidence in our teaching
and medical education practices is as important as it is in assessing a new therapy.
This approach to education is not only associated with better results in terms of
better learning, from the side of the students (the consumers), but also has a wider
impact on patient care and the community. Moreover, in this age of
accountability, litigations and quality assurance, the need for BEME becomes
greater. Some suggestions to implement BEME in Saudi Arabia have been put
forward and these are the training of medical education professionals in the use
the existing information systems, and disseminating information through the
creation of a BEME journal (secondary publication) that publishes a critically
appraised summary of medical education articles that are both valid and of
immediate clinical use.
431: Chronic Illn. 2005 Jun;1(2):165-77.

Evidence of cultural hybridity in responses to epilepsy among

Pakistani muslims living in the UK.
Small N, Ismail H, Rhodes P, Wright J.
School of Health Studies, University of Bradford, 25 Trinity Road, Bradford BD5

0BB, UK. N.A.Small@bradford.ac.uk
OBJECTIVES: To examine how people from Bradford's Pakistani Muslim

community experience living with epilepsy. Specifically, the paper addresses
social interactions and negotiations with care providers and considers how
different understandings of epilepsy are integrated. METHODS: Interviews were
conducted with a sample of Bradford's Pakistani Muslim community (n = 20).
Interviews were analysed to identify themes and significant areas of shared
concern. RESULTS: This paper identifies popular, professional and folk sectors
contributing to an individual's 'health system'. Where sectors overlap, zones of
hybridity are created: that is, a person might simultaneously seek help from a
doctor and from a religious healer, or might offer explanations for seizures that
include neurological and spiritual components. DISCUSSION: While there are
many similarities between the experiences of these minority ethnic community
members and published work on the lived experience of epilepsy in other
communities, there are also important differences that service providers need to
recognize and respond to. Differences include forms of cultural expression and
specific language needs. Improving communication between professionals and
persons with epilepsy needs to be prioritized.
Publication Types:

432: Ann N Y Acad Sci. 2006 Oct;1081:17-29.

Perspectives on applied spatial analysis to animal health: a case of

rodents in Thailand.
Herbreteau V, Demoraes F, Hugot JP, Kittayapong P, Salem G, Souris M,

Gonzalez JP.
Center for Vectors and Vector-borne Diseases, Faculty of Sciences, Mahidol

University, Thanon Rama VI, Phyathai, Bangkok 10400, Thailand.
Vincent.Herbreteau@ird.fr
Geographic information systems (GIS) and remote sensing have been increasingly
used in ecology and epidemiology, providing a spatial approach for animal health
issues. Recent development of earth environmental satellites--i.e., their growing
number, improving sensor resolutions and capabilities--has offered new
opportunities to delineate possible habitats and understand animals and associated
parasites in their environment, by identifying the nature and structure of land use,
hydrological network, soil hydromorphy, and human settlements. Integrated into
GIS, remotely sensed and other geo-referenced data allow both spatial and
temporal analyses of animal ecology and health. However, a review of their
applications has showed the poor quality of data sources and processing used,
revealing limitations between theory and practical implementations. As an
example, the assessment of the expected distribution of Bandicoot rats, main
agricultural pest and vector of zoonoses in Phrae province (North Thailand),
illustrates a rational use of spatial analysis, with the choice of relevant data,
scales, and processing. Vegetation indices are computed on a TERRA ASTER
image and further classified using elevation data. The biotopes of Bandicota
indica and Bandicota savilei are delimited, providing a major source of
knowledge for rodent and human health analyses.
Publication Types:
433: Chudoku Kenkyu. 2006 Oct;19(4):423-8.

[Health hazard cases caused by powder fire extinguishers reported
to Japan Poison Information Center]
Yayoi H.
Publication Types:
• News
434: Drug Alcohol Rev. 2006 Nov;25(6):625-32.

Civil society-a leader in HIV prevention and tobacco control.
Malinowska-Sempruch K, Bonnell R, Hoover J.
International Harm Reduction Development Program (IHRD), Open Society

Institute, New York 10019, USA. kmalinowska@sorosny.org
Many civil society organisations (CSOs) have been at the forefront of identifying
new ideas and implementing innovative models regarding health and health
systems around the world. Their activities become highly charged, however, when
they engage in advocacy efforts designed to influence change in policies and
systems linked with more controversial or complicated public health issues.
Policies, laws and regulations regarding illicit drugs and tobacco fall directly into
that category. There is no doubt that the use of both kinds of substances can have
the same health consequences-including ill health and death-yet they are
approached in widely different ways. Smoking is legal to some extent in every
country in the world, and is generally considered a matter of personal choice.
Many people believe that efforts to limit tobacco use are coercive and impede on
individual rights. Those who use illicit drugs such as heroin, meanwhile, are with
few exceptions considered social deviants, misfits and lawbreakers. Many CSOs
support comprehensive, government-funded prevention strategies coupled with
non-punitive, non-judgmental programmes designed to help users change
behaviour. Such strategies are designed to reflect and respond to the medically
addictive nature of both tobacco and many illegal drugs. Proponents argue that
not only are the public health benefits of expansive, well-conceived interventions
potentially vast, but so too are the social and economic benefits accruing from
lower rates of debilitating disease and premature death. To that end, many
international, national and local CSOs are identifying the direct and indirect
health consequences of tobacco and illegal drug use; proposing and advocating
for strategies to limit their impact; and sharing information and resources with
like-minded organisations elsewhere. This leadership role has helped influence
and shape policy, especially in recent years. This paper examines civil society's
involvement in efforts to change drug and tobacco policy in selected countries in
Central and Eastern Europe and the former Soviet Union (CEE/FSU). It concludes
that in Poland and Kazakhstan, in terms of tobacco control, and increasingly in
Ukraine and parts of Central Asia in terms of harm reduction, multi-sectoral
approaches are the most effective way to engage citizens and to implement
comprehensive strategies to change behaviour by supportive measures, not
punitive ones.
Publication Types:
• Review
435: Br J Gen Pract. 2006 Nov;56(532):869-75.

Communication between South Asian patients and GPs:

comparative study using the Roter Interactional Analysis System.
Neal RD, Ali N, Atkin K, Allgar VL, Ali S, Coleman T.
Department of General Practice, Cardiff University. nealrd@cf.ac.uk
BACKGROUND: The UK South Asian population has poorer health outcomes.

Little is known about their process of care in general practice, or in particular the
process of communication with GPs. AIM: To compare the ways in which white
and South Asian patients communicate with white GPs. DESIGN OF STUDY:
Observational study of video-recorded consultations using the Roter Interactional
Analysis System (RIAS). SETTING: West Yorkshire, UK. METHOD: One
hundred and eighty-three consultations with 11 GPs in West Yorkshire, UK were
video-recorded and analysed. RESULTS: Main outcome measures were
consultation length, verbal domination, 16 individual abridged RIAS categories,
and three composite RIAS categories; with comparisons between white patients,
South Asian patients fluent in English and South Asian patients nonfluent in
English. South Asians fluent in English had the shortest consultations and South
Asians non-fluent in English the longest consultations (one-way ANOVA F =
7.173, P = 0.001). There were no significant differences in verbal domination
scores between the three groups. White patients had more affective (emotional)
consultations than South Asian patients, and played a more active role in their
consultations, as did their GPs. GPs spent less time giving information to South
Asian patients who were not fluent in English and more time asking questions.
GPs spent less time giving information to South Asian patients fluent in English
compared with white patients. CONCLUSIONS: These findings were expected
between patients fluent and non-fluent in English but do demonstrate their nature.
The differences between white patients and South Asian patients fluent in English
warrant further explanation. How much of this was due to systematic differences
in behaviour by the GPs, or was in response to patients' differing needs and
expectations is unknown. These differences may contribute to differences in
health outcomes.
Publication Types:
PMCID: PMC1927096
436: Int J Tuberc Lung Dis. 2006 Nov;10(11):1241-7.

An Internet-based surveillance system for tuberculosis in Korea.
Lew WJ, Lee EG, Bai JY, Kim HJ, Bai GH, Ahn DI, Lee JK, Kim SJ.
Korean Institute of Tuberculosis, Korean National Tuberculosis Association,

Seoul, Korea. wjlew@hanmail.net
SETTING: The Korea Tuberculosis Surveillance (KTBS) network includes 248

health centres throughout the country, as well as other public and private health
institutions. OBJECTIVE: To develop a web-based surveillance system for
tuberculosis (TB) and to monitor implementation of the National TB Control
Programme (NTP) on an ongoing basis. DESIGN: A TB notification form was
developed with new case definitions, and standardised to obtain uniform essential
information of the cases with ease and speed. Data collection, compilation,
analysis and feedback were made available at every level of the health authority
via the Internet without restrictions of time and space. RESULTS: The Internet-
based surveillance system was successfully implemented across the country,
providing real-time national figures of TB using different variables-patient, time,
area, site and type of disease--and facilitating on-line evaluation of NTP
implementation. CONCLUSION: The web-based surveillance system has been
well established within the existing health infrastructure, providing real-time
figures on the TB burden. However, it requires continued improvement of the
quality of information and of case reporting activities.
Publication Types:
437: Psychol Health Med. 2006 Aug;11(3):367-73.

Interventions to address the stigma associated with leprosy: a

perspective on the issues.
Cross H.
ALM Prevention of Disability Consultant, Ayala Center, Cebu City, Philippines.

hacross@pldtdsl.net
This paper presents a perspective on stigma as an effect of leprosy. It identifies

some of the strengths and weaknesses of current approaches to stigma reduction
in leprosy and presents a rationale for considering alternative strategies. It is
suggested that models used to explain health behavior in developed societies are
inappropriate for explaining leprosy stigma or for developing strategies to address
it. The author recommends due consideration of the alternative logic that
characterizes cultural belief systems in countries where leprosy is a challenge.
Criticism of the common practice of information dissemination as a strategy to
address leprosy stigma is defended and the merits and limitations of an integrated
health service in India is discussed. The author defends the suggestion that the
principal objective of stigma interventions should be "normalization". An
example of a Nepalese project based on empowerment theory is given to
demonstrate how the transformation of identity from outcast to positive change
agent, can effect "normalization".
438: Acta Paediatr. 2006 Dec;95(12):1561-6.

Comparative analysis of neonatal morbidity for vaginal and
caesarean section deliveries using hospital charge.
Chang JH, Hsu CY, Lo JC, Chen CP, Huang FY, Yu S.
Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
AIM: To assess the neonatal morbidity of alternative modes of delivery using

economic data. METHODS: Two groups of neonatal morbidity data were
extracted according to mode of delivery from inpatient claims on National Health
Insurance in Taiwan: uncomplicated vaginal and caesarean section deliveries.
Outcome variables included number of infants treated as inpatients, duration of
hospital stay, and hospital charge during both the first month and the first year of
age. RESULTS: Uncomplicated caesarean section delivery of term infants carried
a significant increase either in the first month of life or during the first year after
birth in both duration of hospital stay and hospital discharge when compared with
uncomplicated vaginal delivery. Neonatal jaundice accounted for the greatest
morbidity among term newborns, irrespective of delivery mode, followed by
infectious, gastrointestinal and respiratory morbidity. Logistic regression analysis
demonstrated that uncomplicated vaginal delivery was associated with skin
diseases. Uncomplicated caesarean section delivery was associated with
infectious disease and disease of the respiratory, digestive and circulatory
systems. CONCLUSION: The findings of this study may provide further
information for clinicians and would be an important consideration when advising
pregnant women on the preferred route of delivery.
Publication Types:
439: Int J Qual Health Care. 2007 Feb;19(1):21-8. Epub 2006 Nov 23.
Development and implementation of a nationwide health care

quality indicator system in Taiwan.
Chiu WT, Yang CM, Lin HW, Chu TB.
Taipei Medical University School of Healthcare Administration, No. 250, Wu-

Hsing Street, Taipei 110, Taiwan.
QUALITY ISSUES: Quality is an increasingly important issue to the health care
sector. The Taiwanese government also recognizes the need to implement a
nationwide health care quality indicator system to strengthen quality surveillance.
CHOICE OF SOLUTION: In 1999, the Department of Health funded a 2-year
project led by the Taiwan Healthcare Executive College to develop a
comprehensive performance assessment system, subsequently named as Taiwan
Healthcare Indicator Series (THIS). The series includes four categories of
indicators, namely outpatient, in-patient, emergency care, and intensive care, and
has 139 items in total. IMPLEMENTATION: The system was officially launched
in 2001. Participation is voluntary. The Taiwan Healthcare Executive College
processes the data and provides feedback to the participating hospitals. The
information is for the participating hospitals' own use and is not released to the
public. EVALUATION: Participating hospitals have increased from 45 in 2001 to
227 in 2006 and now constitute approximately 50% of the total hospital
population in Taiwan. The reporting rate averaged 77.7% in 2004. The first five
most reported indicators are the percentage of first-visit outpatients to outpatient
clinics, the average length of in-patient stay, the nosocomial infection rate, the
occupancy rate, and the crude mortality rate. LESSONS LEARNED: How the
data are interpreted and how data interpretation can lead to quality improvement
are the principal concerns of participating hospitals. In light of the success of the
indicator series, the Bureau of National Health Insurance (BNHI) of Taiwan has
proposed participation in the series as being one of the criteria to be reimbursed
for quality.
440: Ann Surg. 2006 Dec;244(6):1018-23.

Suicide bombers form a new injury profile.
Aharonson-Daniel L, Klein Y, Peleg K; ITG.
Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer,
Israel. limorad@gertner.health.gov.il
BACKGROUND: Recent explosions of suicide bombers introduced new and

unique profiles of injury. Explosives frequently included small metal parts,
increasing severity of injuries, challenging both physicians and healthcare
systems. Timely detonation in crowded and confined spaces further increased
explosion effect. METHODS: Israel National Trauma Registry data on
hospitalized terror casualties between October 1, 2000 and December 31, 2004
were analyzed. RESULTS: A total of 1155 patients injured by explosion were
studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe
injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has
changed as metal parts contained in bombs penetrate the human body with great
force and may result in tiny entry wounds easily concealed by hair, clothes etc. A
total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning,
and 53.2% had an x-ray in the emergency department. From the emergency
department, 28.3% went directly to the operating room, 10.1% to the intensive
care unit, and 58.4% directly to the ward. Injuries were mostly internal, open
wounds, and burns, with an excess of injuries to nerves and to blood vessels
compared with other trauma mechanisms. A high rate of surgical procedures was
recorded, including thoracotomies, laparotomies, craniotomies, and vascular
surgery. In certain cases, there were simultaneous multiple injuries that required
competing forms of treatment, such as burns and blast lung. CONCLUSIONS:
Bombs containing metal fragments detonated by suicide bombers in crowded
locations change patterns and severity of injury in a civil population. Specific
injuries will require tailored approaches, an open mind, and close collaboration
and cooperation between trauma surgeons to share experience, opinions, and
ideas. Findings presented have implications for triage, diagnosis, treatment,
hospital organization, and the definition of surge capacity.
PMCID: PMC1856624
441: Can J Public Health. 2006 Sep-Oct;97(5):398-401.

The three networks framework to deal with public health

emergencies in Guangxi, China.
Wen-kui G, Jia-tong Z, De-cheng L, Yan-xia H, Lin H, Hui W, Xiao-lan T.
Public Health College, Guangxi Medical University, Guangxi Zhuang

Autonomous Region, China.
OBJECTIVE: To improve the detection and control of infectious diseases in

Guangxi, China. SETTING/PARTICIPANTS: Guangxi province in southwest
China has almost 50 million people, of whom approximately 30% reside in urban
and 70% in rural areas. There are 12 minority nationality groups living in the
region. INTERVENTION: A village doctor reports any infectious disease
outbreak to the Reporting Network, which notifies the Service Network to
organize the clinical response. This is supported by the Government Network that
coordinates the response among the multiple layers of local governments.
OUTCOMES: Since 2002 when the Three Networks system was first started, the
time from incidence to report has been shortened on average from 30.6 to 7.6 days
and the number of cases has increased from slightly less than 5000 cases/year
(4965) to almost 10,000 cases/year (9873). Average mortality has decreased from
3.23% to 0.74%. The Three Networks system has been successful in controlling
measles outbreaks; and during SARS, when 11 cases came to Guangxi from the
neighbouring Guangdong province, there were only 11 additional new cases with
no community spread and no spread to medical staff. CONCLUSION: The Three
Networks system has played an important role in infectious disease prevention
and control in Guangxi province, and may be applicable to other areas with a
similar situation.
Publication Types:
442: Indian J Lepr. 2006 Jul-Sep;78(3):245-59.

Inter-state variations in integration of leprosy services into general

health system in low/ moderately endemic states of India.
Pandey A, Patel R, Rathod H.
Regional Leprosy Training and Research Institute, Lalpur, Raipur, Chhattisgarh.

rltri@sify.com
The objective of the study was to analyse inter-state variations in integration of

leprosy services into the general health system, covering broad categories of
structure integration, training of health functionaries, availability of MDT services
and record maintenance, in 24 low/moderately endemic states. Multi-stage
random sampling technique was used to select 9 states, 86 health facilities
(including district hospitals, community health centres, primary health centres)
and 108 sub-centres. Information from each level was collected on a pre-tested
form by officers of three leprosy institutions of the Government of India. The
results showed wide inter-state variations on each aspect. Redeployment of
vertical staff was complete (100%) in Tamil Nadu and Tripura. Assam reported a
higher level of training (97%) of medical officers in leprosy. Training of health
supervisors and multipurpose workers was better than that of medical officers in
most of the states. Tripura reported negligible training of all the health
functionaries because of specific local problems. In Assam, Maharashtra and
Sikkim, all the urban and rural health facilities were providing MDT. Three
months' stock of all types of MDT blister packs was available only in one health
facility in Andhra Pradesh and in Goa. Assam and Haryana had lower availability
of MDT stocks. In Assam and Maharashtra, medical officers in all health facilities
were diagnosing and treating leprosy cases, as compared with Himachal Pradesh
where the value was 30%. Involvement of sub-centres in MDT delivery was more
at 92% and 100% in Tamil Nadu and Maharashtra respectively in comparison to
none in Himachal Pradesh and Tripura. Use of the Simplified Information System
(SIS) 2002 guidelines and formats was universal. However, lower involvement of
GHS staff in recording and reporting was noted in Assam (0%), Andhra Pradesh
(10% and 30%). The study emphasized the need for further tailor-made follow-up
studies to suit local problems.
443: J Neurotrauma. 2006 Nov;23(11):1621-31.

Fighting for each segment: estimating the clinical value of cervical

and thoracic segments in SCI.
van Hedel HJ, Curt A.
Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.

hvanhedel@paralab.balgrist.ch
Patients suffering from complete spinal cord injury (SCI) are the most likely
candidates for the application of new interventions for neural repair and
regeneration. It is assumed that some of these treatments will have their strongest
impact at the segmental level. Therefore, it is important to evaluate the clinical
relevance of potential changes at the segmental levels concerning both
improvement and deterioration. Data of 98 motor complete SCI patients were
derived from the European Multicenter Study of Human Spinal Cord Injury
database. Six months after injury, the ASIA motor score and Spinal Cord
Independence Measure (SCIM) were assessed as dependent variables (linear
regression analysis) to disclose the difference between each segment. Separate
analyses using linear regression for tetraplegic patients (n = 39) and paraplegic
patients with thoracic lesions (n = 54) were performed to calculate the difference
between each spinal segment. In tetraplegic patients, both the ASIA motor score
and the SCIM revealed relevant differences per spinal segment (9 and 4 points,
respectively) while in paraplegic patients there was no difference for the SCIM
and the ASIA motor score between T2 and T8. We suggest that in complete
tetraplegic patients, changes of even one spinal segment will either improve or
degrade both motor function and independence. Segmental changes at the thoracic
level are not assessable by the ASIA motor score and SCIM tests. Therefore, the
assessment of efficacy and safety in thoracic patients by these two tests has
limited value when applied to cervical SCI. These findings may be considered in
clinical trials for the evaluation of beneficial effects and risk management when
treating patients with spinal cord injury.
Publication Types:
444: Comput Inform Nurs. 2006 Nov-Dec;24(6):346-52.

Mapping of nursing records into the NIC and the ICNP in a Korean
oriental-medicine hospital.
Lee E, Lee M, Jung OB.
College of Nursing, Kyungpook National University, South Korea (Dr Lee, Ms

Jung); and the College of Nursing, The University of Iowa, Iowa City, IA 52242,
USA. mikyoung-lee@uiowa.edu
This study uses mapping methodology to examine the applicability of the Nursing
Interventions Classification and the International Classification of Nursing
Practice to nursing practice in a Korean Oriental-medicine hospital. Data were
collected from the nursing records of 56 stroke patients in one unit, and
intervention statements were mapped into NIC and ICNP. Of 147 unique nursing
intervention statements extracted, 136 (92.52%) could be mapped into NIC and
99 (67.35%) statements could be completely mapped into ICNP. Using mapping
methodology, this study validates that both NIC and ICNP would be useful for
documenting nursing care in a Korean hospital, but it also identifies additional
concepts that need to be represented in both of these standardized nursing
languages. It is recommended that nurses be more careful in documenting their
interventions and also that SNLs be developed further to more completely
represent nursing practice.
Publication Types:

• Validation Studies
445: Gan To Kagaku Ryoho. 2006 Nov;33(11):1563-7.

[Team approach for treatment of patients with cancer, how to

cooperate with staffs of other medical institutions--a recent trend in
Japan]
Tanimizu M, Kikuuchi Y, Funada C, Kameshima K, Kurita A, Takashima S.
National Hospital Organization, Shikoku Cancer Center.
For the team approach to patients with cancer both of consistency of medical
services and patient's satisfaction are important. Japanese health care reform
planning prescribes an establishment of a section which accepts patient's
consultation and provides proper advice or information. Technology of the
internet is also promising for team approaches with staffs of other medical
institutions as well as the patient support section in the cancer centers.
Publication Types:
446: Stud Health Technol Inform. 2006;124:699-704.

Agent based simulations in healthcare.
Bilge U, Saka O.
Akdeniz University Faculty of Medicine, Antalya, Turkey. ubilge@akdeniz.edu.tr
Agent Based Simulations (ABS) is a relatively recent computer paradigm. As

opposed to "top down" conventional computer simulations, the ABS approach is a
"bottom-up" modelling technique where a medium to high number of independent
agents is modelled. These agents' interactions sometimes cause unexpected
"emergent" system behaviour. ABS is particularly suitable in the social context
such as healthcare where a large number of human agents interact and co-operate
for common goals. Today ABS in the social context is often used together with
the recently introduced network analysis techniques and network visualization
tools for modelling and simulating social agents within organisations. At Akdeniz
University we are starting a number of projects for applying ABS technology in
healthcare. In this paper we present two of the ongoing projects in this field.
Firstly we have developed a prototype simulator for the long term monitoring of
Chronic Obstructive Pulmonary Disease (COPD) as a major public health
problem. We present the COPD simulator, its agents, parameters and working
principles. Secondly we want to apply ABS and the network analysis techniques
to visualise and explore informal social networks amongst staff at the Akdeniz
University Hospital to assess and evaluate properties of the organisation in terms
of its ability to innovate and share knowledge. In our applications, we primarily
aim to use ABS in a web-based platform to create a virtual environment for
discussion, visualising and running what-if scenarios to test out various options
for managing healthcare, as well as sharing information and creating a virtual
community.
447: Int J Cardiol. 2007 Sep 14;121(1):127-9. Epub 2006 Nov 14.
Impact of hospital and physician characteristics on medical

expenditures for acute myocardial infarction hospitalization.
Chen CS, Liu TC, Chiu WT, Lin HC.
This study aims to examine the impact of length of stay, hospital characteristics,
physician characteristics and other factors on the expenditures of hospitalization
for acute myocardial infarction (AMI) under Taiwan's National Health Insurance
program. This study uses data collected from the Taiwan's National Health
Research Institute's 2001-2003 National Health Insurance Research Database. We
estimated contributors to increased expenditures of hospitalization using three-
stage least square regression model. The hospital expenditures for the treatment of
AMI averaged NT$126,366 (US$3829, US$1=NT$33) per discharge, with the
largest proportion (27%) spent on room expenditures. They were strongly
impacted by length of stay, increasing around 4.8% per day. We conclude that
hospital expenditures for the treatment of AMI patients may vary widely
depending on the characteristics of the hospital and physicians that provide them
care.
Publication Types:
• Letter

448: Stud Health Technol Inform. 2006;122:991.
Nursing data set development in Thailand.
Phuphaibul R.
Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol

University, Thailand. rarph@mahidol.ac.th
The survey on nursing minimum data set was performed. Questionnaires were
sent to 500 randomly selected hospitals, 378 returned questionnaires were
analyzed. The top 10 minimum nursing data set were identified. They were
patient's hospital number, name, personal ID number, medical diagnosis, referral,
admission date, patient/family history, address and phone, gender, birth, religion,
education, laboratory tests, discharge/expiration date, condition before discharge,
nursing outcome, nursing problem, nursing intervention, admission number,
health insurance, discharge plan and home visit.
Publication Types:

Development of a web-based health information service system for

maternal health care.
Bae J, Heitkemper M.
Department of Nursing, Inje University, Busan, Korea. jibai@inje.ac.kr
Information technology skills are essential for effective and efficient practice in
maternal and child health. The purpose of this study was to develop a web-based
multimedia health information system for maternal health care using principals of
user centered design. Research process includes needs assessment, needs analysis,
design, development/testing, and application release. This system will be a new
way of nursing intervention and contribute to the maternal health promotion.
Publication Types:

To realize easy-to-understand description of nursing practice

terminology for consumer.
Uchino S, Inoue M, Tsuru S, Nakanishi M, Dannoue H.
Graduate School of Health Sciences, Tokyo Medical and Dental University,

Tokyo, Japan. seikgh@tmd.ac.jp
In Japan it is an important issue to introduce Electronic Health Records (EHR) in

over 60% of hospitals with more than 400 beds. Introducing E.H.R is supposed to
help provide a safe medical environment as well as practice medicine by
description in plain terms among professionals and among patients and medical
professions. We've developed Nursing Pr Terminology understandable to
consumers visualization of nursing action, and arranged them by level and
category. However, it is still difficult to express the appropriate contents because
they consist of expert decisions and processes. Hereafter, it is a very important
challenge of ours to develop an easy-to-understand description of the Nursing
Practice Terminology to supply safe and patient-centered medicine to consumers.
Publication Types:

Data mining approach to model the diagnostic service management.
Lee SM, Lee AK, Park IS.

The Catholic University of Korea, Seoul, Korea.
Korea has National Health Insurance Program operated by the government-owned

National Health Insurance Corporation, and diagnostic services are provided
every two year for the insured and their family members. Developing a customer
relationship management (CRM) system using data mining technology would be
useful to improve the performance of diagnostic service programs. Under these
circumstances, this study developed a model for diagnostic service management
taking into account the characteristics of subjects using a data mining approach.
This study could be further used to develop an automated CRM system
contributing to the increase in the rate of receiving diagnostic services.

An XML-based framework for personalized health management.
Lee HJ, Park SH, Jeong BS.
Department of Medical Information System, Yongin Songdam College, Yongin,

Gyeonggi, Korea.
This paper proposes a framework for personalized health management. In this

framework, XML technology is used for representing and managing the health
information and knowledge. Major components of the framework are Health
Management Prescription (HMP) Expert System and Health Information
Repository. The HMP Expert System generates a HMP efficiently by using XML-
based templates. Health Information Repository provides integrated health
information and knowledge for personalized health management by using XML
and relational database together.
Publication Types:

The evaluation criteria of internet health information.

Kang NM, Kim S, Hong S, Ryu S, Chang HJ, Kim J.
College of Nursing, Konkuk University, Seoul, Korea.
The Internet has great powerful forces for health information and education. This
describes the development of a web-based evaluation criteria for internet health
information. The purpose of this study was to explore the evaluation criteria (tool)
of internet health information for Korean. This utilized a cross-sectional design
with four sections: (1) CAHPS (Consumer assessment of health plans studies); (2)
Health consumer terminology and understanding review; (3) web based
interactive tool construction; (4) semantic web technology application. The
findings showed follows; (1) literature review related quality evaluation tool for
internet health information; (2) case study; (3) development of evaluation
prototype; (4) validity assessment of tool; (5) Evaluation system information
strategic planning.

The development of NRMIS (Nursing Resources Management

Information System)--Focused on patient classification.
Moon WH.
Department of Health & Medical Informatics, Daejeon Health Sciences College,

Korea. whmoon@hit.ac.kr
Information system can be useful to effective and flexible decision making of

nursing resource administration. A Nurse Resources Management Information
Model and a Nurse Resources Management Information System (NRMIS) were
developed in this study. The NRMIS consisted of a nursing staff scheduling
system (NRS), a patient classification system (PCS), and an optimal nursing
manpower estimating system (ONMES). The patient classification system was
developed according to nursing intensity. The system was evaluated through user
interface satisfaction and usefulness in the clinical settings. The main challenge is
how we realize this information model to support evidence-based nursing
resource administration.

Difference of needs on functionality of electronic health record
systems.
Hwang JI, Yoon SY, Chin HJ, Seo JW.
Nursing Administration, Kyung Hee University, Korea.
The study was conducted to assess needs on the functionalities of an electronic

health record (EHR) system and to determine the difference of needs among MR
administrators' groups and expert groups in Korea.

Analysis of Nursing Interventions Classification (NIC) performed in

the medical-surgical unit.
Lee E.
College of Nursing, Kyungpook National University, Daegu, Korea.
To identify the interventions used in a medical-surgical unit, data were collected

from 167 nurses working in 8 hospitals in Korea and analyzed by descriptive
statistics. Two hundred and two interventions were selected by Korean nurses and
9 interventions used more than 50% of nurses surveyed. The nursing interventions
of Korean nurses were heavily focused on the physiological domain. The
identified intervention lists can be used to develop nursing information systems,
staff education, competency evaluation, referral networks, certification and
licensing exams, and developing educational curriculars for nursing students.

Intelligent mobile voice information centre system: Taking the

emergency triage support system as an example.
Hsiao FY, Chang P.
Institution of Health Informatics and Decision Making, National Yang-Ming

University, Taipei, Taiwan ROC.
According to research by the International Telecommunications Union (ITU),

Taiwan has the highest percentage of people holding mobile (cell) phones, and
every one has one or two cell phones. We usually use mobile phones to make
contact with hospitals or dial 119 in an emergency. We have developed a new call
flow style and combine traditional passive call flow. The system is designed with
a voice menu and users can command services actively. The telephone connects
to a computer server to enter the call flow module with ASR and TTS. The
recognition term comes from a voice term database. The voice management
center is an ER triage decision system. We have tested three scenarios which are
DOA, a large number of patients and critical trauma. We measured the
completion time and recognition rate for all the scenarios. The recognition rate in
all three cases was above 90%. The average completion time for DOA is 38.6
seconds, for the large number of patients is 20 seconds and for the critical trauma
case, the average is 252.7 seconds. It is too slow to input one patient's data but the
communication transfer of the message is fast and convenient; the DOA notice
only takes 38 seconds to inform medical staff, which is very efficient and medical
staff believe that this can help their communication. We will continue to extend
our system and further apply it to other domains. Future studies may combine the
Internet platform with the WiFi phone and soft phone (Skype) and broaden the
scope of the application in Taiwan.
Publication Types:

Experience sharing on the implementation of telehealth system in

Hong Kong.
Wong TK, Chung JW, Fan KL, Chow MW, Lau YK, Cheung CC, Au AY,
Ma PM.
Faculty of Health and Social Sciences, The Hong Kong Polytechnic University,
Hong Kong SAR, China.
With the growth of the ageing population in Hong Kong, healthcare professionals
believe that there will be a great demand of healthcare service at the community
level. In 2000, the first prototype of telehealth system was developed, tested and
validated by the School of Nursing, The Hong Kong Polytechnic University. With
the advancement of information technology and inexpensive video- conference
facility, an inter-clinic patient-centered healthcare information system has been
evolved and used by a number of satellite clinics since 2003. In order to foster the
importance of personal healthcare education at the community level, different
versions of the telehealth system were designed and developed for school children
and teenagers. Now the research team is focusing on the development of the
pocket PC's version. Experience on the deployment of such technology-intensive
system in healthcare was discussed in this paper.

Attitudes of nurses towards End-user Development.
Liu SC, Chang P, Huang F, Hou IC.
Institute of Healthy Informatics and Decision Making, National Yang-Ming

University, Taiwan ROC.
The purpose of this study is to explore nurses' attitudes toward developing self-
made information tools. In order to understand nurses' attitudes, we studied the
factors that affect nurses' attitudes toward End-user Development (EUD). The
investigation of nurses in Taiwan hospitals showed that nurses had positive
attitudes toward EUD. A framework of nurses' attitudes toward EUD is presented.
A gap was found between the functions provided by the nursing information
system and self-assessment required by the job. The nurses were inclined to be
dissatisfied with support provided by the information centers. Nursing managers
were advised to enhance on-the-job training for computer applications, and to
include computer competencies in the nursing ladders program. The results
indicated that nurses were willing to develop their own tools. We believe that
nurses with computer application skills who are provided with appropriate tools
can become nursing application developers. The results encourage nurses to
develop software by themselves. Further research and development is required to
enhance the impact of EUD and establish a sharing environment for EUD
applications.

Evaluation of electronic health records from viewpoint of patients.

Koide D, Asonuma M, Naito K, Igawa S, Shimizu S.
Clinical Bioinformatics Research Unit, Graduate School of Medicine, The

University of Tokyo, Bunkyo, Tokyo, Japan. koide.tky@umin.ac.jp
OBJECTIVE: To clarify the impacts of electronic health records (EHRs) on

patients, especially patient's satisfaction by using questionnaire. DESIGN:
Surveys were conducted at three hospitals. One of them was surveyed three times;
three-months before (pre-EHR) and three-months after (post-3mo EHR) and nine-
months after implementation of EHR (post-9mo EHR). The other two hospitals
(metropolitan-stable EHR and suburban-stable EHR) spent more than three years
after implementation. Thus there were five stages of EHR. MEASUREMENTS:
Comparisons were made among these five stages. RESULTS: The longer EHR
has been operating, the more patients answered waiting time shortened. The
patients in pre-EHR (73%) expected the benefit of cooperation between hospitals
and clinics using EHR more. The longer experience of EHR a hospital had, the
more patients were explained by watching the screen. Although overall
satisfaction was high, there was no difference among the stages except
metropolitan-stable EHR. CONCLUSION: Main benefits of EHR are reducing
patient's waiting time, and enhancing explanation to patients. However it does not
have significant effects to improve patient's satisfaction.
Publication Types:

Early detection of pulmonary hypertension with heart sounds

analysis pilot study.
Chen J, Chung J, Wong T, Fan KL, Pun CO.
School of Nursing, Faculty of Health and Social Science, The Hong Kong
Polytechnic University, Hong Kong.
There are strong evidences to support that the modification of the characteristics
of the second heart sound has a high correlation with the pulmonary arterial
pressure (PAP). It is hence postulated that a specific heart sound spectrum for this
disease group could be generated as a decision support system to help healthcare
workers for the early detection of pulmonary hypertension. This paper described
the design of a case-control study on identifying the heart sound pattern of people
with pulmonary hypertension. In the proposed study, the heart sound of patients
having pulmonary hypertension will be captured by an electronic stethoscope and
processed into digital sound spectra which will be analysed to identify a specific
heart sound pattern. In the future, an intelligent device will be developed based on
the identified pattern to identify and diagnose early stage of pulmonary
hypertension.

Feeling the digital pulse: Consumer-centered approach to individual

health profiling.
Wong TK.
Faculty of Health and Social Sciences, The Hong Kong Polytechnic University,
Hong Kong.
New technologies from the new digital era are overcoming temporal, spatial and
physical hurdles in the development and realization of individual health profiling
and consumer health monitoring devices. Mature wireless and networking
technologies promise more accessibility and portability of health data and records,
and health monitoring. The increase in convenience and efficiency underlie the
technological foundation for development of telehealth systems, which make
personal health care available anytime, anywhere. On the one hand, advances in
information technology are aiding in the creation of lifelong health records and
hence in the tracking and understanding of the health history of individuals, which
in turn will help shift the public health care delivery model toward more primary
and secondary care and prevention from the current emphasis on curing. On the
other, health monitoring devices are also benefiting from technological progress,
and are increasingly moving toward more self-assistive, compact and appealing to
consumers. However, although most of the necessary hardware and technologies
are already mature and widely available, they have yet to be fully exploited for
personal health care, and the general public also need to be educated and
encouraged to adopt the concepts of individual health profiling and regular health
monitoring into their lives. In this regard, the School of Nursing at The Hong
Kong Polytechnic University has been working proactively on two fronts. First, a
telehealth system has been installed in community-based venues such as clinics,
hospitals and, most important, schools and youth centers in order to promote
lifelong health profiling for all individuals. Second, the School of Nursing is
committed to utilizing advanced technologies for developing more compact and
user-friendly consumer health monitoring devices such as non-invasive meters.
This is with a view to encourage individuals to take more responsibility for their
own health and behavior, which fits in with the Hong Kong government's aim of
shifting the burden of public health care provision away from hospitals to
community-based primary and secondary care. The ultimate goal of the School of
Nursing's efforts in telehealth and consumer health monitoring devices is the wide
adoption of home-based telehealth systems that will subsequently spur individual
health profiling, which will in turn encourage personal responsibility for
improving one's health.
Publication Types:
463: Environ Sci. 2006;13(4):201-5.

Related Articles
Current situation of web-based chemical registration system in the

University of Tokyo.
Tomita K, Tonokura K, Yamamoto K, Nakanishi T.
Division for Environment, Health and Safety, The University of Tokyo, 7-3-1
Hongo, Bunkyo-ku, Tokyo 113-8654, Japan. tomita@esc.u-tokyo.ac.jp
The web-based University of Tokyo Chemical Registration Information System

with computational support has been introduced in all areas using chemicals
owing to the unified management of the university and the management of
chemicals in conformity with legal controls. This system enables chemical users
to manage chemicals easily and reduces the burden inflicted by such management.
In this report, we introduce the style of chemical management in the University of
Tokyo, the functions of the web-based chemical registration system, the current
situation of the system and future plans.

Empowering the impaired through the appropriate use of

Information Technology and Internet.
Sanyal I.
Turning Point, Rehabilitation Center, India. ishitasanyal@hotmail.com
Developments in the fields of science and technology have revolutionized Human

Life at material level. But in actuality, this progress is only superficial: underneath
modern men and women are living in conditions of great mental and emotional
stress, even in developed and affluent countries. People from all over the world
irrespective of culture and economic background suffer from mental illness and
though a number of researches are carried out worldwide but till date it has not
been possible to resolve the problem.In today's world stress is increasing
everyday. The individualistic approach towards life; the neonatal family system
has increased the burden even further. Without adequate support system of friends
and relatives--people are falling prey to mental illness. The insecurities, the
inferiority feelings of these persons lead to disruption of communication between
the sufferer and the family members and friends. The sufferers prefer to confine
themselves within the four walls of their home and remain withdrawn from the
whole world. They prefer to stay in touch with their world of fantasy--far away
from the world of reality. Disability caused by some of the mental illnesses often
remains invisible to the society leading to lack of support system and facilities for
them. These unfortunate disabled persons not only need medication and
counseling but a thorough rehabilitation programme to bring them back to the
main stream of life. The task being not an easy one. According to the research
works these persons need some work and income to improve their quality of
life.In this scenario where society is adverse towards them, where stigma towards
mental illness prevails; where help from friends and community is not available-
training them in computer and forming groups through computer was thought to
be an ideal option for the solution- a solution to the problems of modern life
through modern technology. * It was seen that this insecure disabled persons feel
free to experiment with machine more easily than with society and people. *
Computer provides them the needed education and information needed for their
further developments. * Computers provide them facilities to interact with others
and form self-help groups. * Computers also enabled them to earn their
livelihood. Thus this modern gadget, which is sometimes believed to make a man
loner, has been actually acting as the bridge between the persons suffering from
mental illness to the society in general. The disabled person also gains confidence
and courage as they gain control over the machine. Gaining control over the
machine helps them to gain control over their life. The product of Science and
technology has been seen to revolutionized Human Life not only in material level
but also on personal level- helping the disabled to gain control over their lives.
Publication Types:
465: Kekkaku. 2006 Oct;81(10):591-602.

[Evaluation of effect of community DOTS on treatment outcomes by

TB surveillance data]
Hoshino H, Kobayashi N.
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo,

Japan. hhoshino@jata.or.jp
OBJECTIVE: The purpose of this study is to evaluate effects of community

DOTS on treatment outcome by cohort data derived from TB surveillance system
and to find further problems. SUBJECTS: New sputum smear positive pulmonary
TB patients registered in 2003 and 1998 under standard course regimens.
METHODS: In Japan, DOTS as a method of directly observed treatment by Short
Course Chemotherapy is divided into hospital DOTS and community DOTS.
Hospital DOTS is to observe hospitalized patients' drug taking directly by hospital
staff such as nurses, pharmacists or other hospital staff. Community DOTS is to
observe or confirm discharged patients' drug taking by several methods such as
direct observation at facility or patient's home, confirmation through checking
treatment notes and examining empty blister packages and so on. TB patients
were categorized to following 3 groups by available methods of community
DOTS. Treatment outcome of patients registered in 2003 was compared with
outcome of patients registered in 1998 as the control group before the introduction
of community DOTS. Group 1: TB patients under PHC where at least daily
observation DOTS (daily observation of drug taking at clinic or PHC to TB
patients with risk factors of defaulting such as homeless, alcohol abuse, past
history of default and so on) is available. Group 2: TB patients under PHC where
home-visit DOTS (home-visit for observation of drug taking to the elderly TB
patients who have risk to forget to take TB medicines regularly) only is available
or, PHC where home-visit DOTS and confirmation DOTS (periodical
confirmation of drug taking to TB patients without risk of defaulting) is available.
Group 3: TB patients under PHC where only confirmation DOTS is available.
Group 4: TB patients under PHC where community DOTS is not available. In
addition, high death rate of patients under public assistance is analyzed.
RESULTS: In group 1 with daily observation DOTS, TB patients under social or
national health insurance showed higher treatment success rate and lower
defaulter rate. TB patients with insurance for aged showed lower defaulter rate
but high death rate due to old age did not improve. Patients under public
assistance showed relatively lower defaulter rate. In group 2 with home-visit
DOTS, TB patients with national health insurance and insurance for aged showed
rather lower defaulter rate. Cohort evaluation of TB patients under group 3 with
confirmation DOTS and group 4 without community DOTS is difficult as high
rate of unknown treatment result. TB patients receiving public assistance showed
lower death rate than patients requiring but not receiving public assistance.
Patients detected at clinic and hospitals showed higher death rate than other
patients detected by screening for high risk groups and so on. CONCLUSION:
Daily observation DOTS and home-visit DOTS were effective to improve success
rate and defaulter rate but effect of confirmation DOTS was not proved due to
lack of information. High death rate of patients with insurance for aged in all
groups and lack of treatment results in group 3 and 4 were problems to be solved
in the future. In order to avoid TB death among TB patients under public
assistance, screening for homeless people as high risk groups, earlier detection
and referral system of TB symptomatics and improvement of coverage in public
assistance might be effective and be tried.
Publication Types:
466: J Wildl Dis. 2006 Jul;42(3):561-9.

First report of Streptococcus agalactiae and Lactococcus garvieae

from a wild bottlenose dolphin (Tursiops truncatus).
Evans JJ, Pasnik DJ, Klesius PH, Al-Ablani S.
Aquatic Animal Health Research Laboratory, United States Department of

Agriculture, Agricultural Research Service, Chestertown, Maryland 21620, USA.
The isolation and characterization of two bacterial species, Streptococcus

agalactiae and Lactococcus garvieae, previously unreported in wild marine
mammals are described from a freshly dead bottlenose dolphin, Tursiops
truncatus, from Kuwait Bay, Kuwait, in September 2001. Conventional and rapid
identification systems were used to determine that isolates from muscle and
kidney were S. agalactiae and L. garvieae, respectively. The isolates were gram-
positive, catalase-negative, oxidase-negative, nonhemolytic cocci. The S.
agalactiae was serotyped to group antigen B, whereas the L. garvieae could not be
assigned to any serogroup. These Kuwait isolates displayed considerable
homogeneity with corresponding American Type Culture Collection (ATCC) type
isolates. Although the dolphin S. agalactiae isolate was nonhemolytic, it was
biochemically similar to S. agalactiae isolated from mullet sampled in the
concurrent Kuwait Bay fish kill. Some biochemical heterogeneity was observed
between the dolphin isolates and corresponding mammalian ATCC type isolates,
especially with Voges Proskauer, alanine-phenylanaline-proline arylamidase, and
alpha-galactosidase tests. Nile tilapia, Oreochromis niloticus, experimentally
infected with the dolphin S. agalactiae and L. garvieae isolates experienced 90%
and 0% mortalities, respectively. This is the first isolation of S. agalactiae and L.
garvieae from a wild marine mammal, and the microbial characteristics
established here provide pertinent information for the future isolation of these
bacteria.
467: Gig Sanit. 2006 Sep-Oct;(5):4-10.

[Sanitary and epidemiological well-being: topical problems]
[Article in Russian]
Onishchenko GG.
The interaction of the interested services and authorities in implementing a

package of goal-oriented organizational, comprehensive preventive and
antiepidemic measures has given stability of the sanitary-and-epidemiological
situation in the Russian Federation in some recent years. To accomplish the tasks,
particularly those in developing a package of measures to reduce the prevalence
of infectious diseases, the "Health" national program has been drawn up for 2006-
2007 this year. One of the priorities of the program is to enhance the prophylactic
orientation of the public health care system. Within the framework of this
direction, it is planned to provide a further steady decline in the incidence of
infections controlled by specific preventive means, primarily, in that of hepatitis
B and rubella, to eliminate the congenital rubella syndrome, and to maintain the
status of the Russian Federation as a poliomyelitis-free area. The subjects of the
Russian Federation should redistribute allocations, by taking into account the
funds envisaged in the Health program for purchase of vaccines, and direct them
for implementation of other measures, such as personnel training, refrigerating
equipment purchase, information-propagandistic work among the population, etc.
In 2005, the poor situation established in the world due to the spread of avian
influenza and there was a possible threat of influenza pandemic. Investigations
ascertained the identity of influenza A virus (H5N1) isolated in the Russian
Federation with the South-Eastern Asia-isolated viruses that caused mass
epizooties of birds and severe diseases in persons contacting infected birds. It was
assumed that 2006 spring migration might lead to the spread of pathogenic
influenza H5N1 viruses throughout European Russia. This was due to the fact that
the birds migrating to European Russia and a portion of birds migrating from
Siberia have common winter nesting areas. To prevent mass influenza virus-
infected birds' death and human infection in the epizootic localities, the federal
surveillance service for protection of users' rights and human well-being jointly
with the federal veterinary and phytosanitary surveillance service, and public
health care administrative bodies has organized and implemented a package of
measures: active headquarters have been set up in the epizooty-afflicted subjects
to coordinate activities in localizing the spread of epizooty of birds; emergency
commissions and antiepizootic commissions have been held; regulatory
documents on the Russian Federation's subjects have been published; daily
collection, analysis, systematization, and exchange of information between
interested services, et. are under way.
Publication Types:
• Review
468: J Med Liban. 2006 Apr-Jun;54(2):61-4.

Epidemiology of HIV infection in Lebanon. Data from 1985-2005.
Traboulsi R, Kanafani ZA, Nakib M, Kanj SS.
Division of Infectious Diseases, Department of Internal Medicine, American

University of Beirut Medical Center, Hamra, Lebanon.
Lebanon is considered among the countries where the HIV epidemic is still in its
early phase of spread. Little information is available on the magnitude of the
problem due to the lack of an efficient surveillance system. In this review, we
report on the epidemiology of HIV infection in Lebanon, based on limited data
generated by the Lebanese National AIDS Control Program (NAP). By May
2005, a cumulative number of 813 cases had been diagnosed. The most prevalent
mode of HIV transmission in Lebanon is heterosexual exposure accounting for
around 50% of the cases. Two hundred ninety-six patients (36.4%) fulfilled the
AIDS case definition. Despite the availability of highly active antiretroviral
therapy (HAART) provided by the Ministry of Health, the disease burden of HIV
infection remains unknown in this country.
469: Burns. 2007 Feb;33(1):46-51. Epub 2006 Nov 2.

Burns in Turkish children and adolescents: nine years of experience.
Sakallioğlu AE, Başaran O, Tarim A, Türk E, Kut A, Haberal M.
Başkent University, Burn and Fire Disaster Institute, Turkey.
AIM: The aim of this study was to describe information about burns that occur in
children and adolescents in Turkey. PATIENTS AND METHODS: The subjects
were 362 patients whom were younger than 18 years who were treated at 3 burn
centers in 2 different regions of Turkey between 1997 and 2005. The data
collected for each case were age, gender, place of residence, cause and extent of
burn, body sites affected, environment in which the injury occurred, interval from
injury to arrival at a burn center, hospitalization status (inpatient versus
outpatient), surgical treatment, and mortality. RESULTS: The 362 patients
comprised 35.5% of all 1021 burn victims admitted during the study period. There
were 183 boys and 179 girls (ratio 1:0.98) and the mean total body surface area
burned was 17.7+/-16.5%. The highest proportion of patients were in the 1-6
years age group. Non-bath (not immersed) hot water scalding (216 cases, 59.7%)
was the leading burn cause. The most common environment in which burn injury
occurred was the home. The trunk was the body site most frequently affected
(62.7%). 241 (66.6%) subjects lived in urban environments and 121 (33.4%) lived
in rural areas. 171 patients (47.2%) were taken directly to the burn units, whereas
the others (52.8%) were referred from other medical centers. 124 (34.3%) subjects
were treated as outpatients and 238 (65.7%) were hospitalized. The overall
mortality rate was 8.6% (31 deaths). Of the 238 inpatients, 92 (38.7%) were
treated with daily dressings only, 128 (53.8%) required debridement, and 75
(31.5%) needed both debridement and grafting. CONCLUSION: Every country
needs a nationwide public education system that is aimed at preventing burns and
ensuring that burn victims receive proper first aid and age-appropriate, specialized
burn care.
Publication Types:
470: Comput Biol Med. 2007 Jun;37(6):879-89. Epub 2006 Nov 1.

Creating a GIS application for health services at Jeddah city.

Murad AA.
Department of Urban and Regional Planning, Faculty of Environmental Design,

King Abdulaziz University, PO Box 80210, Jeddah 21589, Saudi Arabia.
amurad25@hotmail.com
This paper explores the possibilities of using GIS for private hospitals at Jeddah
city, Saudi Arabia. A GIS application is created to cover three main health
planning issues which are distribution of health demand, classification of hospital
patients and the definition of hospital service area. Each one of these issues is
covered using several GIS functions including network analysis and overlay
analysis. The former is used to produce drive-time hospital service area and the
latter is applied at the selected hospital to calculate the size of its served demand.
GIS has several useful functions and tools that can be used in health planning
field. This paper uses some of these functions for one private hospital. These
functions are used to help health planners on evaluating the spatial distribution of
hospital demand and for defining hospital service area. All the produced models
can be applied on any private or public hospital in Jeddah city. They can be used
to build a spatial decision support system for hospitals in Jeddah city.
471: Health Care Manage Rev. 2006 Oct-Dec;31(4):280-8.

Using path analysis to examine causal relationships among balanced

scorecard performance indicators for general hospitals: the case of a
public hospital system in Taiwan.
Yang MC, Tung YC.
Institute of Health Care Organization Administration, National Taiwan

University, Taipei. mcy@ha.mc.ntu.edu.tw
Examining whether the causal relationships among the performance indicators of

the balanced scorecard (BSC) framework exist in hospitals is the aim of this
article. Data were collected from all twenty-one general hospitals in a public
hospital system and their supervising agency for the 3-year period, 2000-2002.
The results of the path analyses identified significant causal relationships among
four perspectives in the BSC model. We also verified the relationships among
indicators within each perspective, some of which varied as time changed. We
conclude that hospital administrators can use path analysis to help them identify
and manage leading indicators when adopting the BSC model. However, they
should also validate causal relationships between leading and lagging indicators
periodically because the management environment changes constantly.
472: J Prev Med Pub Health. 2006 Sep;39(5):433-7.

[Estimation of a nationwide statistics of hernia operation applying

data mining technique to the National Health Insurance Database]
[Article in Korean]
Kang S, Seon SK, Yang YJ, Lee A, Bae JM.
School of Health Administration, Inje University.
OBJECTIVES: The aim of this study is to develop a methodology for estimating

a nationwide statistic for hernia operations with using the claim database of the
Korea Health Insurance Cooperation (KHIC). METHODS: According to the
insurance claim procedures, the claim database was divided into the electronic
data interchange database (EDI_DB) and the sheet database (Paper_DB).
Although the EDI_DB has operation and management codes showing the facts
and kinds of operations, the Paper_DB doesn't. Using the hernia matched
management code in the EDI_DB, the cases of hernia surgery were extracted. For
drawing the potential cases from the Paper_DB, which doesn't have the code, the
predictive model was developed using the data mining technique called SEMMA.
The claim sheets of the cases that showed a predictive probability of an operation
over the threshold, as was decided by the ROC curve, were identified in order to
get the positive predictive value as an index of usefulness for the predictive
model. RESULTS: Of the claim databases in 2004, 14,386 cases had hernia
related management codes with using the EDI system. For fitting the models with
applying the data mining technique, logistic regression was chosen rather than the
neural network method or the decision tree method. From the Paper_DB, 1,019
cases were extracted as potential cases. Direct review of the sheets of the
extracted cases showed that the positive predictive value was 95.3%.
CONCLUSIONS: The results suggested that applying the data mining technique
to the claim database in the KHIC for estimating the nationwide surgical statistics
would be useful from the aspect of execution and cost-effectiveness.
Publication Types:

473: J Prev Med Pub Health. 2006 Sep;39(5):397-403.
[Cost-of-illness study of asthma in Korea: estimated from the Korea

National Health insurance claims database]
[Article in Korean]
Park CS, Kang HY, Kwon I, Kang DR, Jung HY.
Health Insurance Review Agency, Graduate School of Public Health, Yonsei

University.
OBJECTIVES: We estimated the asthma-related health care utilization and costs

in Korea from the insurer' s and societal perspective. METHODS: We extracted
the insurance claims records from the Korea National Health Insurance claims
database for determining the health care services provided to patients with asthma
in 2003. Patients were defined as having asthma if they had > or =2 medical
claims with diagnosis of asthma and they had been prescribed anti-asthma
medicines. Annual claims records were aggeregated for each patient to produce
patient-specific information on the total utilization and costs. The total asthma-
related cost was the sum of the direct healthcare costs, the transportation costs for
visits to healthcare providers and the patient's or caregivers' costs for the time
spent on hospital or outpatient visits. RESULTS: A total of 699,603 people were
identified as asthma patients, yielding an asthma prevalence of 1.47%. Each
asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per
year to treat asthma.The per-capita insurance-covered costs increased with age,
from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged
75 or older. The total cost in the nation varied from 121,865 million to 174,949
million Won depending on the perspectives. From a societal perspective, direct
healthcare costs accounted for 84.9%, transportation costs for 15.1% and time
costs for 9.2% of the total costs. CONCLUSIONS: Hospitalizations and ED visits
represented only a small portion of the asthma-related costs. Most of the societal
burden was attributed to direct medical expenditures, with outpatient visits and
medications emerging as the single largest cost components.
Publication Types:
474: Environ Int. 2007 Feb;33(2):206-18. Epub 2006 Oct 30.

A systemic health risk assessment for the chromium cycle in Taiwan.
Ma HW, Hung ML, Chen PC.
Graduate Institute of Environmental Engineering, National Taiwan University, 71

Chou-Shan Rd., Taipei 106, Taiwan. hwma@ntu.edu.tw
Health risk assessment (HRA) has been recognized as a useful tool for identifying
health risks of human activities. In particular, this method has been well applied
to spatially defined units, such as a production plant, a treatment facility, and a
contaminated site. However, the management strategies based on the risk
information will be more efficient if the comprehensive picture of total risks from
all kinds of sources is depicted. In principle, the total risks can be obtained when
all risk sources are assessed individually. Apparently, this approach demands
huge amount of efforts. This study develops a methodology that combines
substance flow and risk estimation to facilitate examination of risk in a systemic
way and provide comprehensive understanding of risk generation and distribution
corresponding to flows of substances in the anthroposphere and the environment.
Substance flow analysis (SFA) and HRA method is integrated to produce a
systemic risk assessment method, from which substance management schemes
can be derived. In this study, the chromium cycle in Taiwan is used as an example
to demonstrate the method, by which the associated substance flow in the
economy and the risk caused by the substance in the environmental system is
determined. The concentrations of pollutants in the environmental media, the
resultant risks and hazard quotients are calculated with the widely-used CalTOX
multimedia model.
475: Fertil Steril. 2006 Dec;86(6):1716-22. Epub 2006 Oct 30.

Methylenetetrahydrofolate reductase C677T polymorphism and the

risk of unexplained recurrent pregnancy loss: a meta-analysis.
Ren A, Wang J.
Institute of Reproductive and Child Health, Peking University Health Science

Center, Beijing, China. renag@sohu.com <renag@sohu.com>
OBJECTIVE: To investigate the association between methylenetetrahydrofolate

reductase (MTHFR) C677T polymorphism and the risk of unexplained recurrent
pregnancy loss (URPL). DESIGN: Meta-analysis of published case-control
studies of the MTHFR C677T variant and URPL risk. SETTING: A research
institution in China. PATIENT(S): Women with URPL. INTERVENTION(S):
None. MAIN OUTCOME MEASURE(S): Odds ratios (ORs) and 95% confidence
intervals (CIs) for TT versus CC genotype, CT versus CC genotype, TT versus
CT and CC genotype combined, and for T versus C allele. RESULT(S): Twenty-
six studies with 2120 URPL cases and 2949 controls were included. Overall
random-effects ORs of 1.49 (95% CI, 1.12-2.00) for TT versus CC genotype, 1.40
(95% CI, 1.11-1.77) for TT versus CT and CC genotype combined, and 1.21
(95%CI, 1.04-1.40) for T versus C allele were found. Stratified analysis showed
that significant strong associations between MTHFR C677T polymorphism and
URPL were present only in the five Chinese studies (OR = 2.96 for TT versus CC
genotype; OR = 2.30 for TT versus CT+CC genotype; OR = 1.73 for T versus C
allele), but not in any other studies, including the studies conducted in the
European countries. CONCLUSION(S): The MTHFR C677T mutation is not a
genetic risk factor for URPL except in a Chinese population.
Publication Types:
• Meta-Analysis
476: J Cross Cult Gerontol. 2005 Dec;20(4):269-84.

Aging in Southeast and East Asia: issues and policy directions.
Chan A.
Department of Sociology, National University of Singapore, 11 Arts Link,

Singapore 117570, Singapore. socchana@nus.edu.sg
Population aging is unique in Asia given the speed at which it is occurring and the
immense social and economic changes that the region is experiencing at the same
time. Compared to their Western counterparts, Asian governments have much less
time to prepare for population aging. Asian countries that have traditionally relied
on family-based support for older family members are worried that increased
numbers of older adults may stress these family systems. At the same time,
information concerning the effectiveness of formal programs for older adults is
scarce. This paper reviews current research on informal support versus formal
support of older adults in Southeast and East Asia, with a larger aim of assessing
the current well-being of older Asians and suggesting areas of policy concern.
Current research reveals that formal programs in the majority of Southeast and
East Asian countries have very low coverage of today's older adults, and the
figures for future generations are not that much higher. However, family support
of older persons may not be deteriorating as predicted by modernization theory.
Asian families continue to play a major role in supporting older members, thus
policies should focus on enabling Asian families to provide this support.
Publication Types:
• Review
477: Int Dent J. 2006 Oct;56(5):277-82.

A reassessment of recall frequency intervals for screening in low

caries incidence populations.
Tan EH, Batchelor P, Sheiham A.
Eastman Dental Institute, London, UK.
OBJECTIVES: To reassess the recall frequency interval for dental examinations

for children, based on annual caries increments. METHODS: Cross sectional data
collected on school children in eight rural and urban schools through the national
Incremental Dental Care Programme (IDCP) for one district in Malaysia were
analysed to assess their annual caries increment and trend lines. The Restorative
Index was calculated to assess the success of the IDCP in rendering children
dentally fit. RESULTS: The annual caries increments were low; the current caries
levels were between 0.65 and 1.50 for 12 year-old children in Kota Tinggi
District. Most of the caries experience was on pits and fissures. From 7 to 12
years old, the overall annual caries increment for the total study population was
0.19. The mean annual caries increment increased slightly between the ages of 12
to 14 years and 14 to 16 years and was 0.24 and 0.25 respectively. Two distinct
caries incremental trend lines were observed for children aged 7 to 16 years. One
group reached a mean DMFT of about 0.75 while the other group a mean DMFT
of about 1.4 at 12 years. The trend lines continued over the next 4 years until the
children were 16 years old. The Restorative Index was higher in urban schools
that also had low DMFT levels. CONCLUSIONS: Based on the low annual caries
increments of between 0.65 and 1.50, yearly dental examination intervals can
safely be extended to 2-yearly intervals or even longer. Such a change of
screening recall intervals would help improve resource allocation. Resources
saved by extending recall intervals can be redirected to the small proportion of
children with higher disease levels. This will help render more school children
dentally fit and reduce inequalities in oral health.

478: Int Dent J. 2006 Oct;56(5):272-6.
Education of dentists in China.
Komabayashi T, Zhu Q, Jiang J, Hu DY, Kim KJ, Toda S, Tanne Y,

Tanimoto K, Kirkland MD, Bird WF.
Division of Endodontology, School of Dental Medicine, University of

Connecticut, Farmington 06030-1715, USA. Tkomabayashi@gde.uchc.edu
China is geographically located in the east of Asia and its population exceeds 1.3
billion. An understanding of dental education in China is thus of interest.
However, as there is little published information on this topic, this paper provides
information about China regarding its dental history, dental school system
including curriculum and dental licensure. High school graduates take a
nationwide entrance examination to apply for dental school, of which there are
more than 50 in China. A five year dental education leads to the BDS degree.
Dental school graduates must then pass the nationwide licensure examination to
practise dentistry. Currently, there are not adequate numbers of dentists to provide
the necessary oral health care for people living outside metropolitan areas.
Publication Types:
479: Beijing Da Xue Xue Bao. 2006 Oct 18;38(5):525-8.

[The community health diagnosis of life-way disease in Peking

University Health Science Center]
Han FQ, Ma YH, Ding SQ, Guo Q, Li HF.
Hospital of Peking University Health Science Center, Beijing 100083, China.

maxu@bjmu.edu.cm
OBJECTIVE: To study the basic information of life way disease and the
corresponding risk factors of behavior in the community of Peking University
Health Science Center, understand the background issue and social support
system, and analyze the requirement for community health service so that the
critical issue for health can be dealt with and the comprehensive program of
prevention and treatment of the disease can be accordingly supplied. METHODS:
The random face to face questionnaire about life way disease and risk factors in
1051 residents over 6 years of age in the community of Peking University Health
Science Center was conducted according to the typical sampling principle in 1
primary school, 1 middle school, 1 university and its community, and the
investigations of health data from the hospital and the police office in the
community were also conducted through discussing about life ways risk factors.
Accordingly , the data obtained by way of EXCEL were analyzed and processed
using SPSS 11.5. RESULTS: Diagnostic data of demography, epidemiology,
behavior environment, education and organization were obtained concerning the
public health of the Peking University Health Science Center community.
CONCLUSION: The key health issue in the Peking University Health Science
Center community is significantly influenced by the bad way of life. And some
behavior risk factors, such as fatness, lack of outdoor exercise in the community
members. Thus, the major necessary health service of Peking University Health
Science Center residents is to carry out a comprehensive management program of
life way disease for the whole people.
Publication Types:
480: J Microbiol Immunol Infect. 2006 Oct;39(5):402-7.

Complications of varicella infection in children in southern Taiwan.
Chi CY, Wang SM, Lin HC, Liu CC.
Division of Clinical Research, National Health Research Institutes, Zhunan,

Taiwan.
BACKGROUND AND PURPOSE: This study was designed to compare the

change in complications of varicella infection in children requiring hospitalization
before and after varicella vaccine introduction at a tertiary care hospital in
southern Taiwan. METHODS: Based on the results of a retrospective study
conducted in the pre-vaccine era (1988-1998), a second study was carried out
from 1998-2004 (post-vaccine era). In children admitted for varicella-related
complications, demographic data, clinical features, microbiological findings, and
outcomes were recorded and compared between the two eras. RESULTS: A
decreased annual rate of hospitalization was observed between the two eras. Age-
specific hospitalization rates significantly declined in the age group of 1-10 years
after vaccine introduction. Secondary skin or soft tissue infections were the most
common complications in both periods (pre-vaccine era, 44.1%; post-vaccine
introduced era, 56.6%). In the post-vaccine era, 23 (52%) patients had positive
bacterial isolates, including 19 Staphylococcus aureus (12 oxacillin-sensitive, 7
oxacillin-resistant) and 4 coagulase-negative staphylococci; a higher rate of
pneumonitis and lower rate of central nervous system involvement were also
observed. No differences were observed in other complications between the two
eras. In the post-vaccine era, hematological diseases were the most common
underlying conditions (17/18, 94%). The case-fatality rate in the post-vaccine era
(1.3%) was similar to that in the pre-vaccine era (2.2%). CONCLUSIONS: A
universal childhood varicella vaccination program would ultimately prevent the
spread and potential complications of varicella. The result of this study may serve
as baseline information as the national vaccination program begins.
Publication Types:
481: Eur J Public Health. 2007 Jun;17(3):306-13. Epub 2006 Oct 25.
'We will speak as the smoker': the tobacco industry's smokers'

rights groups.
Smith EA, Malone RE.
Department of Social and Behavioral Sciences, University of California San

Francisco Box 0612 San Francisco, CA 94143, USA. libby.smith@ucsf.edu
Introduction: The tobacco industry usually keeps its commercial and political
communications separate. However, the images of the smoker developed by the
two types of communication may contradict one another. This study assesses
industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of
the smoker that underlay these efforts. METHODS: Searches of the Legacy
Tobacco Documents Library, the British American Tobacco documents database,
and Tobacco Documents Online. RESULTS: 1100 documents pertaining to SRGs
were found, including groups from across Europe and in Australia, New Zealand,
and Hong Kong. From the late 1970s through the late 1990s they were active in
numerous policy arenas, particularly the defeat of smoke-free laws. Their
strategies included asserting their right to smoke and positioning themselves as
courteous victims of tobacco control advocates. However, most SRGs were short-
lived and apparently failed to inspire smokers to join in any significant numbers.
CONCLUSION: SRGs conflated the legality of smoking with a right to smoke.
SRGs succeeded by focusing debates about smoke-free policies on smokers rather
than on smoke. However, SRGs' inability to attract members highlights the
conflict between the image of the smoker in cigarette ads and that of the smokers'
rights advocate. The changing social climate for smoking both compelled the
industry's creation of SRGs, and created the contradictions that led to their failure.
As tobacco control becomes stronger, the industry may revive this strategy in
other countries. Advocates should be prepared to counter SRGs by exposing their
origins and exploiting these contradictions.
Publication Types:

• Review
482: Sangyo Eiseigaku Zasshi. 2006 Sep;48(5):169-75.

[Occupational health of endoscope sterilization workers in medical

institutions in Osaka Prefecture]
Miyajima K, Tabuchi T, Kumagai S.
Osaka Prefectural Institute of Public Health, Osaka, Japan.

kimiyaji@iph.pref.osaka.jp
To clarify the actual condition of endoscope sterilization work and the adverse
health effects of disinfectants on personnel, a questionnaire was sent to 173
medical institutions in Osaka Prefecture. Glutaraldehyde (GA), ortho-
phtalaldehyde (OPA), and hyperacetic acid were used as disinfectants of
endoscopes by 55.5%, 32.4%, and 8.7% of the medical institutions respectively.
The kind of disinfectant used had been changed in 57.8% of these institutions
during the past five years, and it was confirmed that the use of substitutes for GA,
such as OPA and hyperacetic acid, has increased. Personnel in 35.8% of the
institutions complained about symptoms during sterilization work. The kind of
disinfectant being used when they complained was GA in many cases and OPA in
others. A general ventilation system has now been installed in 72.3% of the
institutions; local exhaust systems have been installed in fewer, only 23.4%.
Protective gloves were used at about half of the institutions, but protective masks
and glasses were seldom used. This study shows that the occupational health
problems of endoscope sterilization work have not been resolved. Consequently,
it is necessary to promote the installation of ventilation systems and the use of
protective devices in all institutions. Health education in regard to the handling of
disinfectants is also necessary. Because little information is available about the
toxic effects of OPA and hyperacetic acid, epidemiological studies must be
conducted to clarify the human health effect of these disinfectants.
Publication Types:
483: J Nurs Educ. 2006 Oct;45(10):391-5.

The history of nursing services and education in Sri Lanka and the
effects on developing professionalism.
Jayasekara RS, McCutcheon H.
The University of Adelaide, Eleanor Harrold Building, Level 3, Royal Adelaide

Hospital, Adelaide, South Australia 5005. rasika.jayasekara@adelaide.edu.au
Understanding the evolution of nursing in a country provides perspective on the

origins of current successes and dilemmas and enables the development of
strategies and plans for future trends in the profession. This article explores the
evolution of nursing services and education in Sri Lanka and the effects on
developing professionalism in nursing. Internet database searches, personal
communication, and published and unpublished literature and reports were
reviewed to obtain historical information on nursing services and education in Sri
Lanka. The Sri Lankan health system is reviewed, and the establishment of
Western medicine in Sri Lanka and its effects on developing institutionalized
nursing education is presented, with a focus on the evolution of nursing education.
Major challenges for the nursing profession in Sri Lanka are discussed, and some
recommendations are shared.
Publication Types:
• Historical Article
484: Environ Monit Assess. 2007 Apr;127(1-3):363-81. Epub 2006 Oct 21.
Characteristics and driving factors of marsh changes in Zhalong

wetland of China.
Han M, Sun Y, Xu S.
School of Electronic and Information Engineering, Dalian University of

Technology, Dalian, 116023, China. minhan@dlut.edu.cn
Zhalong National Nature Reserve in the northeast of China is a large wetland and
a habitat of hundreds species of fauna and flora. The rare red-crowned crane is
one kind of endangered birds in it. Recently, Zhalong wetland is shrinking and it
encounters many problems including occasional fires, bad water quality, human
activities, etc. In order to find out a proper way to protect and restore the wetland,
this study, using a geographic information system, the global positioning system
and remote sensing techniques, analyses the spatial characteristics of the changes
in marsh landscape pattern and examines the driving factors for these changes.
Data sources include 8 Landsat Thematic Mapper satellite images of Zhalong area
in the period of 1986-2002 and the investigation information on site. Based on the
analysis of changes of marsh area and annual precipitation during the 16 years, it
is found that there is a close correlation between annual precipitation and marsh
area. It means that climate is one of driving factors of marsh pattern changes. To
understand influences of other kinds of land uses on marsh spatial distribution in
Zhalong wetland, this paper analyses the relationship between marsh and different
kinds of land uses, such as water surface, residential area, farm land, salina land
and grass land, respectively. According to the patch analysis theory, a fragmental
index and a fractal dimension of the marsh are calculated with perimeter-area
method. The results indicate that the marsh pattern is affected by human activities
significantly. In addition, the location alteration of marsh centroid point over the
16 years is studied. The movement trace of marsh centroid point is concerned
with different hydrological situation in different areas of the wetland. In summary
the characteristics of the marsh landscape pattern evolution during the 16 years
are affected by multiple driving factors. The main driving factors are climate,
human activities, distribution of other kinds of land uses and hydrological
situation in different areas.
Publication Types:

485: J Adolesc Health. 2006 Nov;39(5):720-8. Epub 2006 Jul 10.

Can the Internet be used effectively to provide sex education to

young people in China?
Lou CH, Zhao Q, Gao ES, Shah IH.
Department of Epidemiology and Social Science on Reproductive Health,

Shanghai Institute of Planned Parenthood Research, Shanghai, China.
chaohual@sippr.stc.sh.cn
PURPOSE: To assess the feasibility and effectiveness of sex education conducted

through the Internet. METHODS: Two high schools and four colleges of a
university in Shanghai were selected as the research sites. Half of these were
assigned to the intervention group and the other half to the control group. The
interventions consisted of offering sexual and reproductive health knowledge,
service information, counseling and discussion to all grade one students in the
intervention group. The intervention phase lasted for 10 months and was
implemented through a special website, with web pages, online videos, Bulletin
Board System (BBS) and expert mailbox. In total, 624 students from the
intervention, and 713 from the control schools and colleges participated in the
baseline survey, and about 97% of them were followed up in postintervention
survey to assess changes that can be attributed to the sex education interventions
provided through the Internet. RESULTS: The median scores of the overall
knowledge and of each specific aspect of reproductive health such as
reproduction, contraception, condom, sexually transmitted infections (STIs) and
human immunodeficiency virus/acquired immune deficiency syndrome
(HIV/AIDS) were significantly higher in the intervention group as compared with
those in the control group at postintervention (p < .0001), although no significant
differences were found between these two groups in the baseline survey (p > .05).
Group by time interaction effects in ordinal logistic regression analysis were
found on knowledge score (p < .0001) and in attitude of high school students
toward sex-related issues (p < .05), suggesting that interventions increased
subjects' knowledge significantly and changed high school students' attitudes to
being less liberal toward sex. The intervention also had positive influence on
students' attitudes toward providing contraceptive service for unmarried people.
CONCLUSIONS: Providing sex education to students in Shanghai through the
Internet was found feasible and effective. The Internet-based sex education
program increased students' reproductive health knowledge effectively and
changed their attitudes toward sex-related issues in terms of being less liberal
toward sex and more favorable to providing services to unmarried young people.
The Internet thus offers an important and hitherto untapped potential for
providing sex education to students and young people in China.
Publication Types:
486: Vet Parasitol. 2007 Feb 28;143(3-4):364-7. Epub 2006 Oct 10.
Validation of a geographic information system model for mapping

the risk of fasciolosis in cattle and buffaloes in Cambodia.
Tum S, Puotinen ML, Skerratt LF, Chan B, Sothoeun S.
Department of Animal Production and Health, 74 Monivong Boulivard, Sangkat

Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia.
Maps showing gradations of risk of fasciolosis due to Fasciola gigantica in

Cambodia were produced using geographic information systems (GIS) technology
in conjunction with determinants of fasciolosis. A comparison between levels of
risk predicted by the maps and field measurements of prevalence in 11 provinces
(n=1406) showed general agreement, which suggested the epidemiological
determinants and weightings used to produce the maps were appropriate.
However, due to logistical constraints, prevalence was measured at the provincial
level and animals were not randomly sampled (and thus were unlikely to be
representative of variability within provinces). To address this, additional field
work was carried out to measure prevalence in more detail--faecal samples were
collected from a randomly selected set of animals in four districts across a
representative province for areas predicted to be at high risk (n=311), moderate
risk (n=268) and no risk (n=262). As with the original field survey, the results
show general agreement between prevalence and risk predicted by the maps, with
the best fit found for areas predicted to be at high risk.
Publication Types:


487: Int J Health Plann Manage. 2006 Jul-Sep;21(3):229-38.
The cost of treatment for child pneumonias and meningitis in the

Northern Areas of Pakistan.
Hussain H, Waters H, Omer SB, Khan A, Baig IY, Mistry R, Halsey N.
Department of International Health, Johns Hopkins Bloomberg School of Public

Health, 615 N. Wolfe St, Rm. W5504 Baltimore, MD 21205, USA.
hhussain@jhsph.edu
Pneumonia, meningitis, and sepsis place a significant economic burden on health

care systems, particularly in developing countries. This study estimates treatment
costs for these diseases in health facilities in the Northern Areas of Pakistan.
Health facility resources are organized by categories--including salaries, capital
costs, utilities, overhead, maintenance and supplies--and quantified using activity-
based costing (ABC) techniques. The average cost of treatment for an outpatient
case of child pneumonia is dollar 13.44. For hospitalized care, the health system
spent an average of dollar 71 per episode for pneumonia, dollar 235 for severe
pneumonia, and dollar 2,043 for meningitis. These costs provide important
background information for the potential introduction of the conjugate
Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in
Pakistan.
Publication Types:
488: J Adv Nurs. 2006 Nov;56(3):314-24.

Comment in:
• J Adv Nurs. 2007 Dec;60(5):570-1; author reply 572-3.
A revision of a job evaluation system.
Kahya E.
Department of Industrial Engineering, Eskisehir Osmangazi University, Bademlik
Campus, TR26030 Eskisehir, Turkey. ekahya@ogu.edu.tr
AIMS: This paper reports a revision of the United Kingdom's National Health
Service Job Evaluation System and tests the revised system in eight clinical
nursing management jobs in four Turkish hospitals. BACKGROUND: A job
evaluation system was developed in the United Kingdom in 2003-2004. Most
studies have focused on how the whole system will be implemented in a health
organization. No study investigating proficiency of the system in terms of factors
and their level definitions was found. METHODS: The factors Knowledge,
Training and experience and Working conditions were divided into five factors:
Knowledge, Experience, Education, Environmental conditions and Hazards. To
test the revised system, all the nursing management jobs in four hospitals were
evaluated using a factor-based questionnaire including nurses' demographic
information and 19 variables. The questionnaire was distributed to 57 supervisor
nurses in 31 clinics at four hospitals in one Turkish city in 2005. All the
questionnaires were analysed to evaluate the jobs. RESULTS: The job scores
change depending on clinical conditions. Although the score range in the National
Health Service Job Evaluation system has been determined as 405-465 points
(band VI) for Nurse team leader and 469-536 points (band VII) for Nurse team
manager jobs, the job scores in the present study were 363 (band V) - 557 points
(band VIIIa) and 379 (band V) - 586 points (band VIIIa) respectively.
CONCLUSION: Although this exploratory study was limited to four hospitals in
one city in Turkey, the results indicated that two new jobs would be identified in
the National Health Service system to match the jobs in the intensive care and
emergency units.
Publication Types:
489: Int J Biometeorol. 2007 Jan;51(3):193-200. Epub 2006 Oct 13.

Heat wave impacts on mortality in Shanghai, 1998 and 2003.
Tan J, Zheng Y, Song G, Kalkstein LS, Kalkstein AJ, Tang X.
Jiangsu Key Laboratory of Meteorological Disaster, Nanjing University of

Information Science & Technology, Nanjing, 210044, People's Republic of
China. jianguot@21cn.com
A variety of research has linked extreme heat to heightened levels of daily
mortality and, not surprisingly, heat waves both in 1998 and in 2003 all led to
elevated mortality in Shanghai, China. While the heat waves in the two years
were similar in meteorological character, elevated mortality was much more
pronounced during the 1998 event, but it remains unclear why the human
response was so varied. In order to explain the differences in human mortality
between the two years' heat waves, and to better understand how heat impacts
human health, we examine a wide range of meteorological, pollution, and social
variables in Shanghai during the summers (15 June to 15 September) of 1998 and
2003. Thus, the goal of this study is to determine what was responsible for the
varying human health response during the two heat events. A multivariate
analysis is used to investigate the relationships between mortality and heat wave
intensity, duration, and timing within the summer season, along with levels of air
pollution. It was found that for heat waves in both summers, mortality was
strongly associated with the duration of the heat wave. In addition, while slightly
higher than average, the air pollution levels for the two heat waves were similar
and cannot fully explain the observed differences in human mortality. Finally,
since the meteorological conditions and pollution levels for the two heat waves
were alike, we conclude that improvements in living conditions in Shanghai, such
as increased use of air conditioning, larger living areas, and increased urban green
space, along with higher levels of heat awareness and the implementation of a
heat warning system, were responsible for the lower levels of human mortality in
2003 compared to 1998.
Publication Types:
490: Int J Health Geogr. 2006 Oct 13;5:45.

Application of Poisson kriging to the mapping of cholera and

dysentery incidence in an endemic area of Bangladesh.
Ali M, Goovaerts P, Nazia N, Haq MZ, Yunus M, Emch M.
International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7 dong,
Kwanak-gu, Seoul, Korea. mali@ivi.int
BACKGROUND: Disease maps can serve to display incidence rates

geographically, to inform on public health provision about the success or failure
of interventions, and to make hypothesis or to provide evidences concerning
disease etiology. Poisson kriging was recently introduced to filter the noise
attached to rates recorded over sparsely populated administrative units. Its benefit
over simple population-weighted averages and empirical Bayesian smoothers was
demonstrated by simulation studies using county-level cancer mortality rates. This
paper presents the first application of Poisson kriging to the spatial interpolation
of local disease rates, resulting in continuous maps of disease rate estimates and
the associated prediction variance. The methodology is illustrated using cholera
and dysentery data collected in a cholera endemic area (Matlab) of Bangladesh.
RESULTS: The spatial analysis was confined to patrilineally-related clusters of
households, known as baris, located within 9 kilometers from the Matlab hospital
to avoid underestimating the risk of disease incidence, since patients far away
from the medical facilities are less likely to travel. Semivariogram models reveal
a range of autocorrelation of 1.1 km for dysentery and 0.37 km for cholera. This
result translates into a cholera risk map that is patchier than the dysentery map
that shows a large zone of high incidence in the south-central part of the study
area, which is quasi-urban. On both maps, lower risk values are found in the
Northern part of the study area, which is also the most distant from the Matlab
hospital. The weaker spatial continuity of cholera versus dysentery incidence rates
resulted in larger kriging variance across the study area. CONCLUSION: The
approach presented in this paper enables researchers to incorporate the pattern of
spatial dependence of incidence rates into the mapping of risk values and the
quantification of the associated uncertainty. Differences in spatial patterns, in
particular the range of spatial autocorrelation, reflect differences in the mode of
transmission of cholera and dysentery. Our risk maps for cholera and dysentery
incidences should help identifying putative factors of increased disease incidence,
leading to more effective prevention and remedial actions in endemic areas.
Publication Types:
PMCID: PMC1617092
491: Diabetes Technol Ther. 2006 Oct;8(5):587-97.

Diabetes information systems: a rapidly emerging support for

diabetes surveillance and care.
Joshy G, Simmons D.
Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
joshyg@waikatodhb.govt.nz
BACKGROUND: With the rapid advances in information technology in the last

decade, various diabetes information systems have evolved in different parts of
the world. Availability of new technologies and information systems for
monitoring and treating diabetes is critical to achieving recommended metabolic
control, including glycosylated hemoglobin levels. The first step is to develop a
registry, including a patient identifier that can link multiple data sources, which
can then serve as a springboard to electronic mechanisms for practitioners to gain
information on performance and results. OBJECTIVE: The aim is to review the
provisions for diabetes surveillance in different parts of the world. This is a
systematic review of national and regional information systems for diabetes
surveillance. LITERATURE REVIEW: A comprehensive review was undertaken
using Medline literature review, internet search using the Google search engine,
and e-mail consultation with opinion leaders. TOPICS REVIEW:
National/regional-level diabetes surveillance systems in Europe, the United
States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art
diabetes information systems linking multiple data sources, with extensive audit
and feedback capabilities, have also been looked at. RESULTS:
National/regional-level audit databases have been tabulated. Diabetes information
systems linking multiple data sources have been described. Most of the developed
countries have now implemented systems such as diabetes registers and audits for
diabetes surveillance in at least some regions, if not nationally. Developing
nations are beginning to recognize the need for chronic disease management.
CONCLUSIONS: With the advancements in information technology, the diabetes
registers have the potential to rise beyond their traditional functions with dynamic
data integration, decision support, and data access, as demonstrated by some
diabetes information systems. With the rapid pace of development in electronic
health records and health information systems, countries that are beginning to
build their health information technology infrastructure could benefit from
planning and funding along these lines.
Publication Types:
• Review
492: J Expo Sci Environ Epidemiol. 2007 Jan;17(1):106-21. Epub 2006 Oct 11.
On ecological fallacy, assessment errors stemming from misguided

variable selection, and the effect of aggregation on the outcome of
epidemiological study.
Portnov BA, Dubnov J, Barchana M.
Department of Natural Resources & Environmental Management, University of

Haifa, Haifa, Israel. portnov@nrem.haifa.ac.il
In social and environmental sciences, ecological fallacy is an incorrect

assumption about an individual based on aggregate data for a group. In the present
study, the validity of this assumption was tested using both individual estimates of
exposure to air pollution and aggregate data for 1,492 schoolchildren living in the
in vicinity of a major coal-fired power station in the Hadera region of Israel. In
1996 and 1999, the children underwent subsequent pulmonary function tests
(PFT), and their parents completed a detailed questionnaire on their health status
and housing conditions. The association between children's PFT results and their
exposure to air pollution was investigated in two phases. During the first phase,
PFT averages were compared with average levels of air pollution detected in
townships, and small census areas in which the children reside. During the second
phase, individual pollution estimates were compared with individual PFT results,
and pattern detection techniques (Getis-Ord statistic) were used to investigate the
spatial data structure. While different levels of areal data aggregation changed the
results only marginally, the choice of indices measuring the children's PFT
performance had a significant influence on the outcome of the analysis. As
argued, differences between individual-level and group-level effects of exposure
(i.e., ecological or cross-level bias) are not necessary outcomes of data
aggregation, and that seemingly unexpected results may often stem from a
misguided selection of variables chosen to measure health effects. The
implications of the results of the analysis for epidemiological studies are
discussed, and recommendations for public health policy are formulated.
493: Med Lav. 2006 Mar-Apr;97(2):369-75.

Lessons from SARS in an age of emerging infections.
Ooi PL, Lim S, Tham KW.
Ministry of Health, Singapore. ooi_lim@moh.gov.sg
SARS, the first pandemic of this century, commanded the world's attention and
required public health actions at the national and international levels. In an age of
emerging infections, the lessons learnt from combating SARS can be used to
improve our preparedness capabilities in three key areas to effectively tackle a
public health emergency of international concern. The first area is in outbreak
alert, which encompasses use of surveillance to detect, assess, notify and report
events involving death or disease, and share information widely to enable proper
risk assessment. The system must able to build up a comprehensive picture with
appropriate warning for zoonotic diseases, environmental health and food safety.
The second area is in public health response. In the event of an outbreak alert, the
authorities must be able to quickly investigate cases/deaths and institute
comprehensive control measures to break the chain of transmission. Protection of
healthcare workers and reducing the opportunities for spread of infection through
contact tracing and quarantine are important. The third area is in international
health. This comprises health requirements for inbound and outbound travellers at
the border checkpoints and global information exchange to mitigate the risks of
travel abroad. Extrapolating these lessons to a wider public health context, our
rapidly changing global infectious diseases situation mandates that we evaluate all
available public health tools and build institutional capacity to effectively manage
emerging infections.
494: Yakugaku Zasshi. 2006 Oct;126(10):1003-10.

Introduction and evaluation of a newly established holiday work

system in the pharmacy ward at Municipal Ikeda Hospital.
Myotoku M, Iwamoto C, Tomida Y, Murayama Y, Irishio K, Nakanishi A,

Shimomura K, Ihara Y, Shioishi T, Inui T, Yohiro C, Miyamoto E, Suemura
N, Kawaguchi S.
Department of Pharmacy, Municipal Ikeda Hospital, Ikeda City, Japan.

miyoutoku-mi@umin.ac.jp
At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one

ward pharmacy dispense drugs to be administered by injection and injectable
preparations delivered to patients' bedsides was introduced in April 2000. This
system was aimed at minimizing risks related to injections. Initially, however, on
holidays, nurses played the roles of pharmacists in terms of the injections, and
there were concerns over a possible rise in the incidence of errors (adverse
events/near-misses) related to injections on these days compared with weekdays.
Later, when planning to introduce a new holiday work system in the ward
pharmacy, we took into account such factors as the number of pharmacists needed
on holidays, their duties on holidays and the influence on weekday pharmacy
activity of compensatory days-off taken by such pharmacists. In May 2004, the
new holiday work system was introduced in the ward pharmacy. Under the new
system, 5 pharmacists work at the ward pharmacy on holidays. After this system
was put into operation, the number of injections dispensed at the ward pharmacy
averaged 230 per day, and 177 per holiday. To evaluate the validity of this
system, we recently conducted a questionnaire survey of nurses at our hospital.
The survey involved 139 nurses. Of these nurses, 69.1% responded that the
number of incidents (adverse events/near-misses) related to dispensing injections
on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease
in incidents related to the delivery and administration of injectable preparations.
More than half of the nurses answered that the new system had made it easier for
them to collect information on medicines and helped them provide better nursing
services. When the nurses were asked to make a general assessment of the new
system, 90% rated the system as "good." The results of this survey indicate that
keeping the ward pharmacy open on holidays contributes to the promotion of the
proper use of medicines, reduction of risks related to injections and improvement
in the quality of medical care.
495: Public Health. 2006 Nov;120(11):1055-63. Epub 2006 Oct 2.

Trends in rural and urban differentials in incidence rates for

ruptured appendicitis under the National Health Insurance in
Taiwan.
Huang N, Yip W, Chang HJ, Chou YJ.
Institute of Public Health, National Yang Ming University, 155 Ni-Long Street,
Taipei 112, Taiwan, ROC.
OBJECTIVES: Rural-urban disparities in health remain a major focus of concern.

This population-based study examined the performance of Taiwan's universal
healthcare system in reducing rural-urban disparities in health, through better
accessibility. Changes in the rates of ruptured appendicitis were compared
between residents of remote and non-remote areas in Taiwan, under the National
Health Insurance (NHI) programme. METHODS: We identified all 128,930
patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI
inpatient files, enrolment files, major disease files, hospital registry and the
household registry were linked to provide comprehensive individual and hospital
information. Probit regression analyses were used to obtain adjusted estimates.
RESULTS: During the first 3 years, although the differences between the remote
and non-remote areas were apparent, they were seen to be narrowing. This
downward trend continued, and, since 1999, few discernible differences have
been observed. After adjusting for individual and hospital characteristics, over
time, the ruptured appendix rate among remote area residents was seen to be
decreasing significantly faster (1.1%) than among non-remote area residents.
More specifically, the children showed a substantially steeper narrowing trend
(3.3%) in rural-urban disparities, than did adults. CONCLUSIONS: Our findings
have shown a significant narrowing of health disparities between remote and non-
remote populations, resulting from free access to care and more healthcare
provision in remote areas under the NHI programme; particular success has been
observed in rural children. Although certain disparities still exist, Taiwan's
universal healthcare system has effectively reduced rural-urban disparities in
access to care and in ultimate health outcomes.
Publication Types:
• Evaluation Studies
496: Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):86-95.

Usage of the claim database of national health insurance programme

for analysis of cisapride-erythromycin co-medication in Taiwan.
Gau CS, Chang IS, Lin Wu FL, Yu HT, Huang YW, Chi CL, Chien SY, Lin
KM, Liu MY, Wang HP.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei,

Taiwan.
PURPOSE: This study aimed to use the National Health Insurance Research
Database, Taiwan for risk analysis of concomitant use of cisapride and
erythromycin. METHODS: The sample consisted of subjects identified in the
Outpatient Sampling Database (OSD) and Longitudinal Health Insurance
Database 2000 (LHID 2000), derived from the original claim data of the National
Health Insurance Research Database, Taiwan. RESULTS: According to the LHID
2000, a total of 464 individuals experienced 685 episodes of cisapride-
erythromycin co-medication prescribed by 295 physicians, revealing a prevalence
of 4.5% concomitant use, with higher prevalence in clinics (9.2%) than in other
medical institutes (3.7-5.4%). Among the co-medication episodes, 81.9% and
61.2% were prescribed from the same health institutes and by the same
physicians, respectively. No medical record of cardiac arrhythmias was found
among these patients in 2001 and 2002, probably due to the fact that 78.9% of the
464 individuals were under age 16, 84.0% had short exposure duration (1-4 days)
and 98.0% of the episodes were prescribed with a cisapride dose of less than 0.8
mg/kg/day. CONCLUSIONS: Findings from this study suggest that there exists
an urgent need for accreditation in terms of pharmacovigilance of clinical sites
and their practicing physicians for the prevention of irrational concomitant
prescription in Taiwan. Our findings also indicate that it is necessary to
investigate other possible conditions of potentially dangerous co-medication in
Taiwan and other developing countries. Copyright (c) 2006 John Wiley & Sons,
Ltd.
497: J Air Waste Manag Assoc. 2006 Sep;56(9):1342-8.

Determination and impact of volatile organics emitted during rush

hours in the ambient air around gasoline stations.
Wu BZ, Hsieh LL, Sree U, Chiu KH, Lo JG.
Department of Biomedical Engineering and Environmental Sciences, National

Tsing Hua University, Hsinchu, Taiwan, Republic of China.
This study analyzes the volatile organic compounds (VOCs) in the ambient air
around gasoline stations during rush hours and assesses their impact on human
health. Results from this study clearly indicate that methyl tertiary butyl ether
(MTBE), toluene, and isobutane are the major VOCs emitted from gasoline
stations. Moreover, the concentrations of MTBE and toluene in the ambient air
near gasoline stations are remarkably higher than those sampled on surrounding
roads, revealing that these compounds are mainly released from gasoline stations.
The concentration of VOCs near the gasoline stations without vapor recovery
systems are approximately 7.3 times higher than those around the gasoline
stations having the recovery systems. An impact on individual health and air
quality because of gasoline station emissions was done using Integrated Risk
Information System and Industrial Source Complex Short Term model.
Publication Types:
498: Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2006 May-Jun;(3):32-6.

[Problems of registration of morbidity and ways of its improvement]

[Article in Russian]
Asadov DA, Ismailov SI, Durmanov BD.
New system of registration of primary morbidity was developed for the purpose
of elimination of systemic error factors and decrease of human element input. The
following principles are included: simplification of registration rules; more exact
registration of acute conditions; unified rules of registration for out-patient and in-
patient medical institutions; unified form of information fields in medical
documentation for morbidity registration in out-patient and in-patient medical
institutions; succession in basic parameters, indicators and terms of medical
statistics in currently in force and modernized systems. New system includes
following information fields: "stage of diagnostics", "urgency of condition";
"ICD-10 code", "diagnosis", "life identification", "calendar year identification".
All fields, except field "diagnosis", are formalized and for them (except field
"ICD-10 code") corresponding codings are developed. Rules for filling
information fields, algorithms of validity control of primary information and
receiving such indicators as first time identified morbidity", "chronic morbidity",
"emergency (acute) morbidity", "chronic sickliness/morbidity identified for the
first time in previous years", "chronic sickliness" are developed. This system is
implemented experimentally in medical institutions of primary and secondary
levels of health care system in Yakka-Saraysk district of City of Tashkent.
Publication Types:
• Review
499: Healthc Inform. 2006 Sep;23(9):32.

Against all odds. Political unrest creates unique challenges for

healthcare organizations in regions of strife.
Marietti C.
500: Int J Epidemiol. 2006 Oct;35(5):1211-9. Epub 2006 Sep 19.

Decomposing socioeconomic inequality in infant mortality in Iran.
Hosseinpoor AR, Van Doorslaer E, Speybroeck N, Naghavi M, Mohammad

K, Majdzadeh R, Delavar B, Jamshidi H, Vega J.
Department of Equity, Poverty and Social Determinants of Health, Evidence and

Information for Policy, World Health Organization, Geneva, Switzerland.
hosseinpoora@who.int
BACKGROUND: Although measuring socioeconomic inequality in population

health indicators like infant mortality is important, more interesting for policy
purposes is to try to explain infant mortality inequality. The objective of this
paper is to quantify for the first time the determinants' contributions of
socioeconomic inequality in infant mortality in Iran. METHODS: A nationally
representative sample of 108 875 live births from October 1990 to September
1999 was selected. The data were taken from the Iranian Demographic and Health
Survey (DHS) conducted in 2000. Households' socioeconomic status was
measured using principal component analysis. The concentration index of infant
mortality was used as our measure of socioeconomic inequality and decomposed
into its determining factors. RESULTS: The largest contributions to inequality in
infant mortality were owing to household economic status (36.2%) and mother's
education (20.9%). Residency in rural/urban areas (13.9%), birth interval
(13.0%), and hygienic status of toilet (11.9%) also proved important contributors
to the measured inequality. CONCLUSIONS: The findings indicate that
socioeconomic inequality in infant mortality in Iran is determined not only by
health system functions but also by factors beyond the scope of health authorities
and care delivery system. This implies that in addition to reducing inequalities in
wealth and education, investments in water and sanitation infrastructure and
programmes (especially in rural areas) are necessary to realize improvements of
inequality in infant mortality across society. These findings can be instrumental
for the recent 5 year Economic, Social and Cultural Development Plan of Iran,
which identified the reduction of inequalities in social determinants of health.
Publication Types:

501: Int J Health Serv. 2006;36(3):623-9.
Distortion of some of the basic principles of public health practice in

India.
Banerji D.
Centre of Social Medicine and Community Health, Jawaharlal Nehru University,

New Delhi, India. nhpp@airtelbroadband.in
India's political leadership has chosen personnel from the Indian Administrative
Service cadre of generalist administrators and from the clinician-dominated cadre
of the Central Health Services to run the country's health service system. The
personnel's inadequate or distorted understanding of some of the basic principles
of public health practice--such as developing an epidemiological approach to
solving community health problems, choice of appropriate technology, and
optimization of health service systems--has had a very deleterious effect on the
health service system. These administrators have become vulnerable to
manipulation by personnel from international agencies, who also have
questionable public health credentials, to create space for imposition of their
technocentric, ill-conceived, and ill-designed agenda. To rationalize adoption of
such an obviously faulty agenda, they have to be ahistorical, apolitical, and
atheoretical and indulge in misinformation, disinformation, and suppression and
manipulation of information. This amounts to what Navarro has termed
"intellectual fascism."
502: Trans R Soc Trop Med Hyg. 2007 Mar;101(3):216-25. Epub 2006 Sep 18.
Accuracy of the health information system on malaria surveillance

in Vietnam.
Erhart A, Thang ND, Xa NX, Thieu NQ, Hung LX, Hung NQ, Nam NV, Toi
LV, Tung NM, Bien TH, Tuy TQ, Cong LD, Thuan LK, Coosemans M,
D'Alessandro U.
Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000

Antwerp, Belgium. aerhart@itg.be
The health information system (HIS) is a key component of control programs and
its accuracy is necessary for the assessment of disease risks, the formulation of
priorities and the evaluation of the cost-effectiveness of different interventions. In
order to assess the quality of the HIS in estimating malaria morbidity in Vietnam,
we compared data obtained by a 2-year active (ACD) and passive case detection
(PCD) study with those routinely collected at the local commune health centres
(CHC) at three sites having different malaria epidemiology. The majority of
malaria cases (80-95%) detected by ACD were missed by the HIS. Similarly,
most malaria cases (50-90%) detected by PCD were also missed by the HIS, and
this was proportional to the number of active private practitioners. Reasons for
this low sensitivity are low CHC attendance, high attendance at private health
facilities, widespread self-medication and attendance at central health facilities. In
conclusion, although malaria has sharply decreased in Vietnam over the past 10
years, the current HIS greatly underestimates the malaria burden. Involvement of
the private sector and the establishment of sentinel sites might improve the quality
of data and the relevance of HIS in malaria control.
Publication Types:
503: J Med Syst. 2006 Aug;30(4):269-75.

Comparison of computing capability and information system

abilities of state hospitals owned by Ministry of Labor and Social
Security and Ministry of Health.
Tengilimoğlu D, Celik Y, Ulgü M.
Educational Faculty of Business and Tourism, Gazi University, Golbasi Campus,

Ankara, Turkey. dilaver@gazi.edu.tr
The main purpose of this study is to give an idea to the readers about how big and
important the computing and information problems that hospital managers as well
as policy makers will face with after collecting the Ministry of Labor and Social
Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure
in Turkey by comparing the current level of computing capability of hospitals
owned by two ministries. The data used in this study were obtained from 729
hospitals that belong to both ministries by using a data collection tool. The results
indicate that there have been considerable differences among the hospitals owned
by the two ministries in terms of human resources and information systems. The
hospital managers and decision makers making their decisions based on the data
produced by current hospital information system (HIS) would more likely face
very important difficulties after merging MoH and MoLSS hospitals in Turkey. It
is also possible to claim that the level and adequacy of computing abilities and
devices do not allow the managers of public hospitals to use computer technology
effectively in their information management practices. Lack of technical
information, undeveloped information culture, inappropriate management styles,
and being inexperienced are the main reasons of why HIS does not run properly
and effectively in Turkish hospitals.
Publication Types:
504: J Ayub Med Coll Abbottabad. 2006 Apr-Jun;18(2):64-8.

An assessment study of maternal mortality ratio databank in five

districts of North Western Frontier Province Pakistan.
Farooq N, Jadoon H, Masood TI, Wazir MS, Farooq U, Lodhi MS.
Department of Community Medicine, Ayub Medical College, Abbottabad,

Pakistan. drnasirf@yahoo.com
BACKGROUND: Maternal mortality ratio is an indicator to measure the

summary of information about mother and child health. It is estimated that about
500 maternal deaths occur per 100,000 live births each year in Pakistan. It is a
well known fact that all health statistics coming out of the developing countries
are calculated "guesstimates" some are perhaps more close to the real figures than
the others. There is a dire need to help generate information that can be used by
health professionals, health care planners and managers to save women's lives by
improving the quality of care provided to turn away maternal mortality. The
maternal mortality ratio for Pakistan as well as for NWFP is projected as
533/100,000 live births for the year 1990-91 produced by National Institute of
Population Studies, Pakistan. METHODS: This was a retrospective cross-
sectional quantitative study for the period (2001-2002) conducted in five districts
of (NWFP) North Western Frontier Province, Pakistan. RESULTS: National
HMIS data opened the maternal mortality ratio for; Haripur as 0.168 and 0.173,
Mansehra 00 and 00, Battagram 00 and 00, Swat 0.051. and 0.524 and Swabi 00
and 0.968 per/1000 live births, respectively. The small part exercise outcome (the
study) endorsed more shadowy side of the actual maternal mortality ratio for the
same period in the same districts. CONCLUSION: In our country there is a urgent
need to institute an efficient mode of operation to get accurate maternal mortality
database. Verbal Autopsy method is cost effective and feasible approach for
implementation in a country like Pakistan.

505: BMC Health Serv Res. 2006 Sep 13;6:115.
Ethnic minorities and prescription medication; concordance

between self-reports and medical records.
Uiters E, van Dijk L, Devillé W, Foets M, Spreeuwenberg P, Groenewegen

PP.
Netherlands Institute for Health Services Research (NIVEL), Utrecht,

Netherlands. e.uiters@minjus.nl
BACKGROUND: Ethnic differences in health care utilisation are frequently

reported in research. Little is known about the concordance between different
methods of data collection among ethnic minorities. The aim of this study was to
examine to which extent ethnic differences between self-reported data and data
based on electronic medical records (EMR) from general practitioners (GPs)
might be a validity issue or reflect a lower compliance among minority groups.
METHODS: A cross-sectional, national representative general practice study,
using EMR data from 195 GPs. The study population consisted of Dutch, Turks,
Surinamese, Antilleans and Morrocans. Self-reported data were collected through
face-to-face interviews and could be linked to the EMR of GPs. The main
outcome measures were the level of agreement between annual prescribing rate
based on the EMRs of GPs and the self-reported receipt and use of prescriptions
during the preceding 14 days. RESULTS: The pattern of ethnic differences in
receipt and use of prescription medication depended on whether self-reported data
or EMR data were used. Ethnic differences based on self-reports were not
consistently reflected in EMR data. The percentage of agreement above chance
between EMR data and self-reported receipt was in general relative low.
CONCLUSION: Ethnic differences between self-reported data and EMR data
might not be fully perceived as a cross-cultural validity issue. At least for
Moroccans and Turks, compliance with the prescribed medication by the GP is
suggested not to be optimal.
Publication Types:
PMCID: PMC1578560
506: Soc Work Health Care. 2006;43(2-3):115-30.
Social workers confront terrorist victims: The interventions and the

difficulties.
Fraidlin N, Rabin B.
Social Services Department, Sapir Medical Center, Meir Hospital, Kfar Saba,
Israel. nellyfr@clalit.org.il
The article deals with unremitting stress experienced by social workers dealing
with terror victims. The article will describe the activity of social workers
responsible for setting up a hospital information center. It will describe how they
assist families searching for their loved ones and the process of identifying
victims. The process in which the uncertainty is treated, the anxiety is contained,
bad news are conveyed and concrete solutions are provided, will be elaborated on.
Special emphasis will be placed on the multifaceted complimentary relationship
between team members and between the provision of support, role exchange and
the opportunity to share difficult experiences. The team is expert in identifying
both personal and collective signs of distress. This is of particular significance
and importance in connection with compassion fatigue, survival guilt, anxiety,
depression and ongoing burnout, regarding themselves and their colleagues. The
article will propose organizational and clinical solutions, which could also be of
service to other frameworks within the health system.
507: Spinal Cord. 2006 Sep;44(9):530-4.

International Spinal Cord Injury Data Sets.
Biering-Sørensen F, Charlifue S, DeVivo M, Noonan V, Post M, Stripling T,

Wing P.
Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital,

Copenhagen, Denmark.
STUDY DESIGN: Discussion and development of final consensus. OBJECTIVE:

Present the background, purpose, and process for the International Spinal Cord
Injury (SCI) Data Sets development. SETTING: International. METHODS: An
international meeting on SCI data collection and analysis occurred at a workshop
on May 2, 2002, before the combined meeting of the American Spinal Injury
Association (ASIA) and the International Spinal Cord Society (ISCoS) in
Vancouver, British Columbia, Canada. At this meeting, a process was developed
for selection of data elements to be included in International SCI Data Sets.
RESULTS: An overall structure and terminology has been developed following
the format of the International Classification of Functioning, Disability and
Health (ICF). This includes definitions of the Core Data Set, as well as Modules
with Basic Questions or Data Sets and Expanded Data Sets. The Core Data Set
has been developed and will be presented separately. Working groups for
additional modules are being established as well as general guidelines for the
development of the modules. CONCLUSION: The presented format should help
in developing data sets and modules within various topics related to SCI.
Publication Types:

• Review
508: Soc Sci Med. 2006 Dec;63(11):2899-911. Epub 2006 Sep 6.

Targeted intervention for the ultra poor in rural Bangladesh: Does it

make any difference in their health-seeking behaviour?
Ahmed SM, Petzold M, Kabir ZN, Tomson G.
BRAC, Dhaka, Bangladesh. ahmed.sm@brac.net
It is now well recognised that regular microcredit intervention is not enough to

effectively reach the ultra poor in rural Bangladesh, in fact it actively excludes
them for structural reasons. A grants-based integrated intervention was developed
(with health inputs to mitigate the income-erosion effect of illness) to examine
whether such a targeted intervention could change the health-seeking behaviour of
the ultra-poor towards greater use of health services and "formal allopathic"
providers during illness, besides improving their poverty status and capacity for
health expenditure. The study was carried out in three northern districts of
Bangladesh with high density of ultra poor households, using a pre-test/post-test
control group design. A pre-intervention baseline (2189 interventions and 2134
controls) survey was undertaken in 2002 followed by an intervention (of 18
months duration) and a post-intervention follow-up survey of the same
households in 2004. Structured interviews were conducted to elicit information on
health-seeking behaviour of household members. Findings reveal an overall
change in health-seeking behaviour in the study population, but the intervention
reduced self-care by 7 percentage units and increased formal allopathic care by 9
percentage units. The intervention increased the proportion of non-deficit
households by 43 percentage units, as well as the capacity to spend more than Tk.
25 for treatment of illness during the reference period by 11 percentage units.
Higher health expenditure and time (pre- to -post-intervention period) was
associated with increased use of health care from formal allopathic providers.
However, gender differences in health-seeking and health-expenditure
disfavouring women were also noted. The programmatic implications of these
findings are discussed in the context of improving the ability of health systems to
reach the ultra poor.
Publication Types:
509: Saudi Med J. 2006 Sep;27(9):1306-10.

On the Ottoman consent documents for medical interventions and

the modern concept of informed consent.
Kara MA, Aksoy S.
Department of History of Medicine and Deontology, Ege University Medical

School, 35100 Bornova, Izmir, Turkey. malpertunga@superonline.com
Information for patients prior to medical intervention is one of the principles of

modern medical practice. In this study, we looked at an earlier practice of this
principle. Ottoman judges had record books called sicil. One of the categories in
sicils was the consent documents called riza senedi, which was a patient-physician
contract approved by the courts. These contracts were especially for the protection
of physicians from punishment if the patient dies. It is not clear whether patients
were informed properly or not. Consent for minors was obtained from parents.
However, a situation where an adult does not have the capacity to consent, was
not clear in these documents. Any sign of free withdrawal of consent was not
found in these records. Due to the legal system of Ottoman State, these contracts
were related to Islamic law rather than modern civil law. We aim, in this paper, to
present a legal practice, which is possible to consider as an early example of the
informed consent practice.
Publication Types:
• Historical Article
510: Int J Qual Health Care. 2006 Oct;18(5):346-51. Epub 2006 Sep 1.
Comparison of health care professionals' and surveyors' opinions on

problems and obstacles in implementing quality management system
in Thailand: A national survey.
Pongpirul K, Sriratanaban J, Asavaroengchai S, Thammatach-Aree J,

Laoitthi P.
International Health Policy Program (IHPP-Thailand), Quality of Care, Ministry

of Public Health, Nonthaburi, Thailand. doctorkrit@gmail.com
OBJECTIVE: To explore problems and obstacles of hospitals in Thailand

implementing quality management systems according to the hospital accreditation
(HA) standards. DESIGN: Questionnaire survey. SETTING: Thirty-nine hospitals
in all 13 regions of Thailand. PARTICIPANTS: A total of 728 health care
professionals and 41 surveyors of the national accreditation program. MAIN
OUTCOME MEASURES: Health care professionals' and surveyors' opinions on
problems and obstacles in 24 items representing Thailand HA standards.
RESULTS: The response rates were 94.9 and 73.2% in health care professionals
and surveyors, respectively. More than 90% of both groups thought that there had
been problems in the items such as 'quality improvement (QI) activities' and
'integration and utilization of information'. The items considered by health care
professionals as major obstacles included 'adequacy of staff' (34.6%) and
'integration and utilization of information' (26.6%), for example. For surveyors,
'integration and utilization of information' was ranked highest as presenting a
major obstacle (43.9%), followed by 'discharge and referral process' (31.7%) and
'medical recording process' (29.3%). The rank orders for the 24 items as problems
and major obstacles were similar in both groups (Spearman's rank correlation
0.436, P = 0.033 and 0.583, P = 0.003, respectively). Surveyors had a higher
degree of concern and paid more attention to care-related items than health care
professionals. CONCLUSIONS: Health care professionals have been facing many
problems with multidisciplinary process-related issues of the accreditation
standard, whereas surveyors might have had some difficulties in conveying the
core QI concepts to them. The findings might be explained by the effects of health
care reform on the underlying accreditation principles. One of the strategies to
respond to the situation was presented.
Publication Types:
511: Biol Trace Elem Res. 2006 Summer;111(1-3):1-9.

Serum levels of trace elements and iron-deficiency anemia in adult

Vietnamese.
Van Nhien N, Khan NC, Yabutani T, Ninh NX, Kassu A, Huong BT, Do TT,
Motonaka J, Ota F.
Department of Preventive Environment and Nutrition, Systems of Nutritional

Sciences, Graduate School of Health Biosciences Research, Hanoi, Vietnam.
This study was aimed at assessing the serum levels of vitamin A, copper, zinc,
selenium, and iron among adult Vietnamese with and without iron-deficiency
anemia. Blood was collected from adult Vietnamese living in the midland of
northern Vietnam. One hundred twenty-three subjects in the age range 20-60 yr
were included in the study. Anemia, where the concentration of hemoglobin in
whole blood is less than 120 g/L in females and 130 g/L in males, was found in
30% (37/123) of the study population. The levels of vitamin Aand selenium in the
sera of anemic subjects (n = 37) were significantly lower than that in nonanemic
group (n = 86). On the other hand, no significant differences were observed in the
concentrations of copper and zinc between the two groups. This study was the
first to show serum levels of trace elements in adult Vietnamese, providing useful
baseline information for further studies.
512: PLoS Med. 2006 Aug;3(8):e268.

Core verbal autopsy procedures with comparative validation results

from two countries.
Setel PW, Rao C, Hemed Y, Whiting DR, Yang G, Chandramohan D, Alberti

KG, Lopez AD.
MEASURE Evaluation/Carolina Population Center, University of North Carolina,

Chapel Hill, North Carolina, USA. psetel@unc.edu
BACKGROUND: Cause-specific mortality statistics remain scarce for the
majority of low-income countries, where the highest disease burdens are
experienced. Neither facility-based information systems nor vital registration
provide adequate or representative data. The expansion of sample vital
registration with verbal autopsy procedures represents the most promising interim
solution for this problem. The development and validation of core verbal autopsy
forms and suitable coding and tabulation procedures are an essential first step to
extending the benefits of this method. METHODS AND FINDINGS: Core forms
for peri- and neonatal, child, and adult deaths were developed and revised over 12
y through a project of the Tanzanian Ministry of Health and were applied to over
50,000 deaths. The contents of the core forms draw upon and are generally
comparable with previously proposed verbal autopsy procedures. The core forms
and coding procedures based on the International Statistical Classification of
Diseases (ICD) were further adapted for use in China. These forms, the ICD
tabulation list, the summary validation protocol, and the summary validation
results from Tanzania and China are presented here. CONCLUSIONS: The
procedures are capable of providing reasonable mortality estimates as adjudged
against stated performance criteria for several common causes of death in two
countries with radically different cause structures of mortality. However, the
specific causes for which the procedures perform well varied between the two
settings because of differences in the underlying prevalence of the main causes of
death. These differences serve to emphasize the need to undertake validation
studies of verbal autopsy procedures when they are applied in new
epidemiological settings.
Publication Types:
PMCID: PMC1502154
513: Yonsei Med J. 2006 Aug 31;47(4):524-33.

The perceived care needs of breast cancer patients in Korea.
Hwang SY, Park BW.

Department of Social Welfare, Duksung Women's University College of Social
Sciences, Seoul, Korea.
By analyzing the data of 459 patients who completed the Supportive Care Needs
Survey (SCNS), the prevalence, medical and non-medical predictors of unmet
needs were investigated. Breast cancer patients in Korea experienced high levels
of unmet needs across the needs domains, particularly in the health system and
information domain (56.9%). Various medical and non-medical variables were
identified as significant predictors of unmet needs in each domain. By
multivariate analyses, several predictors were identified across the domains
including; less education (< or = 9 years) in the psychologic, chemotherapy, short
post-surgical interval, and less education in the physical and daily living, younger
age (< 50 years) in the sexuality, larger tumor size (> 2 cm) and younger age in
the health system and information, and more education (> or = 13 years) in the
care and support domain. The results of this study suggest medical professional
should consider the complexity and dynamics of meeting patients' needs in
providing supportive care services.
Publication Types:
514: Pediatrics. 2006 Oct;118(4):e1055-60. Epub 2006 Aug 28.

The incidence of anemia in an Israeli population: a population

analysis for anemia in 34,512 Israeli infants aged 9 to 18 months.
Meyerovitch J, Sherf M, Antebi F, Barhoum-Noufi M, Horev Z, Jaber L,

Weiss D, Koren A.
Research and Health Planning Department, Health Planning and Policy Division,
Clalit Health Services, 101 Arlozorov St, PO Box 16250, Tel Aviv 62098, Israel.
josephm@clalit.org.il
OBJECTIVES: The purpose of this work was to use the comprehensive

computerized database of Clalit Health Services to analyze the prevalence and
contributing factors of anemia among the population of Clalit Health Services-
insured Israeli infants aged 9 to 18 months, characterized by ethnic sector.
METHODS: This was a cross-sectional retrospective study for the year 2003
using the computerized database of Clalit Health Services for 34,512 infants aged
9 to 18 months insured by the Clalit Health Services sick fund. Children with
abnormal white blood counts at the time of the hemoglobin test and with chronic
diseases were excluded. The data were analyzed for age, infant hemoglobin level,
ethnic origin, district distribution, type of clinic where the infant received
treatment, the number of iron prescriptions dispensed to each child, and the
mother's last hemoglobin level before giving birth. Anemia was defined as a
hemoglobin level <105 g/L. RESULTS: The prevalence of anemia among Israeli
infants is 15.5%. The prevalence is significantly higher in the non-Jewish
population (22.5%) as compared with the Jewish population (10.5%). The lowest
prevalence of anemia was found in pediatric health centers (10.7%). A significant
correlation was found between the presence of anemia in infants and the presence
of anemia found in their mothers. Infants with anemia used significantly less iron
preparations. CONCLUSIONS: This study is one of the first studies to use a
comprehensive computerized database to perform a population-based analysis of
anemic infants. We found a considerable percentage of infants to be anemic and
identified a specific population to be at high risk for anemia. We describe 2
factors that have the potential to be altered through intervention: improving
compliance of iron intake and maternal anemia. Major national efforts should be
made to minimize the prevalence of anemia, especially in the non-Jewish
population, and to learn more about the causes of iron-deficiency anemia in this
group. This study provides a base for an intervention study.
515: BMC Public Health. 2006 Aug 25;6:218.

Acute symptoms related to air pollution in urban areas: a study

protocol.
Yunesian M, Asghari F, Vash JH, Forouzanfar MH, Farhud D.
School of Public Health & Centre for Environmental Research, Tehran University
of Medical Sciences, Poursina Street, Keshavarz Boulevard, P.O. Box 14155-
6446, Tehran, Iran. younesia@sina.tums.ac.ir
BACKGROUND: The harmful effects of urban air pollution on general

population in terms of annoying symptoms are not adequately evaluated. This is
in contrast to the hospital admissions and short term mortality. The present study
protocol is designed to assess the association between the level of exposure to
certain ambient air pollutants and a wide range of relevant symptoms. Awareness
of the impact of pollution on the population at large will make our estimates of
the pertinent covert burden imposed on the society more accurate.
METHODS/DESIGN: A cross sectional study with spatial analysis for the
addresses of the participants was conducted. Data were collected via telephone
interviews administered to a representative sample of civilians over age four in
the city. Households were selected using random digit dialling procedures and
randomization within each household was also performed to select the person to
be interviewed. Levels of exposure are quantified by extrapolating the addresses
of the study population over the air pollution matrix of the city at the time of the
interview and also for different lag times. This information system uses the data
from multiple air pollution monitoring stations in conjunction with meteorological
data. General linear models are applied for statistical analysis. DISCUSSION:
The important limitations of cross-sectional studies on acute effects of air
pollution are personal confounders and measurement error for exposure. A wide
range of confounders in this study are controlled for in the statistical analysis.
Exposure error may be minimised by employing a validated geographical
information system that provides accurate estimates and getting detailed
information on locations of individual participants during the day. The
widespread operation of open air conditioning systems in the target urban area
which brings about excellent mixing of the outdoor and indoor air increases the
validity of outdoor pollutants levels that are taken as exposure levels.
Publication Types:
PMCID: PMC1569380
516: Mil Med. 2006 Aug;171(8):691-7.

The Navy-Marine Corps Combat Trauma Registry.
Galarneau MR, Hancock WC, Konoske P, Melcer T, Vickers RR, Walker

GJ, Zouris JM.
Naval Health Research Center, San Diego, CA 92186-5122, USA.
The U.S. military services, drawing on the experiences of civilian trauma systems
in monitoring trauma care delivery, have begun to implement their own registries,
emphasizing injury incidence and severity in a combat environment. This article
introduces and describes the development of the U.S. Navy-Marine Corps Combat
Trauma Registry and presents several preliminary inquiries of its database
regarding combat injury patterns and casualty management during Operation Iraqi
Freedom. The Navy-Marine Corps Combat Trauma Registry is composed of data
sets describing events that occur from the point of injury through the medical
chain of evacuation and on to long-term rehabilitative outcomes. Data were
collected from Navy-Marine Corps level 1B, 2, and 3 medical treatment facilities.
Data from the official combat period were analyzed to present a variety of
preliminary findings that indicate, among other things, how many and for what
type of injury casualties were evacuated, specific mechanisms of injury, and types
of injuries treated at the medical treatment facilities.
Publication Types:
517: Blood Press Monit. 2006 Oct;11(5):257-67.

The economic impact of the introduction of home blood pressure

measurement for the diagnosis and treatment of hypertension.
Funahashi J, Ohkubo T, Fukunaga H, Kikuya M, Takada N, Asayama K,

Metoki H, Obara T, Inoue R, Hashimoto J, Totsune K, Kobayashi M, Imai
Y.
Department of Clinical Pharmacology and Therapeutics, Tohoku University

Graduate School of Pharmaceutical Science and Medicine, Tokyo, Japan.
OBJECTIVES: To investigate the economic consequences resulting from

introduction of home blood pressure measurement in diagnosis of hypertension
instead of casual clinic blood pressure measurement. METHODS: We constructed
a decision tree model using data from the Ohasama study and a Japanese national
database. The Ohasama study provided the prognostic value of home blood
pressure as compared with clinic blood pressure measurement. RESULTS: It is
predicted that the use of home blood pressure for hypertension diagnosis results in
a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related
medical costs in Japan. Most of this was attributable to medical costs saved by
avoiding the start of treatment for untreated individuals who were diagnosed as
hypertensive by clinic blood pressure but whose blood pressures were in the
normal range when based on home blood pressure; that is, the so called white-coat
hypertension. Furthermore, it could be expected that adequate blood pressure
control mediated by the change in the diagnostic method from clinic to home
blood pressure measurement would improve the prognosis for hypertension. We
estimated that the prevention of hypertensive complications resulted in a
reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In
addition, stroke prevention due to adequate blood pressure control based on home
blood pressure measurement reduced annual long-term care costs by 39 million
US dollars (4.2 billion yen). A per-person break-even cost for introducing home
blood pressure monitoring was calculated as 409 US dollars (44,580 yen).
CONCLUSIONS: The introduction of home blood pressure measurement for the
diagnosis and treatment of hypertension would be very effective to save costs.
Publication Types:
518: Int J Med Inform. 2007 Sep;76(9):688-700. Epub 2006 Aug 23.
Building a reference functional model for EHR systems.
Sumita Y, Takata M, Ishitsuka K, Tominaga Y, Ohe K.
Department of Planning, Information and Management, The University of Tokyo

Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. yukis-
tky@umin.ac.jp
INTRODUCTION: Our aim was to develop a reference functional model for

electric health record systems (RFM). Such a RFM is built from functions using
functional descriptive elements (FDEs) and represents the static relationships
between them. This paper presents a new format for describing electric health
record (EHR) system functions. METHODS: Questionnaire and field interview
survey was conducted in five hospitals in Japan and one in the USA, to collect
data on EHR system functions. Based on survey results, a reference functional list
(RFL) was created, in which each EHR system function was listed and divided
into 13 FDE types. By analyzing the RFL, we built the meta-functional model and
the functional model using UML class diagrams. The former defines language for
expressing the functional model, while the latter represents functions, FDEs and
their static relationships. RESULTS: A total of 385 functions were represented in
the RFL. Six patterns were found for the relationships between functions. The
meta-functional model was created as a new format for describing functions.
Examples of the functional model, which included the six patterns in the
relationships between functions and 11 verbs, were created. DISCUSSIONS: We
present the meta-functional model, which is a new description format for the
functional structure and relationships. Although a more detailed description is
required to apply the RFM to the semiautomatic generation of functional
specification documents, our RFM can visualize functional structures and
functional relationships, classify functions using multiple axes and identify the
similarities and differences between functions. The RFM will promote not only
the standardization of EHR systems, but also communications between system
developers and healthcare providers in the EHR system-design processes. 2006
Elsevier Ireland Ltd
Publication Types:
519: BMC Med Educ. 2006 Aug 22;6:43.

Do community medicine residency trainees learn through journal

club? An experience from a developing country.
Akhund S, Kadir MM.
Human Development Programme, Aga Khan University, Karachi, Pakistan.

saima.akhund@aku.edu
BACKGROUND: Journal clubs are an internationally recognized teaching tool in

many postgraduate medical education fields. In developing countries lack of
funds for current print materials may have limited journal club use. But with
advancing information technology trainees in developing countries increasingly
have more access to high quality journals online. However, we are aware of no
studies describing journal club existence and effectiveness in postgraduate
medical training in Pakistan. Also we have found no published effectiveness
studies of this teaching modality in Community Medicine (Public Health) in any
country. This study evaluated the effectiveness of Community Medicine (Public
Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using
international criteria for successful journal clubs (2 years continuous existence
and more than 50% attendance) and examining resident and alumni satisfaction.
METHODS: Journal club effectiveness criteria were searched using electronic
search databases. Departmental records were reviewed from September 1999-
September 2005. Ninety percent of residents and alumni of Community Medicine
Residency Programme participated voluntarily in a confidential survey.
RESULTS: The CMR-JC was regularly conducted. More than 95% of residents
attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29
current residents/alumni responded to the anonymous questionnaire. Acquisition
of critical appraisal skills (23 respondents) and keeping up with current literature
(18 respondents) were the two most important objectives achieved. Respondents
recommended improved faculty participation and incorporating a structured
checklist for article review. CONCLUSION: CMR-JC fulfils criteria for effective
journal clubs. Residents and alumni agree CMR-JC meets its objectives.
Incorporating suggested recommendations will further improve standards. The
journal club learning modality should be included in residency training programs
in developing countries. Effective use of online resources to support journal clubs
is demonstrated as a successful alternative to excessive expenditure for obtaining
print journals. Those trying to start or improve journal clubs can benefit from our
experience.
PMCID: PMC1564014
520: Genomics. 2006 Nov;88(5):535-40. Epub 2006 Aug 17.

SNP identification, linkage disequilibrium, and haplotype analysis

for a 200-kb genomic region in a Korean population.
Kim KJ, Lee HJ, Park MH, Cha SH, Kim KS, Kim HT, Kimm K, Oh B, Lee
JY.
Center for Genome Sciences, Korean National Institute of Health, Eunpyung-Gu,

Seoul 122-701, Korea.
Understanding patterns of linkage disequilibrium (LD) across genomes may

facilitate association mapping studies to localize genetic variants influencing
complex diseases, a recognition that led to the International Haplotype Mapping
Project (HapMap). Divergent patterns of haplotype frequency and LD across
global populations require that the HapMap database be supplemented with
haplotype and LD data from additional populations. We conducted a pilot study
of the LD and haplotype structure of a genomic region in a Korean population. A
total of 165 SNPs were identified in a 200-kb region of 22q13.2 by direct
sequencing. Unphased genotype data were generated for 76 SNPs in 90 unrelated
Korean individuals. LD, haplotype diversity, and recombination rates were
assessed in this region and compared with the HapMap database. The pattern of
LD and haplotype frequencies of Korean samples showed a high degree of
similarity with Japanese data. There was a strong correlation between high LD
and low recombination frequency in this region. We found considerable
similarities in local LD patterns between three Asian populations (Han Chinese,
Japanese, and Korean) and the CEPH population. Haplotype frequencies were,
however, significantly different between them. Our results should further the
understanding of distinctive Korean genomic features and assist in designing
appropriate association studies.
Publication Types:
521: Bull World Health Organ. 2006 Aug;84(8):629-35.

Linking local knowledge with global action: examining the Global

Fund to Fight AIDS, Tuberculosis and Malaria through a
knowledge system lens.
van Kerkhoff L, Szlezák N.
National Centre for Epidemiology and Population Health, The Australian

National University, Canberra, Australia. lorrae.vankerkhoff@anu.edu.au
New global public health institutions are increasingly emphasizing transparency

in decision-making, developing-country ownership of projects and programmes,
and merit- and performance-based funding. Such principles imply an institutional
response to the challenge of bridging the "know-do gap", by basing decisions
explicitly on results, evidence and best practice. Using a knowledge systems
framework, we examine how the Global Fund to Fight AIDS, Tuberculosis and
Malaria has affected the ways in which knowledge is used in efforts to combat
these three diseases. We outline the formal knowledge system embedded in
current rules and practices associated with the Global Fund's application process,
and give three examples that illustrate the complexity of the knowledge system in
action: human immunodeficiency virus/acquired immunodeficiency syndrome
(HIV/AIDS) policy in China; successful applications from Haiti; and responses to
changing research on malaria. These examples show that the Global Fund has
created strong incentives for knowledge to flow to local implementers, but with
little encouragement and few structures for the potentially valuable lessons from
implementation to flow back to global best practice or research-based knowledge.
The Global Fund could play an influential role in fostering much-needed learning
from implementation. We suggest that three initial steps are required to start this
process: acknowledging shared responsibility for learning across the knowledge
system; analysing the Global Fund's existing data (and refining data collection
over time); and supporting recipients and technical partners to invest resources in
linking implementation with best practice and research.
Publication Types:
522: Fam Pract. 2006 Dec;23(6):699-705. Epub 2006 Aug 17.

Comment in:
• Fam Med. 2007 Apr;39(4):288-90.
The use of text messaging to improve attendance in primary care: a

randomized controlled trial.
Leong KC, Chen WS, Leong KW, Mastura I, Mimi O, Sheikh MA,
Zailinawati AH, Ng CJ, Phua KL, Teng CL.
Department of Family Medicine, International Medical University Puchong, Jalan

Rasah, Malaysia. leongk@pc.jaring.my
BACKGROUND: Non-attendance is common in primary care and previous

studies have reported that reminders were useful in reducing broken
appointments. OBJECTIVE: To determine the effectiveness of a text messaging
reminder in improving attendance in primary care. DESIGN: Multicentre three-
arm randomized controlled trial. SETTING: Seven primary care clinics in
Malaysia. Participants. Patients (or their caregivers) who required follow-up at the
clinics between 48 hours and 3 months from the recruitment date. Interventions.
Two intervention arms consisted of text messaging and mobile phone reminders
24-48 hours prior to scheduled appointments. Control group did not receive any
intervention. Outcome measures. Attendance rates and costs of interventions.
RESULTS: A total of 993 participants were eligible for analysis. Attendance rates
of control, text messaging and mobile phone reminder groups were 48.1, 59.0 and
59.6%, respectively. The attendance rate of the text messaging reminder group
was significantly higher compared with that of the control group (odds ratio 1.59,
95% confidence interval 1.17 to 2.17, P = 0.005). There was no statistically
significant difference in attendance rates between text messaging and mobile
phone reminder groups. The cost of text messaging reminder (RM 0.45 per
attendance) was lower than mobile phone reminder (RM 0.82 per attendance).
CONCLUSIONS: Text messaging reminder system was effective in improving
attendance rate in primary care. It was more cost-effective compared with the
mobile phone reminder.
Publication Types:
• Randomized Controlled Trial
523: ANZ J Surg. 2006 Aug;76(8):704-9.

Outcome after pancreatic necrosectomy: trends over 12 years at an

Indian centre.
Reddy M, Jindal R, Gupta R, Yadav TD, Wig JD.
Department of General Surgery, Postgraduate Institute of Medical Education and

Research, Chandigarh, India.
BACKGROUND: Pancreatic necrosectomy for necrotizing pancreatitis is a

formidable operation. There are limited data from the Indian subcontinent
regarding outcome and recent trends in management. METHODS: Patients
undergoing pancreatic necrosectomy over a 12-year period were identified from a
prospective database. Data regarding the hospital course, complications and
outcome were extracted by case file review. Descriptive statistics were used to
present the data. An attempt was made to identify trends in management and
outcome over the study period. RESULTS: One hundred and eighteen patients
underwent necrosectomy. The median age was 39.5 years (interquartile range, 32-
46). Median Acute Physiology And Chronic Health Evaluation II score at
admission was 8 (interquartile range, 6-10). Thirty-nine patients (33%) had organ
failure at admission. Patients underwent surgery a median of 23 days
(interquartile range, 14-34) after onset of illness. There was high incidence of
loco-regional complications (68/118, 58%) and organ failure (88/118, 75%) in the
postoperative period. The mortality rate was 38%. There was an increase in the
median onset to surgery interval (17 vs 25.5 days; P = 0.001), increased use of
percutaneous interventions (20 vs 36%; P = 0.05) and decreased mortality (47 vs
29%; P = 0.052) in the later half of the study period. CONCLUSION: Pancreatic
necrosectomy continues to be associated with significant morbidity and mortality
in India. A trend towards increased use of percutaneous interventions and delayed
surgery is evident.
524: ANZ J Surg. 2006 Aug;76(8):683-7.

Cleft surgery in East timor: the first four years.
Moore MH, Fernandes AL.
Overseas Specialist Surgical Association of Australia, Adelaide, South Australia.

mhmoore@adelaide.on.net
BACKGROUND: Following the vote for independence in 1999, this team

commenced the first coherent reconstructive surgical service in East Timor. The
aim of this paper is to report the cleft lip and palate surgical experience during the
4 years since independence. METHODS: From June 2000, a record of all cleft
surgical procedures carried out by our team in East Timor has been maintained.
This has been reviewed to identify the clinical experience, procedures carried out
and the outcomes of the cleft population in this, the poorest and newest, nation in
Asia. RESULTS: From the 519 reconstructive surgical procedures carried out by
this team in East Timor during the first 4 years, 267 were for cleft lip and palate
deformity. Cleft lip and nose repairs were most commonly undertaken, although
over the period of the study increasing numbers of cleft palate repairs were
evident, reflecting the developing confidence in the service by the local
population. CONCLUSION: The establishment of a regular, consistent cleft lip
and palate surgical team in East Timor has not only seen the successful correction
of a large number of untreated cleft patients, but has also contributed to a
restoration of trust in the newly developing health system in East Timor.
525: J Clin Nurs. 2006 Sep;15(9):1179-87.

Turkish nurses' information about, and administration of,

chemotherapeutic drugs.
Kosgeroglu N, Ayranci U, Ozerdogan N, Demirustu C.
Osmangazi University, School of Health, Meselik, Eskisehir, Turkey.
AIM: The aim of this study was to determine both the level of information that
nurses possessed and the method of administration nurses used during
chemotherapeutic drug preparation and administration. BACKGROUND: While
compliance with the regulations related to chemotherapeutic drug preparation and
administration seems to be very difficult, it is at the same time vital. METHODS:
This descriptive study was conducted between 1 May 2002 and 1 May 2003 in the
chemotherapy administration units of all hospitals in Eskisehir, west Turkey. The
sample consisted of 121 nurses. Data were obtained first via questionnaire forms
developed by the researchers to learn the level of awareness concerning exposure
to chemotherapy. This was then followed up by the completion of observation
forms during drug administrations. RESULTS: The average score for information
levels pertaining to nurses' protection of the environment was 7.82 +/- 0.38 of a
total of 14 points, and that of self-protection was 7.94 +/- 0.24 of a total of 11
points. Nurses showed that their actual administration method was insufficient
according to their level of information, with average administration evaluations of
5.46 for protection of the environment and 6.59 for self-protection. The ratio for
nurses' usage of the safety cabinet during the preparation of chemotherapeutic
drugs was very low at 14.2%. Only 7.4% of nurses had received in-service
education about chemotherapeutics. CONCLUSION: In order to ensure the taking
of sufficient preventive precautions during the preparation and administration of
chemotherapeutic agents, hospitals should be required to provide sufficient
equipment and to give this precedence in hospital politics. RELEVANCE TO
CLINICAL PRACTICE: Healthcare workers who prepare and administer
chemotherapeutic drugs may experience the cytotoxic effects of the drugs through
direct skin contact, respiratory and digestive system exposure, and these effects
are vital to human life. Thus, it has been recognized that nurses' information and
administrations during preparation and administration of chemotherapeutic drugs
are of utmost vital importance in removing the harmful effects of
chemotherapeutic agents.
526: CMAJ. 2006 Aug 15;175(4):385.

Comment on:
• CMAJ. 2006 Jan 3;174(1):52-4.
ADRs and smart health cards.
Hsu MH, Li YC, Liu CT.
Publication Types:
• Comment
• Letter

PMCID: PMC1534097
527: Int J Med Inform. 2007 Jan;76(1):66-77. Epub 2006 Aug 8.

Mobile computing acceptance factors in the healthcare industry: a

structural equation model.
Wu JH, Wang SC, Lin LM.
Department of Information Management, National Sun Yat-sen University, 70

Lien-Hai Road, Kaohsiung 804, Taiwan. jhwu@mis.nsysu.edu.tw
OBJECTIVE: This paper presents a revised technology acceptance model to

examine what determines mobile healthcare systems (MHS) acceptance by
healthcare professionals. METHOD: Conformation factor analysis was performed
to test the reliability and validity of the measurement model. The structural
equation modeling technique was used to evaluate the causal model. RESULTS:
The results indicated that compatibility, perceived usefulness and perceived ease
of use significantly affected healthcare professional behavioral intent. MHS self-
efficacy had strong indirect impact on healthcare professional behavioral intent
through the mediators of perceived usefulness and perceived ease of use. Yet, the
hypotheses for technical support and training effects on the perceived usefulness
and perceived ease of use were not supported. CONCLUSION: This paper
provides initial insights into factors that are likely to be significant antecedents of
planning and implementing mobile healthcare to enhance professionals' MHS
acceptance. The proposed model variables explained 70% of the variance in
behavioral intention to use MHS; further study is needed to explore extra
significant antecedents of new IT/IS acceptance for mobile healthcare. Such as
privacy and security issue, system and information quality, limitations of mobile
devices; the above may be other interesting factors for implementing mobile
healthcare and could be conducted by qualitative research.
Publication Types:
528: Int J Health Geogr. 2006 Aug 10;5:33.

Investigation of geo-spatial hotspots for the occurrence of
tuberculosis in Almora district, India, using GIS and spatial scan
statistic.
Tiwari N, Adhikari CM, Tewari A, Kandpal V.
Department of Statistics, Kumaon University, S.S.J.Campus, Almora,

Uttaranchal, India. kumarn_amo@yahoo.com
BACKGROUND: The World Health Organization has declared tuberculosis a

global emergency in 1993. It has been estimated that one third of the world
population is infected with Mycobacterium tuberculosis, the causative agent of
tuberculosis. The emergence of TB/HIV co-infection poses an additional
challenge for the control of tuberculosis throughout the world. The World Health
Organization is supporting many developing countries to eradicate tuberculosis. It
is an agony that one fifth of the tuberculosis patients worldwide are in India. The
eradication of tuberculosis is the greatest public health challenge for this
developing country. The aim of the present population based study on
Mycobacterium tuberculosis is to test a large set of tuberculosis cases for the
presence of statistically significant geographical clusters. A spatial scan statistic is
used to identify purely spatial and space-time clusters of tuberculosis. RESULTS:
Significant (p < 0.05 for primary clusters and p < 0.1 for secondary clusters) high
rate spatial and space-time clusters were identified in three areas of the district.
CONCLUSION: There is sufficient evidence about the existence of statistically
significant tuberculosis clusters in Almora district of Uttaranchal, India. The
spatial scan statistics methodology used in this study has a potential use in
surveillance of tuberculosis for detecting the true clusters of the disease.
PMCID: PMC1557839
529: Ann Surg Oncol. 2006 Sep;13(9):1182-8. Epub 2006 Aug 5.

Hospital volume and inpatient mortality after cancer-related

gastrointestinal resections: the experience of an Asian country.
Lin HC, Xirasagar S, Lee HC, Chai CY.
School of Health Care Administration, Taipei Medical University, Taipei,

Taiwan. henry11111@tmu.edu.tw
BACKGROUND: Using 4-year nationwide population-based data for Taiwan,
this study compared in-hospital surgical mortality rates with hospital volume for
five cancer-related gastrointestinal resections. METHODS: The study sample was
drawn from the Taiwan National Health Insurance Research Database. A total of
34,715 patients, each of whom had undergone a cancer-related colectomy,
gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between
2000 and 2003, were selected as the study sample. The outcome measure was in-
hospital mortality. The study sample was categorized into five patient groups for
each procedure, and logistic regression analyses were performed for each
procedure after adjustment for hospital and patient characteristics to assess the
independent association between hospital volume and in-hospital mortality.
RESULTS: The adjusted odds ratios showed a steady decline in mortality rates
for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing
hospital volume. The adjusted mortality odds for these four procedures in very-
high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to
.05. As regards pancreatic resection, after adjustment for patient, clinical, and
hospital factors, no statistically significant association was discernible between
hospital volume and the likelihood of mortality. CONCLUSIONS: After
adjustment for hospital and physician characteristics, in four of the five
procedures, patients treated at higher-volume hospitals had lower in-hospital
mortality rates than those treated at lower-volume hospitals. Our findings confirm,
for the most part, the hypothesis that better outcomes are associated with higher-
volume hospitals.
530: Transcult Psychiatry. 2006 Jun;43(2):259-74.

Characteristics of Vietnamese patients attending an anxiety clinic in

Australia and perceptions of the wider Vietnamese community
about anxiety.
Wagner R, Manicavasagar V, Silove D, Marnane C, Tran VT.
University of New South Wales Australia. r.wagner@unsw.edu.au
This article examined the causes underlying low utilization of mental health
services by Vietnamese immigrants in Australia. Study 1 examined cases of
Vietnamese patients who had attended an anxiety disorders clinic, while Study 2
surveyed Vietnamese people in the community on their knowledge and attitudes
towards common mental problems. Results from Study 1 showed that Vietnamese
patients had significantly higher attrition rates, and presented with a larger
number of nonanxiety disorders than their Australian-born counterparts. Study 2
results indicated that many Vietnamese people did not differentiate clearly
between the terms 'stress', 'anxiety' and 'depression'. Additionally, many
participants felt that there was a generally negative cultural attitude towards
people suffering from these problems and the mental health system itself. These
outcomes suggest the importance of education for ethnic communities regarding
available mental health facilities and treatments offered, as well as specific
information on mental illness to help remove stigma.
Publication Types:
531: Prehosp Disaster Med. 2006 May-Jun;21(3):204-10.

Prehospital care of tsunami victims in Thailand: description and

analysis.
Schwartz D, Goldberg A, Ashkenasi I, Nakash G, Pelts R, Leiba A, Levi Y,

Bar-Dayan Y.
Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.
INTRODUCTION: On 26 December 2004 at 09:00 h, an earthquake of 9.0

magnitude (Richter scale) struck the area off of the western coast of northern
Sumatra, Indonesia, triggering a Tsunami. As of 25 January 2005, 5,388 fatalities
were confirmed, 3,120 people were reported missing, and 8,457 people were
wounded in Thailand alone. Little information is available in the medical
literature regarding the response and restructuring of the prehospital healthcare
system in dealing with major natural disasters. OBJECTIVE: The objective of the
study was to analyze the prehospital medical response to the Tsunami in Thailand,
and to identify possible ways of improving future preparedness and response.
METHODS: The Israeli Defense Forces (IDF) Home Front Command Medical
Department sent a research delegation to study the response of the Thai medical
system to the 2004 earthquake and Tsunami disaster. The delegation met with
Thai healthcare and military personnel, who provided medical care for and
evacuated the Tsunami victims. The research instruments included questionnaires
(open and closed questions), interviews, and a review of debriefing session
reports held in the days following the Tsunami. RESULTS: Beginning the day
after the event, primary health care in the affected provinces was expanded and
extended. This included: (1) strengthening existing primary care facilities with
personnel and equipment; (2) enhancing communication and transportation
capabilities; (3) erecting healthcare facilities in newly constructed evacuation
centers; (4) deploying mobile, medical teams to make house calls to flood
refugees in affected areas; and (5) deploying ambulance crews to the affected
areas to search for survivors and provide primary care triage and transportation.
CONCLUSION: The restructuring of the prehospital healthcare system was
crucial for optimal management of the healthcare needs of Tsunami victims and
for the reduction of the patient loads on secondary medical facilities. The disaster
plan of a national healthcare system should include special consideration for the
restructuring and reinforcement prehospital system.
532: Nippon Koshu Eisei Zasshi. 2006 Jun;53(6):448-56.

[Analysis of an adult measles outbreak in the eastern part of Ehime

prefecture in Japan]
Tomita N.
Saijo Public Health Center, Ehime.
PURPOSE: An outbreak of adult measles occurring in the eastern part of Ehime

prefecture in Japan was analyzed, and the future directions of measures against
infectious diseases in public health centers was studied. METHOD: An outbreak
of adult measles (in individuals more than 18 years old) occurred in the eastern
part of Ehime prefecture between October 2002 and July 2003. During this
outbreak, provisional surveillance of adult measles as well as pediatric measles
(less than 18 years old) was performed by all clinics and hospitals in addition to
that by The Ehime Epidemiological Surveillance of Infectious Diseases (sentinel
surveillance). Furthermore, identification of viral genes was performed from
pediatric and adult measles patient samples. RESULTS: 112 cases of measles in
adults and 200 cases in children were reported in Ehime between October 2002
and July 2003, and the rates for the eastern part of the prefecture accounted for
89.7% and 94.1% respectively. The relation between the pediatric measles and
adult measles could be followed by change in the outbreak number of patients
week by week. The genotype of the measles viruses isolated was type H1, which
is prevalent in China and Korea. The results of an epidemiological survey showed
that 59.3% of adult and 84.1% of pediatric cases had not been vaccinated. The
measles vaccination rates for adult and pediatric cases were 21.9% and 11.4%,
respectively. While the number of measles cases detected by sentinel pediatric
surveillance comprised 32.0% of the measles cases reported by all pediatricians,
the figure for adult measles cases was only 11.6% of those reported by all clinics
and hospitals. CONCLUSIONS: It was suggested that improvement in the
vaccination rates and revaccination rates mainly among school children or young
people is necessary to prevent measles outbreaks. The surveillance system must
be strengthened to increase the number of sentinel hospitals because an outbreak
may not be detected with the current approach, especially for measles among
adults. Positive information exchange between public health centers and medical
institutions also appear to be particularly important.
Publication Types:
533: Int Nurs Rev. 2006 Sep;53(3):197-204.

A comparison of sexual satisfaction and post-natal depression in the

UK and Taiwan.
Huang YC, Mathers NJ.
Department of Nursing, Fu-Jen Catholic University, Shin-Juang, Taipei County,

Taiwan.
AIM: To compare the sexual expression and sexual satisfaction of women in the
UK and Taiwan before and after childbirth, to determine if there is an association
between self reported sexual satisfaction and postnatal depression (PND) and the
main sources of sexual information for women during this period. METHOD: A
comparative survey of postnatal women in the UK and Taiwan using a
selfadministered questionnaire, a semi structured interview and the Edinburgh
Postnatal Depression Scale (EPDS) to investigate sexual satisfaction, sexual
expression and main sources of information as well the prevalence of postnatal
depression. RESULTS: Seventy per cent of the UK women and 89% of the
Taiwanese women were generally satisfied with their sex life during the postnatal
period although in both countries women thought that sexual expression was not
as important to themselves as to their partner. There were differences in ranking
criteria for physical and emotional sexual satisfaction in the two countries.
Eighty-three per cent of UK women had sufficient information about sex during
the postnatal period compared to 60% of Taiwanese women. There was no
significant difference in the prevalence of PND (18% UK, 19% Taiwan p < 0.01
ANOVA) but significant negative associations (correlation coefficient) between
'sexual self-confidence' and PND in the UK (p < 0.01) and Taiwan (p < 0.05). UK
Women with an unsatisfactory sex life (p < 0.05), insufficient sexual information
(p < 0.05) and sexual worries after birth (p < 0.05) were more likely to have
symptoms of PND. There was a strong association between a poor relationship
with her partner and PND (p < 0.001). CONCLUSIONS: These associations may
be either a consequence of or a contributing factor to PND. The observed
differences between the two countries may be attributed to cross cultural factors
and differences in health care systems although further investigation is required.
Publication Types:
534: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(2-3):267-86.
Assessing doctors' compliance with guidelines on diabetes

management.
Tan KB.
Ministry of Health, Singapore. harold1812@yahoo.com.sg
PURPOSE: In 2002 the Singapore Ministry of Health (MOH) audited doctors'

compliance with diabetes clinical practice guidelines in public healthcare
institutions and attempted to postulate factors that influenced the degree of
conformity. This study aims to address this issue.
DESIGN/METHODOLOGY/APPROACH: A retrospective cross-sectional chart
review of diabetes patient records sampled from hospital specialist outpatient
clinics (SOCs) and polyclinics was performed. Childhood, gestational and
secondary diabetes cases were excluded. The nine audit parameters used were
process measures concerning the assessment of HbA1c, weight, blood pressure,
urinary protein, serum creatinine, serum lipids, electrocardiography, retina and
feet. Age-standardised prevalence rate ratios of parameter adherence were
calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases,
94 per cent were analysed. FINDINGS: Adherence to ECG and foot assessment
parameters was poor among SOC cases, while poor adherence to weight and foot
assessment parameters was seen in the polyclinics. There was poorer adherence to
blood pressure and ECG parameters in the SOCs, but better adherence was seen
for weight assessment. Among the SOC cases, Cluster A fared better than Cluster
B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A
for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment
parameters. ORIGINALITY/VALUE: Based on pre-existing information on local
diabetes care, certain system, physician, patient and guideline factors are
postulated to explain clinical practice guideline non-compliance among doctors.

535: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(2-3):195-220.
Clinical practice guidelines: a critical review.
Tan KB.
Ministry of Health, Singapore. harold1812@yahoo.com.sg
PURPOSE: Clinical practice guidelines (CPGs) have been developed for many
years with the aim of improving the quality of care. A review of the use of CPGs
and assessments of CPG compliance among practitioners so far would aid the
understanding of factors influencing CPG compliance. This study seeks to
provide this. DESIGN/METHODOLOGY/APPROACH: A general review and
discussion of CPGs in areas of their attributes, benefits and pitfalls were carried
out. Articles concerning the assessment of CPG compliance were also reviewed to
understand the kind of data collected for such assessments (qualitative vs
quantitative), the methods used to collect data (objective versus subjective), and
the assessment measures employed (process versus outcome). FINDINGS: A total
of 57 CPG compliance assessment studies were reviewed. Almost two-thirds
employed objective methods. Of the subjective assessments, 47 per cent analysed
solely quantitative data, 32 per cent analysed solely qualitative information and 21
per cent analysed both. More than four-fifths of all studies used process measures
to determine CPG compliance and only 5 per cent used solely outcome measures.
PRACTICAL IMPLICATIONS: Depending on the methods used, assessments
can help identify various factors influencing CPG compliance. Such factors may
be related to the physician, guidelines, health system or patient. A good
understanding of these factors and their role in influencing compliance behaviour
will help health regulators and administrators plan better and more effective
strategies to improve doctors' CPG compliance. ORIGINALITY/VALUE: This
review looks at the various aspects of CPGs to understand how these influence
practitioners' compliance.
Publication Types:
• Review
536: Lancet Infect Dis. 2006 Aug;6(8):508-21.

Comment in:
• Lancet Infect Dis. 2007 Mar;7(3):178-9.
Containing HIV/AIDS in India: the unfinished agenda.
Chandrasekaran P, Dallabetta G, Loo V, Rao S, Gayle H, Alexander A.
Avahan-India AIDS Initiative, The Bill & Melinda Gates Foundation, New Delhi,
India.
India's HIV epidemic is not yet contained and prevention in populations most at
risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as
measured through surveillance of antenatal and sexually transmitted disease
clinics is the chief source of information on HIV in India, but these data cannot
provide real insight into where transmission is occurring or guide programme
strategy. The factors that influence the Indian epidemic are the size, behaviours,
and disease burdens of high-risk groups, their interaction with bridge populations
and general population sexual networks, and migration and mobility of both
bridge populations and high-risk groups. The interplay of these forces has resulted
in substantial epidemics in several pockets of many Indian states that could
potentially ignite subepidemics in other, currently low prevalence, parts of the
country. The growth of HIV, unless contained, could have serious consequences
for India's development. India's national response to HIV began in 1992 and has
shown early success in some states. The priority is to build on those successes by
increasing prevention coverage of high-risk groups to saturation level, enhancing
access and uptake of care and treatment services, ensuring systems and capacity
for evidence-based programming, and building in-country technical and
managerial capacity.
Publication Types:
• Review
537: J Adv Nurs. 2006 Aug;55(4):487-96.

Adopting a personal digital assistant system: application of Lewin's

change theory.
Lee TT.
National Taipei College of Nursing, Taipei, Taiwan. tingting@mail1.ntcn.edu.tw

AIM: This paper reports a study exploring nurses' perceptions of adopting an
information system using handheld computers (personal digital assistants) in their
daily practice. BACKGROUND: Handheld computers have recently been used in
nursing information systems for patient care, but few studies have explored their
impact on users. By understanding clinicians' experiences of using this
technology, strategies can be implemented to smooth the change process in
adopting their use, thus achieving optimal patient outcomes. METHOD: A
descriptive, exploratory approach was used to study nurses' perceptions of using
personal digital assistants as part of a hospital information system. A purposive
sample of 15 nurses participated in one-to-one, in-depth interviews from February
to March 2004. Nurses' perceptions of the adoption process were analysed using
Lewin's force field theory of change as a framework. FINDINGS: Nurses initially
resisted using the personal digital assistant system (unfreezing stage), then came
around to using it (moving stage), and finally adopted the system in their daily
practice (re-freezing stage). However, an anticipatory stage also occurred and this
could serve as a feedback mechanism to improve the system for current and future
use. CONCLUSION: Educational programmes should be provided and strategic
planning should be done in the early stage of implementing a policy to adopt new
technology. In addition, the adoption process and learning period could be
shortened by improving the system's content design. During this transition stage,
dual charting should be used as a backup only for a limited time to avoid adding
extra work to nurses' already heavy workload. Finally, the concept of
confidentiality should be reinforced and stressed early in the educational
programme to protect patient data, which can easily be accessed in computerized
systems.
Publication Types:
538: Cult Health Sex. 2005 Jul-Aug;7(4):319-32.

Knowledge of personal and sexual development amongst young

people in Pakistan.
Hennink M, Rana I, Iqbal R.
Division of Social Statistics, University of Southampton, UK. mon@soton.ac.uk
Pakistan has one of the largest cohorts of young people in its history, yet research
on their circumstances and needs is still relatively new. In this study, twenty four
focus group discussions were conducted to explore young peoples' experiences of
gaining knowledge of personal and sexual development. Young women typically
gained information from a limited number of sources within the home, while
young men accessed a wide variety of information sources outside the home.
Gaining information was frequently event-based, whereby specific events (i.e.
puberty, marriage) trigger information provision to young people, however often
too late to be educative. Overall, young people were critical of the quality of
information they received, which often led to confusion and stress in
understanding sexual development. Findings highlight a gap in formal systems of
information provision. Although young people highlighted the merits of school-
based information delivery, low school attendance and high drop-out rates
amongst girls mean that alternative mechanisms of reaching young Pakistani
women need to be identified.
539: Oncol Nurs Forum. 2006 Jul 1;33(4):E71-8.

Comment in:
• Oncol Nurs Forum. 2006 Nov;33(6):1053.
Filipino American women's perceptions and experiences with breast

cancer screening.
Wu TY, Bancroft J.
School of Nursing, Eastern Michigan University, Ypsilanti, USA.

tywu@umich.edu
PURPOSE/OBJECTIVES: To determine information about Filipino American

women's perceptions of breast cancer, the most frequently diagnosed cancer and
number-one killer of Asian American women, and their experiences with
screening. DESIGN: A qualitative, exploratory approach with focus groups.
SETTING: Suburban Filipino American communities in the midwestern United
States. SAMPLE: 11 Filipino American women aged 45-80 years who shared
their experiences with breast cancer screening. METHODS: Focus groups were
conducted, and the meetings were recorded on audiotape, transcribed, and
analyzed using constant comparison techniques. MAIN RESEARCH
VARIABLES: Breast cancer screening, experiences, motivators, and barriers.
FINDINGS: Avoidance was the main theme for Filipino American women in
dealing with a cancer diagnosis in the Filipino American culture. Facilitators of
Filipino American women's screening practices were support from family
members, recommendations from familiar physicians, health insurance
reinforcement, and personal attributes of physical symptoms, family history, past
diagnosis, and health literacy. Barriers identified were different mind-sets and
healthcare systems in the Philippines in regard to early detection, unpleasant
experiences with mammography, cultural beliefs, and difficulties accessing
services. CONCLUSIONS: Results of the focus group discussions provide useful
information about facilitators and barriers that affect Filipino American women's
screening practices. IMPLICATIONS FOR NURSING: The findings of the study
can be used to develop tailored interventions for addressing culturally specific
barriers and promoting screening practices in the Filipino American community.
Publication Types:

540: Climacteric. 2006 Aug;9(4):305-11.

Menopausal symptoms and health problems of women aged 50-65

years in southern Jordan.
Shakhatreh FM, Mas'ad D.
University of Jordan, Faculty of Medicine, Family and Community Medicine,

Amman, Jordan.
OBJECTIVES: To identify menopausal symptoms and health disorders of women

aged 50-65 years in under-privileged areas of southern Jordan. METHOD: A
multistage, random-sampling design was applied to select a sample of households
from three governorates. A total of 143 women were eligible to be included in the
analysis. Women were asked about a list of symptoms (somatic, psychological
and genitourinary) and about a list of morbidities such as hypertension, diabetes
mellitus and urinary tract infection. Ever-screening by mammogram, regular
breast self-examination, ever-screening by cervical smear, general medical check-
up, physical activity, smoking habit, and ever-receiving information about
menopause were also investigated. RESULTS: The median age of onset of natural
menopause was 50 years; 77% of women were illiterate, and 59% of the couples
were relatives. The most frequently reported somatic symptoms were joint
aches/stiffness (89%), bone pains (74%) and paresthesia in the extremities (51%).
Hot flushes were experienced by 62% and urinary incontinence by 30%. Almost
62% reported irritability and mood changes, 56% had high blood pressure, and
18% and 14% suffered from urinary tract infection and reproductive tract
infection, respectively. Eight percent and 11% reported ever-screening by
mammogram and cervical smear, respectively, and 11% reported performing
breast self-examination regularly. Regular physical exercise was reported by 8%,
and 81% were overweight or obese. One-quarter received information on
menopause, and 58% reported the need to know 'everything' about menopause.
CONCLUSION: Women in southern Jordan experienced multiple menopause-
related symptoms and morbidities. The majority of them did not receive any
health education about this phase of life. Preventive health practices and health-
promoting behaviors are relatively uncommon. Effective health-care delivery
systems responsive to menopausal women's health needs are highly
recommended.
Publication Types:
541: Health Promot Int. 2006 Dec;21(4):266-73. Epub 2006 Jul 19.
Implementation of the Healthy Cities' principles and strategies: an

evaluation of the Israel Healthy Cities network.
Donchin M, Shemesh AA, Horowitz P, Daoud N.
Braun School of Public Health, Hadassah and the Hebrew University, Jerusalem.
milka@hadassah.org.il
The Israel network of Healthy Cities has been operating since 1990, and the first
evaluation of its performance was carried out in 2004. The objectives were to
evaluate the level of implementation of the 'Healthy Cities' principles and
strategies in each network city and to assess the contribution of the network to its
member cities. Coordinators of 18 active healthy cities participated in the study
by completing a questionnaire with the aid of key informants in the municipality.
The survey covered six dimensions of Healthy Cities' principles and strategies,
and each was analyzed as a sum of scores of separate components and measures,
converted to a 0-10 scale. Cities were found to differ in their performances. The
dimension of intersectoral collaboration received the highest mean score (8.0 +/-
1.6), while the environmental protection dimension received the lowest one (4.5
+/- 2.2). Time investment by the coordinator of > 20 h a week is significantly
associated with a higher score on the management dimension (7.8 versus 4.4
where the coordinator invests 20 h a week or less, P < 0.001). Previous work
experience in either public health or community work was associated with higher
scores of the community participation and intersectoral partnership dimensions
(6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was
associated with the city equity policy dimension (8.1 versus 4.8 in cities with high
versus low political support, P < 0.01). Coordinator's participation in the
network's activities is associated with better scores on all the dimensions except
for environmental protection. It appears that political commitment and support is
a significant enabling condition, which, together with the capacity building of the
coordinator, may lead to better implementation of Healthy Cities' policy.
Environmental issues should be incorporated into training sessions to enhance the
environmental protection dimension.
Publication Types:
• Evaluation Studies
542: Eur J Contracept Reprod Health Care. 2006 Jun;11(2):132-7.

Assessing knowledge, exploring needs: a reproductive health survey

of adolescents and young adults in Pakistan.
Shaikh BT, Rahim ST.
Health Systems Division, Department of Community Health Sciences, Aga Khan

University, Karachi, Pakistan. babar.shaikh@aku.edu
RATIONALE & OBJECTIVE: The sexual and reproductive health (SRH) needs
of adolescents have increased over the last few years, but are largely unmet. Lack
of involvement of youth in the programs and limitations of the mass media in a
conservative milieu are some of the issues. Our objectives were to assess the
baseline SRH knowledge and to suggest interventions based on needs with regard
to SRH promotion, so that the level of existing services could be upgraded.
METHODS: A cross-sectional survey was conducted in 20 villages of Lahore, in
which 400 adolescents and young adults were interviewed using a semi-structured
questionnaire. Respondents were equally divided in gender in all villages, using
stratified random sampling. RESULTS: Adolescents and young adults do have
some knowledge of SRH issues. Males are relatively more knowledgeable than
females about puberty (M = 68%; F = 58%), pregnancy (M = 55%; F = 43%),
family planning (M = 62%; F = 50%) and sexually transmitted infections (M =
56%; F = 44%). Yet, a large majority needs clarification on their concepts and
perceptions. They believe that having sound SRH knowledge will promote mother
& child health and family health. CONCLUSION: Peers, media and a family
doctor could be the acceptable source of information on SRH. Life skills
programs to increase unmarried girls' cognitive skills and young men's
involvement in such programs is a must. Involving families and communities will
enhance the effectiveness of youth programs.
Publication Types:
543: Int J Nurs Terminol Classif. 2006 Apr-Jun;17(2):108-17.

Comparison of nursing interventions performed by medical-surgical

nurses in Korea and the United States.
Lee E, Lee M.
College of Nursing, Kyungpook National University, Daegu, Korea.

jewelee@knu.ac.kr
PURPOSE: To compare the Nursing Interventions Classification (NIC)

interventions used in two countries, Korea and the United States. METHODS:
Data were collected from 167 nurses working in eight hospitals in Korea and
analyzed with descriptive statistics. FINDINGS: Korean nurses selected 202
interventions, nine of which were used by more than 50% of nurses surveyed. In
comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United
States identified 68 interventions as core interventions. Among the top ranked 68
interventions selected by Korean nurses, 29 (43%) matched those selected by U.S.
nurses. CONCLUSIONS: The nursing interventions selected by Korean nurses
were more heavily focused on the physiologic domain than those selected by the
U.S. nurses. PRACTICE IMPLICATIONS: The identified intervention lists can
be used to develop nursing information systems, staff education, competency
evaluation, referral networks, certification and licensing exams, and educational
curricula for nursing students.
Publication Types:
544: Water Sci Technol. 2006;53(9):247-52.

Estimation of reduced and increasing health risks by installation of

urban wastewater systems.
Aramaki T, Galal M, Hanaki K.
School of Environment, Resources and Development, Asian Institute of

Technology, Pathumthani, Thailand. aramaki@ait.ac.th
This paper aims to propose a methodological framework for quantifying the

reduction and increase of health risks associated with urban wastewater systems.
A risk assessment model was used to quantify reduction in disease burden while a
life cycle assessment approach was used to quantify increasing risks by
environmental loading. Disability adjusted life years (DALYs) was used to
quantify health risks. This framework was applied to a hypothetical watershed to
evaluate health risks by installation of wastewater treatment systems. In this
hypothetical case, 55 DALYs per year of health risk would be reduced for
200,000 people in the downstream community by constructing wastewater
systems for 200,000 people, while a range from 1.9 to 22 DALYs per year of
health risks would be generated by materials and energy consumption for
construction and operation of wastewater systems. However, this result would
significantly change, depending on the parameters used in this analysis. The
proposed methodology should be improved to obtain more precise results, but it
will suggest useful information to discuss the overall effects due to the installation
of various types of urban wastewater systems.
Publication Types:
545: Asian Pac J Cancer Prev. 2006 Apr-Jun;7(2):279-82.

The accuracy of midwives' clinical breast examination in detection

of breast lumps.
Kaviani A, Delavar B, Noparast M, Hatmi Z, Najafi M, Haghighat S, Majd

M.
Department of Surgery, Imam Hospital, Tehran University of Medical Sciences,

Toohid Sq., Tehran, Iran. akaviani@sina.tums.ac.ir
BACKGROUND: Screen-detected breast cancers are usually diagnosed at earlier

stages. Therefore, countries with limited resources are recommended to
implement clinical breast examination (CBE) as a screening method in
conjunction with mammography. Since there are so many limitations to
performance of CBE by surgeons in the health system and CBE by midwives is
more feasible, this study was conducted to test the agreement of CBE by
midwives and surgeons. METHODS: One thousand and twenty seven patients
with no personal history of breast cancer received breast physical examination by
both a midwife and a surgeon and designed forms including patients' general
information, cause of referral and abnormal physical findings were completed for
each patient. RESULTS: The inter-observer agreement (kappa) for mass detection
was 36 % (95% CI= 31% to 41%), indicating a "fair" agreement exists between
the midwife's and the surgeon's physical examination. Sensitivity, specificity,
positive and negative predictive values of "midwife's physical examination" to
detect abnormal breast masses in comparison to "surgeon's physical examination"
as the gold standard were 75, 67, 48, and 87 percent respectively.
CONCLUSIONS: The results of this study do not justify the replacement of
general surgeons by midwives in the health care system as the first examiner for
clinical breast screening. Decisions about this issue need more comprehensive
studies considering cost-effectiveness and training procedures.
546: Nature. 2006 Jul 13;442(7099):114-5.

Family tragedy spotlights flu mutations.
Butler D.
Publication Types:
• News
547: Stud Fam Plann. 2006 Jun;37(2):111-22.

Validating neonatal mortality and use of NGO reproductive health
outreach services in rural Bangladesh.
Mercer A, Uddin N, Huq NL, Haseen F, Khan MH, Larson CP.
Health Systems and Economics Unit, International Centre for Diarrhoeal Disease
Research Centre for Health and Population Research, Health Systems and
Infectious Diseases Division, Bangladesh. amercer@icddrb.org
Although the neonatal mortality rate (NMR) in Bangladesh remained steady

between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence
from the management information system (MIS) of a large nongovernmental
organization (NGO) program indicates that the NMR declined by about 50
percent between 1996 and 2002 in the area served. This study aims to validate the
recording of neonatal deaths among the cohort of children registered as born in
2003 and to assess the evidence of a decline in the NMR. It also measures the
coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs
that have provided services in the same areas since 1996. Field-workers' registers,
verbal autopsy reports, and immunization records were checked to confirm
infants' survival. Interviews were conducted with 142 mothers of children who
died within 28 days postpartum and with a random sample of 109 women with
registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal
deaths were found, compared with 194 deaths that were reported in the MIS for
2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the
range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because
underreporting of neonatal deaths was probably higher in 1996 when the MIS-
reported NMR was 39 deaths per 1,000 live births, the decline in the NMR is
likely to have been genuine.
Publication Types:

548: Pharm World Sci. 2006 Apr;28(2):107-14. Epub 2006 Jul 4.

Inhaler technique in Turkish people with poor English: a case of

information discrimination?
Goodyer L, Savage I, Dikmen Z.

Department of Pharmacy, King's College London, 150 Stamford Street, London,
SE1 9NN, UK.
OBJECTIVES: (a) To compare metered dose inhaler (MDI) technique in users

with poor English and fluent English, (b) to evaluate two interventions: a
translated patient information leaflet (PIL) plus support from an translator (PIL +
verbal) and a multimedia touch screen system (MTS) using video clips and own-
language instruction. METHODS: (a) Inhaler technique was videotaped and key
steps rated blind for 105 fluent English-speakers (FE) and 69 Turkish-speakers
with poor English (EP). (b) The EP group was randomised to receive information
by MTS (n = 34) or PIL + verbal (n = 35). Inhaler technique was videotaped
before and after information. MAIN OUTCOME MEASURES: (a) Global inhaler
technique; (b) breathing-in time; (c) co-ordination of inspiration and inhaler
actuation. RESULTS: Global technique, co-ordination and breath-holding were
all significantly worse in MDI users with poor English. Only 17% of that group
had adequate technique compared to over half (62%) of FE. The EP group were
significantly less likely than the FE group to report ever seeing the practice nurse
about their asthma. After information, global technique was rated as improved in
50% of the MTS group compared to 28% of those given a translated PIL. A
further six people (17%) in the PIL group improved after subsequent verbal
advice in their own language. Both information methods significantly increased
inhaler shaking and mouthpiece checking, but co-ordination only improved in a
small number of people. CONCLUSIONS: The study suggests that Turkish-
speaking MDI users with poor English may be disadvantaged in terms of access
to medicines information in the UK. The acceptability of pharmacy-based support
services for this, and other specific language groups should be explored.
Multimedia offers an alternative to a translator for brief explanations, particularly
for first-time users, but improving poor co-ordination requires individualised
"hands on" teaching from health professionals.
Publication Types:
• Randomized Controlled Trial

549: Nature. 2006 Jun 29;441(7097):1028.

Action stations.
[No authors listed]

Publication Types:
• Editorial
550: Health Policy. 2007 Apr;81(1):93-101. Epub 2006 Jun 27.

Hong Kong's health spending projections through 2033.
Leung GM, Tin KY, Chan WS.
Department of Community Medicine and School of Public Health, Faculty of

Medicine Building, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong
Kong, China. gmleung@hku.hk
OBJECTIVE: To derive actuarial projection estimates of Hong Kong's total

domestic health expenditure to the year 2033. METHODS: Disaggregating health
expenditure by age, sex, unit cost and utilisation level, we estimated future health
spending by projecting utilisation (by public/private, inpatient/outpatient care) to
reflect demographic changes and associated increase in demand (from higher
expectations and greater intensity of care), and then multiplying such by the
projected unit costs (incorporating the impact of key cost drivers such as public
expectations, technological changes and potential productivity gains) to obtain
total expenditure estimates. RESULTS: The model was most sensitive to the
excess health care price inflation rate, i.e. the annual price/cost growth of medical
goods and services over and above per capita GDP growth. Population ageing and
growth per se, without taking into account related technologic innovation for
chronic conditions that particularly afflict older adults, contribute relatively little
to overall spending growth. Given the model assumptions, it is possible to limit
total health spending to below 10% of GDP by 2033, where the public share
would gradually decline from the current 57% to between 46% and 49%.
CONCLUSIONS: Expenditure control through global budgeting, technology
assessment and demand-side constraints should be considered although their
effectiveness remains inconclusive.
551: Int J Med Inform. 2007 Aug;76(8):614-20. Epub 2006 Jun 21.
An investigation into health informatics and related standards in
China.
Zhang Y, Xu Y, Shang L, Rao K.
Institute for Health Information, Fourth Military Medical University, Changle

West Road 17#, Xi'an 710032, China.
OBJECTIVE: To describe the current status of and future plans for health
informatics and related standards in China and analyze the problems raised in the
process of standardization for health informatics. METHODS: Data were
collected through investigation and interviews, complemented by a
comprehensive review of relevant literatures and regulations/law documents about
health informatics and related standards in China. RESULTS: Health informatics
has been greatly developed in China. Significant resources were committed to
construct and improve the health information system. Approximately 35-40% of
hospitals have constructed hospital information system. Over 80% of medical
organizations above the county/district level, 27% of town level hospitals and all
CDC above the county/district level can transmit real-time epidemic situation
reporting through public health information system. However, lack of standards
became a bottleneck to utilize and improve health informatics. China has adopted
some vocabulary, classification, coding standards and message standards.
Moreover, several national standardization actions for health informatics have
been taken. In the process of standardization, the main barriers consist of
financial, technical, cultural and language problems, legal and ethical concerns
and others. CONCLUSIONS: Informatics has the potential to play an important
role in China's healthcare reform process and standards are the basis for the
information sharing and interoperability. Governments and partners of health
informatics have realized the importance of standards and taken the initiatives in
trying to solve the problem of lacking standards, but much work still needs to be
done.
552: Arch Environ Health. 2004 Dec;59(12):725-31.

Relationship between health status and psychological distress among

the inhabitants in a methylmercury-polluted area in Japan.
Ushijima K, Miyake Y, Kitano T, Shono M, Futatsuka M.
Department of Public Health, Kumamoto University School of Medicine,

Kumamoto, Japan. meshima@cis.fukuoka-u.ac.jp
This study examined the relationship between health parameters and
psychological distress among inhabitants of methylmercury-polluted areas in
Japan. The subjects were 133 inhabitants over the age of 40 yr living in two
methylmercury-polluted villages. Information on demographic factors, health
status, and mental health was obtained using questionnaires, including the General
Health Questionnaire (GHQ). The proportional odds model was used to estimate
the adjusted odds ratios of factors associated with a higher GHQ score after
adjustment for age, gender, and district. Very poor self-rated health status, a high
number (5+) of subjective symptoms, having monthly outpatient visits and
medical house calls, and receiving compensation for methylmercury poisoning
were significantly associated with psychological distress. Poor physical condition
may lead to the development of psychological distress.
553: Ann Surg Oncol. 2006 Jul;13(7):977-84. Epub 2006 May 18.
Ethnic disparities in breast cancer management among Asian

Americans and Pacific Islanders.
Gelber RP, McCarthy EP, Davis JW, Seto TB.
Massachusetts Veterans Epidemiology Research and Information Center, VA

Boston Healthcare System, Harvard Medical School, 150 S. Huntington Avenue,
(151MAV), Boston, Massachusetts 02130, USA. rgelber@hsph.harvard.edu
BACKGROUND: Little is known about breast cancer management among Asian

Americans and Pacific Islanders (AAPI). METHODS: We performed a
retrospective analysis of 2030 women (935 Japanese, 144 Chinese, 235 Filipino,
293 Hawaiian, and 423 white; mean age +/- SD, 59 +/- 13 years) with a diagnosis
of early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. We
linked data from the Surveillance, Epidemiology, and End Results program's
Hawaii Tumor Registry to administrative health care claims. We evaluated (1)
breast-conserving surgery (BCS); (2) radiotherapy after BCS; and (3)
chemotherapy for node-positive disease. We used logistic regression to examine
the association between AAPI ethnicity and treatment, adjusting for age, year,
rural residence, tumor size, grade, nodal status, receptor status, prior cancer,
comorbidity index, health plan type, and income. RESULTS: Overall, 60.3% of
women had stage I disease, 36.8% had stage II, and 2.9% had stage IIIA. Only
55.6% received BCS, and 85.1% of these women also received radiation. Of those
with nodal involvement (n = 521), 82.7% received chemotherapy. Japanese and
Filipino women were significantly less likely than white women to undergo BCS
(for Japanese: adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80; for
Filipinos: adjusted odds ratio, 0.47; 95% confidence interval, 0.33-0.66). Filipinos
tended to be less likely than white women to receive radiation after BCS (adjusted
odds ratio, 0.80; 95% confidence interval, 0.42-1.49). AAPI women were as
likely as white women to receive adjuvant chemotherapy for nodal spread.
CONCLUSIONS: We found disparities in the management of early-stage breast
cancer among AAPI women, particularly among Japanese and Filipinos. Further
study is needed to determine the reasons for the observed disparities and to
understand their effect on health outcomes.
Publication Types:
• Research Support, U.S. Gov't, P.H.S.
554: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Jun;18(6):346-9.

[Retrospective discriminant analysis of the clinical diagnostic

criteria for serious contagious severe acute respiratory syndrome]
Xu YD, Jiang M, Chen RC, Fang JQ, Xiao ZL, Zhong NS.
Guangdong Province SARS Working Group, Guangzhou Institute of Respiratory

Disease, Guangzhou 510120, Guangdong, China.
OBJECTIVE: To analyze the clinical diagnostic criteria for serious severe acute
respiratory syndrome (SARS) in Guangdong retrospectively discriminant with
SARS database, and to screen out the sensitive warning factors in predicting the
outcome. METHODS: Four hundred and two SARS patients were selected based
on the diagnostic criteria for SARS from Ministry of Health, China. Of them, 358
SARS patients were selected as their clinical manifestations conformed to the
diagnostic criteria of serious SARS. The study subjects were divided into two
groups. One group consisted of the patients with serious SARS (358 patients), and
they either underwent invasive or non-invasive mechanical ventilation or died of
the disease. The remaining 44 SARS patients constituted the non-serious SARS
group. Taking the lowest value of oxygen index (OI) as the main index, the OI
was categorized into 3 classes, namely< or =200 mm Hg (1 mm Hg=0.133 kPa)
as 1,200-300 mm Hg as 2, and >300 mm Hg as 3. According to this index, the
seriousness and the prognosis were analyzed. RESULTS: OI less than 300 mm
Hg were identified as the unequivocal serious SARS patients, and the mistake
judgement rate was 6.800%. Furthermore mortality and complications were
compared with Logistic regression, and questionable SARS patients were
excluded. The results showed that the patients identified with OI less than 300
mm Hg had worse outcome than the original ones diagnosed with criteria of
Ministry of Health. CONCLUSION: OI less than 300 mm Hg in patients with
ALI meet the diagnostic criteria of serious SARS better, and it can be taken as a
prognostic criterion in clinic.
Publication Types:
555: Indian J Med Res. 2006 Apr;123(4):553-60.

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in

2001.
Harit AK, Ichhpujani RL, Gupta S, Gill KS, Lal S, Ganguly NK, Agarwal
SP.
Directorate General of Health Services, Nirman Bhawan, Maulana Azad Road,

New Delhi 110 011, India. drakharit@gmail.com
BACKGROUND & OBJECTIVE: The viral encephalitides caused by animal or

human viruses are characterized by sudden outbreaks of neurological disease in
both tropical and temperate regions. An outbreak of acute encephalitis occurred in
Siliguri (West Bengal) town of India between January 31 and February 23, 2001.
This outbreak was investigated by a team of scientists from four major
institutions, and the findings are presented here. METHODS: Detailed
information about the outbreak was collected with the help of local health
authorities. Limited entomological investigations were also done. Samples
collected from cases and contacts were sent for analysis. RESULTS: A total of 66
probable cases and 45 deaths were reported. Epidemiological linkages between
cases point towards person-to-person transmission and incubation period of
around 10 days. There was neither any concurrent illness in animals nor was there
any exposure of cases to animals. Centres for Disease Control and Prevention,
Atlanta, USA concluded on the basis of tests carried out on serum specimen from
four cases and two contacts that the causative pathogen appears to be Nipah/
Hendra or closely related virus. INTERPRETATION & CONCLUSION: This
outbreak highlights the importance and urgency of establishing a strong
surveillance system supported by a network of state-of-the-art laboratories
equipped to handle and diagnose new pathogens and including patient isolation
techniques, use of personal protective equipment, barrier nursing and safe
disposal of potentially infected material in the prevention and control measures
for Nipah/Hendra virus infection.
556: Eur J Anaesthesiol. 2006 Oct;23(10):882-9. Epub 2006 Jun 19.

The implementation of an anesthesia information management

system.
Eden A, Grach M, Goldik Z, Shnaider I, Lazarovici H, Barnett-Griness O,

Perel A, Pizov R.
Lady Davis Carmel Medical Center, Department of Anesthesiology and Critical

Care Medicine, Haifa, Israel. arieed@clalit.org.il
BACKGROUND AND OBJECTIVE: Anaesthesia information management

systems, though still not used widely, will inevitably replace handwritten records
and may eventually serve as a core for the development of computerized decision
support. We investigated staff expectations and the accuracy of data entry in a
recently implemented commercially available anaesthesia information
management system. METHODS: A structured questionnaire was administered to
the staff before and 1 week and 3 months after implementation in order to assess
their opinion. The quality of manual data entry, and of automatic data record was
evaluated by looking for missing data and the prevalence of artefacts. RESULTS:
Despite initial fears the users quickly accepted the system. Both automatic and
manual data entry were found to be accurate and reliable while the prevalence of
artefacts was relatively low. CONCLUSIONS: A commercially available
anaesthesia information management system can be easily implemented and used
instead of paper charts.
557: AMIA Annu Symp Proc. 2005:1007.

Development of an instrument to measure health center (HC)

personnel's computer use, knowledge and functionality demand for
HC computerized information system in Thailand.
Kijsanayotin B, Pannarunothai S, Speedie S.

Health Informatics Program,University of Minnesota, Twin cities, Minnesota,
USA..
Knowledge about socio-technical aspects of information technology (IT) is vital

for the success of health IT projects. The Thailand health administration
anticipates using health IT to support the recently implemented national universal
health care system. However, the national knowledge associate with the socio-
technical aspects of health IT has not been studied in Thailand. A survey
instrument measuring Thai health center (HC) personnel's computer use, basic IT
knowledge and HC computerized information system functionality needs was
developed. The instrument reveals acceptable test-retest reliability and reasonable
internal consistency of the measures. The future nation-wide demonstration study
will benefit from this study.
Publication Types:
PMCID: PMC1560896
558: AMIA Annu Symp Proc. 2005:311-5.

Linking primary care information systems and public health vertical

programs in the Philippines: an open-source experience.
Herman T, Marcelo A, Marcelo P, Maramba I.
Medical Informatics Unit, University of the Philippines Manila College of

Medicine, Manila, Philippines.
Community-based primary care information systems are one of the building

blocks for national health information systems. In the Philippines, after the
devolution of health care to local governments, we observed "health information
system islands" connected to national vertical programs being implemented in
devolved health units. These structures lead to a huge amount of "information
work" in the transformation of health information at the community level. This
paper describes work done to develop and implement the open-source Community
Based Health Information Tracking System (CHITS) Project, which was
implemented to address this information management problem and its outcomes.
Several lessons learned from the field as well as software development strategies
are highlighted in building community level information systems that link to
national level health information systems.
Publication Types:
PMCID: PMC1560490
559: Chest. 2006 Jun;129(6):1441-52.

Treatment of severe acute respiratory syndrome with glucosteroids:

the Guangzhou experience.
Chen RC, Tang XP, Tan SY, Liang BL, Wan ZY, Fang JQ, Zhong N.
Guangzhou Institute of Respiratory Diseases, 151 Yanjiang Rd, Guangzhou,

China. nanshan@vip.163.com
STUDY OBJECTIVE: To investigate the efficacy and safety profiles of

corticosteroid therapy in severe acute respiratory syndrome (SARS) patients.
DESIGN: Four hundred one of 1,278 SARS cases treated in Guangzhou China
between December 2002 and June 2003 fulfilled the diagnostic criteria issued by
the World Health Organization for confirmed identification of SARS. Among
them, the diagnosis of critical SARS was defined by criteria of SARS guidelines
incorporated with a low oxygenation index (OI) [< 300 mm Hg]. Data of these
patients retrieved from a database were retrospectively analyzed by logistic
regression and Cox regression for the effect of corticosteroid therapy on death,
hospitalization days, and complication presentation. RESULTS: Among the 401
SARS patients studied, 147 of 249 noncritical patients (59.0%) received
corticosteroids (mean daily dose, 105.3 +/- 86.1 mg) [+/- SD], and all survived the
disease; 121 of 152 critical patients (79.6%) received corticosteroids at a mean
daily dose of 133.5 +/- 102.3 mg, and 25 died. Analysis of these 401 confirmed
cases did not show any benefits of corticosteroid on the death rate and
hospitalization days. However, when focused on 152 critical SARS cases, factors
correlated with these end points indicated by univariate analysis included use of
corticosteroid, age, rigor at onset, secondary respiratory infections, pulmonary
rales, grading of OI, and use of invasive ventilation. After adjustment for possible
confounders, treatment with corticosteroid was shown contributing to lower
overall mortality, instant mortality, and shorter hospitalization stay (p < 0.05).
Incidence of complications was significantly associated with the need for invasive
ventilation but not with use of corticosteroids. CONCLUSION: This Guangzhou
retrospective study revealed that proper use of corticosteroid in confirmed critical
SARS resulted in lowered mortality and shorter hospitalization stay, and was not
associated with significant secondary lower respiratory infection and other
complications.
Publication Types:
560: Clin Chem Lab Med. 2006;44(7):867-76.

Use of total patient data for indirect estimation of reference intervals

for 40 clinical chemical analytes in Turkey.
Ilcol YO, Aslan D.
Department of Biochemistry, Uludag University Medical School, Bursa, Turkey.

yesim@uludag.edu.tr
In the present study we used patient data to calculate laboratory-specific indirect

reference intervals. These values were compared with reference intervals obtained
for a healthy group according to recommendations of the International Federation
of Clinical Chemistry and Laboratory Medicine and manufacturer suggestions.
Laboratory results (422,919 records) from all subjects of 18-45 years of age over
a 1-year period were retrieved from our laboratory information system and
indirect reference intervals for 40 common analytes were estimated using a
modified Bhattacharya procedure. Indirect reference intervals for most of the
biochemical analytes were comparable, with small differences in lower [alkaline
phosphatase (ALP) (male), alanine aminotransferase (ALT), creatine kinase, iron
(male), total iron-binding capacity, folic acid, calcium (female), lactate
dehydrogenase (LDH), lipoprotein (a) [Lp(a)], thyroid-stimulating hormone
(TSH), total triiodothyronine (T(3)), direct bilirubin, apolipoprotein A-I (apoA-I),
glucose, homocysteine, total cholesterol, ferritin, total protein, ceruloplasmin,
sodium, blood urea nitrogen (BUN) and uric acid (female)] and/or upper limits
[albumin, ALP (male), amylase, apoA-I, creatine kinase-MB (CK-MB), total iron-
binding capacity, phosphorus, glucose, total cholesterol, gamma-
glutamyltransferase (gamma-GT), magnesium, total protein, high-density
lipoprotein cholesterol (HDL-C), total T(3), ALP (male), ALT, aspartate
aminotransferase (AST) (male), direct bilirubin (male), creatine kinase, iron, folic
acid (female), Lp(a), uric acid and triglycerides], to the reference intervals
determined for healthy subjects in our laboratory. The indirect reference intervals,
with the exception of a few parameters (creatinine, direct total bilirubin, calcium,
BUN and potassium), were not similar to the reference intervals suggested by the
manufacturers. We conclude that laboratory-specific reference intervals can be
determined from stored data with a relatively easy and inexpensive method.
Indirect reference intervals derived from stored data may be particularly suitable
for the evaluation of results for the presenting population.
Publication Types:
561: Ethn Dis. 2006 Spring;16(2 Suppl 2):S2-2-4.

Incidence, prevalence, and treatment of end-stage renal disease in

the Middle East.
Abboud O.
Department of Medicine, Hamad Medical Corporation, Doha, Qatar.

oiabboud@yahoo.com
INTRODUCTION: This article reviews the status of end-stage renal disease in

the Middle East, with emphasis on its incidence, prevalence, and treatment.
METHODS: Data were obtained from English-language published literature
through a Medline search over the past 40 years. Supplementary information was
gathered from regional congresses and symposia, websites of specialized
nephrology centers, and direct communications. RESULTS: Of the 14 Middle
East countries, attention was focused on 10 countries with similar renal care
systems: 7 Arabian Peninsula countries and 3 eastern Mediterranean countries.
Collectively, they have a population of 72.5 million. Incidence of ESRD ranged
between 64 and 212 patients per million population (pmp) with an average of 93
patients pmp. The lowest prevalence was 320, the highest was 462, and the
average was 352 patients pmp. Hemodialysis is the preferred dialysis modality
and is freely available in all countries for citizens. Non-citizen residents' access to
hemodialysis is markedly restricted. Peritoneal dialysis is available on a limited
scale. Renal transplantation is available in all countries with variable program
activities. Most of the transplants are from living, related donors. Active deceased
donor transplant programs exist in four countries. The results from countries with
active programs are excellent, with 5-year patient and graft survival of > 90%.
CONCLUSIONS: This review provides information on the incidence, prevalence
and treatment modalities of ESRD in 10 Middle East countries.
Publication Types:
• Review
562: Health Policy. 2007 Mar;80(3):459-64.

Development of a capitation scale for IDF career soldiers in Israel.
Magnezi R, Weiss Y, Cohen Y, Shmueli A.
Department of Health Systems Management, School of Health Sciences, The

Ariel College of Judea and Samaria, Israel.Rachelim2@bezeqint.net
The Israeli National Health Insurance Law allocates a national healthcare budget
to the sickness funds, which provide medical care to civilian population. Medical
care for members of the IDF is financed through the budget of the Ministry of
Defense and is not included in the national healthcare budget. Benefits provided
to soldiers serving in the permanent forces are far more extensive than those
provided to civilians. Because of no co-payments, poor management, and the
cost-based budget, military healthcare costs in Israel are expected to exceed
civilian healthcare costs, adjusting for age and sex. The present paper derives age-
and sex-based capitation rates for military personnel, and compares military and
civilian age-based expenditure and capitation rates. The study population
comprised career soldiers and civilians aged 21-54 years. Expenses of career
soldiers were calculated to provide information on the financial costs of medical
services for each age group in 2003. Overall expenses for women were higher
than for men in all age groups. As anticipated, the older the group, the higher the
total expenditure for both men and women. In-patient care represented a higher
percentage of the total costs for men (28.3%) than for women (22.1%).
Emergency room care was higher for women in the 22-24 age group but
comparable to that of men in higher age groups. Specialist visits represented a
significantly higher percentage of the total costs for women than for men in the
22-24 and 25-34 age groups (by 6% and 15%, respectively). The difference
decreased to 13% in the 35-44 age groups and, in the 45-54 age group, the
difference for men was 14% higher than for women. Military costs were similar to
civilian costs in the 22-24 age groups, higher in the following two groups, and
lower in the 45-54 age group. Like in other organizations, military healthcare
services might benefit from outsourcing. The inequality in medical services to
soldiers and civilians, the over-use of the military healthcare system, and the
decrease of standards and budgetary resources will compel the establishment of
more creative means of providing these services through contracts and
agreements, perhaps through the civilian sickness funds.
563: Br J Nutr. 2006 Jun;95(6):1150-8.

Phyto-oestrogen intake and plasma concentrations in South Asian

and native British women resident in England.
Bhakta D, Higgins CD, Sevak L, Mangtani P, Adlercreutz H, McMichael AJ,

dos Santos Silva I.
Department of Epidemiology and Population Health, London School of Hygiene

and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Phyto-oestrogens, naturally occurring hormone-like chemicals in plant food, may

play a protective role against hormone-related chronic diseases. South Asian
migrants in the UK have a lower incidence of hormone-related cancer than their
hosts but the extent to which this difference may be due to phytoestrogen intake is
not known. The aim was to compare habitual phytoestrogen intake in first-
generation South Asian migrant women and native British women. South Asian (n
221) and native British women (n 50) were recruited from general practitioner
lists and were asked to provide monthly 24 h recalls for a period of 1 year. An
enhanced phytoestrogen database was compiled using data from a literature
search and unpublished data. A sub-sample of South Asian women (n 100) and
the native British women (n 40) also provided blood samples every 3 months
during the 1-year period. The median daily intakes (microg/d) of isoflavones
(184.2 v. 333.9) and lignans (110.8 v. 148.8) were significantly lower in South
Asians than in the native British (P<0.001, P=0.04 respectively). There were no
significant differences in mean plasma isoflavone levels (nmol/l) but plasma
enterolactone was significantly lower in the South Asians (13.9 (SD 17.5) v. 28.5
(SD 23.3), P<0.001). The main sources of phytoestrogens were bread and
vegetables in both ethnic groups. Habitual phytoestrogen intake in South Asian
and native British women was below 1 mg/d and was higher in the native British
diet. The present study does not support the hypothesis that differences in
phytoestrogen intake, or in circulating levels, could explain differences in
hormone-related cancer risks between these two populations.
Publication Types:
564: Euro Surveill. 2005 Apr 21;10(4):E050421.5.

New communicable disease notification system launched in Turkey.
Bayazit Y, Buyurgan V, Tumay S.
Department of Communicable Diseases and Epidemic Control, Ministry of

Health), Ankara, Turkey. Yildirim.Bayazit@saglik.gov.tr
565: Mil Med. 2006 May;171(5):360-4.

Quality assessment in primary military clinics of the Israel Defense

Forces Northern Command.
Riskin A, Reis S, Tamir A, Shemer J.
Medical Corps, Israel Defense Forces.
OBJECTIVE: To assess the quality of care provided in primary military clinics.

METHODS: A standardized assessment tool was used, with medical record audits
and tracers (minimal clinical criteria for proper care of common conditions), peer-
review observations of medical encounters, assessments of organization and
administration, and patient satisfaction and physicians' occupational stress
questionnaires. RESULTS: Forty-three clinics and 113 physicians were assessed.
Tracers were high for management of upper respiratory infections and low for low
back pains and mental problems. The average encounter time was 9 minutes, and
25% of medical encounters resulted in referrals to specialists. Regular physicians
performed better than reservists. Surgeons performed worst as primary health care
providers. Female physicians did better than male physicians. The integration of
new immigrant physicians was successful, and they expressed less occupational
stress. Smaller clinics were better, with longer encounter times and better patient
satisfaction scores. CONCLUSIONS: Quality assessment of primary health care
is feasible in the military system, providing useful information for future
improvement.
566: Nippon Koshu Eisei Zasshi. 2006 Apr;53(4):277-84.

[Forming network for oral health care of dependent elderly in the

community]
Fujinaka T.
Publication Types:
567: Am J Epidemiol. 2006 Aug 1;164(3):200-7. Epub 2006 Jun 5.

Comment in:
• Am J Epidemiol. 2006 Aug 1;164(3):208-11.
Residential exposure to petrochemicals and the risk of leukemia:

using geographic information system tools to estimate individual-
level residential exposure.
Yu CL, Wang SF, Pan PC, Wu MT, Ho CK, Smith TJ, Li Y, Pothier L,
Christiani DC; Kaohsiung Leukemia Research Group.
Occupational Health Program, Department of Environmental Health, Harvard

School of Public Health, Boston, MA 02115, USA.
The authors conducted a population-based, case-control study in Kaohsiung,

southern Taiwan, Republic of China, to investigate the association between
residential petrochemical exposure and leukemia risk among subjects 29 years of
age and younger. Between November 1997 and June 2003, 171 cases and 410
controls matched for age and sex were recruited. Since assessment of
petrochemical impacts depends on accurate exposure estimates, the authors
developed a procedure using geographic information system tools to assign
subjects' exposure. The resulting individual-level exposure estimates (the
exposure opportunity score) are an integrated exposure measure that accounts for
subjects' mobility, length of stay at each residence, distance to petrochemical
plant(s), monthly prevailing wind direction, and multiple petrochemical pollution
sources. Different conditional logistic regression models were fitted for subjects
aged 0-19 and 20-29 years to evaluate separately childhood versus adulthood
leukemia. No overall association was observed for the younger age group.
However, residential petrochemical exposure was a significant risk factor for
leukemia for the older age group. For one unit of increase in the log-transformed
exposure opportunity score, the adjusted odds ratio was 1.54 (95 percent
confidence interval: 1.14, 2.09). This study illustrates the utility of geographic
information system tools for providing refined exposure estimates for residential
exposure to petrochemical pollution.
Publication Types:

568: Logoped Phoniatr Vocol. 2006;31(2):76-88.

A Turkish perspective on communication disorders.
Topbas S.
Education, Research, and Training Centre for Speech & Language Disorders,
Anadolu University, Eskisehir, Turkey. stopbas @anadolu.edu.tr
The population of Turkey is approximately 65 million people, and another 3

million people of Turkish descent live in Europe and the United States. The
purpose of the present paper is to relay information that American or European
clinicians who work with Turkish clients should know about their clients' country,
including its language, education system, the current status of the profession and
organization of professional services for communication disorders. The paper
shows that the profession of speech-language pathology is young in Turkey; as a
result, the roles of speech-language pathologists in this country are substantially
different from those in the United States and in most European countries. It is
envisioned that as the profession grows in Turkey its role will increasingly
include direct provision of services, in-service training to service providers, and
research on communication disorders.
569: Drug Saf. 2006;29(6):537-48.

Herbal medicines used during the first trimester and major

congenital malformations: an analysis of data from a pregnancy
cohort study.
Chuang CH, Doyle P, Wang JD, Chang PJ, Lai JN, Chen PC.
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan

University College of Public Health, Taipei, Taiwan.
BACKGROUND: Major congenital malformations place a considerable burden

on the affected child, the family and society. Any kind of medicine used during
pregnancy might have a harmful impact; therefore, such practice has raised
concerns. The objective of the current study was to explore the relationship
between the use of herbal medicines by pregnant women during the first trimester
of pregnancy and the risk of major congenital malformation in their live born
infants. METHODS: This was a cross-sectional analysis of data from a
prospective pregnancy cohort, which was established between 1984 and 1987. To
assemble the cohort, pregnant women of >or=26 weeks of gestation who came to
the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care
were enrolled in the study and interviewed using a structured questionnaire.
Detailed information, including herbal medicine use during different periods of
pregnancy, was obtained during the interview. Past medical history, current
obstetric data and details on conventional medicines used during pregnancy were
abstracted from medical records. Data on birth weight, gestational duration and
characteristics of live born infants were gathered from the Taiwan national birth
register. Congenital malformation information was obtained from multiple
sources: the newborn examination record (1984-7); the national death register
(1984-2003); and Taiwan National Health Insurance data (1996-2000). Multiple
logistic regression was used to estimate the odds ratio [OR] of major congenital
malformation by herbal medicines used during the first trimester. RESULTS: A
total of 14,551 live births were analysed. After adjustment for confounding
factors, taking huanglian during the first trimester of pregnancy was found to be
associated with increased risk of congenital malformations of the nervous system
(adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an
increased risk of congenital malformations of the musculoskeletal and connective
tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30,
95% CI 1.47, 36.18). CONCLUSION: We found evidence for a possible link
between the use of specific herbal medicines during the first trimester of
pregnancy and increased risks of specific groups of congenital malformations. We
could not investigate whether the adverse effects were related to direct toxicity
from the herbal medicines, or were from misuse, contamination or uncontrolled
confounding. Nonetheless, we would advise caution regarding use of herbal
medicines during pregnancy, and we suggest that further investigation of these
findings is warranted.
Publication Types:
570: Int J Health Geogr. 2006 Jun 4;5:25.

The effect of the development of an emergency transfer system on

the travel time to tertiary care centres in Japan.
Miwa M, Kawaguchi H, Arima H, Kawahara K.
Department of Health Policy Science, Graduate School of Tokyo Medical and

Dental University, Tokyo, Japan. makiko@meno-sg.net
BACKGROUND: In Japan, the emergency medical system is categorized into

three levels: primary, secondary, and tertiary, depending on the severity of the
condition of the patient. Tertiary care centres accept patients who require 24-h
monitoring. In this research, the average travel times (minutes) from the centroids
of all municipalities in Japan to the nearest tertiary care centre were estimated,
using the geographic information system. The systems affecting travel time to
tertiary care centres were also examined. Regression analysis was performed to
determine the factors affecting the travel time to tertiary care centres, using
selected variables representing road conditions and the emergency transfer
system. Linear regression analysis was performed to identify specific benchmarks
that would be effective in reducing the average travel time to tertiary care centres
in prefectures with travel times longer than the average 57 min. RESULTS: The
mean travel time was 57 min, the range was 83 min, and the standard deviation
was 20.4. As a result of multiple regression analysis, average coverage area per
tertiary care centre, kilometres of highway road per square kilometre, and
population were selected as variables with impact on the average travel time.
Based on results from linear regression analysis, benchmarks for the emergency
transfer system that would effectively reduce travel time to the mean value of 57
min were identified: 26% pavement ratio of roads (percentage of paved road to
general roads), and three tertiary care centres and 108 ambulances.
CONCLUSION: Regional gaps in the travel time to tertiary care centres were
identified in Japan. The systems we should focus on to reducing travel time were
identified. Further reduction of travel time to tertiary care centres can be
effectively achieved by improving these specific systems. Linear regression
analysis showed that a 26% pavement ratio and three tertiary care centres are
beneficial to prefectures with an average time longer than the mean score, to
achieve a reduction of travel time. Measures for reducing travel time need to be
considered in policy-making to re-evaluate the current locations of tertiary care
centres to provide equality of access to emergency medicine.
PMCID: PMC1534023
571: Health Educ Res. 2006 Jun;21(3):407-15. Epub 2006 Jun 1.

School-based smoking prevention programs for adolescents in South

Korea: a systematic review.
Park E.
Nursing, Cheju National University, 66 Jejudaehakro, Ara 1 Dong, Jejusi 690-

756, Republic of Korea. eopark@cheju.ac.kr
The number of research papers evaluating programs designed to prevent

adolescent smoking have increased in the last 13 years in Korea. The purpose of
this study was to evaluate these programs, to review the features of the studies
and to systemically assess the results on the knowledge about, and attitude to,
smoking and smoking behavior. Database searched were national digital library
(NDL) and the Research Information Service System, which are major literature
search systems for all academic fields in South Korea, and the Research
Information Center for Health, which is a database for health field. A total of 11
papers were included. Program contents are described under five categories and
the mode of delivery is described. Methodological features were investigated and
effect of the size of the study on variables investigated was computed. Knowledge
was the main content of the program in most of the studies. Most studies
delivered classroom-based instructions that were mainly didactic presentations.
School-based smoking programs have not influenced adolescent smoking
behavior as much as anticipated. Methodological problems were discussed.
Several recommendations are made to improve effectiveness of smoking
prevention programs and reduce methodological flaws in future studies.
Publication Types:
• Review
572: Health Educ Behav. 2008 Feb;35(1):105-18. Epub 2006 May 31.
Knowledge of the effects of indoor air quality on health among

women in Jordan.
Madanat H, Barnes MD, Cole EC.
Department of Community Health, College of Science and Health, Utah Valley

State College, Orem 84058, USA. madanaha@uvsc.edu
OBJECTIVE: To assess the extent of knowledge about symptoms relating to

respiratory illnesses and home environments among a random sample of 200
urban Jordanian women. METHOD: This customized, validated, cross-sectional
questionnaire evaluated the knowledge of these women about the association
between the indoor environment and health, the presence or absence of indoor
discomforts, symptoms of respiratory illnesses, and behaviors related to the home
environment such as cleaning practices. RESULTS: Results showed an alarming
rate of smoking in the homes; the extent of knowledge was moderate but higher
among those exhibiting symptoms and those with children. Cleaning practices
associated with healthy home environments were reported at a high rate but
seemed to be based on cultural influences. CONCLUSIONS: This type of
information is crucial to the formation of health education programs and policy
recommendations for pollutant source and exposure reductions in homes in the
Middle East and other developing countries.
Publication Types:
573: Schizophr Res. 2006 Sep;86(1-3):23-9. Epub 2006 Jun 5.

Maternal household crowding during pregnancy and the offspring's

risk of schizophrenia.
Kimhy D, Harlap S, Fennig S, Deutsch L, Draiman BG, Corcoran C, Goetz
D, Nahon D, Malaspina D.
Department of Psychiatry, Columbia University, New York, NY 10032, USA.

dk553@columbia.edu
BACKGROUND: Animal models of schizophrenia suggest a link between

maternal crowding during pregnancy and increased risk of the offspring to
develop physiological, developmental, and behavioral abnormalities that are
comparable to those observed in schizophrenia. We tested the hypothesis that a
similar link is present in humans. METHOD: We investigated whether prenatal
exposure to household crowding was associated with the risk of schizophrenia in
a sub-cohort of the Jerusalem Perinatal Study (JPS) consisting 11,015 individuals
born between 1964 and 1976. During these years mothers participated in face to
face interviews in early pregnancy. The prenatal and birth data, including the
number of rooms and individuals living in the mothers' household, was cross-
linked with the Israel Psychiatric Registry by ministry personnel. RESULTS: 104
schizophrenia cases were identified in the cohort. Offspring who, while in utero,
their mother resided in a household with five or more individuals had RR of 1.47
(95% CI: 0.99-2.16, p=0.05) to develop schizophrenia, compared to those whose
mother resided with four or fewer individuals. However, when adjusted for
paternal age, the RR was reduced to 1.18 (95% CI: 0.76-1.84, p=0.46). The
number of rooms in the household and the household crowding during pregnancy
did not significantly impact the offspring's risk to develop schizophrenia.
CONCLUSION: The link between maternal household crowding during
pregnancy and the offspring's risk of schizophrenia was explained primarily by
the impact of paternal age. The authors discuss the results in view of findings
from animal and human studies.
Publication Types:
574: Adv Parasitol. 2006;61:509-66.

Control of Taenia solium cysticercosis/taeniosis.
Willingham AL 3rd, Engels D.

WHO/FAO Collaborating Center for Parasitic Zoonoses, Royal Veterinary and
Agricultural University, Frederiksberg, Denmark.
Cysticercosis is emerging as a serious public health and agricultural problem in

many poorer countries of Latin America, Africa, and Asia. Caused by the pork
tapeworm, Taenia solium, this zoonotic disease forms larval cysts in humans and
pigs that can lead to epilepsy and death in humans, reduces the market value of
pigs and makes pork unsafe to eat. It occurs where pigs range freely, sanitation is
poor, and meat inspection is absent or inadequate, and is thus strongly associated
with poverty and smallholder farming. Although theoretically easy to control and
declared eradicable cysticercosis remains neglected in most endemic countries
due to lack of information and awareness about the extent of the problem, suitable
diagnostic and management capacity, and appropriate prevention and control
strategies. Human neurocysticercosis occurs when the larval cysts develop in the
brain. It is considered to be the most common parasitic infection of the human
nervous system and the most frequent preventable cause of epilepsy in the
developing world. Thus far the infection has not been eliminated from any region
by a specific program, and no national control programs are yet in place. We
consider the tools available for combating cysticercosis and suggest simple
packages of interventions, which can be conducted utilizing existing services and
structures in the endemic countries to provide appropriate and sustainable control
of the disease.
Publication Types:
• Review
575: Comput Methods Programs Biomed. 2006 Jun;82(3):277-82. Epub 2006 May
30.
Taiwan's perspective on electronic medical records' security and

privacy protection: lessons learned from HIPAA.
Yang CM, Lin HC, Chang P, Jian WS.
Taipei Medical University School of Healthcare Administration, No. 250, Wu-

Hsing Street, Taipei 110, Taiwan.
The protection of patients' health information is a very important concern in the

information age. The purpose of this study is to ascertain what constitutes an
effective legal framework in protecting both the security and privacy of health
information, especially electronic medical records. All sorts of bills regarding
electronic medical data protection have been proposed around the world including
Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The
trend of a centralized bill that focuses on managing computerized health
information is the part that needs our further attention. Under the sponsor of
Taiwan's Department of Health (DOH), our expert panel drafted the "Medical
Information Security and Privacy Protection Guidelines", which identifies nine
principles and entails 12 articles, in the hope that medical organizations will have
an effective reference in how to manage their medical information in a
confidential and secured fashion especially in electronic transactions.
Publication Types:
576: MMWR Morb Mortal Wkly Rep. 2006 May 26;55(20):556-9.

Tobacco use among students aged 13-15 years--Kurdistan Region,

Iraq, 2005.
Centers for Disease Control and Prevention (CDC).
Tobacco use is one of the major preventable causes of premature death and
disease in the world. The Global Youth Tobacco Survey (GYTS), part of the
Global Tobacco Surveillance System initiated by the World Health Organization
(WHO), CDC, and the Canadian Public Health Association, was developed to
monitor tobacco use, attitudes about tobacco, and exposure to secondhand smoke
among youths and has been conducted in 140 countries. This report presents
findings from the GYTS conducted in the Kurdistan region of Iraq (i.e., Irbil, as-
Sulaymaniyah, and Dahuk governorates) in 2005, which revealed that one in 10
students currently smoked cigarettes or used other tobacco products. Boys (21%)
were statistically significantly more likely than girls (2.1%) to smoke cigarettes,
but no significant difference was observed between boys and girls in their use of
other tobacco products. Public health authorities in the Kurdistan Region of Iraq
can use the baseline information from the GYTS to design and implement
tobacco-control programs to reduce youth smoking.
577: Circ J. 2006 Jun;70(6):679-85.

Physician and hospital characteristics related to length of stay for

acute myocardial infarction patients: a 3-year population-based
analysis.
Lin HC, Chen CS, Lee HC, Liu TC.
School of Health Care Administration, Taipei Medical University, Taipei,

Taiwan. henry11111@tmu.edu.tw
BACKGROUND: The lack of studies on the simultaneous contributions of

hospital and physician to the length of stay (LOS) for acute myocardial infarction
(AMI) has hampered the development of hospital- and physician-level strategies
by clinicians and policymakers. This study used 3 years of population-based data
to examine the relationships of physician and hospital characteristics with LOS
for AMI patients in Taiwan. METHODS AND RESULTS: Multiple regression
analysis was carried out to explore the relationships, using the 2001-2003
National Health Insurance Research Database of the National Health Research
Institute, Taiwan. The study samples were identified by a principal diagnosis of
AMI (ICD-9-CM code 410), with a total of 19,907 eligible admissions. The mean
LOS was 9.1 days. The results revealed that compared with district hospitals, the
LOS was significantly longer in both medical centers and regional hospitals (both
p<0.001). The LOS among patients attended by cardiologists was 28.0% shorter
than those attended by physicians specializing in surgery, family medicine, or
emergency medicine. CONCLUSIONS: The results of this study demonstrate that
there are wide variations among the different types of physician and levels of
hospital in the LOS for AMI patients, which highlights the importance of
developing national treatment protocols for AMI in order to reduce variations in
hospital and physician behaviors.
Publication Types:
578: Eur J Orthod. 2006 Aug;28(4):393-9. Epub 2006 May 24.

A socio-dental approach to assessing children's orthodontic needs.
Gherunpong S, Tsakos G, Sheiham A.

Department of Community Dentistry, Chulalongkorn University, Thailand.
Traditional methods of assessing orthodontic treatment need using mainly clinical

measures are inadequate and would be improved by integrating normative, oral
health-related quality of life (OHRQoL), and behavioural propensity measures.
This study aimed to develop and test a socio-dental system of orthodontic needs
assessment, and to compare normative and socio-dental estimates of orthodontic
need. The socio-dental system integrates three types of need: normative need
(NN), impact-related need (IRN) and propensity-related need (PRN). A cross-
sectional survey of all 1,126 children aged 11-12 years in Suphanburi, Thailand,
was carried out to test the new system. The dental health component of the Index
of Orthodontic Treatment Need was used to assess NN, and the simplified oral
hygiene index for oral hygiene status. Oral impacts were assessed using the child-
Oral Impacts on Daily Performances (child-OIDP) index. A self-administered
questionnaire recorded information on demographic and oral health-related
behaviour. Treatment needs were assessed according to the developed socio-
dental system. The socio-dental approach to assess orthodontic needs was easy to
use and readily accepted by the children. The estimates of orthodontic need
assessed normatively and socio-dentally differed markedly. The prevalence of NN
and IRN was 35.0 and 10.5 percent, respectively, thus representing a reduction of
approximately 70 percent in the volume of treatment need according to the new
method. Children with IRN had different levels of propensity for orthodontic
treatment, and therefore required appropriate treatment plans according to their
PRN. Of the 10.5 percent with IRN, 6.9 percent had high or medium-high PRN,
while 3.6 percent were at medium-low and low levels of propensity.
Publication Types:
579: J Eval Clin Pract. 2006 Jun;12(3):353-64.

Evidence-based medical education -quo vadis?
Leung GM, Johnston JM.
Department of Community Medicine, University of Hong Kong, Hong Kong,

China. gmleung@hku.hk
The evidence base for most educational initiatives, at least until very recently, is
largely composed of low-level evidence. Four major barriers underlie this
historical observation, namely: (1) perceived ethical and acceptability problems
arising from the unequal treatment of learners in experimental designs; (2) limited
choice of outcome measures and validated instruments; (3) time and resource
constraints; and (4) methodological issues concerning contextual confounding and
small sample sizes. We advocate the adoption of a 'balanced scorecard' approach
in the evaluation of education interventions that brings together a comprehensive
panel of outcomes under one framework. We require a diversity of rigorously
applied methods to generate these outcomes, drawing from the quantitative and
qualitative disciplines of epidemiology, psychology and economics. We further
suggest that the research community discuss and agree on a standardized set of
common metrics or benchmarks. We conclude with a case study examining
whether a hand-held computer clinical decision support tool improves clerkship
learning of evidence-based medicine. The era of Brownian motion in health
education research is over. What we demand in terms of burden of proof for
educational effectiveness should be no less rigorous than our call for an ever
escalating threshold concerning evidence of clinical care.
580: Inhal Toxicol. 2006 Jul;18(8):549-54.

Air pollution and hospital admissions for asthma in a tropical city:

Kaohsiung, Taiwan.
Tsai SS, Cheng MH, Chiu HF, Wu TN, Yang CY.
Department of Health Care Administration, I-Shou University, Kaohsiung,

Taiwan.
This study was undertaken to determine whether there is an association between

air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan.
Hospital admissions for asthma and ambient air pollution data for Kaohsiung
were obtained for the period from 1996 through 2003. The relative risk of hospital
admission was estimated using a case-crossover approach, controlling for weather
variables, day of the week, seasonality, and long-term time trends. In the single-
pollutant models, on warm days (> or = 25 degrees C) statistically significant
positive associations were found in all pollutants except sulfur dioxide (SO2). On
cool days (< or = 25 degrees C) all pollutants were significantly associated with
asthma admissions For the two pollutant models, CO and O3 were significant in
combination with each of the other four pollutants on warm days. On cool days
NO2 remained statistically significant in all the two-pollutant models. This study
provides evidence that higher levels of ambient pollutants increase the risk of
hospital admissions for asthma.
Publication Types:
581: Ann Nucl Med. 2006 Apr;20(3):195-202.

Surveillance study for creating the national clinical database related

to ECG-gated myocardial perfusion SPECT of ischemic heart
disease: J-ACCESS study design.
Kusuoka H, Nishimura S, Yamashina A, Nakajima K, Nishimura T.
Osaka National Hospital, Saitama Medical School Hospital, Japan.
BACKGROUND: ECG-gated myocardial perfusion SPECT is widely applied to

diagnose ischemic heart disease, and such findings are useful to predict patient
prognosis. However, Japan does not have a database that correlates SPECT image
findings with the prognosis of patients who have ischemic heart disease.
METHODS: A large-scale clinical study involving 117 medical facilities
throughout Japan was established to survey the clinical background and image
findings of patients who have undergone ECG-gated stress perfusion SPECT.
These patients were followed up for three years to investigate the occurrence of
cardiac events. RESULTS: The 4,629 registered patients comprised 2,989 males
(age 64.9 +/- 10.3 y, mean +/- SD) and 1,640 females (age 67.2 +/- 9.7 y). The
most frequent complication was hypertension (54.5%), followed by
hyperlipidemia (47.2%) and diabetes (29.4%). Percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) was conducted on 1,925 of the
patients. SPECT examinations were ordered for further examination of chest pain
(32.8%), periodic follow-up after coronary artery intervention (24.2%), screening
for coronary artery disease (15.1%), follow-up of old myocardial infarction
(14.9%), more detailed investigation of ECG or echocardiographic abnormalities
(13.1%), etiological assessment of heart failure (1.6%), and further inspection for
acute coronary syndrome (0.3%). The method of inducing stress was most often
exercise loading at 68.8%, and infusion of either dipyridamole (14.6%) or
adenosine triphosphate (ATP, 13.8%). The most frequently applied amount of
99mTc-tetrofosmin was an initial dose of 200 to 300 MBq combined with a
second dose of 700 to 800 MBq (37.7%). The mean doses were 305 +/- 81 at the
initial and 709 +/- 132 MBq at the second administration. A history of angina
pectoris (41.2%) was the most frequent, followed by myocardial infarction
(29.5%). CONCLUSIONS: During the two years of follow-up after registration,
46 of the 4,629 subjects have discontinued or dropped out, 134 have died, and
4,449 (97.8%) continue to undergo follow-up investigations. A complete report
will be presented when the follow-up data for 3 years have been compiled and
analyzed.
Publication Types:
582: Jpn J Clin Oncol. 2006 May;36(5):280-4. Epub 2006 May 19.
The lung cancer database project at the National Cancer Center,

Japan: study design, corresponding rate and profiles of cohort.
Nakaya N, Goto K, Saito-Nakaya K, Inagaki M, Otani T, Akechi T, Nagai K,

Hojo F, Uchitomi Y, Tsugane S, Nishiwaki Y.
Psycho-Oncology Division, National Cancer Center Hospital East, 6-5-1

Kashiwanoha, Kashiwa, Japan.
BACKGROUND: The lung cancer database project was established in 1999 at the
National Cancer Center Hospital East, Japan, as an ongoing project to integrate
data on various factors in lung cancer patients. The aim of the project was to
construct a large-scale cancer registry for lung cancer that would contribute to
basic research and clinical research in the future. METHODS: Between July 1999
and July 2004, consecutive lung cancer patients were recruited into this project.
The baseline survey consisted of self-administered questionnaires concerning
various demographic data, health habits and psychological factors. Medical
information was obtained from the patients' medical charts. Urine specimens and
blood samples were collected, and DNA was extracted from blood lymphocytes.
RESULTS: Out of the 2506 patients who were asked to participate in the project,
2036 (81%) patients with newly diagnosed, untreated primary lung cancer were
enrolled. The final analytic cohort consisted of 1995 patients. Virtually all of the
1995 patients (corresponding rate, 99%) completed the questionnaires on
demographic data and health habits. The corresponding rates for the
questionnaires on psychological factors and dietary habits were 99 and 94%,
respectively. In a follow-up survey conducted to determine vital status as of
December 2004, a total of 1051 patients (53%) had died and 44 patients (2%)
were lost to follow-up. CONCLUSIONS: This paper overviews the rationale for
initiating the lung cancer database project, Japan. This database should prove
useful for researchers examining the pathogenesis of lung cancer and may
contribute to the formulation of a framework for cancer treatment.
Publication Types:
583: Vaccine. 2006 Jun 19;24(25):5341-8. Epub 2006 May 2.

Use of National Health Insurance database to evaluate the impact of

public varicella vaccination program on burden of varicella in
Taiwan.
Tseng HF, Tan HF, Chang CK.
Institute of Medical Research, Chang-Jung Christian University, 396, Sec. l,

Chang Jung Rd, Kway Jen, Tainan 711, Taiwan, ROC.
tsenghf2000@yahoo.com.tw
The aims of this study were to investigate the epidemiology of varicella and
evaluate the effect of varicella vaccination on the burden of varicella in Taiwan.
The outpatient and hospitalization claims made to the National Health Insurance
(NHI) in public and private vaccination areas were compared during 2000-2002.
In 2002, the outpatient visit rates for 1- to 5-year-old children in public
vaccination areas were 66-78% lower than their counterparts in private
vaccination areas. The reduction in outpatient visit rate was the greatest among
preschool children. The reductions also occurred in every age group including
infants and adults. This study showed significant evidence of vaccine impact with
a marked decline in clinical cases in the short term.
Publication Types:
584: Hokkaido Igaku Zasshi. 2006 Jan;81(1):53-65.

[Relationship between medical expenses for the aged residing in
farming villages and a social support network--documentation using
details of medial expenses]
Sakakura E.
585: Ann Acad Med Singapore. 2006 Apr;35(4):236-41.

Modelling the utility of body temperature readings from primary

care consults for SARS surveillance in an army medical centre.
Chen MI, Tan IB, Ng YY.
Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.

Mark_Chen@ttsh.com.sg
INTRODUCTION: There is interest in surveillance systems for outbreak

detection at stages where clinical presentation would still be undifferentiated.
Such systems focus on detecting clusters of syndromes in excess of baseline
levels, which may indicate an outbreak. We model the detection limits of a
potential system based on primary care consults for the detection of an outbreak
of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS:
Data from an averaged-sized medical centre were extracted from the Patient Care
Enhancement System (PACES) [the electronic medical records system serving the
Singapore Armed Forces (SAF)]. Thresholds were set to 3 or more cases
presenting with particular syndromes and a temperature reading of >or=38oC (T
>or=38). Monte Carlo simulation was used to insert simulated SARS outbreaks of
various sizes onto the background incidence of febrile cases, accounting for
distribution of SARS incubation period, delay from onset to first consult, and
likelihood of presenting with T >or=38 to the SAF medical centre. RESULTS:
Valid temperature data was available for 2,012 out of 2,305 eligible syndromic
consults (87.2%). T >or=38 was observed in 166 consults (8.3%). Simulated
outbreaks would peak 7 days after exposure, but, on average, signals at their peak
would consist of 10.9% of entire outbreak size. Under baseline assumptions, the
system has a higher than 90% chance of detecting an outbreak only with 20 or
more cases. CONCLUSIONS: Surveillance based on clusters of cases with T
>or=38 helps reduce background noise in primary care data, but the major
limitation of such systems is that they are still only able to confidently detect large
outbreaks.
586: J Epidemiol. 2006 May;16(3):107-16.

Impact of the revision of a nutrient database on the validity of a self-

administered food frequency questionnaire (FFQ).
Ishihara J, Inoue M, Kobayashi M, Tanaka S, Yamamoto S, Iso H, Tsugane

S; JPHC FFQ Validation Study Group.
Epidemiology and Prevention Division, Research Center for Cancer Prevention

and Screening, National Cancer Center, Tokyo, Japan.
BACKGROUND: Revision of the national nutrient database in 2000 had a strong

impact on the absolute level of estimated nutrient intake in dietary assessments.
However, whether it influenced the ranking of individuals by estimated intake, a
more important function in epidemiologic studies, has not been investigated.
Here, we investigated the effect of this revision of the nutrient database on the
validity of a food frequency questionnaire (FFQ) used to estimate nutrient intake
in the Japan Public Health Center-based prospective Study (JPHC Study).
METHODS: Subjects were a subsample of the JPHC Study who volunteered to
participate in the validation study of the FFQ. Validity of the FFQ was evaluated
by reference to the 28-day weighed dietary records as a gold standard. Nutrient
intake according to the FFQ was recalculated using the revised database, and the
results were compared to those using the previous database. Spearman's rank
correlation coefficients (CCs) between intakes estimated by the FFQ and dietary
records were computed using the revised database, and were compared to CCs
computed using the previous database. RESULTS: For most of the nutrients,
mean intake increased or decreased significantly using the revised database.
However, no notable change was seen for the CC between estimated intake
according to dietary records and FFQ when the revised database was used for
calculation. Differences in the point estimates of the CCs ranged from -0.14 to
0.15. Likewise, CCs between biomarkers and estimated intake according to FFQ
were similar for the two databases. CONCLUSION: Despite changes in intake
levels for many nutrients, the validity of our FFQ using rank correlation by
nutrient intake was not influenced by revision of the nutrient database in Japan.
Publication Types:
587: Int J Environ Res Public Health. 2005 Aug;2(2):343-54.

Use of multi-objective air pollution monitoring sites and online air

pollution monitoring system for total health risk assessment in
Hyderabad, India.
Anjaneyulu Y, Jayakumar I, Hima Bindu V, Sagareswar G, Mukunda Rao

PV, Rambabu N, Ramani KV.
Institute of Science and Technology, JNT University, Kukatpally, Hyderabad -

500 072, Andhra Pradesh, India. directorist2004@yahoo.co.in
A consensus has been emerging among public health experts in developing

countries that air pollution, even at current ambient levels, aggravates respiratory
and cardiovascular diseases and leads to premature mortality. Recent studies have
also presented well-founded theories concerning the biological mechanisms
involved and the groups of people that are probably more susceptible to health
effects caused or exacerbated by inhalation of ambient particulate matter (PM.).
On the basis of prognostic studies carried out in Center for Environment, JNT
University, Hyderabad "it has been estimated that in Hyderabad some 1,700 to
3,000 people per year die prematurely as a result of inhaling PM". These figures
reflect only the effects of acute exposure to air pollution. If the long-term effects
of chronic exposure are taken into account, 10,000-15,000 people a year could die
prematurely in Hyderabad. This estimate of the chronic effects is based on other
studies, which are not completely comparable with the Hyderabad situation.
While the study designs and analyses in these other studies may indeed be
different or irrelevant to Hyderabad, the fact they were carried out in other
countries is irrelevant. Taking into account these considerations, a model for total
health risk assessment for the city of Hyderabad, and its state of Andhra Pradesh
in India has been developed using a multi-objective air pollution monitoring
network and online and real time air pollution monitoring stations. For the model
studies a number of potential monitoring sites were screened for general and site-
specific criteria in a geographic information system (GIS) environment that may,
on a local basis, affect the representativeness of the data collected. Local features
that may affect either the chemical or meteorological parameters are evaluated to
assure a minimum of interference. Finally, for monitoring air pollution, an online
and real-time monitoring system was designed using advanced electrochemical
sensor systems (sulphur dioxide, oxides of nitrogen, carbon monoxide,
hydrocarbons, ozone, mercaptans and hydrogen sulphide) and a particulate matter
analyzer (total suspended particulate matter TSPM), PM2.5 and PM10). The
sensor and data acquisition systems are programmed to monitor pollution levels at
1/2 hour durations during peak hours and at 1-hour intervals at other times.
Presently, extensive statistical and numerical simulations are being carried out at
our center to correlate the individuals living in the monitored areas with
respiratory infections with air pollution.
588: Regul Toxicol Pharmacol. 2006 Nov;46(2):142-8. Epub 2006 May 15.
The development and regulation of occupational exposure limits in

Taiwan.
Shih TS, Wu KY, Chen HI, Chang CP, Chang HY, Huang YS, Liou SH.
Institute of Occupational Safety and Health, Council of Labor Affairs, No 99,

Lane 407, Heng-Ke Rd., Sijhih City, Taipei, Taiwan.
The occupational exposure limits (OELs) in Taiwan was promulgated in 1974 and
has been revised five times since then. Many of the OELs were adopted from the
most recent ACGIH TLVs and US OSHA PELs. A total of 483 chemicals were
listed in the current Taiwan OELs Standard. The procedures of OELs
development in Taiwan include the IOSH organized a recommended exposure
limits (RELs) Committee to select the target chemicals and to recommend the
RELs through literature review based on the health effects in the first stage, then,
the CLA put policy needs, economical and technical feasibility into consideration
and set up the final OELs at the second stage. A standard operation manual of
RELs Committee has been developed. Based on our experience, several issues
including the participation of representatives from a comprehensive spectrum,
communication/education and training/enforcement, continuous collection of the
local exposure data and health hazard information, use of health risk assessment,
consideration of economic, and technical feasibility, as well as the globalization
and information and experience sharing are critical in developing the appropriate
OELs. Three examples including benzene, crystalline silica, and 2-methoxy
ethanol are given to demonstrate the operation of system.
589: Am J Ind Med. 2006 Aug;49(8):609-16.

Respiratory health in Turkish asbestos cement workers: the role of

environmental exposure.
Akkurt I, Onal B, Demir AU, Tüzün D, Sabir H, Ulusoy L, Karadağ KO,
Ersoy N, Cöplü L.
Department of Chest Disease, Cumhuriyet University Medical School, Sivas,

Turkey.
AIM: Benign and malignant pleural and lung diseases due to environmental
asbestos exposure constitute an important health problem in Turkey. The country
has widespread natural deposits of asbestos in rural parts of central and eastern
regions. Few data exists about the respiratory health effects of occupational
asbestos exposure in Turkey. A cross-sectional study was conducted to investigate
respiratory health effects of occupational asbestos exposure and the contribution
of environmental asbestos exposure. METHODS: Investigations included
asbestos dust measurements in the workplace and application of an interviewer-
administered questionnaire, a standard posteroanterior chest X-ray and
spirometry. Information on birthplace of the workers was obtained in 406 workers
and used to identify environmental exposure to asbestos, through a map of
geographic locations with known asbestos exposure. RESULTS: Asbestos dust
concentration in the ambient air of the work sites (fiber/ml) ranged between 0.2
and 0.76 (mean: 0.25, median: 0.22). Environmental exposure to asbestos was
determined in 24.4% of the workers. After the adjustment for age, smoking,
occupational asbestos exposure, and potential risk factors environmental asbestos
exposure was associated with small irregular opacities grade > or = 1/0 (44.2% vs.
26.6%, P < 0.01), FVC% (97.8 vs. 104.5, P < 0.0001), and FEV1% (92.4 vs. 99.9,
P < .0001). Occupational exposure to asbestos was associated with small irregular
opacities grade > or = 1/0 (OR: 2.0, 95% CI: 1.3-3.1, per 1 unit increase in the
natural logarithm of fiber/ml) and FEV1/FVC% (beta: 1.1, SEM: 0.54; P < 0.05,
per 1 unit increase in the natural logarithm of fiber/ml). CONCLUSIONS:
Environmental exposure to asbestos could increase the risk of asbestosis and lung
function impairment in workers occupationally exposed to asbestos, independent
from occupational exposure and smoking. Copyright 2006 Wiley-Liss, Inc.
590: Public Health Nutr. 2006 May;9(3):313-9.

Breast-feeding and feeding practices of infants in a developing

country: a national survey in Lebanon.
Batal M, Boulghourjian C, Abdallah A, Afifi R.
Department of Nutrition and Food Sciences, American University of Beirut, PO

Box 11-0236, Beirut, Lebanon. malek.batal@aub.edu.lb
OBJECTIVE: Breast-feeding (BF) provides the ideal food for the healthy growth
and development of infants. The prevalence of BF in Lebanon shows mixed
results. The present study was the first large-scale, extensive survey on BF
parameters in Lebanon that aimed to explore demographic, socio-economic and
other fundamental issues associated with the initiation and duration of BF by
Lebanese mothers.DESIGN: The survey was cross-sectional in design and
administered over 10 months.SETTING: Information on all variables was
collected from mothers at health centres.SUBJECTS: Two-stage sampling was
conducted to select participants. A total of 1,000 participants were randomly
selected. A consent form was provided to each participant. Data were collected
from 830 of these.RESULTS: Almost all mothers were Lebanese, married and
had given birth in a hospital. About a third stated that breast milk was the first
food introduced after birth. Although 55.9% started breast-feeding their newborns
within a few hours after birth, and 18.3% within half an hour, 21.2% replied that
they initiated BF a few days after birth. Only 4.6% of the mothers replied that
they never breast-fed their infant. Timing of initiation of BF was associated with
the type of delivery (vaginal/Caesarean section) and hospital-related factors
(rooming-in, night feedings and frequency of mother-infant interaction). Of the
mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a
few hours following delivery, while only 13.3% had initiated BF a few days later.
Compared with the exceptionally high proportion of BF initiation, exclusivity of
BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated
with place of residence (urban/rural) and negatively associated with educational
level of the mother. Duration of BF was inversely associated with the use of pain
killers during delivery and maternal education. Rural mothers and those who
practised exclusive BF maintained BF for a longer duration.CONCLUSION:
Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low
and duration of BF is short. Future research targeting the factors associated with
BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers
who initiated BF, an ecological perspective on intervention aimed at women and
their social support system is required to improve duration and exclusivity.
Publication Types:
591: Nippon Ronen Igakkai Zasshi. 2006 Mar;43(2):230-5.

[Collaboration between university hospitals and local medical

communities in Japan evaluated by a questionnaire among doctors]
Tanaka M, Yokode M.
Department of Social Service, Kyoto University Hospital.
AIM AND METHODS: To provide quality medical service in a society with

many elderly, university hospitals should clearly define their roles and contribute
to the establishment of an integrated, comprehensive medical system. In this
study, we conducted a questionnaire survey of doctors working at Kyoto
University Hospital and at private practices in Kyoto about their attitude toward
collaboration between the university hospital and private practices and asked their
opinions on the role of university hospitals in the local medical community.
RESULTS: The survey showed that doctors both at the university hospital and in
private practice regarded close collaboration as important, but also highlighted
obstacles and problems that block collaboration. CONCLUSION: Overcoming
these problems and constructing collaboration models will be a key for university
hospitals to fully contribute to the establishment of a quality medical system.
Publication Types:
592: Scand J Work Environ Health. 2006 Apr;32(2):91-8.

Life-expectancy estimations and the determinants of survival after

15 years of follow-up for 81 249 workers with permanent
occupational disabilities.
Ho JJ, Hwang JS, Wang JD.
College of Public Health, National Taiwan University, No 17, Hsu-Chow Road,

Taipei, Taiwan, R.O.C.
OBJECTIVES: This study attempts to estimate life expectancy and explore the
determinants of survival for workers with permanent occupational disabilities.
METHODS: A database on permanent occupational disabilities occurring
between 1986 and 2000 was linked with the national death registry database to
construct the survival function. A method with Monte Carlo simulation was used
to extrapolate survival for up to 600 months to derive the life expectancy for
different disability grades (N=81249). A Cox (proportional hazard) regression
was carried out to explore the determinants and to estimate the hazard ratios.
Demographic variables, including age, gender, insured wage, severity of
disability, injury causes, and organ-system disability, were included in the model
as covariates. RESULTS: The results indicate that the survival period for workers
suffering permanent occupational disabilities is shorter than that of the general
population, amounting to an estimated loss of life expectancy ranging from 5 to
19 years. After adjustment for age and gender, a higher severity of disability,
impairment of vital organs or lower extremities, and a lower insured wage had a
significant association with shorter survival. Injury types, including transportation
incidents, being struck by sliding objects, or a trip, slip or stumble, and collapse
injury, indicated hazard ratios of between 1.24 and 1.34, as compared with
injuries such as being trapped or caught in machinery. CONCLUSIONS: The
findings identify major determinants for predicting survival for workers with
permanent occupational disabilities; these determinants may be of use in
improving the equity of the compensation system for workers.
Publication Types:
593: Lancet. 2006 May 6;367(9521):1487-94.

Comment in:
• Lancet. 2006 Jul 8;368(9530):117-8.
Stillbirth rates: delivering estimates in 190 countries.
Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K.
The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BACKGROUND: While information about 4 million neonatal deaths worldwide

is limited, even less information is available for stillbirths (babies born dead in the
last 12 weeks of pregnancy) and there are no published, systematic global
estimates. We sought to identify available data and use these to estimate the rates
and numbers of stillbirths for 190 countries for the year 2000, and provide
uncertainty estimates. METHODS: We assessed three sources of stillbirth data
according to specified inclusion criteria: vital registration; demographic and
health surveys (DHS), based on a new analysis of contraceptive calendar data;
and study reports that include published studies identified through systematic
literature searches of more than 30,000 abstracts and unpublished studies. A
random effects regression model was developed to predict national stillbirth rates
and associated uncertainty intervals. FINDINGS: Data from 44 countries with
vital registration (71,442 stillbirths), 30 DHS surveys from 16 countries (2989
stillbirths), and 249 study populations from 103 countries (93,023 stillbirths) met
the inclusion criteria. Model-based estimates were used for 128 countries. For 62
countries, the observed values were adjusted by a correction factor derived from
the model. The resultant stillbirth rates ranged from five per 1000 in rich countries
to 32 per 1000 in south Asia and sub-Saharan Africa. The estimated number of
global stillbirths is 3.2 million (uncertainty range 2.5-4.1 million). In light of the
data limitations and the conservative approach taken, the real number might be
higher than this. INTERPRETATION: The numbers of stillbirths are high and
there is a dearth of usable data in countries and regions in which most stillbirths
occur, with under-reporting being a major challenge. Although our estimates are
probably underestimates, they represent a rigorous attempt to measure the
numbers of babies dying during the last trimester of pregnancy. Improving
stillbirth data is the first step towards making stillbirths count in public-health
action.
Publication Types:

• Review
594: Suicide Life Threat Behav. 2006 Feb;36(1):97-102.

Suicide attempts in israel: age by gender analysis of a national

emergency departments database.
Levinson D, Haklai Z, Stein N, Gordon ES.
Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem, Israel.
Daphna.Levinson@moh.health.gov.il
An analysis of all emergency department admissions in Israel classified as an

attempted suicide in the years 1996-2002 was done to examine attempted suicide
rates by age and gender with particular attention to adolescents and young adults.
Gender differences in attempted suicide rates were significant only during
adolescence and young adulthood, ages 13 to 26. The highest rate for females was
3 years earlier than the highest rate for males. The results lead to the conclusion
that women do not attempt suicide more than men, except for 13-26 year olds.
595: J Med Dent Sci. 2005 Dec;52(4):229-36.

Toward secure distribution of electronic health records: quantitative

feasibility study on secure E-mail systems for sharing patient
records.
Gomi Y, Nogawa H, Tanaka H.
Department of Bioinformatics, Graduate School of Medicine and Dentistry,

Tokyo Medical and Dental University, Japan. yg@hen.jp
If the quality and efficiency of medical services are to be ensured, electronic

health records (EHR) and EHR-supporting infrastructure must be prevalent. Many
hospitals, however, have EHR systems for their internal use only, and the
standardization process for the exchange of medical information is still in process.
This standardization process addresses information security and is considering
public key infrastructure (PKI) as one security measure, but PKI is rarely used by
medical practioners because of its poor user-friendliness. Here we propose an
effective use of the identity-based encryption (IBE) system as a security measure.
This system enables us to send encrypted and signed messages without requiring
the receiver to get a public key, and it enables us to deliver secured messages to
ambiguous receivers like those to whom letters of reference are sent. We
evaluated the feasibility of this technology by using the analytic hierarchy
process, which is an effective analysis tool when selection and judgment depend
on nonquantitative psychological factors, to analyze the results of an experiment
in which medical workers used E-mail agents with and without PKI and IBE. We
found that medical practioners and researchers avoid using PKI because of its
poor user-friendliness and instead use IBE even though it is harder to install. We
therefore think IBE would encourage medical institutions to share patient records.
596: Singapore Med J. 2006 May;47(5):376-82.

Unintentional injuries in infants in Singapore.
Snodgrass AM, Ang A.
Department of Paediatric Medicine, KK Women's and Children's Hospital,

Singapore. amsnodgrass@yahoo.co.uk
INTRODUCTION: To describe the risk factors, causes and outcome of infant

injuries so as to guide the formulation of injury prevention strategies specific for
Singapore babies less than one year old. METHODS: Demographical, socio-
economic data, and data on the circumstances of injury, nature, severity of injury
and clinical outcome of all infants less than one year old and who sought medical
attention for or died from unintentional childhood injuries or poisoning, at the
Emergency Departments of three SingHealth hospitals, two SingHealth primary
care polyclinics and the Forensic Medicine Department, Health Sciences
Authority during a six-month period, were extracted from a larger Childhood
Injuries Surveillance database and analysed. RESULTS: 405 cases of accidental
injury and poisoning in infants aged less than one year were seen from February
to July 2002. 40.5 percent of injuries occurred when infants were left alone. Most
infants were aged between nine months to one year (37 percent), male (57.3
percent), first-born (57.3 percent) and Chinese (69 percent), with no past medical
history (96.1 percent). 91 percent of the injuries occurred at home, of which 60.5
percent occurred in the bedroom. Falls were the major mechanism of injury (77
percent). A total of 431 injuries were sustained. 63 percent were head injuries -
mainly stable head injuries, which made up 93.1 percent of all the head injuries.
67.5 percent of the cases were discharged without follow-up, while 17.9 percent
required hospital admission, mostly to the general ward (98.6 percent of total
admissions), and to the neurosurgery department (84.9 percent of total
admissions). There were two fatalities in this study population. The mechanisms
and patterns of injury changed with increasing motor ability of the infants.
CONCLUSION: Parents and caregivers of infants should be taught and reminded
about the age specific measures in injury prevention as their wards go through the
various developmental stages in the first year of life. Emphasis should be placed
on close caregiver supervision, identifying potential injury hazards in the home,
fall prevention, adopting safe infant care practices and the safe use of infant care
products.
597: BMC Infect Dis. 2006 Apr 26;6:77.

Spatial analysis of hemorrhagic fever with renal syndrome in China.
Fang L, Yan L, Liang S, de Vlas SJ, Feng D, Han X, Zhao W, Xu B, Bian L,

Yang H, Gong P, Richardus JH, Cao W.
Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of

Pathogen and Biosecurity, Beijing, China. fang_lq@163.com
BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is endemic in
many provinces with high incidence in mainland China, although integrated
intervention measures including rodent control, environment management and
vaccination have been implemented for over ten years. In this study, we
conducted a geographic information system (GIS)-based spatial analysis on
distribution of HFRS cases for the whole country with an objective to inform
priority areas for public health planning and resource allocation. METHODS:
Annualized average incidence at a county level was calculated using HFRS cases
reported during 1994-1998 in mainland China. GIS-based spatial analyses were
conducted to detect spatial autocorrelation and clusters of HFRS incidence at the
county level throughout the country. RESULTS: Spatial distribution of HFRS
cases in mainland China from 1994 to 1998 was mapped at county level in the
aspects of crude incidence, excess hazard and spatial smoothed incidence. The
spatial distribution of HFRS cases was nonrandom and clustered with a Moran's I
= 0.5044 (p = 0.001). Spatial cluster analyses suggested that 26 and 39 areas were
at increased risks of HFRS (p < 0.01) with maximum spatial cluster sizes of < or
= 20% and < or = 10% of the total population, respectively. CONCLUSION: The
application of GIS, together with spatial statistical techniques, provide a means to
quantify explicit HFRS risks and to further identify environmental factors
responsible for the increasing disease risks. We demonstrate a new perspective of
integrating such spatial analysis tools into the epidemiologic study and risk
assessment of HFRS.
Publication Types:
PMCID: PMC1471792
598: J Commun Dis. 2005 Mar;37(1):39-43.

Geographical information system (GIS) in investigation of an

outbreak.
Nisha V, Gad SS, Selvapandian D, Suganya V, Rajagopal V, Suganti P,

Balraj V, Devasundaram J.
Dept of Community Health, Christian Medical College, Vellore, India.
An outbreak of fever in a village in southern India was reported on 1st September,

2001. The first reported case presented with epistaxis and a platelet count of
27000h(1)/mm3. Clinical, laboratory and entomological evidence supported a
diagnosis of dengue fever. One third of the village was affected and 3.7 % of the
population presented with haemorrhagic symptoms; none were fatal. Five acute
cases tested for dengue specific IgM showed that two were positive. The larvae of
Aedes aegypti were discovered from domestic water collections in the village.
Spatial analysis done with the help of Geographical Information Systems software
(GIS) demonstrated a centrifugal spread of cases from the most affected street
until it involved the entire village. Spatial analysis revealed that cases occurred in
clusters and that these could not have occurred by chance. This was our first
experience in producing a geo-referenced map of a village area and in spatial
analysis. GIS is a novel and simple tool for outbreak investigations and the spatial
analyst adds additional information to the data collected. Control of adult
mosquitoes and larvae prevented the outbreak from spreading to an adjacent
village.
599: Eur J Oral Sci. 2006 Apr;114(2):102-8.

World dental research production: an ISI database approach (1999-

2003).
Gil-Montoya JA, Navarrete-Cortes J, Pulgar R, Santa S, Moya-Anegón F.
Faculty of Dentistry, Granada University, Spain. jagil@ugr.es
The objective of this study was to obtain a geographic world map of scientific
production in dentistry by analysing published papers. Articles and reviews in the
Dentistry, Oral Surgery & Medicine category published from 1999 to 2003 were
accessed through the ISI database. The data were analyzed quantitatively (number
of documents, number of researchers, productivity, interannual variation rate and
relative specialization index), qualitatively (weighted impact factor, relative
impact factor, citation rate per document and top 5 publications) and
socioeconomically (number of documents per inhabitant and per dentist and in
relation to the country's GDP). The USA, UK, Japan and Scandinavian countries
were found to be the most productive countries (number of publications).
Publications from Scandinavian countries were also of high quality as measured
by Impact Factor and Citation Rate, while the UK had one of the highest
productivity rates (number of documents per researcher).

600: Perit Dial Int. 2006 Mar-Apr;26(2):155-61.
The Japanese health-care system and reimbursement for dialysis.
Naito H.
Suzuka University of Medical Science, Suzuka, and Naito Medical Research

Institute, Kobe, Japan. naito@kh.rim.or.jp
Like most countries, Japan is facing constraints on expansion of health system

financial resources. There are almost 250000 Japanese patients with end-stage
renal disease and almost all are managed by chronic dialysis. Hospital
hemodialysis is the modality used by 96% of these patients. The Japanese health-
care system has tended to support resource-intensive treatments because the fee-
for-service remuneration system has rewarded their utilization. This has benefited
hemodialysis at the expense of peritoneal dialysis. However, this may now be
changing. Case management and global budget-related approaches are being more
widely introduced, as are incentives to reward more efficient treatment options.
The relative costs of dialysis modalities are difficult to appreciate, as center-based
services, such as hospital hemodialysis, are dependent upon fixed resources, while
home-based options, such as peritoneal dialysis, are dependent upon variable
resources. The aim of this review is to reconcile various sources of information
relevant to end-stage renal disease funding in Japan. The review will suggest that
modifying the approach to modality selection could lead to more efficient
allocation of future dialysis-related resources and so reduce the strain on Japan's
health-care budget.

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401: Soc Sci Med. 2007 Apr;64(7):1536-47. Epub 2007 Jan 17.

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