His 2

201: Bull World Health Organ. 2007 Jul;85(7):561-6.
Related Articles, Links
Reducing vector-borne disease by empowering farmers in integrated

vector management.
van den Berg H, von Hildebrand A, Ragunathan V, Das PK.
Laboratory of Entomology, Wageningen University, Wageningen, the

Netherlands. henk.vandenberg@wur.nl
PROBLEM: Irrigated agriculture exposes rural people to health risks associated

with vector-borne diseases and pesticides used in agriculture and for public health
protection. Most developing countries lack collaboration between the agricultural
and health sectors to jointly address these problems. APPROACH: We present an
evaluation of a project that uses the "farmer field school" method to teach farmers
how to manage vector-borne diseases and how to improve rice yields. Teaching
farmers about these two concepts together is known as "integrated pest and vector
management". LOCAL SETTING: An intersectoral project targeting rice
irrigation systems in Sri Lanka. RELEVANT CHANGES: Project partners
developed a new curriculum for the field school that included a component on
vector-borne diseases. Rice farmers in intervention villages who graduated from
the field school took vector-control actions as well as improving environmental
sanitation and their personal protection measures against disease transmission.
They also reduced their use of agricultural pesticides, especially insecticides.
LESSONS LEARNED: The intervention motivated and enabled rural people to
take part in vector-management activities and to reduce several environmental
health risks. There is scope for expanding the curriculum to include information
on the harmful effects of pesticides on human health and to address other public
health concerns. Benefits of this approach for community-based health
programmes have not yet been optimally assessed. Also, the institutional basis of
the integrated management approach needs to be broadened so that people from a
wider range of organizations take part. A monitoring and evaluation system needs
to be established to measure the performance of integrated management
initiatives.
Publication Types:
• Research Support, Non-U.S. Gov't
PMID: 17768506 [PubMed - indexed for MEDLINE]
202: Ann Acad Med Singapore. 2007 Aug;36(8):655-61.

Public trust in primary care doctors, the medical profession and the
healthcare system among Redhill residents in Singapore.
Lee YY, Ng CT, Siti Aishah MG, Ngiam JZ, Tai BC, Lim MK, Hughes K.
Department of Community, Occupational and Family Medicine, National

University of Singapore, Singapore.
INTRODUCTION: There have been few studies on public trust in doctors and
healthcare systems and this is the first in Singapore. MATERIALS AND
METHODS: A cross-sectional survey was carried out in Redhill in January 2005.
Citizens or Permanent Residents aged > or =18 years were randomly selected, one
per household to avoid cluster bias, and 361 participated (response rate 68.7%).
An interview administered questionnaire included 3 questionnaires measuring
public trust: "Interpersonal Trust in Physicians Scale" for primary care doctors;
"Trust in Physicians Generally Scale" for the medical profession; and "Trust in
Healthcare System Scale" for the Healthcare System. Questions were answered on
a Likert scale: 1. Strongly Disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly
Agree. Individual transformed scores of trust (range, 0 to 100) were equally
divided into 5 categories with their average being the transformed mean.
RESULTS: Trust in primary care doctors (mean 59.7) had proportions
(prevalence rates) of: very low 0.3%, low 2.5%, neutral 40.4%, high 54.0%, and
very high 2.8%. Trust in the medical profession (mean 61.8) had proportions of:
very low 1.0%, low 7.7%, neutral 33.7%, high 47.0%, and very high 10.5%. Trust
in the healthcare system (mean 61.5) had proportions of: very low 0.5%, low
4.1%, neutral 40.0%, high 48.7%, and very high 6.7%. For areas of the healthcare
system, proportions of high/very high trust were: "Healthcare Providers'
Expertise" (70.8%), "Quality of Care" (61.5%), "Patient Focus of Providers"
(58.7%), "Information Supply and Communication by Care Providers" (52.3%),
"Quality of Cooperation" (43.3%), and Policies of the Healthcare System"
(24.6%). CONCLUSIONS: While low proportions had low/very low trust, the
high proportions with neutral trust and the rather low level of trust in "Policies of
the Healthcare System" are causes for concern.
Publication Types:
203: Kaohsiung J Med Sci. 2007 Sep;23(9):463-9.

Epidemiologic study on work-related eye injuries in Kaohsiung,
Taiwan.
Ho CK, Yen YL, Chang CH, Chiang HC, Shen YY, Chang PY.
Department of Occupational and Environmental Medicine, Kaohsiung Medical

University Hospital, Kaohsiung, Taiwan.
To describe the epidemiologic features of work-related eye injuries in Kaohsiung,

a hospital-based study was performed. Four hundred and eighty-six patients who
were treated at emergency service or were admitted to the ophthalmology ward
over a 4-year period were reviewed. Among these, 38.9% of eye injuries in the
study were work-related. Male workers had a 3.99 higher odds ratio (OR) than
females to suffer from eye injuries (95% confidence interval [CI], 1.99-8.04).
Most of the work-related eye injuries occurred in subjects who were 30-49 years
old (OR, 3.02, and 95% CI, 1.56-5.82, when compared with those aged < or = 29
years). The most common type of eye injury in the occupational exposure group
was foreign body injury (31.2%), followed by blunt injuries (20.6%), chemical
burn (19.6%), UV light radiation (12.7%), and corneal abrasions (11.6%). On the
other hand, in the non-occupational exposure group, the most common types of
eye injury were blunt injuries (43.4%), corneal abrasions (28.3%), and foreign
body injury (20.2%). Our study found that foreign body injury and blunt injuries
were the two highest priority injuries for which prevention strategies should be
developed in Kaohsiung city. Furthermore, after advanced examination of types
of media that caused eye injuries, we found that being hit by wooden objects
around the eye, by flying objects in the eye, and by welding flashes are important
risk factors for workers to avoid. In conclusion, most of the occupational eye
injuries occurred among male workers aged 30-49 years. Due to the lack of an
occupational eye injury surveillance system to monitor the incidence of eye
injuries and to undertake risk assessment, preventable occupational eye injuries
have not been properly controlled. We hope to provide information for further
development of preventive strategies.
204: Philos Trans R Soc Lond B Biol Sci. 2008 Feb 27;363(1492):877-91.
Strategies and models for agricultural sustainability in developing

Asian countries.
Kesavan PC, Swaminathan MS.

M.S. Swaminathan Research Foundation, Third Cross Street, Taramani, Chennai-
600 113, India. pckesavan@mssrf.res.in
The green revolution of the 1960s and 1970s which resulted in dramatic yield
increases in the developing Asian countries is now showing signs of fatigue in
productivity gains. Intensive agriculture practiced without adherence to the
scientific principles and ecological aspects has led to loss of soil health, and
depletion of freshwater resources and agrobiodiversity. With progressive
diversion of arable land for non-agricultural purposes, the challenge of feeding the
growing population without, at the same time, annexing more forestland and
depleting the rest of life is indeed daunting. Further, even with food availability
through production/procurement, millions of marginal farming, fishing and
landless rural families have very low or no access to food due to lack of income-
generating livelihoods. Approximately 200 million rural women, children and
men in India alone fall in this category. Under these circumstances, the evergreen
revolution (pro-nature, pro-poor, pro-women and pro-employment/livelihood
oriented ecoagriculture) under varied terms are proposed for achieving
productivity in perpetuity. In the proposed 'biovillage paradigm', eco-friendly
agriculture is promoted along with on- and non-farm eco-enterprises based on
sustainable management of natural resources. Concurrently, the modern ICT-
based village knowledge centres provide time- and locale-specific, demand-driven
information needed for evergreen revolution and ecotechnologies. With a system
of 'farm and marine production by masses', the twin goals of ecoagriculture and
eco-livelihoods are addressed. The principles, strategies and models of these are
briefly discussed in this paper.
Publication Types:
• Review
205: Food Nutr Bull. 2007 Mar;28(1):3-17.

Nutritional status in postconflict Afghanistan: evidence from the

National Surveillance System Pilot and National Risk and
Vulnerability Assessment.
Johnecheck WA, Holland DE.
Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts
University, Boston, Massachusetts, USA.
BACKGROUND: Two large-scale studies, the National Surveillance System
(NSS) Pilot Study (2003-2004) and the National Risk and Vulnerability
Assessment (NRVA) 2003, were conducted by government, United Nations, and
nongovernmental organizations in Afghanistan, as part of wider efforts
characterizing Afghan livelihoods in relation to particular outcomes of interest:
vulnerability to poverty, food insecurity, and malnutrition. OBJECTIVE: To
present the data from these two surveys with nutrition as the key outcome of
interest, and to further construct the understanding of the underlying causes of
malnutrition, thus providing public health practitioners and other sector specialists
with insight into how a variety of sectoral programs can impact nutritional
outcomes in Afghanistan. METHODS: The NSS gathered information on
livelihoods, food security, and nutrition from 20 to 40 randomly selected
households in each of 26 purposively selected sentinel sites (representative of
livelihood zones) during November-December 2003 and May-June 2004. The
NRVA gathered information nationally from households selected with a two-
stage sampling (based on livelihood zone and then socioeconomic group) during
July-September 2004. RESULTS: Acute malnutrition is below emergency levels
for children under five. The level of chronic malnutrition in children under five
indicates a problem of public health importance. Dietary diversity in Afghanistan
is not as low as expected but still shows room for improvement, particularly in
remote areas and with respect to food groups associated with adequate
micronutrient intake. The findings also suggest that in addition to lack of adequate
household food intake, recurrent illness and suboptimal infant and young child
feeding and hygiene practices contribute to poor nutritional outcomes in this age
group. The survey also found poor access to health care, markets, and water for
household use. CONCLUSIONS: Improving nutritional status requires a
multipronged approach, directly targeting malnutrition, coupled with economic
growth, household livelihood security, social protection, access to public health
services, and water and sanitation. Nutrition policy, programming, and monitoring
need to reflect the immediate and underlying causes of malnutrition. Future
research needs to be designed to quantify the relative contribution of underlying
causes of poor nutrition, allowing practitioners to prioritize responses aimed at
improving nutritional outcomes.
Publication Types:
206: J Gastroenterol Hepatol. 2007 Sep;22(9):1369-77.

Comparative cost-effectiveness of antiviral therapies in patients with

chronic hepatitis B: a systematic review of economic evidence.
Sun X, Qin WX, Li YP, Jiang XH.
Department of Clinical Epidemiology and Evidence-Based Medicine, Chinese

Evidence-Based Medicine Center, West China Hospital, Sichuan University,
Chengdu, China.
BACKGROUND AND AIM: Economic efficiency of the alternative antiviral

therapies for chronic hepatitis B has not been systematically investigated and their
quality remains unknown. The aim of the present study was to systematically
overview economic evidence of antiviral therapies for chronic hepatitis B.
METHODS: We searched six databases and eight major journals supplemented
with screening references of eligible studies. Full economic evaluations
comparing alternative antiviral therapies in patients with chronic hepatitis B virus
infection were included. Two investigators assessed the study quality and
transferability, independently. Data were analyzed qualitatively with adjustment
when appropriate. RESULTS: Fourteen studies (six modeling vs eight trials and
database analyses) were included. Quality was high in five studies, moderate in
one US and five Chinese studies, and low in three Chinese studies. The major
problems of quality are costing methods and analysis and the presentation of
results. In Australia and Poland, lamivudine-preferred strategies dominated
interferon (IFN)-alpha and its related strategy from the health-care sector
perspective. In the US, adefovir salvage produced US$8446 per additional
quality-adjusted life years (QALY) compared with IFN-alpha. In Spain, the cost
of adefovir was US$34,840 for additional virological response. In Taiwan, the use
of pegylated IFN-alpha (pegIFN-alpha) produced US$11,711.4 per additional
QALY, compared with lamivudine. In China, the incremental cost-effectiveness
ratios of combination therapy lamivudine ranged from US$2860 to US$22,160
per additional loss of hepatitis B e antigen (HBeAg), and IFN-alpha versus
lamivudine ranged from US$2490 to US$8890 per additional loss of HBeAg.
CONCLUSION: The cost-effectiveness frontiers of treatment alternatives vary
and are influenced by the comparators and socioeconomic conditions of countries.
Lamivudine-containing therapy is cost-effective when newer antiviral agents (e.g.
adefovir/pegIFN-alpha) were not available. Economic methods should be further
improved in studies, particularly in China.
Publication Types:
• Review
207: Soc Psychiatry Psychiatr Epidemiol. 2007 Nov;42(11):916-22. Epub 2007 Aug
21.
Risk of readmission in compulsorily and voluntarily admitted

patients.
Valevski A, Olfson M, Weizman A, Shiloh R.
Geha Psychiatric Hospital and Felsenstein Medical Research Center, Beilinson

Campus, Petah Tiqva, Israel. valevski@post.tau.ac.il
OBJECTIVES: The aim of this study is to examine relationships between hospital

admission legal status (voluntary, psychiatrist-ordered, and court ordered), length
of stay and risk of hospital readmission. METHODS: The records (1994-2005) of
all consecutive admissions (n = 16,016) to one inpatient mental health facility
were reviewed. Patients (n = 6,656) were classified into 3 groups at first
admission: voluntary (n = 5,442), psychiatrist-ordered (n = 1,067) and court
ordered (n = 147). RESULTS: The probability of readmission of the court-ordered
and psychiatrist-ordered groups were significantly lower than that of voluntarily
admitted patients (P < 0.05). The length of stay at first admission was
significantly longer for the court-ordered group than for the others (P < 0.001). As
compared with the other groups, court ordered-patients were significantly younger
(P < 0.001), had attained fewer years of education (P < 0.001) and included a
lower percentage of immigrants (P < 0.05). Significant differences were found in
the mean morality age of the three groups (P < 0.005). CONCLUSIONS: As
compared with psychiatrist-ordered and voluntarily admitted patients, court
ordered patients have a lower probability for hospital readmission, possibly
related to longer length of stay.
Publication Types:
• Comparative Study
208: J Med Assoc Thai. 2007 Jul;90(7):1411-6.

Aerobic capacity of fifth-year medical students at Chiang Mai

University.
Tongprasert S, Wattanapan P.
Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai

University, Chiang Mai 50200, Thailand.
OBJECTIVE: To study the level of aerobic capacity using maximal oxygen
consumption (VO2max) in the fifth-year medical students at Chiang Mai
University. MATERIAL AND METHOD: This was a retrospective study in
which data were collected from the database of the fifth-year medical students
who attended the rehabilitation medicine course at Department of Rehabilitation
Medicine, Faculty of Medicine, Chiang Mai University between January 2003 and
December 2004. The level of aerobic capacity was evaluated by maximal oxygen
consumption (VO2max), which was calculated using sub-maximal exercise test
on a bicycle ergometer (Astrand-Rhyming test). RESULTS: During two-year
period, 226 medical students performed 226 Astrand-Rhyming submaximal cycle
ergometer tests. The mean age was 22.3 +/- 0.7 years (range 21-26 years) and
average body weight was 56.8 +/- 11.9 kg (range 30-125 kg). The number of male
and female students was comparable (male 44.7% and female 55.3%). Average
VO2max of the students was 38.1 +/- 8.6 ml/kg/min (range 18.5-76.7 ml/kg/min)
and there was no statistical significance between sex (VO2max of male = 38.4 +/-
7.6 and female = 37.9 +/- 9.4 ml/kg/min, p 0.636). When standard VO2max value
of Thai people was compared, 39.4% was categorized in low health fitness group,
40.7% was in health fitness group, and only 19.9% was in high health fitness
group. However, 65% of the fifth-year medical students exercised 0-1 sessions
per week (group 1), 24.3% exercised 2-4 sessions per week (group 2) and only 10.
7% exercised >4 sessions per week or everyday (group 3). Mean VO2max in
group 2 (40.3 +/- 9.1 ml/kg/min) and 3 (43.2 +/- 8.4 ml/kg/min) are more than
group 1 (36.5 +/- 8.4 ml/kg/min) significantly (p < 0.001 and p < 0.001
respectively) but there was no significant difference between group 2 and 3 (p =
0.16). The two most popular exercises were jogging and aerobic dance, 48.7%
and 31.9% respectively. There was no significant difference of VO2max between
methods ofexercise (p = 0.132) and between the single and combination of
exercises (38.9 +/- 9.3 and 37.9 +/- 7.4 ml/kg/min respectively, p = 0.4).
CONCLUSION: VO2max in most of the medical students was in poor to average
range when compared to the standard value of Thai population. This information
should prompt medical educators to address this problem, consider promoting
exercise and corporate physical fitness into the medical school curriculum.
209: Int J Health Plann Manage. 2007 Oct-Dec;22(4):289-300.

Management initiatives in a community-based health insurance

scheme.
Sinha T, Ranson MK, Chatterjee M, Mills A.
Self-Employed Women's Association, Chanda Niwas, Opposite Karnavati

Hospital, Ellisbridge, Ahmedabad, India. taragsinha@yahoo.co.in
Community-based health insurance (CBHI) schemes have developed in response

to inadequacies of alternate systems for protecting the poor against health care
expenditures. Some of these schemes have arisen within community-based
organizations (CBOs), which have strong links with poor communities, and are
therefore well situated to offer CBHI. However, the managerial capacities of
many such CBOs are limited. This paper describes management initiatives
undertaken in a CBHI scheme in India, in the course of an action-research project.
The existing structures and systems at the CBHI had several strengths, but fell
short on some counts, which became apparent in the course of planning for two
interventions under the research project. Management initiatives were introduced
that addressed four features of the CBHI, viz. human resources, organizational
structure, implementation systems, and data management. Trained personnel were
hired and given clear roles and responsibilities. Lines of reporting and
accountability were spelt out, and supportive supervision was provided to team
members. The data resources of the organization were strengthened for greater
utilization of this information. While the changes that were introduced took some
time to be accepted by team members, the commitment of the CBHI's leadership
to these initiatives was critical to their success. Copyright (c) 2007 John Wiley &
Sons, Ltd.
Publication Types:
210: BMC Health Serv Res. 2007 Aug 17;7:129.

Healthcare in schizophrenia: effectiveness and progress of a

redesigned care network.
Tzeng DS, Lian LC, Chang CU, Yang CY, Lee GT, Pan P, Lung FW.
Department of Psychiatry, Military Kaohsiung General Hospital, Kaohsiung,

Taiwan. tzengds@seed.net.tw
BACKGROUND: The aim of this study was designed to investigate the care-
effectiveness of different healthcare models for schizophrenic patients and the
impact of it on caregivers. METHODS: Sample cases were randomly selected
from southern Taiwan, 257 patients in redesigned care network, including a
general hospital, a chronic ward, 10 outpatient clinics, and multialternative
community programs, was compared to 247 patients in other traditional
healthcare provider that were utilized as the control group. The quality of life
(QOL) questionnaire and the Chinese health questionnaire (CHQ) were used.
RESULTS: The controls had longer duration of illness (p = 0.001) and were older
(p = 0.004). The average resource utilization in the study group (US$ 2737/year,
per case) was higher than the control group (US$ 2041) (t = 7.91, p < 0.001). For
the study group, the average length of stay was shorter, but the admission rate was
higher. The QOL of the patients in the study group was better than that of the
controls (p = 0.01). The family burden of the study group was lower (p = 0.035)
and the score of general health questionnaire higher (p = 0.019). CONCLUSION:
We found that patients in the redesigned care network had a better QOL, lower
family burden, decreased days of hospital stay, higher medical resource utilization
and less frequent admission to a hospital, and the caregivers had better mental
health. Although the costs were higher, the continued care network was more
helpful in providing comprehensive mental illness services.
Publication Types:
PMCID: PMC2000889
211: J Int Neuropsychol Soc. 2007 Sep;13(5):781-90.

Neurobehavioral effects of HIV-1 infection in China and the United

States: a pilot study.
Cysique LA, Jin H, Franklin DR Jr, Morgan EE, Shi C, Yu X, Wu Z, Taylor

MJ, Marcotte TD, Letendre S, Ake C, Grant I, Heaton RK; HNRC Group.
Department of Psychiatry, University of California at San Diego, and VA San

Diego Health Care System, La Jolla, California 92093-0603, USA.
The HIV epidemic in China has been increasing exponentially, yet there have
been no studies of the neurobehavioral effects of HIV infection in that country.
Most neuroAIDS research has been conducted in Western countries using
Western neuropsychological (NP) methods, and it is unclear whether these testing
methods are appropriate for use in China. Twenty-eight HIV seropositive (HIV+)
and twenty-three HIV seronegative (HIV-) individuals with comparable gender,
age, and education distributions were recruited in Beijing and the rural Anhui
province in China. Thirty-nine HIV+ and thirty-one HIV- individuals were
selected from a larger U.S. cohort recruited at the HIV Neurobehavioral Research
Center, in San Diego, to be matched to the Chinese sample for age, disease status,
and treatment variables. The NP test battery used with the U.S. and China cohorts
included instruments widely used to study HIV infection in the United States. It
consisted of 14 individual test measures, each assigned to one of seven ability
areas thought to be especially vulnerable to effects of HIV on the brain (i.e.,
verbal fluency, abstraction/executive function, speed of information processing,
working memory, learning, delayed recall, and motor function). To explore the
cross-cultural equivalence and validity of the NP measures, we compared our
Chinese and U.S. samples on the individual tests, as well as mean scaled scores
for the total battery and seven ability domains. On each NP test measure, the
mean of the Chinese HIV+ group was worse than that of the HIV- group. A series
of 2x2 analyses of variance involving HIV+ and HIV- groups from both countries
revealed highly significant HIV effects on the Global and all Domain mean scaled
scores. Country effects appeared on two of the individual ability areas, at least
partly due to education differences between the two countries. Importantly, the
absence of HIV-by-Country interactions suggests that the NP effects of HIV are
similar in the two countries. The NP test battery that was chosen and adapted for
use in this study of HIV in China appears to have good cross-cultural equivalence,
but appropriate Chinese norms will be needed to identify disease-related
impairment in individual Chinese people. To inform the development of such
norms, a much larger study of demographic effects will be needed, especially
considering the wide range of education in that country.
Publication Types:
• Research Support, N.I.H., Extramural
212: BMC Med. 2007 Aug 15;5:24.

Planning an integrated disease surveillance and response system: a

matrix of skills and activities.
Perry HN, McDonnell SM, Alemu W, Nsubuga P, Chungong S, Otten MW

Jr, Lusamba-dikassa PS, Thacker SB.
Centers for Disease Control and Prevention, Atlanta, GA, USA. hap5@cdc.gov
BACKGROUND: The threat of a global influenza pandemic and the adoption of

the World Health Organization (WHO) International Health Regulations (2005)
highlight the value of well-coordinated, functional disease surveillance systems.
The resulting demand for timely information challenges public health leaders to
design, develop and implement efficient, flexible and comprehensive systems that
integrate staff, resources, and information systems to conduct infectious disease
surveillance and response. To understand what resources an integrated disease
surveillance and response system would require, we analyzed surveillance
requirements for 19 priority infectious diseases targeted for an integrated disease
surveillance and response strategy in the WHO African region. METHODS: We
conducted a systematic task analysis to identify and standardize surveillance
objectives, surveillance case definitions, action thresholds, and recommendations
for 19 priority infectious diseases. We grouped the findings according to
surveillance and response functions and related them to community, health
facility, district, national and international levels. RESULTS: The outcome of our
analysis is a matrix of generic skills and activities essential for an integrated
system. We documented how planners used the matrix to assist in finding gaps in
current systems, prioritizing plans of action, clarifying indicators for monitoring
progress, and developing instructional goals for applied epidemiology and in-
service training programs. CONCLUSION: The matrix for Integrated Disease
Surveillance and Response (IDSR) in the African region made clear the linkage
between public health surveillance functions and participation across all levels of
national health systems. The matrix framework is adaptable to requirements for
new programs and strategies. This framework makes explicit the essential tasks
and activities that are required for strengthening or expanding existing
surveillance systems that will be able to adapt to current and emerging public
health threats.
Publication Types:
• Research Support, U.S. Gov't, Non-P.H.S.
PMCID: PMC1988797
213: BMC Public Health. 2007 Aug 15;7(147):207.

Analysis of the geographic distribution of HFRS in Liaoning

Province between 2000 and 2005.
Lin H, Liu Q, Guo J, Zhang J, Wang J, Chen H.
National Institute for Communicable Disease Control and Prevention, Chinese

Center for Disease Control and Prevention, Beijing, China.
linhualiang2002@163.com
BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is endemic in

Liaoning Province, China, and this province was the most serious area affected by
HFRS during 2004 to 2005. In this study, we conducted a spatial analysis of
HFRS cases with the objective to determine the distribution of HFRS cases and to
identify key areas for future public health planning and resource allocation in
Liaoning Province. METHODS: The annual average incidence at the county level
was calculated using HFRS cases reported between 2000 and 2005 in Liaoning
Province. GIS-based spatial analyses were conducted to detect spatial distribution
and clustering of HFRS incidence at the county level, and the difference of
relative humidity and forestation between the cluster areas and non-cluster areas
was analyzed. RESULTS: Spatial distribution of HFRS cases in Liaoning
Province from 2000 to 2005 was mapped at the county level to show crude
incidence, excess hazard, and spatial smoothed incidence. Spatial cluster analysis
suggested 16 and 41 counties were at increased risk for HFRS (p < 0.01) with the
maximum spatial cluster sizes at < or = 50% and < or = 30% of the total
population, respectively, and the analysis showed relative humidity and
forestation in the cluster areas were significantly higher than in other areas.
CONCLUSION: Some clustering of HFRS cases in Liaoning Province may be
etiologically linked. There was strong evidence some HFRS cases in Liaoning
Province formed clusters, but the mechanism underlying it remains unknown. In
this study we found the clustering was consistent with the relative humidity and
amount of forestation, and showed data indicating there may be some significant
relationships.
Publication Types:
PMCID: PMC2194774
214: Asian Pac J Cancer Prev. 2007 Apr-Jun;8(2):183-6.

Cancer pattern in Western Nepal: a hospital based retrospective

study.
Binu VS, Chandrashekhar TS, Subba SH, Jacob S, Kakria A, Gangadharan

P, Menezes RG.
Department of Community Medicine, Manipal College of Medical Sciences,
Pokhara, Nepal. gangadharanp@aims.amrita.edu
Information on cancer patterns is an important basis for determining the priorities

for cancer control in different countries worldwide. There is no reliable
information about the incidence or pattern of cancer in Nepal and hence an
attempt was made to assess the situation based on hospital data which is the only
source in the western region of Nepal. Cancer cases diagnosed by all methods or
treated in Manipal Teaching Hospital, affiliated to Manipal College of Medical
Sciences, Pokhara, during 1st January 2003 to 30th May 2005 were used for the
present study. A total of 957 cancer cases were identified with a male to female
ratio of 1.1:1. The median age of male and female patients was 63 and 60 years,
respectively. The proportion of microscopically confirmed cases, both from
primary and metastatic sites was 87.5% and tobacco-related cancers constituted
48% of all cancers among males and 28% among females. For males the leading
cancer sites were lung (22.2%), larynx (9.8%) and stomach (9%) and that for
females was lung (20%), cervix (19.7%) and breast (7.8%). Among males, 33.1%
of all cancers were in the respiratory system followed by digestive organ cancers
(23.2%). Among females, 28.4% cancers were related to the reproductive system,
22.8% to the respiratory system and 14.1% to digestive organs. The cancer pattern
revealed by the present study provides valuable leads to cancer epidemiology in
Nepal, particularly in the western region, and provides useful information for
health planning and future research.
215: Behav Res Methods. 2007 May;39(2):259-66.

An introduction to association rule mining: an application in

counseling and help-seeking behavior of adolescents.
Goh DH, Ang RP.
Division of Information Studies, School of Communication and Information,

Nanyang Technological University, Singapore. ashlgoh@ntu.edu.sg
Association rule mining (ARM) is a technique used to discover relationships

among a large set of variables in a data set. It has been applied to a variety of
industry settings and disciplines but has, to date, not been widely used in the
social sciences, especially in education, counseling, and associated disciplines.
This article thus introduces ARM and presents aspects of existing work that will
be relevant and useful to researchers practitioners in the social sciences.
Definitions and concepts are presented, and examples of ARM applications are
highlighted to strengthen these ideas. We also discuss an example from our
existing research to show that ARM can be used to investigate help-seeking
behavior in a sample of secondary school students in Singapore. We also present
some guidelines and recommendations for using ARM.
216: J Prev Med Pub Health. 2007 Jul;40(4):278-84.

[Adverse drug reaction surveillance system in Korea]
[Article in Korean]
Choi NK, Park BJ.
Department of Preventive Medicine, Seoul National University College of

Medicine, Korea.
Despite extensive researches and pre-market clinical trials, only limited

information on the adverse drug reactions (ADRs) of a drug can be collected at
the time of market approval from regulatory agency. ADRs constitute a major
public health problem. Post-marketing surveillance of drugs is important to detect
signals for ADR. In Korea, one of the main methods for monitoring the safety of
marketed drugs is spontaneous reporting system of suspected ADRs. Re-
examination and re-evaluation system are in force for monitoring safety of new
market approval drugs and currently under marketing drugs, respectively.
Recently, regional pharmacovigilance centers were designated from Korean Food
and Drug Administration for facilitating ADR surveillance. Over recent years,
with the development of information technology, there has been an increased
interest in establishing data mining system for detecting signals from Health
Insurance Review Agency database. The purpose of this paper is to review the
current status of Korean ADR surveillance system and suggest the possible
solutions for developing active pharmacovigilance system in Korea.
Publication Types:
• English Abstract
• Review

[Circulatory disease surveillance system in Korea]
[Article in Korean]
Chun BY.
Department of Preventive Medicine, Kyungpook National University College of

Medicine and Health Promotion Research Center, Korea. bychun@knu.ac.kr
The purpose of establishing the circulatory disease surveillance system in Korea

is to ensure that the problems of circulatory disease importance are being
monitored efficiently and effectively. The goals of circulatory disease surveillance
system are to monitor the epidemiological trends of circulatory disease and to
evaluate the outcome of health activity for controlling circulatory diseases.
Surveillance system are being updated to achieve the needs for the integration of
the surveillance and information system, the establishment of data standards, the
electronic exchange of data, and changes in the goals of circulatory disease
surveillance system to facilitate the response of this system to manage the national
health problem effectively. This article provides the target diseases and
determinant indicators to be monitored, structure of circulatory disease
surveillance system, and many tasks and related activities that should be applied
to this system.
Publication Types:

[Introduction and evaluation of communicable disease surveillance

in the republic of Korea]
[Article in Korean]
Park O, Choi BY.
Center for Disease Control, Korea Centers for Disease Control and Prevention,
Department of Preventive Medicine, Hanyang University College of Medicine,
Korea.
Effective communicable disease surveillance systems are the basis of the national
disease prevention and control. Following the increase in emerging and re-
emerging infectious diseases since late 1990 s, the Korean government has strive
to enhance surveillance and response system. Since 2000, sentinel surveillance,
such as influenza sentinel surveillance, pediatric sentinel surveillance, school-
based sentinel surveillance and ophthalmological sentinel surveillance, was
introduced to improve the surveillance activities. Electronic reporting system was
developed in 2000, enabling the establishment of national database of reported
cases. Disweb, a portal for sharing communicable disease information with the
public and health care workers, was developed. In general, the survey results on
usefulness and attributes of the system, such as simplicity, flexibility,
acceptability, sensitivity, timeliness, and representativeness, received relatively
high recognition. Compared to the number of paid cases of national health
insurance, reported cases by national notifiable disease surveillance system, and
various sentinel surveillance system, the result of the correlation analysis was
high. According to the research project conducted by KCDC, the reporting rate of
physicians in 2004 has also greatly improved, compared with that in 1990 s.
However, continuous efforts are needed to further improve the communicable
disease surveillance system. Awareness of physicians on communicable disease
surveillance system must be improved by conducting education and information
campaigns on a continuous basis. We should also devise means for efficient use
of various administrative data including cause of death statistics and health
insurance. In addition, efficiency of the system must be improved by linking data
from various surveillance system.
Publication Types:
219: Hosp Health Netw. 2007 Jul;81(7):40-55, 2.

The 2007 Most Wired results. Ten lessons from the top 100.
Solovy A, Hoppszallern S, Brown SB.
Information technology provides a wide range of tools to help hospitals improve

quality. Here are 10 IT lessons from this year's 100 Most Wired Hospitals and
Health Systems. Also inside, we reveal the 2007 award winners for Most
Improved, Innovator, Small and Rural, Supply Chain and Most Wireless. And
inaugural Most Wired International Certificates of Merit go to hospitals in
Ireland, Spain and Japan.
220: East Mediterr Health J. 2007 May-Jun;13(3):492-504.

Quality improvement programme for diabetes care in family

practice settings in Dubai.
Khattab MS, Swidan AM, Farghaly MN, Swidan HM, Ashtar MS, Darwish
EA, Al Mazrooei AK, Mohammad AA.
Primary Health Care Sector, Department of Health and Medical Services, Dubai,
United Arab Emirates. msKhattab@dohms.gov.ae
A continuous quality improvement programme for the care of registered diabetes

patients was introduced in 16 government-affiliated primary health care centres in
Dubai. Quality improvement teams were formed, clinical guidelines and
information systems were developed, diabetes nurse practitioners were introduced
and a team approach was mobilized. Audits before and after the introduction of
the scheme showed significant improvements in rates of recording key clinical
indicators and in their outcomes. For example, the proportion of patients with
glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with
LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic
blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.
Publication Types:
• Evaluation Studies
221: Health Serv Manage Res. 2007 Aug;20(3):141-52.

Success factors in hospital network performance: evidence from

Korea.
Kim KJ, Burns LR.
Graduate School of Health Care Management and Policy, The Catholic University
of Korea, Korea.
Collaborative networks have become a common organizational strategy to deal
with uncertain and dynamic environments. Like their counterparts in the USA,
Korean hospitals are establishing cooperative relationships with one another, with
varying performance results. This paper analyses some of the sources of variation
in hospital network performance and identifies some of the possible success
factors. The study finds that the quality of cooperation and information sharing
between network partners are critical. The paper concludes with a discussion of
the implications for researchers and practitioners.
222: Przegl Epidemiol. 2006;60(4):845-55.

The epidemiological situation in Iraq.
Korzeniewski K.
Military Institute of Medicine, Department of Maritime and Tropical Medicine,

Gdynia, Poland. kktropmed@wp.pl
This article presents information on the health condition of the Iraqi population as
well as the situation of the country's health care and education system over the
course of recent decades. Author has discussed a number ofriskfactors which
influence the incidence of diseases among the country " population paying
particular attention to environmental factors. In the 1980's the epidemiological
situation of Iraq and its citizens was comparable with the situation in average
developed countries. Over the last two decades the country, rich in natural
resources, having one of the worlds richest crude oil deposits, has been turned
into an economic ruin. Warfare, famine and catastrophic sanitary conditions are
now widespread and they all intensify the growth of incidence of infectious and
non-infectious diseases.
Publication Types:
• Review
223: Eur J Epidemiol. 2007;22(10):691-8. Epub 2007 Aug 7.

The proportion of individuals with obesity-induced hypertension

among total hypertensives in a general Japanese population:
NIPPON DATA80, 90.
Nakamura K, Okamura T, Hayakawa T, Hozawa A, Kadowaki T,

Murakami Y, Kita Y, Okayama A, Ueshima H; NIPPON DATA80, 90
Research Group.
Department of Health Science, Shiga University of Medical Science, Seta

Tsukinowa-cho, Otsu City, Shiga, 520-2192, Japan. ksnkmr@belle.shiga-
med.ac.jp
The increased prevalence of obesity in Japan may contribute to the high

prevalence of hypertension in Japan. In the present study, we calculated the odds
ratio for hypertension in obesity (body mass index (BMI) >or= 25.0 kg/m(2))
using data from independent nationwide surveys conducted in 1980 and 1990. We
estimated the percentage of hypertensives whose condition was due to obesity
among total hypertensives in the general Japanese population. In the 1980 survey,
18.8% of 4,623 male participants were obese and 50.4% were hypertensive,
whereas 22.6% of 5,893 female participants were obese and 41.1% were
hypertensive. For both sexes, obese participants had a higher odds ratio for
hypertension than non-obese participants (BMI < 25.0 kg/m(2)), and there was a
significant dose-response relationship between BMI and the odds ratio for
hypertension. Among all hypertensives, the percentage whose hypertension was
due to obesity in 1980 and 1990 was 11.4% (95% confidence interval (CI): 4.7-
17.7%) and 15.3% (95% CI: 6.8-23.1%) for men and 19.3% (95% CI: 12.1-
25.9%) and 22.3% (95% CI: 14.6-29.3%) for women, respectively.
Approximately 80-90% of individuals with obesity-induced hypertension were in
the 25.0 <or= BMI < 30.0 kg/m(2) category for both sexes in each year. In
conclusion, we found that obesity-induced hypertension as a proportion of total
hypertension increased between 1980 and 1990 for both sexes. Obesity now is
playing a more important role in the high prevalence of hypertension in Japan
than it was before.
Publication Types:
224: J Water Health. 2007 Jun;5(2):259-65.

Water systems and urban sanitation: a historical comparison of

Tokyo and Singapore.
Otaki Y, Otaki M, Sakura O.
Interfaculty Initiatives in Information Studies, University of Tokyo, 7-3-1 Hongo,

Bunkyo, Tokyo 133-0033, Japan. yurina@iii.u-tokyo.ac.jp
The importance of a water supply and sewage treatment for urban sanitation is
recognized in the modern world. Their contributions to public health have not,
however, been well demonstrated by historical data, especially in Asian cities. In
this research, we focused on the Asian cities of Tokyo and Singapore, which both
developed significantly in the 20th century. We analysed their development
processes statistically to determine what the key elements for the protection of
urban sanitation have been. Although both cities constructed modern water supply
systems at almost same time (Tokyo in 1898 and Singapore in 1878), and
similarly modern wastewater treatment systems (Tokyo in 1922 and Singapore in
1913), the prevalence of water-borne diseases in Tokyo was more serious than it
was in Singapore, in spite of Singapore's high infant mortality rate. The main
reason for this was the differences in the systems of night-soil transport. We
found that the water supply system in itself was not enough to resolve all urban
sanitation problems, and appropriate night-soil removal was also crucial. In
addition, historical trends and water consumption vary by city, so the appropriate
technology and system are also different according to the unique characteristics
and needs of each.
Publication Types:
• Historical Article
225: BMJ. 2007 Aug 4;335(7613):226-7.

WHO database to include drug trials in China and India.
White C.
Publication Types:
• News
PMCID: PMC1939789
226: Med Care. 2007 Aug;45(8):767-74.

Rural and urban disparity in health services utilization in China.
Liu M, Zhang Q, Lu M, Kwon CS, Quan H.
Department of Biostatistics, School of Public Health, Harbin Medical University,

Harbin, China.
OBJECTIVES: To describe patterns in physician and hospital utilization among

rural and urban populations in China and to determine factors associated with any
differences. METHODS: In 2003, the Third National Health Services Survey in
China was conducted to collect information about health services utilization from
randomly selected residents. Of the 193,689 respondents to the survey (response
rate, 77.8%), 6429 urban and 16,044 rural respondents who were age 18 or older
and reported an illness within the last 2 weeks before the survey were analyzed.
Generalized estimating equations with a log link were used to assess the
relationship between rural/urban residence and physician visit/hospitalization to
adjust for respondents clustered at the household level. RESULTS: About half of
respondents did not see a physician when they were ill. Rural respondents used
physicians more than urban respondents (52.0% vs. 43.0%, P < 0.001) and used
hospitals less (7.6% vs. 11.1%, P < 0.001). Factor associated with increased
physician utilization included residing in rural areas among majority Chinese (ie,
Han) [rate ratio (RR), 1.21; 95% confidence interval (95% CI), 1.16-1.26],
residing <3 km away from the medical center (RR, 1.16; 95% CI, 1.12-1.21), or
being uninsured (RR, 1.38; 95% CI, 1.30-1.46). Rural minority Chinese visited
physicians significantly less than urban minority Chinese (RR, 0.90; 95% CI,
0.83-0.98). Hospital utilization was significantly lower among rural males (RR,
0.84; 95% CI, 0.72-0.98), rural seniors (age, > or =65; RR, 0.64; 95% CI, 0.53-
0.77), rural respondents with low education (RR, 0.70; 95% CI, 0.57-0.86 for
illiterate), or rural insured respondents (RR, 0.86; 95% CI, 0.69-0.99) than
hospitalization among urban counterparts. CONCLUSIONS: Three national
approaches should be considered in reforming the healthcare system in China:
universal insurance coverage, higher amounts of insurance coverage, and
increasing the population's level of education. In addition, access issues in remote
areas and by rural minority Chinese population should be addressed.
Publication Types:
227: Health Care Manage Rev. 2007 Jul-Sep;32(3):263-70.

Isomorphic pressures, institutional strategies, and knowledge

creation in the health care sector.
Yang CW, Fang SC, Huang WM.
Department of Information Management, Fooying University, Taiwan, ROC.

weiger789@yahoo.com.tw
BACKGROUND: Health care organizations are facing surprisingly complex

challenges, including new treatment and diagnostic technologies, ongoing
pressures for health care institutional reform, the emergence of new
organizational governance structures, and knowledge creation for the health care
system. To maintain legitimacy in demanding environments, organizations tend to
copy practices of similar organizations, which lead to isomorphism, and to use
internal strategies to accommodate changes. A concern is that a poor fit between
isomorphic pressures and internal strategies can interfere with developmental
processes, such as knowledge creation. PURPOSES: The purposes of this article
are to, first, develop a set of propositions, based on institutional theory, as a
theoretical framework that might explain the influence of isomorphic pressures on
institutional processes through which knowledge is created within the health care
sector and, second, propose that a good fit between isomorphic pressures factors
and health care organizations' institutional strategic choices will enhance the
health care organizations' ability to create knowledge. METHOD: To develop a
theoretical framework, we developed a set of propositions based on literature
pertaining to the institutional theory perspective of isomorphic pressures and the
response of health care organizations to isomorphic pressures. FINDINGS:
Institutional theory perspectives of isomorphic pressures and institutional
strategies may provide a new understanding for health care organizations seeking
effective knowledge creation strategies within institutional environment of health
care sector. PRACTICE IMPLICATIONS: First, the ability to identify three
forces for isomorphic change is critical for managers. Second, the importance of a
contingency approach by health care managers can lead to strategies tailoring to
cope with uncertainties facing their organizations.
Publication Types:
• Review
228: Promot Educ. 2007;14(2):98-9.

Community health promotion in Pakistan: a policy development

perspective.
Ronis KA, Nishtar S.
Heartfile, Pakistan. amna@heartfile.org
Pakistan was one of the initial signatories to the Alma-Ata Declaration in 1978;
however, it was not until 2004 that the first policy dedicated solely to public
health and health promotion was launched. The National Action Plan for
Prevention and Control of Non-communicable Diseases and Health Promotion in
Pakistan has gained a prominent place on the nation's health agenda competing
for resources with traditional health policies that focus on treatment, cure and
evolving technology. From a health promotion perspective the action plan was
unique in that it focused on the community setting through two major behavioral
communication change initiatives--one through the media and the other by
integrating non-communicable disease prevention into the work plan of the Lady
Health Workers. The development phase of this inaugural public health/health
promotion policy follows closely the pathway of the Australian Policy Cycle and
celebrates a comprehensive consultation process. Its strength comes from the
tripartite partnership between the Government, the World Health Organization
and a Non-Government Organization, Heartfile who lent impetus to the creation
of the initiative. This public-private partnership greatly facilitated the process of
policy development and continues to support research, implementation and
evaluation. This paper endeavors to analyze the development of the National
Action Plan with a focus on community health promotion.
229: Promot Educ. 2007;14(2):88-9.

Advocacy for appropriate health policy and effective governance of

the health system.
Mukhopadhyay A.
Voluntary Health Association of India. vhai@vsnl.com

Health policies supported by sustained advocacy efforts need to continually grow
and develop to respond to the increasing pressures of macro-economic policies of
globalization, liberalization and privatization. VHAI, the largest network of
voluntary agencies in health sector is playing a critical role at both macro and
micro levels. Its health advocacy efforts emerge from the grassroots with an
understanding of their health and development problems as well as the strategies
adopted to address them. The process, of strengthening an upward mobilization of
information, towards formulation of an effective health policy, is backed by
serious macro research on various policy dimensions of health, done by the
Independent Commission on Health and Development in India (ICDHI), set up in
1995 by VHAI. These key policy documents are both reflective and prescriptive
and are presented to the highest state authorities along with a discussion at various
levels with varies groups. One of the recent successes was at getting the giant
tobacco companies withdraw from Cricket sponsorship with an association in the
formulation of a comprehensive Bill by the Union Government to prevent this in
future. Various well-researched policy documents have been put together by the
organisation based on its micro and macro level work and persistent advocacy.
Appropriate public health and development policies with their effective
implementation are the cornerstones to realize the fundamental values of Alma-
Ata. The health care system needs to be removed from the current bio-medical
model and closer to a socio-political and spiritual model where health care again
becomes an organic part of community care as it once was in the traditional
society.
230: BMC Med. 2007 Jul 30;5:21.

The effects of dictatorship on health: the case of Turkmenistan.
Rechel B, McKee M.
European Centre on Health of Societies in Transition, London School of Hygiene

and Tropical Medicine, London, UK. bernd.rechel@lshtm.ac.uk
BACKGROUND: There is a health crisis in Turkmenistan similar to, but more

severe than, in other Central Asian countries. This paper asks whether the health
crisis in Turkmenistan is attributable to the consequences of the dictatorship under
president Niyazov, who died in 2006. METHODS: The basis for this paper was a
series of semi-structured in-depth interviews with key informants complemented
by an iterative search of internet sites, initially published as a report in April 2005,
and subsequently updated with feedback on the report as well as a comprehensive
search of secondary information sources and databases. RESULTS: This paper
describes in depth three areas in which the dictatorship in Turkmenistan had a
negative impact on population health: the regime's policy of secrecy and denial,
which sees the "solution" to health care problems in concealment rather than
prevention; its complicity in the trafficking of drugs from Afghanistan; and the
neglect of its health care system. CONCLUSION: The paper concludes that
dictatorship has contributed to the health crisis facing Turkmenistan. One of the
first tests of the new regime will be whether it can address this crisis.
Publication Types:
PMCID: PMC1948003
231: Rinsho Byori. 2007 Jun;55(6):574-8.

[Education in ultrasound examination: how to overcome the

particular difficulty]
[Article in Japanese]
Mikami T.
Division of Medical Technology, Department of Health Sciences, Hokkaido

University School of Medicine, Sapporo.
Ultrasound examination is a painless and safe procedure which provides precise

images of structures within a human body and valuable information in diagnosing
and treating diseases. Ultrasound is widely used to evaluate a fetus, digestive
organs, cardiovascular system, kidney, breast, thyroid gland and so on. However,
the examination requires an expert examiner not merely with sophisticated
technique but with detailed knowledge of anatomy, physiology, pathology and the
correlation between ultrasonic findings and clinical information. These factors
make it difficult to educate students with regard to ultrasound examination. In our
department, all the students experience ultrasound examination during Early
Exposure Practice in the 1st year. For the 3rd-year students in the Medical
Technology Course, ultrasound imaging of several organs is demonstrated just
before starting the lectures on ultrasound, and practical training programs for the
heart, digestive system and thyroid gland are provided soon after finishing the
lectures. More detailed training program on the cardiovascular and abdominal
examinations will be provided in the 4th year. However, it is difficult to educate
them to be experts before graduation, and the Postgraduate School may play an
important role in training versatile sonographers with excellent leadership.
Publication Types:
232: Rinsho Byori. 2007 Jun;55(6):568-73.

[Education concerning pathological/cytological diagnosis at 4-year

colleges]
Fukuda T, Yoshida T.
Course of Medical Laboratory Sciences, School of Health Sciences, Faculty of

Medicine, Gunma University, Maebashi.
Recent students of clinical technologist training courses at 4-year colleges aiming

to qualify as medical technologists or cytotechnologists have diverse future
prospects, for the following reasons: (1) Abundant information can be easily
obtained due to the advancement of IT, (2) 4-year college education is increasing
available professions, and (3) graduate schools for laboratory medicine have been
established, enabling acquisition of a degree. For departments of
pathological/cytological diagnosis, cooperation with pathologists and clinicians
based on a reliable relationship is important, and medical technologists,
cytotechnologists, and pathologists are organically linked in performing tests. To
strengthen this reliable relationship and broaden professions as medical care staff,
not only students but also instructors have to consistently increase their level of
consciousness and energy. In addition to the establishment of the current
cytotechnologist education system, introduction of the 'qualification of senior
cytotechnologist' established in other countries or 'pathologist's assistant (tentative
name)' as a pathological specialist should be seriously considered. The established
graduate schools in the field of laboratory medicine started to produce human
resources capable of performing basic research based on the knowledge and
techniques of laboratory and cytology tests, and were granted a degree. Many
universities have established graduate courses combined with employment, and an
increasing number of cytotechnologists have acquired specialized knowledge and
perform research activities based on knowledge from their routine work.
Publication Types:
233: Hemoglobin. 2007;31(3):343-9.

The molecular analysis of beta-thalassemia mutations in Lorestan

Province, Iran.
Kiani AA, Mortazavi Y, Zeinali S, Shirkhani Y.
Department of Hematology, Lorestan University of Medical Sciences,

Khorramabad, Iran.
Beta-Thalassemia (thal) is one of the most common genetic disorders in Iran and
other countries. Getting information on the distribution of mutations in different
ethnic groups of Iran is of fundamental importance for the purpose of health
planning and prenatal diagnosis programs. One hundred and thirty chromosomes
from 65 unrelated homozygous beta-thal patients were investigated for beta-
globin gene mutations by amplification refractory mutation system-polymerase
chain reaction (ARMS-PCR). The most common mutations of the Mediterranean
region were examined in this study. Our results showed that the frameshift codons
(FSC) 36/37 (-T) mutation, with a frequency of 33.8%, is the most common
mutation in Lorestan Province. The other most frequent mutations were of the
Mediterranean type and consisted of IVS-II-1 (G -->A), IVS-I-110 (G -->A), FSC
8/9 (+G) and IVS-I-5 (G -->C) with frequencies of 27.7, 11.5, 10.8 and 4.5%,
respectively. The less frequent alleles, IVS-II-745 (C -->G), FSC 5 (-CT), IVS-I
(25 bp deletion) and FSC 44 (-C) accounted for only 3.9% of the mutations. The
unknown alleles comprised 7.7% of the mutations. These data showed that the
spectrum of mutations found in Lorestan Province was different from those
reported from other thalassemic regions of Iran and also of some neighboring
countries.
234: J Epidemiol. 2007 Jul;17(4):125-32.

Relationship between smoking status and tooth loss: findings from

national databases in Japan.
Hanioka T, Ojima M, Tanaka K, Aoyama H.

Department of Preventive and Public Health Dentistry, Fukuoka Dental College,
Fukuoka, Japan. haniokat@college.fdcnet.ac.jp
BACKGROUND: A causal association between cigarette smoking and

periodontal disease has been established. The present study examined the
association between smoking and tooth loss using national databases in Japan.
METHODS: Records of the Survey of Dental Diseases and the National Nutrition
Survey in 1999 were linked electronically using common identification. Records
of 3,999 subjects aged older than 40 years were analyzed using logistic regression
models, controlling for confounding factors, such as age, frequency of tooth
brushing, body mass index, alcohol consumption, and intakes of vitamin C and E.
RESULTS: Prevalence of tooth loss in terms of having less than 19 existing teeth
was 37.3% overall. Smoking rates differed in males (45.6%) and females (7.8%).
The prevalence of tooth loss in nonsmokers, former, and current smokers was
28.5%, 38.6%, and 36.9% in males, and 38.6%, 34.3% and 38.9% in females,
respectively. Adjusted means of existing teeth controlling for confounders by
smoking status were 21.5, 19.7 and 18.2 in males and 19.0, 19.2 and 16.4 in
females, respectively. The association of tooth loss was non-significant in former
smokers but significant in current smokers: adjusted odds ratios (95% confidence
intervals) relative to nonsmokers in males and females were 1.29 (0.92-1.80) and
0.86 (0.46, 1.60) for former smokers and 2.22 (1.61-3.06) and 2.14 (1.45-3.15) for
current smokers, respectively. A dose-response relationship between lifetime
exposure and tooth loss was seen (P for trend <0.0001). CONCLUSION: The
findings of this cross-sectional study of a nationwide population of Japanese
indicated an association between smoking and tooth loss.
Publication Types:
235: Ind Health. 2007 Jun;45(3):474-86.

The effect of micro and macro stressors in the work environment on

computer professionals' subjective health status and productive
behavior in Japan.
Tominaga M, Asakura T, Akiyama T.
Department of Nursing, Hyogo University of Health Sciences, Japan.

To investigate the effect of micro and macro stressors in the work environment on
the subjective health status and productive behavior of computer professionals,
we conducted a web-based investigation with Japanese IT-related company
employees in 53 company unions. The questionnaire consisted of individual
attributes, employment characteristics, working hour characteristics, company
size and profitability, personal characteristics (i.e., Growth Need Strength), micro
and macro stressors scale, and four outcome scales concerning the subjective
health status and productive behavior. We obtained 1,049 Japanese IT-related
company employees' data (response rate: 66%), and analyzed the data of
computer engineers (80%; n=871). The results of hierarchical multiple regressions
showed that each full model explained 23% in psychological distress, 20% in
cumulative fatigue, 44% in job dissatisfaction, and 35% in intentions to leave,
respectively. In micro stressors, "quantitative and qualitative work overload" had
the strongest influence on both the subjective health status and intentions to leave.
Furthermore, in macro stressors, "career and future ambiguity" was the most
important predictor of the subjective health status, and "insufficient evaluation
systems" and "poor supervisor's support" were important predictors of productive
behavior as well. These findings suggest that improving not only micro stressors
but also macro stressors will enhance the subjective health status and increase the
productive behavior of computer professionals in Japan.
Publication Types:
236: Dermatol Nurs. 2007 Jun;19(3):253-7.

Quality improvement program to assure the delivery of pathology

test results: a systemic intervention in a large general hospital.
Topol P, Porat N, Zelker R, Ingber A, Zlotogorski A, Brezis M.
Dermatology Clinic, Hadassah University Medical Center, Jerusalem, Israel.
A late or missed notification of pathology results could be disastrous for the

patient as well as for the medical staff and the institution involved. In this article,
the authors describe a systemic intervention implemented and led by nurses to
enhance the safety and the efficiency of the notification process. The two-fold
intervention includes patient and medical staff education along with developing
and implementing a computerized alert system throughout the hospital by a
multidisciplinary team. The measurable outcomes were the rate of patient
notification and the percentage of physicians reading the pathologist's report
through the computerized system. Theses two outcomes improved significantly
after the intervention. This study demonstrates how nurses can play a major role
in both patient and staff education and with performing organizational chance to
strengthen patient safety.
Publication Types:
• Review
237: Med J Malaysia. 2006 Dec;61(5):577-85.

Critical incident monitoring in anaesthesia.
Choy YC.
Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Hospital

Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras
56000, Kuala Lumpur.
Critical incident monitoring in anaesthesia is an important tool for quality

improvement and maintenance of high safety standards in anaesthetic services. It
is now widely accepted as a useful quality improvement technique for reducing
morbidity and mortality in anaesthesia and has become part of the many quality
assurance programmes of many general hospitals under the Ministry of Health.
Despite wide-spread reservations about its value, critical incident monitoring is a
classical qualitative research technique which is particularly useful where
problems are complex, contextual and influenced by the interaction of physical,
psychological and social factors. Thus, it is well suited to be used in probing the
complex factors behind human error and system failure. Human error has
significant contributions to morbidities and mortalities in anaesthesia.
Understanding the relationships between, errors, incidents and accidents is
important for prevention and risk management to reduce harm to patients. Cardiac
arrests in the operating theatre (OT) and prolonged stay in recovery, constituted
the bulk of reported incidents. Cardiac arrests in OT resulted in significant
mortality and involved mostly de-compensated patients and those with unstable
cardiovascular functions, presenting for emergency operations. Prolonged-stay in
the recovery extended period of observation for ill patients. Prolonged stay in
recovery was justifiable in some cases, as these patients needed a longer period of
post-operative observation until they were stable enough to return to the ward.
The advantages of the relatively low cost, and the ability to provide a
comprehensive body of detailed qualitative information, which can be used to
develop strategies to prevent and manage existing problems and to plan further
initiatives for patient safety makes critical incident monitoring a valuable tool in
ensuring patient safety. The contribution of critical incident reporting to the issue
of patient safety is far from clear and very difficult to study. Efforts to do so have
tended to rely on incident reporting, the only practical approach when funding is
limited. The heterogeneity of critically ill patients as a group means that huge
study populations would be required if other research techniques were to be used.
In the era of evidence-based medicine, anaesthetists are looking for alternative
evidence-based solutions to problems that we have accepted traditionally when
we cannot quantify for good practical reasons. In the quest for patient safety,
investment should be made in reliable audit, detection and reporting systems. The
growing recognition that human error usually result from a failure of a system
rather than an individual should be fostered to allow more lessons to be learnt, an
approach that has been successful in other, safety-critical industries. New
technology has a great deal to offer and investment is warranted in novel fail-safe
drug administration systems. Last but not the least the importance of simple and
sensible changes and better education should be remembered.
238: Cancer Epidemiol Biomarkers Prev. 2007 Jul;16(7):1443-8. Epub 2007 Jul 10.
Dietary patterns and breast cancer risk in the shanghai breast

cancer study.
Cui X, Dai Q, Tseng M, Shu XO, Gao YT, Zheng W.
Department of Epidemiology, Harvard School of Public Health, Boston,

Massachusetts, USA.
The association of breast cancer with dietary patterns such as a western diet has
not been studied in Asian women. We examined this among Shanghai Breast
Cancer Study participants. Cases were of ages 25 to 64 years, diagnosed 08/1996-
03/1998, and identified through a rapid case ascertainment system supplemented
by the Shanghai Cancer Registry. Controls, selected from the general population
of urban Shanghai, were frequency matched to cases by 5-year age group.
Participants provided information on diet, lifestyle, and reproductive factors. In
principal component analysis among 1,556 controls, two patterns emerged: a
"vegetable-soy" pattern (tofu, cauliflower, beans, bean sprouts, green leafy
vegetables) and a "meat-sweet" pattern (shrimp, chicken, beef, pork, candy,
desserts). In adjusted unconditional logistic regression analyses including 1,446
cases and 1,549 controls with complete covariate data, risk was not associated
with the vegetable-soy pattern. It was associated with the meat-sweet pattern (4th
versus 1st quartile: odds ratio, 1.3; 95% confidence interval, 1.0-1.7; P(trend) =
0.03), but only in postmenopausal women, specifically among those with estrogen
receptor-positive tumors (4th versus 1st quartile: odds ratio, 1.9; 95% confidence
interval, 1.1-3.3; P(trend) = 0.03). Our findings indicate that a western diet
increases breast cancer risk in postmenopausal Chinese women. They also suggest
the value of quantifying aggregate risk for common combinations of foods.
Publication Types:

239: BMC Public Health. 2007 Jul 5;7(147):142.

Record linked retrospective cohort study of 4.6 million people

exploring ethnic variations in disease: myocardial infarction in
South Asians.
Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G,

Jamieson J, Knowles D.
Information Services Division, NHS National Services Scotland, Gyle Square, 1

South Gyle Crescent, Edinburgh, UK. Colin.Fischbacher@isd.csa.scot.nh
<Colin.Fischbacher@isd.csa.scot.nh>
BACKGROUND: Law and policy in several countries require health services to

demonstrate that they are promoting racial/ethnic equality. However, suitable and
accurate data are usually not available. We demonstrated, using acute myocardial
infarction, that linkage techniques can be ethical and potentially useful for this
purpose. METHODS: The linkage was based on probability matching. Encryption
of a unique national health identifier (the Community Health Index (CHI))
ensured that information about health status and census-based ethnicity could not
be ascribed to an identified individual. We linked information on individual ethnic
group from the 2001 Census to Scottish hospital discharge and mortality data.
RESULTS: Overall, 94% of the 4.9 million census records were matched to a
CHI record with an estimated false positive rate of less than 0.1 %, with 84.9 -
87.6% of South Asians being successfully linked. Between April 2001 and
December 2003 there were 126 first episodes of acute myocardial infarction
(AMI) among South Asians and 30,978 among non-South Asians. The incidence
rate ratio was 1.45 (95% CI 1.17, 1.78) for South Asian compared to non-South
Asian men and 1.80 (95% CI 1.31, 2.48) for South Asian women. After
adjustment for age, sex and any previous admission for diabetes the hazard ratio
for death following AMI was 0.59 (95% CI 0.43, 0.81), reflecting better survival
among South Asians. CONCLUSION: The technique met ethical, professional
and legal concerns about the linkage of census and health data and is transferable
internationally wherever the census (or population register) contains ethnic group
or race data. The outcome is a retrospective cohort study. Our results point to
increased incidence rather than increased case fatality in explaining high CHD
mortality rate. The findings open up new methods for researchers and health
planners.
Publication Types:
PMCID: PMC1965474
240: Pak J Pharm Sci. 2007 Oct;20(4):333-9.

Short communication: pattern of adverse drug reaction related

queries received by the drug information centre of a tertiary care
teaching hospital.
Jimmy B, Jose J, Rao PG.
Department of Pharmacy Practice, Manipal College of pharmaceutical Sciences,

Manipal University, Manipal, India.
Accurate information about safety of drugs is very essential for health care
professionals in identifying, preventing and managing Adverse Drug Reactions
(ADRs), thereby ensuring safe use of medications. The objective of the present
study was to assess the pattern of drug information (DI) queries related to ADRs
received by the Drug Information Center (DIC) of a tertiary care teaching
hospital. Retrospective evaluation of the DI queries received in the DIC over a
period of three and a half years (January 2002-July 2005) was done for various
parameters such as purpose and type of query, characteristics of the drugs and
reactions involved, and references used. Out of 2312 DI queries received, 600
(25.9%) were related to ADRs. Majority of the queries were from the department
of medicine (80.5%) and was received during ward rounds (76%). In most of the
queries, the information was sought for better patient care (66.3%) and the
enquirer wanted the information immediately (59.5%). The category of ADR
queries most commonly asked was regarding identification of an ADR (54.3%).
Considering the reaction characteristics, the organ system most commonly
involved in the queries was nervous system (14.7%) and the reaction was fever
and skin rash (14%). Most of the queries were on uncommon reactions. Drug
class most commonly involved in the queries were antibacterials for systemic use
(18.6%) and the most frequently involved drug was phenytoin (35%).
MICROMEDEX system was used as the reference in answering most (57.1%) of
the queries. Information on ADRs is among the most sought information on drugs
by the health care professionals. Evaluation of pattern of these queries could
reveal opportunities for educational and other interventions in promoting safer
drug use in a health care setting. DICs could play a major role in promoting drug
safety and it needs to be well equipped to respond to these needs.
241: Telemed J E Health. 2007 Jun;13(3):313-21.

Teleophthalmology-based rural eye care in India.
Bai VT, Murali V, Kim R, Srivatsa SK.
Sathyabama University, Chennai, India. thulasi_bai@yahoo.com
Undoubtedly, blindness is a major trauma, which affects an individual not only

physically but also emotionally. There are approximately 46 million visually
impaired people throughout the world. It is becoming a global problem. In India
alone, 19 million people are totally blind or else have visual defects. Out of this
19 million, 15 million reside in rural areas. India is among the countries which
suffers from a shortage of doctors. There are only about 12,000 ophthalmologists
in India, with most concentrating their practice in urban localities. Additionally,
the inadequate infrastructures of roads, telecommunication, transport and financial
status of the patients make it even more difficult to provide health care in rural
areas. Teleophthalmology is a new branch of telemedicine that offers solutions to
this serious problem. This paper discusses Indian teleophthalmology projects
known as Sankara Netralaya Teleophthalmology Project (SNTOP) and Aravind
Teleophthalmology Network (ATN). These have proven successful in the state of
Tamilnadu, India, both in rural and secondary healthcare centers.
242: Saudi Med J. 2007 Jul;28(7):1145-7.

Analysis of Saudi Medical Journal publications in PubMed, January

2001-November 2006.
Afifi M.
Department of Non-Communicable Diseases Control, Ministry of Health (HQ),

PO Box 393, PC 113, Muscat, Oman. afifidr@yahoo.co.uk
243: Health Place. 2008 Mar;14(1):96-105. Epub 2007 May 24.

Risk areas and neighborhood-level risk factors for Shigella

dysenteriae 1 and Shigella flexneri.
Emch M, Ali M, Yunus M.
University of North Carolina at Chapel Hill, Geography & CPC 308 Saunders
Hall, Campus Box 3220, Chapel Hill, NC 27599, USA. emch@email.unc.edu
Annually, there are 165 million cases of shigellosis resulting in 1.1 million deaths
in the developing world. Two species of the causative agent, Shigella dysenteriae
1 and Shigella flexneri, are responsible for acute diarrheal illness. Vaccines are
being developed against both but many questions remain about the disease
burden, distribution of species in space and time, and community-level risk
factors. This study answers two questions. What are the differences in
neighborhood-level risk factors between S. dysenteriae 1 and S. flexneri? Does
shigellosis caused by the two different species occur in the same neighborhoods
and are those high-risk neighborhoods persistent in time? Cases from a hospital in
rural Bangladesh were assigned to one of the two shigellosis types and age-
matched individuals were randomly chosen from the community to be controls.
Information was collected for neighborhood-level variables hypothesized to be
related to shigellosis. During the 3-year study period, there were 161 cases of S.
dysenteriae 1 and 225 cases of S. flexneri. Incidence of both types was highest in
children under 2 followed by children from 2 to 5. The location of S. dysenteriae
1 risk varies in time but S. flexneri risk areas were persistent in time.
Neighborhoods near bazaars with many non-septic latrines were at highest risk for
S. dysenteriae 1. S. flexneri was most common in flood-controlled areas. S.
dysenteriae 1 risk is more related to hygiene and sanitation and S. flexneri is more
related to the environment.
244: J Endocrinol Invest. 2007 May;30(5):404-10.

Goiter rate, serum thyrotropin, thyroid autoantibodies and urinary
iodine concentration in Tehranian adults before and after national
salt iodization.
Heydarian P, Ordookhani A, Azizi F.
Department of Endocrinology and Metabolism, Tehran University of Medical

Sciences, Tehran, Iran.
Goiter rate, serum TSH, antithyroperoxidase (TPOAb), antithyroglobulin (TgAb)

antibodies, and urinary iodine concentration (UIC) were evaluated 10-11 yr prior
(1983-1984) and 5-6 yr after (1999-2000) national salt iodization in Iran. Pre- and
post-iodization groups consisted of 465 and 1426 adults aged > or =20 yr,
respectively, selected by random cluster sampling in Tehran province. Total,
grade 1 and grade 2 goiter rates were 65.2, 53.1, and 12.1% in 1983-1984 vs 25.2,
15.5, and 9.7% in 1999-2000 (p<0.0001). Median serum TSH was 1.5 mIU/l in
1983-1984 vs 0.8 mIU/l in 1999-2000 (p<0.0001). Median TSH also decreased in
20-29, 30-39, 40-49, 50-59, and > or =60- yr-adults in 1983-1984 vs 1999-2000
(p<0.0001). In 1983-1984, positive TPOAb and positive TgAb were detected in
3.2 and 4%, respectively, using agglutination test. Corresponding values were
12.5 and 16.8% using immunoenzymometric assay in 1999-2000. Overt and
subclinical hypothyroidism was present in 0 and 32.8/1000 in 1983-1984 vs 3.5
and 21.7/1000 in 1999-2000, respectively. Overt and subclinical hyperthyroidism
was detected in 4.4 and 4.4/1000 in 1983-1984 vs 0.7 and 5.6/1000 in 1999-2000,
respectively. Subclinical hypothyroidism in males was significantly more frequent
in 1983-1984 vs 1999-2000 (odds ratio 5.02, 95% confidence interval 1.72-14.68;
p=0.004). Salt iodization resulted in adequate UIC, decrease in serum TSH and
subclinical hypothyroidism in males, and an increase in thyroid autoantibodies
without significant change in thyroid abnormalities. Benefits of iodine
supplementation far outweigh its hazards in Tehranian adults.
Publication Types:
245: BMC Public Health. 2007 Jun 26;7(147):125.

Fostering disability-inclusive HIV/AIDS programs in northeast

India: a participatory study.
Morrow M, Arunkumar MC, Pearce E, Dawson HE.
Nossal Institute of Global Health, University of Melbourne, Melbourne, Vic,

Australia. martham@unimelb.edu.au
BACKGROUND: Manipur and Nagaland in northeast India are among the Indian
states with the highest prevalence of HIV. Most prevention and care programs
focus on identified "high risk" groups, but recent data suggest the epidemic is
increasing among the general population, primarily through heterosexual sex.
People with disability (PWD) in India are more likely than the general population
to be illiterate, unemployed and impoverished, but little is known of their HIV
risk. METHODS: This project aimed to enable HIV programs in Manipur and
Nagaland to be more disability-inclusive. The objectives were to: explore HIV
risk and risk perception in relation to PWD among HIV and disability
programmers, and PWD themselves; identify HIV-related education and service
needs and preferences of PWD; and utilise findings and stakeholder consultation
to draft practical guidelines for inclusion of disability into HIV programming.
Data were collected through a survey and several qualitative tools. RESULTS:
The findings revealed that participants believe PWD in these states are potentially
vulnerable to HIV transmission due to social exclusion and poverty, lack of
knowledge, gender norms and obstacles to accessing HIV programs. Neither HIV
nor disability organisations currently address the risks, needs and preferences of
PWD. CONCLUSION: The Guidelines produced in the project and disseminated
to stakeholders emphasise opportunities for taking action with minimal cost and
resources, such as using the networks and expertise of both HIV and disability
sectors, producing HIV material in a variety of formats, and promoting
accessibility to mainstream HIV education and services. The human rights
obligations and public health benefits of modifying national and state policies and
programs to assist this highly disadvantaged population are also highlighted.
Publication Types:
PMCID: PMC1924853
246: Heart. 2008 Mar;94(3):354-9. Epub 2007 Jun 25.

Ethnic differences in healthcare-seeking behaviour and management

for acute chest pain: secondary analysis of the MINAP dataset 2002-
2003.
Ben-Shlomo Y, Naqvi H, Baker I.
Department of Social Medicine, University of Bristol, Bristol, UK. y.ben-

shlomo@bristol.ac.uk
OBJECTIVE: To examine whether there are ethnic differences in the healthcare-

seeking behaviour and management of patients with chest pain. DESIGN:
Prospective cohort of patients attending accident and emergency departments with
chest pain. SETTING: Hospitals in England and Wales from 1 January 2002 to 31
December 2003. PARTICIPANTS: Patients with chest pain. MAIN OUTCOME
MEASURES: Whether patients arrived by ambulance, whether they received
thrombolysis and the time it took from symptom onset to arrive at hospital and
receive thrombolysis. RESULTS: South Asian patients were less likely to arrive
by ambulance (age and sex adjusted odds ratio 0.64, 95% CI 0.60 to 0.69,
p<0.001) regardless of admission diagnosis. Overall, they were more likely to
receive thrombolysis (adjusted multivariable odds ratio 1.19, 95% CI 1.10 to 1.30,
p<0.001) and the difference was more marked if they had non-specific ECG
changes for heart disease rather than definite evidence of a myocardial infarction.
There was no evidence of an important clinical delay in South Asians receiving
thrombolysis after arrival at hospital. CONCLUSIONS: There are ethnic
differences in healthcare-seeking behaviour and the way doctors manage South
Asians with chest pain. The relative underuse of ambulances by South Asians
may either reflect cultural differences or geographical proximity to hospitals.
Doctors may have a lower threshold for giving thrombolytic therapy to South
Asian men with chest pain possibly because they are aware of the increased risk
of coronary heart disease in this population.
247: Circ J. 2007 Jul;71(7):1128-30.

Price disparity of percutaneous coronary intervention devices in

Japan and the United States in 2006.
Yasunaga H, Ide H, Imamura T, Ohe K.
Department of Planning, Information and Management, University of Tokyo

Hospital, Tokyo, Japan. yasunagah-jyo@h.u-tokyo.ac.jp
BACKGROUND: The price disparity between Japan and foreign countries for
medical devices is a controversial issue. Price differences existed between Japan
and USA for various medical devices in early 2005, so in the present study, a
more precise and detailed investigation of the latest market prices of medical
devices between Japan and USA was conducted in 2006, focusing on coronary
stents and percutaneous transluminal coronary angioplasty (PTCA) catheters, for
an evaluation of the efficacy of current Japanese policies. METHODS AND
RESULTS: Japanese market prices were obtained from 31 university hospitals,
and US market prices were obtained from 1 hospital chain and 2 group-
purchasing organizations. The price ratio (Japanese market price/US market price)
was determined to be 1.2-1.4 for drug-eluting stents (DES), 1.6-2.4 for non-DES,
and 4.1-5.1 for PTCA catheters. CONCLUSIONS: Results showed that the price
disparity was relatively small for DES, but still significant for non-DES and
PTCA catheters. Radical measures must be taken to improve the fundamental
causes of price disparity and might include reviewing the implementation of the
Japanese Pharmaceutical Affairs Law, abolishing the reimbursement price system
for medical devices, and establishing centers of clinical excellence.
Publication Types:
248: Ceylon Med J. 2007 Mar;52(1):38-9.

Bibliographic referencing made easy: use of bibliographic software

in health research.
Senarath U.
Publication Types:
• Letter
249: J Public Health Policy. 2007 Jul;28(2):221-37.

History of public health crises in Japan.
Imamura T, Ide H, Yasunaga H.

Department of Planning Information and Management, The University of Tokyo
Hospital, Japan.
In Japan, a number of serious public health crises involving environmental

pollution, food-borne diseases, and health hazards due to pharmaceuticals (i.e.,
"Yakugai") have occurred in the past 50 years. Based on the literature, we
summarize the initial investigations and the subsequent measures. Some common
points emerge: (1) prolonged cause identification, (2) lack of countermeasures
after the cause was identified, and (3) discrimination against victims and they
contributed to spreading the damage. We identify lack of corporate ethics and ill-
timed disclosure of information as the principal problems in Japan's crisis-
management systems. Defects in information gathering were common to all of the
cases, thus we suggest necessary corrective measures, such as the establishment
of a new reporting system for health hazard-related information.
Publication Types:
250: Nippon Koshu Eisei Zasshi. 2007 May;54(5):324-37.

[The action of Amagasaki City Health Center to the train derailment

accident on the Japan Railway Fukuchiyama Line]
Takaoka M, Asano G, Takao H, Shintani Y, Hashimoto T, Ikumi T, Suzu M,

Tanaka K, Asada T, Maruyama A, Tsunoda M.
Amagasaki City Health Center.
OBJECTIVES: To examine and describe the reactions of Amagasaki City Health

Center to the train derailment accident that occurred on April 25th, 2005 on the
Japan Railway (JR) Fukuchiyama Line in order to provide useful information for
health centers to help them deal with such catastrophic disasters in the future.
METHODS: Each day after the accident reactions and actions were examined and
described. They included mental health care provided by the health center for the
inhabitants of the condominium building into which the derailed train had
crashed, as well as the volunteers who participated in the rescue work. Health
checkups were also provided for the latter. RESULTS: Actions directly related to
the rescue were continued by the health center for four days after the accident.
The mainly consisted of the following. The health center asked hospitals to input
information concerming their ability to respond to the emergency situation into
the Hyogo Emergency Medical Information System. A relief party was organized
by the health center staff and engaged in the rescue and on-site rescue triage. The
health center slso coordinated the mortuary work. Two days after the accident,
"postmortem triage," to insure that bodies were taken directly to a mortuary after
death certification by a physician was needed on site after rescue triage was
concluded. The health center confirmed all information for the passengers' safety.
The rescue volunteers and the nearby inhabitants who were affected consulted
with the person in charge of mental health care provided by the health center from
immediately after the accicent for a period of five months to September 30.
Health checkups for rescue volunteers were conducted for infections and post-
traumatic stress disorder. CONCLUSIONS: This JR accident was characterized
by many civilian volunteers engaged in rescue over the relatively long period of
rescue of four days.Mental health care and health checkups were needed for
civililian volunteers and were therefore provided by the health center. During the
four days of rescue, triage was begun immediately after the accident and
subsequent postmortem triage was also required.
Publication Types:
251: BMC Health Serv Res. 2007 Jun 19;7:90.

Integration in primary community care networks (PCCNs):

examination of governance, clinical, marketing, financial, and
information infrastructures in a national demonstration project in
Taiwan.
Lin BY.
Institute of Health Service Administration, China Medical University, Taiwan.

yenju1115@hotmail.com
BACKGROUND: Taiwan's primary community care network (PCCN)

demonstration project, funded by the Bureau of National Health Insurance on
March 2003, was established to discourage hospital shopping behavior of people
and drive the traditional fragmented health care providers into cooperate care
models. Between 2003 and 2005, 268 PCCNs were established. This study
profiled the individual members in the PCCNs to study the nature and extent to
which their network infrastructures have been integrated among the members
(clinics and hospitals) within individual PCCNs. METHODS: The thorough
questionnaire items, covering the network working infrastructures--governance,
clinical, marketing, financial, and information integration in PCCNs, were
developed with validity and reliability confirmed. One thousand five hundred and
fifty-seven clinics that had belonged to PCCNs for more than one year, based on
the 2003-2005 Taiwan Primary Community Care Network List, were surveyed by
mail. Nine hundred and twenty-eight clinic members responded to the surveys
giving a 59.6 % response rate. RESULTS: Overall, the PCCNs' members had
higher involvement in the governance infrastructure, which was usually viewed as
the most important for establishment of core values in PCCNs' organization
design and management at the early integration stage. In addition, it found that
there existed a higher extent of integration of clinical, marketing, and information
infrastructures among the hospital-clinic member relationship than those among
clinic members within individual PCCNs. The financial infrastructure was shown
the least integrated relative to other functional infrastructures at the early stage of
PCCN formation. CONCLUSION: There was still room for better integrated
partnerships, as evidenced by the great variety of relationships and differences in
extent of integration in this study. In addition to provide how the network
members have done for their initial work at the early stage of network forming in
this study, the detailed surveyed items, the concepts proposed by the managerial
and theoretical professionals, could be a guide for those health care providers who
have willingness to turn their business into multi-organizations.
Publication Types:
PMCID: PMC1931593
252: Arch Dermatol. 2007 Jun;143(6):704-7.

Pemphigus variant associated with penicillin use: a case-cohort

study of 363 patients from Israel.
Heymann AD, Chodick G, Kramer E, Green M, Shalev V.
Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine,

Tel Aviv University, Israel. Heymann_t@mac.org.il
OBJECTIVE: To determine whether medication use is associated with the

development of a pemphigus variant. DESIGN: Population-based case-cohort
study. SETTING: Health maintenance organization in Israel. METHODS: All
incident pemphigus variant cases diagnosed from January 1, 1997, through
December 31, 2001, among 1.5 million members were identified. A cohort of
150,000 was randomly selected from the health maintenance organization
population as the control group. Data on case patients and control subjects,
including all medication purchased during the 6 months before the diagnosis,
were obtained using the health maintenance organization's central database.
RESULTS: We identified a total of 363 case patients diagnosed as having
pemphigus during the 5-year study (6,961,853 person-years of follow-up). The
mean age at diagnosis was 49.8 (SD, 22.7) years, and 53% of the cases were
women. Results of a multivariate analysis showed that increased risk for
pemphigus was associated with purchasing penicillin during the 6 months before
the diagnosis (odds ratio, 2.03; 95% confidence interval, 1.56-2.64). Compared
with individuals with no penicillin purchases, we calculated increased risks of
1.84 (95% CI, 1.36-2.49) and 3.02 (95% CI, 1.41-6.49) in those with 1 and 3 or
more purchases, respectively. None of the other examined medications, including
cephalosporins, angiotensin-converting enzyme inhibitors, dipyrone,
anticonvulsants, and nonsteroidal anti-inflammatory drugs, showed similar risks.
CONCLUSIONS: To our knowledge, the present research is one of the largest
published epidemiological studies on pemphigus variant. The use of computerized
medical and administrative databases allowed the detection of case patients in the
community, resulting in a higher calculated incidence rate than previously
reported. The findings suggest a relationship between the use of penicillin and
pemphigus variant. Further studies to assess the nature of this statistical
association are warranted.
253: J R Army Med Corps. 2007 Mar;153(1):22-5.

Various contract settings and their impact on the cost of medical

services.
Magnezi R, Dankner R, Kedem R, Reuveni H.
Medical Service and Supply Center, Medical Corps, Israel Defense Forces, Israel.
Rachelim2@bezeqint.net
OBJECTIVES: This study analyzes the effect of outsourcing healthcare on career

soldiers in the Israel Defense Forces (IDF) in different settings, so as to develop a
model for predicting per capita medical costs METHODS: Demographic
information and data on healthcare utilization and costs were gathered from three
computerized billing database systems: The IDF Medical Corps; a civilian
hospital; and a healthcare fund, providing services to 3,746; 3,971; and 6,400
career soldiers, respectively. Visits to primary care physicians and specialists,
laboratory and imaging exams, number of sick-leave days, and hospitalization
days, were totaled for men and women separately for each type of clinic. A
uniform cost was assigned to each type of treatment to create an average annual
per capita cost for medical services of career soldiers. RESULTS: Significantly
more visits were recorded to primary care physician and to specialists, as well as
imaging examinations by Leumit Healthcare Services (LHS), than visits and tests
in hospitals or in military clinics (p < 0.001). The number of referrals to
emergency rooms and sick-leave days were lowest in the LHS as compared to the
hospital and military clinics (p < 0.001). The medical cost per capita/year was
lowest in LHS as well. CONCLUSIONS: Outsourcing primary care for career
soldiers to a civilian healthcare fund represents a major cost effective change,
lowest consumption and lower cost of medical care. Co-payment should be
integrated into every agreement with the medical corps.
Publication Types:
254: Inj Prev. 2007 Jun;13(3):186-9.

Factors affecting the likelihood of reporting road crashes resulting

in medical treatment to the police.
Loo BP, Tsui KL.
Department of Geography, The University of Hong Kong, Pokfulam, Hong Kong.

bpyloo@hkucc.hku.hk
OBJECTIVE: This paper aims to determine the percentage of road crashes

resulting in injuries requiring hospital care that are reported to the police and to
identify factors associated with reporting such crashes to the police. DESIGN:
The data of one of two hospitals in the Road Casualty Information System were
matched with the police's Traffic Accident Database System. Factors affecting the
police-reporting rate were examined at two levels: the different reporting rates
among subgroups examined and tested with chi2 tests; and multiple explanatory
factors were scrutinised with a logistic regression model to arrive at the odds
ratios to reflect the probability of police-reporting among subgroups. RESULTS:
The police-reporting rate was estimated to be 57.5-59.9%. In particular, under-
reporting among children (reporting rate = 33.6%) and cyclists (reporting rate =
33.0%) was notable. DISCUSSION: Accurate and reliable road crash data are
essential for unveiling the full-scale and nature of the road safety problem. The
police crash database needs to be supplemented by other data. In particular, any
estimation about the social costs of road crashes must recognise the under-
reporting problem. The large number of injuries not reflected in the police crash
database represents a major public health issue that should be carefully examined.
Publication Types:
255: Rev Epidemiol Sante Publique. 2007 Aug;55(4):308-13.

[Drug circuit in Lebanese hospitals]
[Article in French]
Salameh P, Najjar Aad M, Semaan M, El Hawzi R, Bechara M, El Kadi B,

Bou Tanios L.
Faculté de Santé-Publique, université libanaise, section II, Fanar, Lebanon.

pascalesalameh@yahoo.com
BACKGROUND: Drug errors constitute a public health problem. The objective

of our study was to describe drug circuit essential steps in the Lebanese hospitals,
starting at prescription to administration, in comparison with Lebanese
accreditation standards. We also evaluated technical drug errors. METHODS: A
cross sectional study of all hospitals in Beirut and Mount Lebanon was carried
out, where a pharmacist and a nurse per hospital answered anonymous
standardized questionnaires. RESULTS: We found the drug circuit suffered from
gaps in all 59 hospitals that were visited: doctors should increase efforts to clarify
prescriptions and furnish necessary information for nurses, pharmacists better
apply accreditation standards, and nurses verify and re-verify treatments before
administration. CONCLUSION: Regulatory laws are necessary for all involved
actors for best responding to the responsibility in question, that is patient security.
Publication Types:
256: Health Policy. 2007 Dec;84(2-3):284-97. Epub 2007 Jun 12.

Women's status, institutional barriers and reproductive health care:

a case study in Yunnan, China.
Tian L, Li J, Zhang K, Guest P.
The Institute for Health and Development Studies, Kunming Medical College,
Renmin West RD 191, Kunming 650031, China.
OBJECTIVES: Yunnan is one of the poorest and most remote provinces in China.
The reproductive health status of the population is poor. The aim of the study was
to identify factors contributing to poor reproductive health and major barriers in
accessing reproductive health information and care and to inform interventions to
increase access to and the quality of care in service delivery. METHODS: The
study was based on qualitative data collected from structured and unstructured
interviews with health program managers, service providers, clients, and
community members in three counties. Focus group discussions, field
observations, reviews of the records of medical facilities and thematic analysis
were used in the study. RESULTS: Gender inequality and the fragmented health
system were some of the barriers in accessing the services. Incorrect diagnosis,
over treatment and IUD insertion with un-sterilised tools may have contributed to
the persistent high rate of reproductive tract infections (RTI) in the study settings.
CONCLUSIONS: The improvement of reproductive health thus hinges critically
upon the elevation of women's status. All health sectors within China's health
system need to be better integrated and institutionally induced gender inequality
ought to be reduced so that all in the population, particularly the vulnerable, will
have equal and adequate access to reproductive health care.
Publication Types:
257: Infect Control Hosp Epidemiol. 2007 Jul;28(7):791-8. Epub 2007 May 31.
Effectiveness of multifaceted hospitalwide quality improvement

programs featuring an intervention to remove unnecessary urinary
catheters at a tertiary care center in Thailand.
Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D,

Yuekyen C, Warachan B, Warren DK, Fraser VJ.
Division of Infectious Diseases, Faculty of Medicine, Thammasart University

Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
OBJECTIVE: To evaluate the efficacy of a multifaceted hospitalwide quality

improvement program that featured an intervention to remind physicians to
remove unnecessary urinary catheters. METHODS: A hospitalwide
preintervention-postintervention study was conducted over 2 years (July 1, 2004,
through June 30, 2006). The intervention consisted of nurse-generated daily
reminders that were used by an intervention team to remind physicians to remove
unnecessary urinary catheters, beginning 3 days after insertion. Clinical,
microbiological, pharmaceutical, and cost data were collected. RESULTS: A total
of 2,412 patients were enrolled in the study. No differences were found in the
demographic and/or clinical characteristics of patients between the
preintervention and postintervention periods. After the intervention, reductions
were found in the rate of inappropriate urinary catheterization (mean rate,
preintervention vs postintervention, 20.4% vs 11% [P=.04]), the rate of catheter-
associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per
1,000 catheter-days [P<.001]), the duration of urinary catheterization (mean, 11 vs
3 days [P<.001]), and the total length of hospitalization (mean, 16 vs 5 days
[P<.001]). A linear relationship was seen between the monthly average duration
of catheterization and the rate of CA-UTI (r=0.89; P<.001). The intervention had
the greatest impact on the rate of CA-UTI in the intensive care units (mean rate,
preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days
[P=.01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced
by 63% (mean, $3,739 vs $1,378 [P<.001]), and the hospitalization cost for each
patient during the intervention was reduced by 58% (mean, $366 vs $154
[P<.001]). CONCLUSIONS: This study suggests that a multifaceted intervention
to remind physicians to remove unnecessary urinary catheters can significantly
reduced the duration of urinary catheterization and the CA-UTI rate in a hospital
in a developing country.
Publication Types:
258: Twin Res Hum Genet. 2007 Apr;10(2):379-84.

Comparison of motor development between twins and singletons in
Japan: a population-based study.
Yokoyama Y, Wada S, Sugimoto M, Saito M, Matsubara M, Sono J.
Faculty of Health Sciences, Okayama University Medical School, Okayama,

Japan. yyoko@md.okayama-u.ac.jp
This study was performed using population-based data to analyze whether motor
development in early life is different between singletons and twins in Japan. For
better comparison and investigation, we divided the 2 groups into a group with a
birthweight of 2.5 kg or greater (subgroup A) and a group with a birthweight of
less than 2.5 kg (subgroup B), respectively. We analyzed the database of medical
check-ups for children aged 3 years between April 2001 and July 2004. They
received medical checkups at 4 months, 1.5, and 3 years of age. Children who
were suspected of having neurological abnormality or disability were referred to
specialists and excluded from the database. The data of 14,132 children were
analyzed. Among these, 13,040 (92.3%) children were singletons in subgroup A,
75 (0.5%) were twins in subgroup A, 866 (6.1%) were singletons in subgroup B
and 151 (1.1%) were twins in subgroup B. The mean age at achieving milestones
was slower in twins of subgroup A for each developmental outcome than
singletons of subgroup A, and the difference between twins and singletons was
significant after adjustment for rolling over. On the contrary, after adjusting for a
confounding factor (gestational age), singletons of subgroup B attained motor
development facilitating walking independently slower than twins of subgroup B.
There were different tendencies in the results regarding the motor development of
subjects of subgroup A and that of subjects of subgroup B.
Publication Types:
• Twin Study
259: PLoS Med. 2007 Jun;4(6):e191.

Comment in:
• PLoS Med. 2007 Jun;4(6):e216.

Ethnic disparities in diabetes management and pay-for-performance
in the UK: the Wandsworth Prospective Diabetes Study.
Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A.
Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust,

London, United Kingdom. c.millett@imperial.ac.uk
BACKGROUND: Pay-for-performance rewards health-care providers by paying

them more if they succeed in meeting performance targets. A new contract for
general practitioners in the United Kingdom represents the most radical shift
towards pay-for-performance seen in any health-care system. The contract
provides an important opportunity to address disparities in chronic disease
management between ethnic and socioeconomic groups. We examined disparities
in management of people with diabetes and intermediate clinical outcomes within
a multiethnic population in primary care before and after the introduction of the
new contract in April 2004. METHODS AND FINDINGS: We conducted a
population-based longitudinal survey, using electronic general practice records, in
an ethnically diverse part of southwest London. Outcome measures were
prescribing levels and achievement of national treatment targets (HbA1c < or =
7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or
193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP,
and total cholesterol increased significantly after the implementation of the new
contract. The extents of these increases were broadly uniform across ethnic
groups, with the exception of the black Caribbean patient group, which had a
significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95%
confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81)
relative to the white British patient group. Variations in prescribing and
achievement of treatment targets between ethnic groups present in 2003 were not
attenuated in 2005. CONCLUSIONS: Pay-for-performance incentives have not
addressed disparities in the management and control of diabetes between ethnic
groups. Quality improvement initiatives must place greater emphasis on minority
communities to avoid continued disparities in mortality from cardiovascular
disease and the other major complications of diabetes.
Publication Types:
PMCID: PMC1891316
260: Clin Toxicol (Phila). 2007 Jun-Aug;45(5):571-8.
Toxic Exposure Surveillance System (TESS)-based characterization

of U.S. non-native venomous snake exposures, 1995-2004.
Seifert SA, Oakes JA, Boyer LV.
Nebraska Regional Poison Center, University of Nebraska Medical Center,

Omaha, Nebraska, USA. sseifert@nebraskamed.com
BACKGROUND: Non-native (exotic) snake exposures in the United States have

not been systematically characterized. METHODS: The Toxic Exposure
Surveillance System (TESS) database of the American Association of Poison
Control Centers was analyzed to quantify the number and types, demographic
associations, clinical presentations, managements and outcomes, and the health
resource utilization of non-native snake exposures. RESULTS: From 1995
through 2004, there were 399 non-native exposures in the TESS database. Of
these, 350 snakes (87%) were identified by genus and species, comprising at least
77 different varieties. Roughly equal percentages of snakes originated in Asia,
Africa and Latin America, with a smaller number from the Middle-East,
Australia, and Europe. Nearly half were viperids and a little more than a third
were elapids. The vast majority of exposed individuals were adults. However,
almost 15% were aged 17 years or less, and almost 7% were children aged 5 years
or younger. Eighty-four percent were males. The vast majority of exposures
occurred at the victim's own residence. Over 50% were evaluated at a healthcare
facility, with 28.7% admitted to an ICU. Overall, 26% of patients were coded as
receiving antivenom treatment. Coded outcomes were similar between viperid and
elapid envenomations. There were three deaths, two involving viperid snakes and
one elapid. Enhancements to the TESS database are required for better precision
in and more complete characterization of non-native snake envenomations.
261: Int J Health Geogr. 2007 Jun 7;6:23.

Impact of conflict on infant immunisation coverage in Afghanistan:

a countrywide study 2000-2003.
Mashal T, Nakamura K, Kizuki M, Seino K, Takano T.
Health Promotion Section, Division of Public Health, Graduate School of Tokyo

Medical and Dental University, Tokyo, Japan. mtmashal.hlth@tmd.ac.jp
BACKGROUND: Infant immunisation is an effective public health intervention

to reduce the morbidity and mortality of vaccine preventable diseases. However,
some developing countries fail to achieve desirable vaccination coverage;
Afghanistan is one such country. The present study was performed to evaluate the
progress and variation in infant immunisation coverage by district and region in
Afghanistan and to assess the impact of conflict and resource availability on
immunisation coverage. RESULTS: This study analysed reports of infant
immunisation from 331 districts across 7 regions of Afghanistan between 2000
and 2003. Geographic information system (GIS) analysis was used to visualise the
distribution of immunisation coverage in districts and to identify geographic
inequalities in the process of improvement of infant immunisation coverage. The
number of districts reporting immunisation coverage increased substantially
during the four years of the study. Progress in Bacillus Calmette-Guerin (BCG)
immunisation coverage was observed in all 7 regions, although satisfactory
coverage of 80% remained unequally distributed. Progress in the third dose of
Diphtheria-Pertussis-Tetanus (DPT3) immunisation differed among regions, in
addition to the unequal distribution of immunisation coverage in 2000. The results
of multivariate logistic regression analysis indicated a significant negative
association between lack of security in the region and achievement of 80%
coverage of immunisation regardless of available resources for immunisation,
while resource availability showed no relation to immunisation coverage.
CONCLUSION: Although progress was observed in all 7 regions, geographic
inequalities in these improvements remain a cause for concern. The results of the
present study indicated that security within a country is an important factor for
affecting the delivery of immunisation services.
Publication Types:
PMCID: PMC1899486
262: Ying Yong Sheng Tai Xue Bao. 2007 Mar;18(3):575-80.

[Remote sensing estimation of vegetation coverage in guangzhou

based on the correction of atmospheric radiation]
[Article in Chinese]
Gong JZ, Xia BC.
School of Environmental Science and Engineering, Sun Yat-sen University,

Guangzhou 510275, China. gongjzh66@126.com
Vegetation coverage is a basic parameter in describing landscape ecosystem, and

an important index in assessing ecosystem health and security. Based on the four
TM images in 1990, 1995, 2000 and 2005, and by using the correction model to
deduct atmospheric radiation effect and the spatial operating model for TM image
under unsupervised classification, the relationship model between vegetation
coverage and normalized vegetation index was established, and the vegetation
coverage in different phases in Guangzhou was calculated. The results showed
that the vegetation coverage in Guangzhou decreased continuously from 1990 to
2000 but began to increase thereafter, which accorded with the economic
development and environmental construction of the city. The model established in
this paper could simulate well the dynamics of regional vegetation cover, and
have the advantage in describing the dynamics of vegetation coverage more
accurately, being available to the assessment of urban eco-environmental quality
and its dynamic characters.
Publication Types:
263: Emerg Infect Dis. 2007 Mar;13(3):518-9; author reply 519.

Comment on:
• Emerg Infect Dis. 2006 Nov;12(11):1631-7.

• Emerg Infect Dis. 2006 Nov;12(11):1638-43.
Pregnancy and emerging diseases.
Anker M.
Publication Types:
• Comment
• Letter
264: Vox Sang. 2007 Jul;93(1):57-63.

Predicting potential drop-out and future commitment for first-time

donors based on first 1.5-year donation patterns: the case in Hong
Kong Chinese donors.
Yu PL, Chung KH, Lin CK, Chan JS, Lee CK.
Department of Statistics and Actuarial Science, The University of Hong Kong,

Hong Kong. plhyu@hku.hk
BACKGROUND AND OBJECTIVES: Adequate blood supply is crucial to the

health-care system. To maintain a stable donor pool, donation-promotion
strategies should not only be targeted in recruitment but also focus on retaining
donors to give blood regularly. A study using statistical modelling is conducted to
understand the first 4-year donation patterns for drop-out and committed first-time
blood donors and to build model for the donor-type identification based on their
first 1.5-year donation patterns. SUBJECTS AND METHODS: First-time whole
blood (n= 20 631) adult donors recruited in year 2000 and 2001 in Hong Kong
were observed for more than 4 years. Cluster analysis was first applied to group
donor type by their similarities in donation behaviour under the surveillance
period. A decision tree model based on a shorter surveillance period (1.5 years) is
then built to predict the donor type. RESULTS: Three donation patterns - one-
time, drop-out, and committed donor behaviour - were identified in cluster
analysis. Three variables - donation frequencies in the first-year and in the half-
year period after first year, and the number of donation centre visits in the
following half year after first year, were able to predict drop-out donors with
potential to become committed and committed donors with relatively lower
donation frequency. CONCLUSIONS: The present statistical modelling is able to
identify those donors with potential to become committed donors and those
committed donors who can donate more frequently. This information is useful for
development of targeted donor retention strategies.
Publication Types:

265: J Int Med Res. 2007 Mar-Apr;35(2):242-52.
Monitoring vaccination coverage in Istanbul using the lot quality

assurance sampling and geographic information system.
Alkoy S, Ulugtekin N, Dogru AO.
Statistics and Communicable Disease Control Unit, District Health Directorate,

Istanbul, Turkey.
The quality of vaccination services provided for children aged 12-23 months was
determined in different districts of Istanbul, Turkey. Quality was assessed through
a lot quality assurance sampling method, using data extracted from interviews
conducted in 2001 with the mothers or carers of the children. Concurrently,
geographic information system technology was used for integrated evaluation of
the data from different lots and for presentation of the results as thematic maps.
The results of this study helped to identify districts of the city in which
vaccination services were below the expected level of quality and where an
unacceptable number of children were not being fully vaccinated. Subsequent to
this study, actions were taken by the agencies responsible to improve the coverage
and quality of the vaccination services in these districts of Istanbul.
266: Int J Clin Pharmacol Ther. 2007 May;45(5):264-70.

Atypical antipsychotic therapy for treatment of schizophrenia in

Hong Kong Chinese patients--a cost analysis.
Law WL, Hui HY, Young WM, You JH.
Hospital Authority, Hong Kong SAR.
OBJECTIVE: To evaluate the direct medical cost of atypical antipsychotic

therapy for schizophrenia among Hong Kong Chinese patients and to identify
factors affecting the cost of treatment. METHODS: In this retrospective database
analysis, patient data were retrieved from three Hong Kong public hospitals.
Patients aged 2 18 years who received an initial prescription for olanzapine,
risperidone, quetiapine or amisulpride between April 1 and September 30, 2003;
and had an ICD-10-coded diagnosis of schizophrenia were included. Patient data
were collected for a maximum duration of 1 year before and after treatment
initiation. Primary outcome measures were the schizophrenia-related direct
medical costs. Demographic and clinical factors were analyzed by multiple
regression analysis to identify influential factors for the cost of atypical
antipsychotic therapy. RESULTS: A total of 325 patient records were reviewed
and 82 patients were included in the analysis. Cost per patient per month for clinic
visits (US$ 67 +/- 41 versus US$ 78 +/- 41), medications (US$ 8 +/- 12 versus
US$ 97 +/- 83), and the total cost per patient per month (US$ 314 +/- 898 versus
US$ 431 +/- 914) increased significantly after treatment initiation (US$ 1 = HK$
7.8). Previous duration of hospitalization (RR = 1.00, 95% CI = 1.00 1.01),
history of substance abuse (RR = 1.26, 95% CI = 1.05 1.52) and use of depot
antipsychotics (RR = 1.22, 95% CI = 1.05 - 1.42) were associated with higher
cost of atypical antipsychotic therapy. CONCLUSION: The total direct medical
cost increased significantly after initiation of atypical antipsychotic therapy in a
cohort of Chinese patients with schizophrenia. History of drug abuse, use of depot
antipsychotics and prior duration of hospitalization were positive predictors of
cost of therapy.
Publication Types:
267: Food Nutr Bull. 2006 Sep;27(3):260-4.

Nutrition education alone improves dietary practices but not

hematologic indices of adolescent girls in Iran.
Amani R, Soflaei M.
Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundi-Shapour

University of Medical Sciences, Ahvaz, Iran. rezaamani@hotmail.com
BACKGROUND: Iron-deficiency anemia is the most prevalent nutritional

deficiency worldwide. Iron-deficiency anemia has particular negative
consequences on women in their childbearing years, and its prevention is a high
priority in most health systems. OBJECTIVE: This interventional study assessed
the effect of nutrition education on hematologic indices, iron status, nutritional
knowledge, and nutritional practices of high-school girls in Iran. METHODS:
Sixty healthy 16- to 18-year-old girls were randomly selected from two high
schools in the city of Ahvaz and divided into two equally matched groups, one
that received nutrition education, and one that did not. The education group
received instruction in face-to-face sessions, group discussions, and pamphlets for
2 months. The control group did not receive any information during the study.
Hematologic tests, corpuscular indices, and serum ferritin levels were measured at
baseline and after 2 months. Food-frequency questionnaires were administered
and histories taken, clinical signs of nutritional deficiencies observed,
anthropometric measurements taken, nutritional knowledge tested, practices
determined, and lifestyle questionnaires administered to all subjects. RESULTS:
There were no statistically significant differences in any baseline characteristics
between the two groups. Scores for nutritional knowledge and practices of the
education group were significantly higher after two months compared with the
baseline (31.4 +/- 6 vs. 24.3 +/- 5.9 points, p < .001, and 31.2 +/- 5 vs. 28.4 +/-
5.7 points, p < .05, respectively). The scores in the control group showed no
significant changes from baseline to 2 months. Mean corpuscular volume values
were elevated in the education group (p < .001) but not in the control group.
However, in the control group, serum ferritin concentrations showed about a 17%
drop at the end of the study (p < .004). There were no changes in other
hematologic, lifestyle, clinical, or anthropometric data compared with baseline
after completion of the study in both groups. CONCLUSION: These findings
indicate that nutritional education can improve knowledge of healthy nutrition and
lifestyle choices. Focused nutritional education using available resources and
correcting current dietary habits in a vulnerable group of young women may
result in dietary changes that can ultimately improve iron intake.
Publication Types:
• Randomized Controlled Trial

268: Health Policy. 2007 Dec;84(2-3):269-76. Epub 2007 May 30.

'Where is the public health sector?' Public and private sector

healthcare provision in Madhya Pradesh, India.
De Costa A, Diwan V.
RD Gardi Medical College, Ujjain, Madhya Pradesh, India.

Ayesha.de.costa@ki.se
OBJECTIVE: This paper aims to empirically demonstrate the size and

composition of the private health care sector in one of India's largest provinces,
Madhya Pradesh. METHODOLOGY: It is based on a field survey of all health
care providers in Madhya Pradesh (60.4 million in 52,117 villages and 394
towns). Seventy-five percent of the population is rural and 37% live below
poverty line. This survey was done as part of the development of a health
management information system. FINDINGS: The distribution of health care
providers in the province with regard to sector of work (public/private), rural-
urban location, qualification, commercial orientation and institutional set-up are
described. Of the 24,807 qualified doctors mapped in the survey, 18,757 (75.6%)
work in the private sector. Fifteen thousand one hundred forty-two (80%) of these
private physicians work in urban areas. The 72.1% (67793) of all qualified
paramedical staff work in the private sector, mostly in rural areas.
CONCLUSION: The paper empirically demonstrates the dominant heterogeneous
private health sector and the overall the disparity in healthcare provision in rural
and urban areas. It argues for a new role for the public health sector, one of
constructive oversight over the entire health sector (public and private) balanced
with direct provision of services where necessary. It emphasizes the need to build
strong public private partnerships to ensure equitable access to healthcare for all.
Publication Types:
269: Med Teach. 2007 Feb;29(1):e22-5.

Physician assistants: education, practice and global interest.
Legler CF, Cawley JF, Fenn WH.
College of Allied Health and Nursing, Department of Health Science, Nova

Southeastern University, Ft. Lauderdale, FL 33328, USA. Legler@Nova.edu
BACKGROUND: In the United States, the physician assistant (PA) model has
proven to be a cost-effective way to train quality primary care providers with a
high degree of acceptance of the PA role by patients and other healthcare
providers. AIM: Discuss PA model as it pertains to other countries. METHODS:
Review of relevant literature related to physician assistant education, practice and
global interest. RESULTS: Several countries including the United Kingdom,
Scotland, Canada, The Netherlands, Taiwan, South Africa and Ghana are
exploring or re-exploring the concept of the physician assistant as a way to
quickly and efficiently train and employ autonomous and flexible health workers
to address their nation's healthcare needs. CONCLUSIONS: Physician assistant
education is efficient and flexible and the PA model can be easily adapted to the
specific health system needs of other nations. In addition, many PA programs
have affiliation agreements with institutions outside of the United States to host
PA students for clinical rotations and there is an ever-growing interest by students
in international rotations. The Physician Assistant Education Association along
with the American Academy of Physician Assistants is actively involved with
sharing information about the PA profession with other countries.
270: Psychiatr Serv. 2007 Jun;58(6):810-5.

Mental health care of Filipino Americans.
Sanchez F, Gaw A.
G. Werber Bryan Psychiatric Hospital, Columbia Behavioral Health System,

South Carolina Department of Mental Health, SC 29203, USA.
francisgms@yahoo.com
Filipino Americans are the second-fastest-growing Asian immigrant group in the

United States, following the Chinese. Yet there exists a dearth of information on
mental health issues concerning Filipino Americans, who represent a diverse
mixture of culture, beliefs, and practices and vary widely from other minorities as
well as from the larger population. This group has experienced emotional and
behavioral challenges in acclimatizing to Western culture. Their historical
underpinnings, native core values, and traditions exert a crucial influence on their
mental well-being. Filipino Americans underutilize existing mental health care
services that are culturally, socially, and linguistically incompatible with their
needs. Along with stigma, the adherence of traditional practices and healing
methods remains a formidable barrier to the appropriate provision of care. The
authors review factors influencing perceptions of mental health and illness,
including religion, family, support systems, coping styles, and indigenous culture-
bound traits. Recommendations for treatment consist of a structured, culturally
sensitive, comprehensive approach that addresses the individual as well as the
cultural milieu.
271: Kaohsiung J Med Sci. 2007 May;23(5):247-53.

Deliberate self-harm and relationship to alcohol use at an emergency

department in eastern Taiwan.
Li YM.
Department of Family Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi
University, Hualien, Taiwan. yinming@mail.tcu.edu.tw
Suicide incidence has increased dramatically in recent years in Taiwan. In 2004,

3,468 lives were lost due to suicide and the total mortality was 15.3/100,000. It is
well known that alcohol drinking raises the risk of deliberate self-harm (DSH),
especially among psychologically distressed subjects. This study investigated the
characteristics of DSH patients and their association with acute alcohol drinking.
Since 2004, an injury surveillance system has been set up in a medical center,
collecting the minimal information recommended by the World Health
Organization. Attending nurses collected information and assessed each injured
patient as to whether he/she smelled of alcohol. Medical records of DSH injuries
were reviewed for confirmation of any prior DSH and any known mental disorder
was checked. Of 11,837 injuries, 123 (1.0%) were DSH. Those who were first-
time DSH patients (n = 115) were studied. About half of the patients were female
and 83.5% were aged between 20 and 54 years. More than half of the DSH
incidents occurred at home and 80.1% cases were stabbing or cutting injuries.
Injuries were defined as alcohol-related based on the report of "alcohol odor'' or
"intoxicated'' by the nurse or a positive blood alcohol test. In total, 55 (47.8%)
DSH injuries were found to be alcohol-related. The proportion of alcohol-related
injuries was highest (60.0%) in the age range 45-64 years. Of those patients who
tested positive for alcohol (n = 21), the mean blood alcohol concentration was
211.2 mg/dL (standard deviation, 79.1). Most subjects were discharged from the
emergency department (75.7%). Only 20 DSH patients (17.1%) went on to
receive a psychiatric consultation. DSH is not uncommon in eastern Taiwan. Half
of our cases were associated with alcohol use. Males had the same risk of injuring
themselves and were more likely than females to adopt "severe" methods to injure
themselves. Further studies into the causes of DSH or parasuicide attempts are
needed. Psychiatric consultation is essential in caring for DSH patients and in
preventing suicide. ADSH injury also offers an opportunity to recognize alcohol
problems.
272: Transplant Proc. 2007 May;39(4):927-9.

The cost of kidney transplantation in Iran.
Nourbala MH, Einollahi B, Kardavani B, Khoddami-Vishte HR, Assari S,

Mahdavi-Mazdeh M, Simforoosh N.
Nephrology and Urology Research Center, Baqiyatallah Medical Sciences

University, Tehran, Iran. noorbalam@gmail.com
BACKGROUND: Kidney transplantation has gained widespread popularity by
improving the outcome of end-stage renal disease (ESRD) patients. However, this
is a highly complicated and expensive procedure that puts much pressure on the
health system in developing countries. We report the costs in Iran model of
kidney transplantation. MATERIALS AND METHODS: We reviewed the
regulations for kidney transplantation using Dialysis and Transplant Patients
Association (DATPA) information, 2005. All data regarding the cost of
transplantation procedure, immunosuppression, and the money given to donors
were included. The cost of transplantation procedure was categorized into
personnel, drugs, paraclinics, hospital bed, and other expenses. To achieve more
comprehensive results, all costs were converted into US dollars (1 USD = 9000
Rials). RESULTS: The total cost of kidney transplantation procedure was $9224.
Of this, 65.8% ($6076) was related to the immunosuppression therapy in the first
year, 22.2% ($2048) to the transplantation procedure, and 12% ($1100) to organ
procurement. The details of donor nephrectomy were as follows: personnel, $183;
accommodations, $107; drugs, $39; paraclinics, $23; and other, $22. These values
for kidney recipient were personnel, $331; drugs, $367; paraclinics, $278;
accommodations, $475; and other, $222. CONCLUSION: Compared with other
countries, the kidney transplantation cost is low in Iran. The health system also
pays for all the expenses. These, along with full medical insurance coverage of
kidney recipients, make kidney transplantation available for every patient,
regardless of the socioeconomic status due to its low cost. It is expected that a
higher number of transplantation candidates with a low socioeconomic status will
select transplantation.
Publication Types:
273: Transplant Proc. 2007 May;39(4):923-6.

Renal transplantation in Iran over the past two decades: a trend

analysis.
Noorbala MH, Rafati-Shaldehi H, Azizabadi-Farahani M, Assari S.
Nephrology/Urology Research Center (NURC), Kidney Transplant Department,

Baqiyatallah Medical Sciences University, Tehran, Iran. noorbalam@gmail.com
BACKGROUND: In this study, we have reported updated statistics of the Iranian

Transplantation Registry, the status of the recipients and grafts, and a detailed
time trend with respect to patient characteristics. METHODS: We retrospectively
reviewed the Iranian Renal Transplantation Registry and information from the
Dialysis and Transplant Patients Public Association, to obtain data on all kidney
transplantations performed in Iran between 1986 and 2005. Data were gathered
regarding the total number of transplantations, graft loss, recipient death, and
donor and recipient characteristics, including demographic data, cause of end-
stage renal disease (ESRD), and source of kidney. We assessed changes in
variables on a biannual basis. RESULTS: A total of 19521 transplantations were
registered over the study period, of which, 761 recipients (3.9%) had died and
2333 allografts (11.9%) had been lost. The source of the kidney in 2556 (13%)
subjects was a living related donor (LRD), in 16234 (83%) a living unrelated
donor (LURD), and in 831 (4%) cadaveric. During the study decades we noted an
increase in the number of kidney transplantations (from 22 to 3690), age of
recipients (from 30 to 40), male-to-female ratio of recipients (from 0.58 to 0.67),
male-to-female ratio of donors (from 0.48 to 0.52), diabetes mellitus (from 0% to
27%), and hypertension (from 4% to 15%), as causes of ESRD, as well as the use
of cadaveric kidneys (0% to 11%). CONCLUSION: Analyzing renal
transplantation data not only helps to evaluate the effectiveness of transplantation
activities in a country, but also provides information to estimate future costs in the
health care system.
Publication Types:
274: J Am Diet Assoc. 2007 Jun;107(6):942-50.

Chronic diseases and dietary changes in relation to Korean

Americans' length of residence in the United States.
Yang EJ, Chung HK, Kim WY, Bianchi L, Song WO.
Department of Culinary Science, Honam University, Gwangju, Korea.
BACKGROUND: National health in the United States is influenced by the dietary

norms brought into the country by an increasing number of immigrants.
OBJECTIVES: This cross-sectional study aimed to document dietary changes and
disease prevalence in relation to the length of residence in the United States for
Korean Americans in Michigan. DESIGN: Of 1,860 questionnaires mailed out,
637 (34.3%) were returned with respondent-reported information, including
demographics, weight and height, chronic diseases, and dietary patterns.
SUBJECTS/SETTING: Included in the final analyses were 497 first-generation
Korean-American immigrants (263 men, 234 women, aged 30 to 87 years).
STATISTICAL ANALYSES PERFORMED: Analysis of covariance with the
Tukey test and logistic regression models provided sex-specific analysis of dietary
changes and disease patterns. All statistical analyses were adjusted for age.
RESULTS: Chronic diseases reported most frequently by men and women,
respectively, were hypertension, digestive diseases, arthritis, and diabetes. Length
of residence in the United States (<or=15 years, 16 to 25 years, or >or=26 years)
was inversely associated with the prevalence of digestive diseases in men
(P=0.017) and women (P=0.001), and positively with respiratory diseases in men
and thyroid disease in women (P<0.05). Length of residence in the United States
was inversely associated with intake of rice/rice dishes in both men (servings per
week, P<0.001) and women (P=0.012). The prevalence of digestive diseases
associated inversely with length of residence and positively with servings of
rice/rice dishes consumed for Korean-American men. The age-adjusted odds ratio
for digestive diseases was highest among men who had the shortest length of
residence in the United States (<or=15 years) and greater consumption of rice/rice
dishes (>2 servings per day) (odds ratio 12.10; P=0.03). CONCLUSIONS:
Dietary changes of Korean-American immigrants in the United States over time
were associated with changes in their chronic disease patterns. These findings
may help food and nutrition professionals who work with minority immigrants
because they identify factors that affect changes in dietary patterns and work
toward preventing diet-related diseases. Prospective studies could address
underlying mechanisms of the observed diet-disease relationship with subsequent
generations of Korean Americans, as well as various ethnic minority immigrants
in the United States.
Publication Types:
275: Mil Med. 2007 May;172(5):478-81.

Evaluation of magnetic resonance imaging regulatory methods in

the Israeli Air Force.
Levy G, Goldstein L, Paz I, Atar E, Olsha S, Goldberg A, Bar Dayan Y.
Surgeon General Headquarters, Israeli Air Force, Tel-Hashomer, Israel.
BACKGROUND: The use of magnetic resonance (MR) imaging (MRI) among

many medical professions is growing. Many health care systems have formed
control mechanisms to ensure proper utilization of MRI. This western world trend
is also valid in the Israeli Air Force (IAF). At the time of the study, two methods
existed for consideration of MR requests in the IAF: (1) consideration by a
primary reviewer, no clinical guidelines (applied to all MR examination requests,
knee MR excluded). (2) Consideration by a primary reviewer according to basic
clinical guidelines established by the Israeli Defense Forces medical section and
by communication with an orthopedic specialist (applied to knee MR requests).
Both methods did not include consultation with established criteria (such as
American College of Radiology (ACR) appropriateness criteria). OBJECTIVE:
To evaluate the appropriateness of the current regulatory methods of MRI
utilization in the IAF by comparing approval/rejection decisions to established
ACR criteria. METHODS: The study is a retrospective analysis of written records
of air force personnel, for whom MRI was requested by a specialist. We gathered
information regarding the clinical problem and the final decision concerning
approval or rejection of the MRI request. We then consulted with the ACR
appropriateness criteria. In case a matching ACR clinical variant was found, an
appropriateness value was assigned to the request. Otherwise, the request was
noted as "ACR irrelevant". We predetermined to label all studies with an ACR
value of 1 to 3 as inappropriate, 4 to 6 as "gray zone," and 7 to 9 as appropriate.
We then compared the ACR-based decision to the original outcome of the
request. RESULTS: The overall approval rate for MRI requests evaluated by a
primary reviewer only was 96%. The overall approval rate for MRI requests
evaluated by a primary reviewer, basic clinical guidelines, and specialist
consultation was 51%. Among the four most prevalent MR requests types (brain,
knee, spine, and shoulder), requests in the 7 to 9 scale (appropriate requests)
accounted for 52%. Regarding appropriate requests, there was a 100% approval
rate by a primary reviewer only compared with 17% for requests considered by a
primary reviewer, basic guidelines, and specialist consultation (83% of
appropriate requests were rejected by this method). Requests in the 1 to 3 scale
(inappropriate requests) accounted for 3% of all requests. In this group, there was
a 100% approval rate by both methods of consideration. Requests in the 4 to 6
scale (gray zone requests) also accounted for 3% of the total and requests which
could not be assigned an ACR appropriateness value (ACR-irrelevant requests)
accounted for 42% of total requests. The rate of approval of these requests by a
primary reviewer only and by a primary reviewer, guidelines, and consultant was
97% and 83%, respectively. CONCLUSIONS: Both MR approval mechanisms
that were applied in the IAF have not shown a strong correlation with ACR
appropriateness criteria, with significant rates of both overuse and underuse of
MRI. The high rate of requests that could not be assigned an ACR appropriateness
value may indicate a need to broaden the appropriateness criteria coverage of
clinical conditions and variants.
276: J Telemed Telecare. 2007;13(3):148-53.

Qualitative and quantitative assessment of video transmitted by
DVTS (digital video transport system) in surgical telemedicine.
Shima Y, Suwa A, Gomi Y, Nogawa H, Nagata H, Tanaka H.
Information Center for Medical Sciences, Tokyo Medical and Dental University,
Japan. yoichiro@fg7.so-net.ne.jp
Real-time video pictures can be transmitted inexpensively via a broadband

connection using the DVTS (digital video transport system). However, the
degradation of video pictures transmitted by DVTS has not been sufficiently
evaluated. We examined the application of DVTS to remote consultation by using
images of laparoscopic and endoscopic surgeries. A subjective assessment by the
double stimulus continuous quality scale (DSCQS) method of the transmitted
video pictures was carried out by eight doctors. Three of the four video recordings
were assessed as being transmitted with no degradation in quality. None of the
doctors noticed any degradation in the images due to encryption by the VPN
(virtual private network) system. We also used an automatic picture quality
assessment system to make an objective assessment of the same images. The
objective DSCQS values were similar to the subjective ones. We conclude that
although the quality of video pictures transmitted by the DVTS was slightly
reduced, they were useful for clinical purposes. Encryption with a VPN did not
degrade image quality.
Publication Types:
277: Gerodontology. 2007 Jun;24(2):87-92.

Association of total tooth loss with smoking, drinking alcohol and

nutrition in elderly Japanese: analysis of national database.
Hanioka T, Ojima M, Tanaka K, Aoyama H.
Department of Preventive and Public Health Dentistry, Fukuoka Dental College,

Fukuoka, Japan. haniokat@college.fdcnet.ac.jp
OBJECTIVE: Various factors may be associated with edentulism in elderly

people. Association of total tooth loss with smoking, alcohol intake and nutrition
in non-institutionalised elderly Japanese was assessed utilising national database.
MATERIALS AND METHODS: Records of independent surveys, the Survey of
Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999 were
electronically linked using the household identification number. RESULTS:
Among the records of 6903 subjects in the SDD and 12 763 subjects in the NNS,
6805 records were successfully linked. Overall, prevalence of total tooth loss in
adults was very similar in males and females at approximately 7.0%, and the
smoking rate was 47.6% and 9.9% respectively. Total tooth loss was a rare
phenomenon (<2%) in age groups of <60 years. According to the multiple logistic
regression analysis involving 2200 subjects aged 60 years or older, significant
variables were age, current smokers and vitamin C intake in males, and age and
current smokers in females. The variable for current drinkers was significant in
females but the odds ratio was <1.0. No significant relationship was detected with
respect to former smokers and drinkers, body mass index, vitamin E intake and
blood glucose level. CONCLUSIONS: Current smoking was associated with total
tooth loss, although smoking rate was low in females. Gender difference in the
association was suggestive with respect to drinking alcohol and vitamin C intake.
Publication Types:
278: Clin Infect Dis. 2007 Jun 15;44(12):1560-8. Epub 2007 May 7.
Fever in returned travelers: results from the GeoSentinel

Surveillance Network.
Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F,
Schwartz E; GeoSentinel Surveillance Network.
Mount Auburn Hospital, Cambridge, MA, USA. mary_wilson@harvard.edu
BACKGROUND: Fever is a marker of potentially serious illness in returned

travelers. Information about causes of fever, organized by geographic area and
traveler characteristics, can facilitate timely, appropriate treatment and preventive
measures. METHODS: Using a large, multicenter database, we assessed how
frequently fever is cited as a chief reason for seeking medical care among ill
returned travelers. We defined the causes of fever by place of exposure and
traveler characteristics. RESULTS: Of 24,920 returned travelers seen at a
GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever
as a chief reason for seeking care. Of patients with fever, 26% were hospitalized
(compared with 3% who did not have fever); 35% had a febrile systemic illness,
15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness.
Malaria was the most common specific etiologic diagnosis, found in 21% of ill
returned travelers with fever. Causes of fever varied by region visited and by time
of presentation after travel. Ill travelers who returned from sub-Saharan Africa,
south-central Asia, and Latin America whose reason for travel was visiting friends
and relatives were more likely to experience fever than any other group. More
than 17% of travelers with fever had a vaccine-preventable infection or
falciparum malaria, which is preventable with chemoprophylaxis. Malaria
accounted for 33% of the 12 deaths among febrile travelers. CONCLUSIONS:
Fever is common in ill returned travelers and often results in hospitalization. The
time of presentation after travel provides important clues toward establishing a
diagnosis. Preventing and promptly treating malaria, providing appropriate
vaccines, and identifying ways to reach travelers whose purpose for travel is
visiting friends and relatives in advance of travel can reduce the burden of travel-
related illness.
Publication Types:
• Multicenter Study
• Research Support, U.S. Gov't, P.H.S.
279: Kyobu Geka. 2007 May;60(5):409-14.

[Cardiac surgery in Japan from a view of Germany]
Minami K.
Department of Cardiovascular Surgery, Nihon University School of Medicine,

Tokyo, Japan.
In Germany, standards of facilities for cardiovascular surgery are established

under the guidance of the Ministry of Health and Welfare, and numbers of
hospitals are regulated for the needs of patients. Not only in Germany but in many
countries of Europe, it is reasonable by a number of patients 1 to 1 million
population. A number of cardiac operations in 1 authorized institution in Germany
is 10 times as that of Japan. In this condition, I'll introduce the medical care
systems of Germany; postgraduate education system for both medical specialists
and home doctors, introduction of private insurance system based on National
Health Insurance system for everyone, and a release of medical information,
quality control, acknowledged not by an own declaration but by the third
organization.
Publication Types:
280: J Healthc Qual. 2005 Sep-Oct;27(5):28-33.

A computerized surveillance system for the quality of care in

childhood asthma.
Peled R, Tal A, Pliskin JS, Reuveni H.
Department of Health Policy and Management, Ben-Gurion University of the

Negev, Beer Sheva, Israel. ronitpeled@yahoo.com
This article describes the development of a novel model for quality assurance of
pediatric asthma using administrative data and clinical guidelines. Children for
whom drugs for asthma were dispensed during 1998 were recruited from the
drug-dispensing registry of the largest health maintenance organization in the
southern region of Israel. The Israeli clinical guidelines were translated into a list
of six markers for inadequate treatment. This list was used for a computerized
search in the drug registry, and cases with markers were noted as cases in which
inappropriate treatment was provided. The model was validated by proving that
there was an association between inappropriate treatment (markers) and bad
outcomes (emergency room visits, hospitalizations, and healthcare utilization).
This model creates an interface between administrative and clinical information
and provides an easy-to-use tool for quality assurance.
Publication Types:
281: Reprod Health Matters. 2007 May;15(29):172-82.

Situation analysis of quality of abortion care in the main maternity
hospital in Hai Phòng, Viet Nam.
Nguyen MH, Gammeltoft T, Rasch V.
Scientific Institute for Population, Family and Children, Viet Nam Commission of
Population, Family and Children, Hanoi, Viet Nam.
Six months after a Comprehensive Abortion Care project was implemented in

Phu-San Hospital, the main maternity hospital in Hai Phòng, northern Viet Nam,
a study of quality of abortion services was carried out. The study explored the
interaction between providers and women seeking abortion and how cultural
values influenced quality of care. A quantitative and qualitative approach was
employed: a three-part structured survey with 748 women before and after they
had an abortion, 20 in-depth interviews with women just after abortion, seven
informal interviews with health care staff and 100 participant observations. Both
the women and the staff equated quality of care mainly with improved technical
performance of abortion. Insufficient knowledge and skills had a negative impact
on provision of information and good quality counselling in relation to
understanding and uptake of contraception, treating reproductive tract infection
and preventing post-abortion infection. To further improve abortion care in
hospitals such as Phu-San, training programmes are needed that integrate
counselling and clinical skills and address the cultural factors that hinder health
staff and women from interacting in an equitable manner. A supportive
supervisory system that holds health staff accountable for conducting high quality
information and counselling sessions should also be established.
282: Reprod Health Matters. 2007 May;15(29):163-71.

The commodification of obstetric ultrasound scanning in Hanoi, Viet

Nam.
Gammeltoft T, Nguyen HT.
Institute of Anthropology, University of Copenhagen, Copenhagen, Denmark.

tine.gammeltoft@anthro.ku.dk <tine.gammeltoft@anthro.ku.dk>
Growing numbers of pregnant women across the world now routinely have
ultrasound scans as part of antenatal care, including in low-income countries. This
article presents the findings of anthropological research on the use of obstetric
ultrasonography in routine antenatal care in Hanoi, Viet Nam. The findings come
from observation, a survey and interviews with women seeking ultrasound scans
at a main maternity hospital and interviews with doctors providing ultrasound
there. We found a dramatic overuse of ultrasound scanning; the 400 women
surveyed had had an average of 6.6 scans and 8.3 antenatal visits during
pregnancy, while one-fifth had had ten scans or more. Doctors considered
obstetric ultrasound an indispensable part of modern antenatal care. For two-
thirds of the women, the main reason for frequent scans was reassurance of
normal fetal development. However, the women often also said their doctor had
recommended the scans. This overuse must be seen in the context of growing
commercialisation in the Vietnamese health care system, where ultrasound
provides an important source of revenue for both private and public providers.
There is an urgent need in Viet Nam for policy and practice guidelines on the
appropriate use of ultrasonography in pregnancy and how best to combine it with
essential antenatal care, and information dissemination to women.
283: Rural Remote Health. 2007 Apr-Jun;7(2):630. Epub 2007 May 18.
Developments in immunization planning in Cambodia--rethinking

the culture and organization of national program planning.
Soeung S, Grundy J, Kamara L, McArthur A, Samnang C.
National Immunization Program, Ministry of Health, Phnom Penh, Cambodia.
INTRODUCTION: As part of its health system reconstruction following decades

of civil war, Cambodia undertook a program of health sector reform in 1996 to
expand coverage of essential health services to the population of 14 million, 80%
of whom are resident in over 13 000 rural villages. During this reform period, one
of the major national health programs, the National Immunization Program (NIP),
adapted its planning system to accommodate changes in social and health sector
structure. Aims: The aims of this article are to review changes made in the
approach to national immunization planning and to illustrate how these
adaptations can help identify future challenges and opportunities for further
improving immunization coverage in Cambodia. Sources of information for the
study include immunization plans and data from international and national
sources, as well as data from the national health information system. Findings of
review: Management and service delivery reforms undertaken by the NIP include
(1) strengthening links between immunization, health sector and international
health planning; (2) development of immunization program multiyear and
financial sustainability plans; (3) strengthening of national program decision
making structures and processes; (4) widening of decentralized stakeholder
participation in health planning; and (5) implementation of service level micro-
planning. Outcomes: These management reforms have been associated with
significant improvement in public health program performance and outcomes
during this period (2003-2006). There has been an increase in vaccination
coverage for children under the age of one year, over a five-year period (increase
of 29% for fully immunized child at one year of age), with no significant
differences in vaccination rates between urban and rural areas, and a sharp
decrease in the incidence of vaccine preventable diseases. CONCLUSION: The
NIP is now well positioned to take on additional challenges in coming years
associated with expanding international partnerships, the continued development
of civil society, further health system decentralization, and the requirement to
further improve coverage in support of global and regional disease elimination
goals. However, as costs continue to rise, planners in the future will need to
emphasize the economic and public health benefits of immunization programs in
order to sustain increasing levels of national and international investment.
Publication Types:
• Review
284: Waste Manag. 2008;28(2):450-8. Epub 2007 May 15.

Site investigation on medical waste management practices in

northern Jordan.
Abdulla F, Abu Qdais H, Rabi A.
Department of Civil Engineering, Jordan University of Science and Technology,

PO Box 3030, Irbid 22110, Jordan. fabdulla@just.edu.jo
This study investigated the medical waste management practices used by hospitals
in northern Jordan. A comprehensive inspection survey was conducted for all 21
hospitals located in the study area. Field visits were conducted to provide
information on the different medical waste management aspects. The results
reported here focus on the level of medical waste segregation, treatment and
disposal options practiced in the study area hospitals. The total number of beds in
the hospitals was 2296, and the anticipated quantity of medical waste generated
by these hospitals was about 1400 kg/day. The most frequently used treatment
practice for solid medical waste was incineration. Of these hospitals, only 48%
had incinerators, and none of these incinerators met the Ministry of Health (MoH)
regulations. As for the liquid medical waste, the survey results indicated that 57%
of surveyed hospitals were discharging it into the municipal sewer system, while
the remaining hospitals were collecting their liquid waste in septic tanks. The
results indicated that the medical waste generation rate ranges from approximately
0.5 to 2.2 kg/bed day, which is comprised of 90% of infectious waste and 10%
sharps. The results also showed that segregation of various medical waste types in
the hospitals has not been conducted properly. The study revealed the need for
training and capacity building programs of all employees involved in the medical
waste management.
Publication Types:

285: Anaesthesia. 2007 Jun;62(6):586-90.

Customer focused incident monitoring in anaesthesia.
Khan FA, Khimani S.
Department of Anaesthesia, Aga Khan University, Karachi-74800, Pakistan.

fauzia.khan@aku.edu
The database of incident forms relating to anaesthesia services in an institutional

risk management programme were reviewed for 2003-2005, the aim being to
identify any recurring patterns. Incidents were prospectively categorised as
relating to attitude/behaviour, communication breakdown, delay in service, or
were related to care, cost, environment, equipment, security, administrative
process, quality of service or miscellaneous. The total number of anaesthesia-
related incidents reported during the period was 287, which related to 0.44% of
the total number of anaesthetics administered during the time period. In all, 170
incidents were reported by the department, 96 by internal customers and 21 by
external customers. Only 30% of the complaints came from the operating room.
Thirty-four per cent of all incidents related to communication, behaviour and
delay in service. A requirement to teach communication skills and stress handling
formally in anaesthesia training programmes, and at the time of induction of staff
into the department, has been identified.

286: J Epidemiol Community Health. 2007 Jun;61(6):519-26.
Evaluation of the quality of cause of death statistics in rural China

using verbal autopsies.
Wang L, Yang G, Jiemin M, Rao C, Wan X, Dubrovsky G, Lopez AD.
National Centre for Disease Control and Prevention, Beijing, China.
BACKGROUND: Death registration systems in rural China are in a

developmental stage. The Disease Surveillance Points (DSP) system provides the
only nationally representative information on causes of death. In this system,
there are no standard procedures or instruments for ascertaining causes of death;
hence available statistics require careful evaluation before use. AIM: To assess
the reliability of data from the DSP. METHODS: 14 DSP sites were selected
through stratified sampling, enrolling 2482 deaths registered during June-
November 2002. Defined verbal autopsy (VA) procedures were used to derive
underlying causes of death. kappa Measures of agreement between VA and
registered diagnoses were computed. VA diagnoses were used as references to
compute sensitivity and positive predictive values. Finally, patterns of cause-
specific discordance between the two data sources were studied. RESULTS:
kappa Scores indicate only moderate agreement for chronic obstructive
pulmonary disease (COPD) and ischaemic heart disease (IHD). The results also
suggest that COPD is undercounted in registration data. A significant degree of
cross attribution of cause was found between the two data sources. Overall, the
VA was successful in limiting deaths with ill-defined causes to <10%.
CONCLUSIONS: Diagnoses based on structured symptom questionnaires in the
VA approach seem plausible and reliable as compared with lay-reported
diagnoses in registration data. Concerns with attribution of cause of death due to
COPD, IHD and tuberculosis in registration data suggest caution in their use for
research and health programme purposes. The VA methods tested in this study
offer promise for implementation in the routine registration system.
Publication Types:
287: Hum Mutat. 2007 Oct;28(10):944-9.

Documentation of inherited disorders and mutation frequencies in
the different religious communities in Israel in the Israeli National
Genetic Database.
Zlotogora J, van Baal S, Patrinos GP.
Department of Community Genetics, Public Health Services, Ministry of Health,

Ramat Gan, Israel.
The National and Ethnic Mutation Databases (NEMDBs) are continuously

updated mutation depositories that contain extensive information on the described
genetic heterogeneity of an ethnic group or population. Here, we report the
construction of the Israeli National Genetic database (Available at:
www.goldenhelix.org/israeli; Last accessed: 20 April 2007) to document the sheer
genetic heterogeneity found in the Jewish and non-Jewish populations in Israel.
The database is built and maintained online using a newly developed customized
version of the ETHNOS platform. The Israeli NEMDB is the richest in
information among individual NEMDB, containing summaries of 347 genetic
disorders studied for the Israeli populations with numerous relevant references
and links to the respective Online Mendelian Inheritance in Man (OMIM) entries.
Summaries can be selected from an alphabetical summary index or queried using
a keyword-based search functionality. An easy-to-use query interface provides
access to the over 600 entries on allelic and carrier frequencies of the different
mutations responsible for certain inherited disorders in the Jewish and non-Jewish
populations, although such documentation is not as extensive as in the other
ETHNOS-based NEMDBs. Also, the Israeli NEMDB provides a comprehensive
listing of all laboratories providing molecular genetic testing services in Israel
with a separate query interface for the user to select which genetic service is
provided to a certain laboratory. The Israeli NEMDB is a useful user-friendly and
extendable online resource for genetic services in Israel, while the modified
version of the ETHNOS software can be particularly useful for similar projects in
other populations. Copyright 2007 Wiley-Liss, Inc.
Publication Types:
288: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2007 Feb;15(1):184-7.

[Research on Zhejiang blood information network and management
system]
[Article in Chinese]
Yan LX, Xu Y, Meng ZH, Kong CH, Wang JM, Jin ZL, Wu SD, Chen CS,
Luo LF.
Blood center of Zhejiang Province, Key Laboratory of Blood Safety Ministry of

Health, Hangzhou 310006, China.
This research was aimed to develop the first level blood information centralized
database and real time communication network at a province area in China.
Multiple technology like local area network database separate operation, real time
data concentration and distribution mechanism, allopatric backup, and optical
fiber virtual private network (VPN) were used. As a result, the blood information
centralized database and management system were successfully constructed,
which covers all the Zhejiang province, and the real time exchange of blood data
was realised. In conclusion, its implementation promote volunteer blood donation
and ensure the blood safety in Zhejiang, especially strengthen the quick response
to public health emergency. This project lays the first stone of centralized test and
allotment among blood banks in Zhejiang, and can serve as a reference of
contemporary blood bank information systems in China.
Publication Types:
289: J Med Liban. 2007 Jan-Mar;55(1):39-45.

Hospital accreditation policy in Lebanon: its potential for quality

improvement.
El-Jardali F.
Department of Health Management and Policy, Faculty of Health Sciences,

American University of Beirut, Lebanon. fe08@aub.edu.lb
Limited evidence exists on whether government owned-and-funded hospital

accreditation system brings long-lasting impact in terms of continuous quality
improvement to patient care. Literature shows that hospitals might adopt
opportunistic behaviors solely with the aim of gaining accreditation particularly
when governments link the quality improvement objective of accreditation with
payment mechanisms. Literature also suggests that there is true value in creating
an independent, not-for-profit national commission dedicated to improve quality
of care. In 2002, the Lebanese Ministry of Public Health with the assistance of an
Australian consultant team developed and implemented a new hospital
accreditation policy. Since its implementation, little information is known on
whether this policy has the potential to bring long-lasting quality improvement to
patient care. By synthesizing literature, and reviewing other countries'
accreditation experiences, this paper will identify barriers and derive observations
and lessons for health policy makers and hospital leaders in Lebanon to consider
for their ongoing efforts to further improve the hospital accreditation policy and
its implementation. Also, it will provide valuable lessons for other countries in the
East Mediterranean region which have implemented accreditation process or are
in the process of doing so.
Publication Types:
• Review
290: Mil Med. 2007 Apr;172(4):431-5.

Effect of a computerized online grading system on patient

satisfaction in a military primary health care setting.
Levy G, Goldstein L, Barenboim E, Bar-Dayan Y.
Surgeon General Headquarters, Israel Air Force, Tel-Hashomer, Israel.
Patient satisfaction is gaining recognition as an important determinant of the

quality of medical care. We conducted an analysis to evaluate the effect of a
computerized online system that comparatively displays grades of patient
satisfaction among primary care military infirmaries. Fifteen Israel Air Force
primary care infirmaries served as the intervention group, and 130 Israel Defense
Force infirmaries were the control group. Baseline patient satisfaction was
surveyed in all infirmaries. In the intervention group only, infirmaries were
resurveyed at 3-month intervals during a 1-year period. Satisfaction scores were
continuously displayed on an intranet site in a comparative graphical manner by
using the computerized system, available only to the intervention group. At the
endpoint, patient satisfaction improved in both groups. However, the magnitude
of improvement in the intervention group was significantly greater, in comparison
with the control group. The most pronounced improvement was noted in
availability of service (intervention group, 57.9% at baseline vs. 66.0% at
endpoint, p < 0.001; control group, 67.5% vs. 69.6%, p < 0.025). We conclude
that the use of this computerized system in conjunction with promotional efforts
resulted in significant improvements in patient satisfaction.
Publication Types:
• Clinical Trial
291: Harefuah. 2007 Apr;146(4):291-6, 316-7.

[Mental health reform in Israel: how to increase the opportunities

and reduce the threats]
[Article in Hebrew]
Elisha D, Grinshpoon A.
Ministry of Health, Israel. david.elisha@moh.health.gov.il
Since the publication in 1990 of the Netanyahu Commission Report on Health

Reform in Israel the issue of Mental Health Reform (MHR) has been discussed
extensively. As steps toward the implementation of the MHR progressed,
concerns were increasingly voiced that it would adversely affect the accessibility,
availability and quality of mental health services. The main source of threat is
attributed to the mechanisms of Managed Behavioral Health Care (MBHC)
expected to be applied by the Health Funds. The authors review recent evaluation
studies of MBHC in the US with a special reference to issues pertaining to
ambulatory treatment of those suffering from mental illness and to outpatient
psychotherapy. The findings reviewed suggest that the key to the success of
MBHC systems is a strategy endeavoring to bring together the professional and
the economic management mechanisms of the service system in a mutually
supporting effort to bring about a paradigmatic change in the organization,
payment methods and evaluation of the services. The authors also refer to recent
studies of outpatient psychotherapy that provide information about trends and
utilization patterns and provide support for its overall effectiveness. The authors
discuss the implications of the findings reviewed to the implementation of the
MHR in Israel.
Publication Types:
• Review
292: Psychiatry Clin Neurosci. 2007 Jun;61(3):243-8.

Quality of Internet information referring to mental health and

mental disorders in Japan.
Nemoto K, Tachikawa H, Sodeyama N, Endo G, Hashimoto K, Mizukami K,

Asada T.
Division of Psychiatry, Tsukuba University Hospital, Tsukuba, Ibaraki, Japan.

kiyotaka@nemotos.net
Although the Internet has been widely used in Japan, the quality of information on
mental health-related issues has not been evaluated so far. The purpose of the
present study was to investigate the current status of Japanese websites that deal
with mental health, mental disorders, and their associated matters. Using a search
engine, Google, 37 websites were identified that exclusively contain information
on mental health or mental disorders. The characteristics of the sites were then
examined, along with variety of mental disorders mentioned, and quality of
contents for each of the 37 websites. More than half of the websites were set up,
at least in part, for commercial purposes and only 27% of sites were owned by
professionals. Mood disorder, panic disorder, and schizophrenia were the three
most commonly referred disorders on websites. Aside from some exceptions, the
quality of information was inadequate, especially that regarding treatment. Most
of the websites on mental health and mental disorders examined in the present
study have scope for improvement. The challenge is to establish a system to
evaluate the sites and to motivate each webmaster to improve the sites.
Publication Types:
293: Drug Saf. 2007;30(5):457-9.

Hospital-based adverse drug reaction bulletin : an Indian
experience.
Jose J, Rao PG, Jimmy B.
Publication Types:
• Letter
294: J Periodontol. 2007 May;78(5):859-67.

Longitudinal study of the association between smoking as a

periodontitis risk and salivary biomarkers related to periodontitis.
Kibayashi M, Tanaka M, Nishida N, Kuboniwa M, Kataoka K, Nagata H,

Nakayama K, Morimoto K, Shizukuishi S.
Department of Preventive Dentistry, Osaka University Graduate School of

Dentistry, Osaka, Japan.
BACKGROUND: Insufficient data exist regarding the long-term influence of

lifestyle factors including smoking on periodontal health. The objective of this
study was to examine the prospective association between smoking and
periodontal disease progression and the effects of smoking on salivary biomarkers
related to periodontitis. METHODS: Probing depth (PD) was measured at health
checkups of workers in 1999 and 2003; additionally, lifestyle information was
obtained through a questionnaire. In 2003, 219 of 256 (86%) workers examined at
baseline completed PD measurements; saliva samples were also collected. Change
in PD was used for assessment of periodontitis progression when three or more
sites displayed an increase of >or=2 mm over 4 years. Salivary biomarker levels
were determined by real-time polymerase chain reaction and enzyme assay.
Statistical methods included bivariate and multivariate regression analyses.
RESULTS: In the multiple logistic model, in which lifestyle-related factors
served as independent variables, significant variables were current smoking and
hours of sleep; respective odds ratios were 2.3 and 2.1. Additionally, 38.5% of
periodontal disease progression was attributable to current smoking. Moreover,
pack-years of smoking showed a dose-response relationship with disease
progression. Levels of salivary markers including prostaglandin E(2), lactoferrin,
albumin, aspartate aminotransferase, lactate dehydrogenase, and alkaline
phosphatase were significantly lower in current smokers than in non-current
smokers. However, no meaningful differences in the proportions of six
periodontal pathogens were observed between current and non-current smokers.
CONCLUSIONS: Smoking exerted the greatest influence on periodontitis risk
among lifestyle factors. Smoking may suppress the host-defense system, which
may promote periodontal disease progression.
Publication Types:
295: Gan To Kagaku Ryoho. 2006 Dec;33 Suppl 2:251-3.

[The actual activity of the Fukuoka Medical Network for the

Seriously Intractable Neurological Diseases]
Iwaki M, Tateishi T, Kikuchi H, Kira J.
The Fukuoka Prefectural Medical Committee for Intractable Disease, Fukuoka

Prefectural Government.
The Fukuoka Prefectural Medical Health Care Network for Seriously Intractable
Neurological Diseases was initiated in 1998 to improve the care of patients for
seriously intractable neurological diseases. The network, now, consists of 15 basic
cooperative hospitals, and 105 general cooperative hospitals. Two medical care
coordinators manage the transfer of network patients based on information of the
patient's condition and the capacity of cooperative hospitals using information
about the number of available beds in cooperative hospitals. A total number of
patients with seriously intractable neurological diseases who were referred to the
network for the last eight years was 277, 163 of whom were amyotrophic lateral
sclerosis (ALS) patients and of which 75 of them were under mechanical
ventilation. Of these 277 patients, 253 were successfully transferred to chronic
care hospitals or referred to regional visiting physicians through the network.
Cooperative and non-cooperative hospitals accepted 157 and 49 patients,
respectively, while 38 were referred to visiting physicians. A number of medical
care consultations has increased year by year, and reached 17,652 in the eighth
year. The main issues for these consultations were to make hospital arrangements
for a patient. Comprehensive long-term care is necessary for Japanese ALS
patients because one-third is under mechanical ventilation. Despite this, it is still
difficult to secure available beds for such patients who require long-term care. In
the future, it will be necessary to improve the support for an environment for
home care and to make the system in which cooperative hospitals support patients
during the home care.
Publication Types:
296: Hypertens Res. 2007 Jan;30(1):55-62.

Changes in the demographics and prevalence of chronic kidney

disease in Okinawa, Japan (1993 to 2003).
Iseki K, Kohagura K, Sakima A, Iseki C, Kinjo K, Ikemiya Y, Takishita S.
Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan.

chihokun@med.u-ryukyu.ac.jp
To compare the risk factor demographics and the prevalence of chronic kidney
disease (CKD), we analyzed two databases from the 1993 (N=143,948) and 2003
(N=154,019) mass screenings in Okinawa, Japan (Okinawa General Health
Maintenance Association registry). We estimated the glomerular filtration rate
(GFR) using serum creatinine (SCr) levels. SCr was measured by the modified
Jaffe method in 1993 and by enzyme assay in 2003; the relation between the two
methods was: SCr (Jaffe) = 0.194 + 1.079 x SCr (enzyme). CKD prevalence was
compared using the estimated GFR calculated by the abbreviated Modification of
Diet in Renal Disease (MDRD) equation. SCr was measured in 66.2% (1993) and
69.8% (2003) of the total screenees. Proteinuria was present in 3.4% (1993) and
4.3% (2003) of the total screened population, respectively. The prevalence of
CKD (GFR<60 ml/min/1.73 m(2)) was similar between the two databases, being
15.7% in 1993 and 15.1% in 2003. However, the demographics of the CKD risk
factors changed during the study period. The mean level of systolic blood
pressure decreased, whereas the prevalence of obesity and the mean levels of
serum cholesterol and fasting plasma glucose increased. In 2003, the estimated
prevalence of metabolic syndrome in the general population of Japan calculated
using the modified National Cholesterol Education Program (NCEP) criteria was
19.1%. The prevalence of CKD was significantly associated with that of
metabolic syndrome: the age- and sex-adjusted odds ratio was 1.332 (95%
confidence interval [CI], 1.277-1.389; p<0.0001). In conclusion, the
demographics of the participants of the general screenings in Okinawa, Japan
differed between the 1993 and 2003 screenings, but the prevalence of CKD
seemed to be similar, or at least did not increase substantially, between the two
databases.
Publication Types:
297: J Ethnopharmacol. 2007 Jun 13;112(2):341-9. Epub 2007 Mar 20.

Traditional medicinal plants of cold desert Ladakh--used in

treatment of cold, cough and fever.
Ballabh B, Chaurasia OP.
Field Research Laboratory, Defence Research and Development Organisation

(DRDO), Leh-Ladakh, Jammu and Kashmir, India. ballabhbb@yahoo.co.in
This research paper presents the findings of an investigation on traditional

remedies of cold, cough and fever among Boto (the Buddhists) tribal community
of Leh-Ladakh region of India. Ladakh is one of the least populated regions of our
country where major population lives in far-flung villages and higher elevations.
Health care of tribal population is mainly dependent on traditional system of
medicine which is popularly known as Amchi system of medicine. The Amchi
system is principally based on Tibetan system of medicine. Fifty-six valuable
species belonging to 21 families were identified with relevant information and
documented in this paper with regard to their botanical name, family, collection
number, local name, parts used and utilization by 'Amchis' (herbal practitioners)
in treatment of cold, cough and fever.
Publication Types:
298: J Gastroenterol Hepatol. 2007 May;22(5):663-8.

The importance of metabolic factors for the increasing prevalence of
fatty liver in Shanghai factory workers.
Fan JG, Li F, Cai XB, Peng YD, Ao QH, Gao Y.
Center for Fatty Liver, Department of Gastroenterology, Shanghai First People's

Hospital, Jiaotong University, Shanghai, China. fanjg@citiz.net
BACKGROUND AND AIM: To evaluate changes in the prevalence rates of

ultrasonographic fatty liver (FL) in a specific population. METHODS: An
analysis of the medical records of BaoSteel Group (Shanghai, China) employees
was done to evaluate the prevalence of FL in this population, in which health
examinations were performed biennially between 1995 and 2002. RESULTS: The
study reviewed a database of 59 131 employees, of which 27.1% received medical
check-ups four times within the study period, 26.6% three times, and 24.0%
twice. The prevalence rates of obesity and metabolic disorders were high at
baseline and increased significantly with time. The prevalence of ultrasonographic
FL increased from 3.87% to 14.04% in the overall population, while there was an
increase from 4.44% to 14.64% in men and 1.56% to 11.37% in women over the
6-year study period. Increased rates of FL were also noted, from 25.88% to
51.39%, among patients with elevated serum alanine aminotransferase (ALT)
levels (> 40 U/L). The highest overall prevalence rates of FL were found in
individuals aged 50-60 years, with all age-associated prevalence significantly
higher in males than females. CONCLUSION: The prevalence of FL increased
rapidly over the study period with increased rates of obesity and metabolic
disorders; FL is becoming a major cause of abnormal ALT levels in the specific
population.
299: Int J Dermatol. 2007 Apr;46(4):362-6.

Risk factors for chickenpox incidence in Taiwan from a large-scale

computerized database.
Wu PY, Li YC, Wu HD.
Graduate Institute of Medical Informatics, Taipei Medical University, Guangyan

Dermatology Clinic, School of Public Health, China Medical University, Taipei,
Taiwan.
OBJECTIVE: We analyzed data from the National Health Insurance Research

(NHIR) database in the year 2000 to estimate the seasonal variation in the
chickenpox rate in Taiwan. PATIENTS AND METHODS: All chickenpox cases
listed in the NHIR database were included (n = 165,719). A Lorenz curve was
plotted and a chi-square test for equal proportions calculated for seasonal
variation. To determine the effects of temperature and season on outcome values,
generalized estimating equation methods were utilized to adjust the effects of
other possible influencing factors and take into account the within-subject
dependence over repeated assessments. RESULTS: All four regions of the
country had highest incidence rates in January, and three of them had lowest rates
in September. Incidence was significantly higher in females aged 15-24 years than
in males. An increment of 1 degrees C resulted in an incidence ratio of
approximately 0.98 or, equivalently, a 10 degrees C increment gives an incidence
ratio of approximately 0.78. CONCLUSION: The results suggest that season and
temperature are significantly related to the incidence of chickenpox. Infectious
diseases can be monitored. Prevention procedures can be taken by understanding
its pattern and activity in order to decide the best policy for vaccination. Further
studies are warranted, particularly for long-term trends, and in other nations with
different seasonal temperatures from Taiwan.
300: Child Care Health Dev. 2007 May;33(3):257-61.

Congenital anomalies in Iran: a cross-sectional study on 1574 cases

in the North-West of country.
Dastgiri S, Imani S, Kalankesh L, Barzegar M, Heidarzadeh M.
Department of Community and Family Medicine, National Public Health

Management Centre (NPMC), Tabriz University of Medical Sciences, Tabriz,
Iran. saeed.dastgiri@gmail.com
BACKGROUND: At least one congenital anomaly is present in between 1% and

6% of all infants throughout the world. The aim of this study was to document
some epidemiological features of congenital anomalies in the North-West of Iran.
METHODS: The study cases (n = 1574) comprised all births registered/notified to
three university-hospitals of Tabriz University of Medical Sciences, Iran, from
2000 to 2004. RESULTS: Total prevalence of congenital anomalies was 165.5 per
10 000 births [95% confidence interval (CI): 157-174]. Genito-urinary tract and
kidney defects, anomalies of nervous system and limb anomalies accounted
proportionally for more than 65% of anomalies in the region. The total prevalence
of congenital anomalies in the study area increased from 104.6 per 10 000 births
in 2000 (95% CI: 90-119) to 170.1 per 10 000 births in 2004 (95% CI: 152-189).
CONCLUSIONS: It is concluded that the data from this cross-sectional study of
congenital anomalies in the North-West of Iran may be used as the baseline
information to establish a population-based registry of birth defects in the area for
health care and research purposes.
Publication Types:
301: MedGenMed. 2007 Jan 18;9(1):12.

Assessing the effectiveness of informational video clips on Iranian

immigrants' attitudes toward and intention to use the BC
HealthGuide Program in the greater Vancouver area.
Poureslami I, Rootman I, Balka E.
Institute of Health Promotion Research, University of British Columbia,

Vancouver, British Columbia, Canada. pouresla@interchange.ubc.ca
BACKGROUND: Consumer-directed health information resources hold great

potential for improving public health and easing the demand on health systems.
Their value, however, depends largely on the ability of their intended users to
access and use them effectively. Little is known about whether British Columbia's
ethnocultural communities are using the British Columbia (BC) Ministry of
Health's BC HealthGuide (BCHG) program, and if so, when and for what
purposes they use the services, as well as level of satisfaction with and users'
perceptions of the resources. This study investigated attitudes toward and
perceptions of the BCHG program, as well as use patterns and satisfaction levels,
within the Iranian community of the Greater Vancouver Area (GVA)--among
BC's largest and fastest-growing Middle Eastern immigrant communities--and
explored a model for introducing the BCHG program to ethnic communities in the
GVA and BC. METHODS: In a 2-stage quasi-experimental design, with a
combination of quantitative and qualitative research methods, data obtained from
structured telephone surveys, in-person interviews, and focus groups involving a
randomly selected sample of the target population were analyzed before and after
intervention with audiovisual health information: a series of culturally relevant
informative video clips developed by direct participation of the community and
aired on local television channels in the fall of 2004. KEY FINDINGS: There was
low awareness and low utilization of the BCHG program among participants at
the beginning of this study. Furthermore, many participants in the initial stage of
this study cautioned that self-care resources in general are unsuited to Iranian
culture, due to widespread distrust of health advice received via telephone or the
Internet, and due to the strong value placed on health advice received directly
from a professional medical doctor. Nonetheless, attitudes, perceptions, and self-
reported utilization rates of the BCHG program improved substantially among the
participants of this study following the screening of culturally appropriate,
targeted promotional videos. Participants almost unanimously reported that
watching the videos had encouraged them to use the BCHG program, and that
they intended to promote the resources to others. In addition, the majority of
participants who had accessed at least one of the BCHG program resources
reported being satisfied with the services that they had received, and improved
utilization rates were maintained at the follow-up focus group stage. At the same
time, participants cautioned that gaining the confidence of the wider Iranian
community in BC and increasing service utilization will require considerable time
and effort. In particular, they suggested using a variety of media and
communication channels, carefully selecting the health messengers, and targeting
messages to specific community subgroups. Conclusions: The findings of this
study strongly suggest that Iranians living in the GVA are open to alternatives to
routine healthcare services, including the use of preventive and self-care
resources. However, awareness levels and utilization rates of the BCHG program
among the GVA's Iranian immigrant population have until now been low. The
noticeable and sustained improvement to attitudes, perceptions, and self-reported
utilization rates of the BCHG program among Iranian participants in this study
after watching culturally appropriate promotional videos indicates the potential to
modify cultural beliefs in regard to the delivery of preventive health information
if the relevant messages are delivered appropriately. By carefully considering the
demographic and cultural characteristics of the various ethnic communities living
in BC, and by targeting promotional activities and services directly to these
individual communities, the BCHG program could improve awareness and
utilization rates within these communities.
PMCID: PMC1924987
302: J Physiol Anthropol. 2007 Mar;26(2):109-12.

Human variation and body mass index: a review of the universality

of BMI cut-offs, gender and urban-rural differences, and secular
changes.
Mascie-Taylor CG, Goto R.

Department of Biological Anthropology, University of Cambridge, UK.
nmt1@cam.ac.uk
Use of BMI as a surrogate for body fat percentage is debatable and universal BMI
cut-off points do not seem appropriate; lower cut-off points than currently
recommended by WHO should be used in some populations, especially in Asia.
The adult WHO BMI database indicates that, on average, women are more obese
than men, while men are more likely to be pre-obese than women. Urban rates of
overweight and obesity are generally higher than rural rates in both sexes. The
trend in pre-obesity and obesity over time is generally upward, with very marked
increases in the USA and UK in both sexes over the last 10 years.
Publication Types:
• Review
303: Int J Environ Res Public Health. 2007 Mar;4(1):45-52.

Remote sensing and GIS techniques for evaluation of groundwater

quality in municipal corporation of Hyderabad (Zone-V), India.
Asadi SS, Vuppala P, Reddy MA.
Centre for Environment, Institute of Science & Technology, Jawaharlal Nehru

Technological University, Hyderabad-500072, A.P, India.
ssvp_envi@yahoo.co.in
Groundwater quality in Hyderabad has special significance and needs great

attention of all concerned since it is the major alternate source of domestic,
industrial and drinking water supply. The present study monitors the ground water
quality, relates it to the land use / land cover and maps such quality using Remote
sensing and GIS techniques for a part of Hyderabad metropolis. Thematic maps
for the study are prepared by visual interpretation of SOI toposheets and linearly
enhanced fused data of IRS-ID PAN and LISS-III imagery on 1:50,000 scale
using AutoCAD and ARC/INFO software. Physico-chemical analysis data of the
groundwater samples collected at predetermined locations forms the attribute
database for the study, based on which, spatial distribution maps of major water
quality parameters are prepared using curve fitting method in Arc View GIS
software. Water Quality Index (WQI) was then calculated to find the suitability of
water for drinking purpose. The overall view of the water quality index of the
present study area revealed that most of the study area with >50 standard rating of
water quality index exhibited poor, very poor and unfit water quality except in
places like Banjara Hills, Erragadda and Tolichowki. Appropriate methods for
improving the water quality in affected areas have been suggested.
Publication Types:
304: BMC Infect Dis. 2007 Apr 11;7:26.

Geographic prediction of tuberculosis clusters in Fukuoka, Japan,

using the space-time scan statistic.
Onozuka D, Hagihara A.
Department of Information Science, Fukuoka Institute of Health and

Environmental Sciences, 39 Mukaizano, Dazaifu, Fukuoka 818-0135, Japan.
onozuka@fihes.pref.fukuoka.jp
BACKGROUND: Tuberculosis (TB) has reemerged as a global public health

epidemic in recent years. Although evaluating local disease clusters leads to
effective prevention and control of TB, there are few, if any, spatiotemporal
comparisons for epidemic diseases. METHODS: TB cases among residents in
Fukuoka Prefecture between 1999 and 2004 (n = 9,119) were geocoded at the
census tract level (n = 109) based on residence at the time of diagnosis. The
spatial and space-time scan statistics were then used to identify clusters of census
tracts with elevated proportions of TB cases. RESULTS: In the purely spatial
analyses, the most likely clusters were in the Chikuho coal mining area (in 1999,
2002, 2003, 2004), the Kita-Kyushu industrial area (in 2000), and the Fukuoka
urban area (in 2001). In the space-time analysis, the most likely cluster was the
Kita-Kyushu industrial area (in 2000). The north part of Fukuoka Prefecture was
the most likely to have a cluster with a significantly high occurrence of TB.
CONCLUSION: The spatial and space-time scan statistics are effective ways of
describing circular disease clusters. Since, in reality, infectious diseases might
form other cluster types, the effectiveness of the method may be limited under
actual practice. The sophistication of the analytical methodology, however, is a
topic for future study.
PMCID: PMC1853096
305: J Prev Med Pub Health. 2007 Mar;40(2):122-9.
[Ethical considerations in genomic cohort study]
[Article in Korean]
Choi EK, Kim OJ.
Department of History of Medicine and Medical Humanities, College of

Medicine, Seoul National University, Korea.
During the last decade, genomic cohort study has been developed in many
countries by linking health data and genetic data in stored samples. Genomic
cohort study is expected to find key genetic components that contribute to
common diseases, thereby promising great advance in genome medicine. While
many countries endeavor to build biobank systems, biobank-based genome
research has raised important ethical concerns including genetic privacy,
confidentiality, discrimination, and informed consent. Informed consent for
biobank poses an important question: whether true informed consent is possible in
population-based genomic cohort research where the nature of future studies is
unforeseeable when consent is obtained. Due to the sensitive character of genetic
information, protecting privacy and keeping confidentiality become important
topics. To minimize ethical problems and achieve scientific goals to its maximum
degree, each country strives to build population-based genomic cohort research
project, by organizing public consultation, trying public and expert consensus in
research, and providing safeguards to protect privacy and confidentiality.
Publication Types:
306: Crit Care Med. 2007 May;35(5):1312-7.

Comment in:
• Crit Care Med. 2007 May;35(5):1429.

Healthcare climate: a framework for measuring and improving
patient safety.
Zohar D, Livne Y, Tenne-Gazit O, Admi H, Donchin Y.
Faculty of Management, Technion Institute of Technology, Haifa, Israel.

dzohar@tx.technion.ac.il
OBJECTIVES: Reviews of patient safety efforts suggest that

technical/administrative change must be augmented by global factors such as
organizational culture and climate. The objective was to outline a comprehensive
model for healthcare climate and test one of its elements, the nursing subclimate,
in terms of several patient safety outcomes. DESIGN: Measure organizational
climate in nursing units, followed by random sampling of patient safety practices
in each unit 6 months later. SETTING: Sixty-nine inpatient units in three
hospitals that make up the entire tertiary care system in one metropolitan area.
SUBJECTS: A total of 955 nurses. INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: A two-part Nursing Climate Scale
referring to hospital- and unit-level climates, followed by five randomly timed
observations of patient safety practices covering routine and emergency care in
each unit. Climate scales met the criteria of internal reliability, within-unit
agreement, and between-unit variability, using standard statistics of climate
research. Both the hospital and unit nursing climates exhibited significant
variation, which predicted the routine medication safety scores (Z = 2.65 and 2.93
accordingly, p < .01), with similar results for emergency safety scores. A
significant interaction (Z = 2.78, p < .01) indicated that best/worst safety is
obtained when the unit and hospital climates are aligned (for better or worse) and
that positive unit climate can compensate for the detrimental effect of poor
hospital climate. Furthermore, climate's strength increased its predictive power
with regard to patient safety practices (Z = 3.64 for medication and 2.28 for
emergency safety; p < .01). The small number of participating hospitals limits
organization-level analyses. CONCLUSIONS: The nursing climate identifies
units where the likelihood of adverse events is greater or lower than the hospital's
average. Such information can guide prevention efforts in selected units. These
data encourage the development of additional climate subscales subsumed under
the healthcare climate model (e.g., physicians subclimate).
Publication Types:

307: AIDS. 2007 Apr;21 Suppl 2:S99-102.
Role of the data safety and monitoring board in an international

trial.
NIMH Collaborative HIV/STD Prevention Trial.
OBJECTIVE: To describe the composition and role of the data safety and
monitoring board (DSMB) for the National Institute of Mental Health (NIMH)
Collaborative HIV/STD Prevention Trial. DESIGN: NIMH appointed to the
DSMB nine members representing the following areas of expertise: prevention
science, ethnography, infectious diseases (especially HIV and sexually
transmitted diseases), laboratory diagnostics, clinical practice, methodology,
international trial experience, statistics, and ethics. METHODS: The DSMB
assessed the overall study for any concern about plans or implementation and
reviewed cumulative study data to evaluate the safety of study participants, the
ongoing conduct of the study, and the scientific validity and integrity of the Trial.
Because of the Trial's international scope, the DSMB examined the effects of
cultural differences on study implementation and fidelity. RESULTS: Among the
DSMB recommendations that strengthened the Trial was one to conduct initial
epidemiological studies of the venues selected for the intervention to verify risk
and to establish intraclass correlation coefficients that could be used to calculate
appropriate sample sizes. CONCLUSIONS: The DSMB played a critical role in
this Trial. Because members have the expertise required to monitor the Trial, are
not involved in the daily management of the Trial, and can review interim
analyses and adverse event reports, they are in an excellent position to provide
expert advice to ensure that the Trial's goals are achieved and that NIH funds are
well invested.
308: AIDS. 2007 Apr;21 Suppl 2:S91-8.

Formative study conducted in five countries to adapt the community

popular opinion leader intervention.
NIMH Collaborative HIV/STD Prevention Trial Group.
OBJECTIVE: To obtain information about the social and cultural factors related
to health behaviors influencing HIV/sexually transmitted disease (STD)
transmission in study communities in China, India, Peru, Russia, and Zimbabwe
so that the assessment and intervention of the National Institute for Mental Health
(NIMH) Collaborative HIV/STD Prevention Trial could be adapted appropriately.
METHODS: Field observations, focus groups, in-depth interviews with key
informants, and an observation of community social dynamics were conducted as
part of a rapid ethnographic assessment. RESULTS: All five sites reported a
power dynamic tilted towards men, which rendered women particularly
vulnerable to HIV and other STDs. Women's relative lack of power was
exemplified by a double standard for extramarital sex, women's limited ability to
negotiate sex or condom use, and sexual and physical violence against women. In
all sites except Russia, extramarital sex is tolerated for men but proscribed for
women. In Peru, power dynamics between men who have sex with men were
tilted towards men who self-identified as heterosexual. Condom use (reported to
be low across all sites) was often linked to having sex with only those perceived
as high-risk partners. Regardless of site or study population, participants agreed
on the following characteristics of an ideal community popular opinion leader (C-
POL): respectable, credible, experienced (life and sexual), trustworthy,
empathetic, well-spoken, and self-confident. CONCLUSION: The ethnographic
studies provided critical information that enabled the study teams to adapt
elements of the Trial in culturally appropriate ways in diverse international
settings.
309: AIDS. 2007 Apr;21 Suppl 2:S81-90.

Sexually transmitted disease and HIV prevalence and risk factors in

concentrated and generalized HIV epidemic settings.
BACKGROUND: In many developing countries, the threat of nascent HIV

epidemics expanding rapidly requires immediate and appropriate HIV prevention
activities. Inexpensive and sustainable interventions are especially relevant in
resource-constrained environments. In 2001, we assessed the prevalence and
behavioral risk of sexually transmitted disease (STD) and HIV among at-risk
populations in five developing countries in preparation for a community-
randomized controlled trial, the NIMH Collaborative HIV/STD Prevention Trial.
METHODS: Using a standardized protocol, more than 1000 participants in each
country (China, India, Peru, Russia, and Zimbabwe) were selected by random
sampling methods, completed a behavioral risk assessment, and provided
biological specimens using a common laboratory protocol. Sample characteristics
were studied within each country, and risk factors for HIV/STD acquisition were
evaluated using logistic regression models. RESULTS: HIV rates were low (<1%)
in China, India, Peru, and Russia but were high (26%) in rural Zimbabwe. STDs
were generally twice as common in women as men, and serological evidence of
herpes simplex virus type 2 infection was the most frequently detected STD.
Behavioral data showed high rates of multiple partners in the Russian sample, and
very low condom use rates in India and China. Among participants who reported
ever having sex, female sex and having two or more sex partners were the factors
most frequently associated with an increased risk of prevalent STD.
CONCLUSION: Behavioral or biological risks were of sufficient magnitude in
the locations selected in China, Russia, and Zimbabwe to implement the
community-based randomized trial. Higher-risk subsets of community residents in
India and Peru were identified before beginning the Trial.
310: AIDS. 2007 Apr;21 Suppl 2:S69-80.

Ethical issues in the NIMH Collaborative HIV/STD Prevention

Trial.
OBJECTIVE: To develop decision rules regarding key ethical dimensions in

scientific protocols for the National Institute for Mental Health (NIMH)
Collaborative HIV/STD Prevention Trial taking place in five countries (China,
India, Peru, Russia, and Zimbabwe). DESIGN: Countries had HIV rates from 27
to 0.1%, the standard of care varied from access to antiretroviral drugs to no
availability, and the reporting of sexually transmitted diseases (STD) to
government agencies was mandatory in some countries and not in others. These
variations presented challenges when developing decision rules that could be
uniformly adopted across countries and simultaneously follow the ethical
principles of beneficence, respect, and justice. METHODS: We used several
strategies to identify and resolve ethical dilemmas for this international HIV
prevention trial. First, we identified key principles, especially those derived for
clinical therapeutic, biomedical preventive, or device trials. We convened a
'workgroup on protecting human participants' and charged them with identifying
and implementing optimal procedures for ensuring the ethical and equitable
treatment of participants and making recommendations to minimize physical,
psychological, and social harm to the participants. Each site had a community
advisory board, essential in identifying local ethical issues and possible
resolutions to them. The NIMH established a data safety and monitoring board
with ultimate responsibility for adjudicating ethical dilemmas and decisions. The
protocols were deliberated thoroughly by the Trial steering committee, and
approved by nine United States and five in-country institutional review boards.
RESULTS: We summarize the decision rules adopted to resolve the ethical
dilemmas identified. Especially important were the translation of clinical trials
principles for a behavioral intervention trial, strategies for ensuring confidentiality
and informed consent, dilemmas relating to partner notification of sexually
transmitted infections including HIV, minimizing the risks of social harm,
establishing community partnerships, ensuring equity among United States and
in-country principal investigators, and building capacity for additional research.
CONCLUSION: We document our processes and decisions, and their underlying
rationales, and hope they contribute to the development of further thinking and
practice regarding the ethics of social and behavioral HIV and STD prevention
trials in resource-poor settings.
311: AIDS. 2007 Apr;21 Suppl 2:S59-68.

The community popular opinion leader HIV prevention

programme: conceptual basis and intervention procedures.
OBJECTIVE: To describe the community popular opinion leader (C-POL)

intervention employed in the NIMH Collaborative HIV/STD Prevention Trial,
including its theoretical, conceptual, and empirical basis, intervention procedures
and methods, core elements, and how its content was culturally tailored to address
the needs of varied populations. DESIGN: The programme is designed to identify,
recruit, train, and intensively engage C-POLs of a target population to convey
HIV risk reduction messages to people in their communities, with the intention of
reducing high-risk behavior at a population level. METHODS: Based on the
diffusion of innovation theory, the intervention identified, trained, and engaged C-
POL within a high-risk community population to advocate, recommend, and
endorse the importance of safer behavior to other members of the same
population. Nine core elements of the intervention are discussed. Data collected
during rapid ethnography were used to adapt the content of the intervention for
food market owners and workers in China, male patrons of wine shops and at-risk
women congregating nearby in India, young people in social gathering venues in
Peruvian barrios, dormitory students in Russia, and people congregating in
commercial areas of growth points in Zimbabwe. RESULTS: The C-POL
intervention model taps into community strengths, altruism, and people's desire to
do something to help fight against AIDS. With few exceptions, C-POLs
participated enthusiastically in the training sessions and reported having
conversations in the community. CONCLUSION: Rapid ethnography can be used
to tailor an intervention to diverse settings while maintaining fidelity to the core
elements of the intervention.

312: AIDS. 2007 Apr;21 Suppl 2:S49-58.
The feasibility of audio computer-assisted self-interviewing in

international settings.
OBJECTIVE: To determine the feasibility of using audio computer-assisted self-

interviewing (ACASI) for data collection in developing countries, and to compare
responses to questions eliciting sensitive information about sexual behavior using
ACASI versus computer-assisted personal interviewing (CAPI) in five developing
countries. DESIGN: A feasibility study determined whether ACASI could be used
in populations in developing countries. A follow-up, randomized crossover study
compared responses to questions eliciting sensitive information about sexual
behavior using ACASI versus CAPI. METHODS: The NIMH Collaborative
HIV/STD Prevention Trial conducted a feasibility study of ACASI in
convenience samples in China, India, Peru, and Russia, then a randomized
crossover ACASI versus CAPI study among volunteers in these countries plus
Zimbabwe. RESULTS: Approximately equal numbers of men and women
completed the feasibility study; the results suggested a high comfort level among
participants. Married respondents in China and India appeared to give unreliable
responses on sexual activity. In the crossover study, the pattern of responses to
sensitive questions showed few differences. In China, higher rates of sexual risk
were reported on CAPI. In Peru and Russia, differences by mode were found in
the number of partners in the past year. CONCLUSION: Despite variable
computer experience and literacy, feasibility study participants reported ease in
completing ACASI, and preferred a computer to an interviewer for answering
sensitive questions, or had no preference. In the crossover study, most participants
gave similar responses on both modes of survey administration. ACASI appears
to be feasible in these settings, although low literacy may pose problems if
participants cannot clarify questions.
313: AIDS. 2007 Apr;21 Suppl 2:S37-48.

Design and integration of ethnography within an international

behavior change HIV/sexually transmitted disease prevention trial.
OBJECTIVE: To use a common ethnographic study protocol across five countries

to provide data to confirm social and risk settings and risk behaviors, develop the
assessment instruments, tailor the intervention, design a process evaluation of the
intervention, and design an understandable informed consent process. DESIGN:
Methods determined best for capturing the core data elements were selected.
Standards for data collection methods were established to enable comparable
implementation of the ethnographic study across the five countries. METHODS:
The methods selected were participant observation, focus groups, open-ended
interviews, and social mapping. Standards included adhering to core data
elements, number of participants, mode of data collection, type of data collection
instrument, number of data collectors at each type of activity, duration of each
type of activity, and type of informed consent administered. Sites had discretion
in selecting which methods to use to obtain specific data. RESULTS: The
ethnographic studies provided input to the Trial's methods for data collection,
described social groups in the target communities, depicted sexual practices, and
determined core opinion leader characteristics; thus providing information that
drove the adaptation of the intervention and facilitated the selection of venues,
behavioral outcomes, and community popular opinion leaders (C-POLs).
CONCLUSION: The described rapid ethnographic approach worked well across
the five countries, where findings allowed local adaptation of the intervention.
When introducing the C-POL intervention in new areas, local non-governmental
and governmental community and health workers can use this rapid ethnographic
approach to identify the communities, social groups, messages, and C-POLs best
suited for local implementation.
314: AIDS. 2007 Apr;21 Suppl 2:S3-18.

Methodological overview of a five-country community-level

HIV/sexually transmitted disease prevention trial.
OBJECTIVE: To provide an overview of the National Institute of Mental Health

(NIMH) Collaborative HIV/STD Prevention Trial taking place in five populations
at risk of HIV and sexually transmitted diseases in China, India, Peru, Russia, and
Zimbabwe, including the rationale, study management, methods, and proposed
data analyses. DESIGN: The Trial will scientifically evaluate the effectiveness of
the community popular opinion leader (C-POL) community-level HIV prevention
intervention that was adapted for use in the various cultures within the resource
limitations faced by service providers in world regions threatened by high rates of
HIV infection. METHODS: The study phases consist of an ethnographic study,
pilot studies, an epidemiological study, and a community-randomized trial. The
Trial uses the C-POL intervention, which researchers selected on the basis of
research that shows the intervention's success in populations vulnerable to HIV
risk behavior in the United States, and has the potential to be applied in a variety
of international settings. RESULTS: Trial results will be tabulated by and across
country by randomization assignment. Results will include a careful review of
data to substantiate original assumptions used in the study design. Data collection
will not conclude until August 2007. CONCLUSION: Although data collection is
incomplete, researchers have learned lessons throughout the development of the
study. These include the importance of preliminary epidemiological studies; the
close monitoring of biological testing, follow-up rates and process measures at
international sites; the tailoring of assessments and interventions to various
cultures; regular communication; and a review of the timeline to accommodate
Institutional Review Board clearances.
315: AIDS. 2007 Apr;21 Suppl 2:S29-36.

Challenges and processes of selecting outcome measures for the

OBJECTIVE: To review the challenges of designing behavioral and biological

outcome measures for the multinational NIMH Collaborative HIV/STD
Prevention Trial and provide the rationale for selecting these measures. DESIGN:
Although many different evidence-based prevention programmes have been
developed, few have been evaluated in different countries, cultures, and
populations. One issue in evaluating the generalized efficacy of any prevention
approach is to identify a set of common outcome measures useful across diverse
settings and peoples. The Trial is designed to evaluate whether the community
popular opinion leader intervention can be adapted cross-nationally and cross-
culturally for different populations and still retain its efficacy. METHODS:
Literature reviews, investigator experience, ethnographic study, pilot studies, and
epidemiological studies were used to select the endpoints for the Trial. RESULTS
AND CONCLUSION: Both biological and behavioral data will be obtained at
baseline and 12 and 24 months post-baseline. Communities that receive the
intervention will be compared with matched control communities on two primary
outcomes: (i) a change in self-reported unprotected sexual acts with non-spousal,
non-live-in partners; and (ii) the incidence of sexually transmitted disease (STD),
defined as a composite index of viral and bacterial STD.
316: AIDS. 2007 Apr;21 Suppl 2:S19-28.

Selection of populations represented in the NIMH Collaborative

HIV/STD Prevention Trial.
OBJECTIVE: To identify venues with vulnerable populations suitable for testing

the community popular opinion leader intervention in each of the five countries
(China, India, Peru, Russia, and Zimbabwe) participating in the National Institute
of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial. DESIGN:
HIV epidemiology and vulnerable populations differ considerably across the
countries. Therefore, different community populations were targeted in the five
countries. METHODS: Venues and populations were chosen on the basis of
specific selection criteria (investigated during the Trial's ethnographic research
phase): the willingness of stakeholders and gatekeepers of the venues to
cooperate; geographical boundaries defining each venue; population stability
within venues; the independence of venues and non-overlap of population
members across multiple venues; population size within each venue; social
interaction opportunities; and either a high level of sexual risk behavior or a high
prevalence of sexually transmitted diseases (STDs) or HIV. RESULTS: Venues
and populations selected were food market stall owners and workers in China,
male patrons of wine shops and at-risk women congregating near the shops in
India, young men and women in social gathering points in neighborhoods in Peru,
trade and vocational school dormitory residents in Russia, and people
congregating in growth points in Zimbabwe. CONCLUSION: Although the target
populations differed across countries, they shared in common high behavioral or
biological risk at baseline and suitability for a randomized trial of a community-
level HIV/STD prevention behavioral intervention.
317: Am J Public Health. 2007 Apr;97 Suppl 1:S146-51. Epub 2007 Apr 5.
Tsunami mortality estimates and vulnerability mapping in Aceh,

Indonesia.
Doocy S, Gorokhovich Y, Burnham G, Balk D, Robinson C.
Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg
School of Public Health, Baltimore, Md 21205, USA. sdoocy@jhsph.edu
OBJECTIVES: We aimed to quantify tsunami mortality and compare approaches

to mortality assessment in the emergency context in Aceh, Indonesia, where the
impact of the 2004 tsunami was greatest. METHODS: Mortality was estimated
using geographic information systems-based vulnerability models and
demographic methods from surveys of tsunami-displaced populations. RESULTS:
Tsunami mortality in Aceh as estimated by demographic models was 131066 and
was similar to official figures of 128063; however, it was a conservative estimate
of actual mortality and is substantially less than official estimates of 168561
presumed dead, which included those classified as missing. Tsunami impact was
greatest in the district of Aceh Jaya, where an estimated 27.0% (n=23862) of the
population perished; Aceh Besar and Banda Aceh were also severely affected,
with mortality at 21.0% (n = 61 650) and 11.5% (n = 25 903), respectively.
Mortality was estimated at 23.7% for the population at risk and 5.6% overall.
CONCLUSIONS: Mortality estimates were derived using methodologies that can
be applied in future disasters when predisaster demographic data are not available.
Models could be useful in the early stages of disaster response by facilitating
geographic targeting and management of humanitarian assistance.
PMCID: PMC1854998 [Available on 04/01/09]
318: Eur J Public Health. 2007 Dec;17(6):593-9. Epub 2007 Apr 2.

Estimating mortality and causes of death in Turkey: methods,

results and policy implications.
Akgün S, Rao C, Yardim N, Basara BB, Aydin O, Mollahaliloglu S, Lopez

AD.
Baskent University School of Medicine, Ankara, Turkey.
BACKGROUND: Cause-specific mortality statistics are primary evidence for

health policy formulation, programme evaluation, and epidemiological research.
In Turkey, a partially functioning vital registration system in urban areas yields
fragmentary evidence on levels and causes of mortality. This article discusses the
application of innovative methods to develop national mortality estimates in
Turkey, and their implications for national health development policies.
METHODS: Child mortality levels from the Demography and Health Survey
(DHS) were applied to model life tables to estimate age-specific death rates.
Reported causes of death from urban areas were adjusted using re-distribution
algorithms from the Global Burden of Disease (GBD) Study. Rural cause
structure was estimated from epidemiological models. Local epidemiological data
was used to adjust model-based estimates. RESULTS: Life expectancy at birth in
2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10
years lower than in Western Europe. Leading causes of death include major
vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths,
chronic obstructive lung disease and lung cancer in men, but also perinatal causes,
lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of
deaths, although this may be an underestimate. CONCLUSIONS: Mortality
estimates are uncertain in Turkey, given the poor quality of death registration
systems. Application of burden of disease methods suggests that there has been
progress along the epidemiological transition. Key health development strategies
for Turkey include improved access to communicable disease control
technologies, and urgent attention to the development of a reliable, nationally
representative health information system.
Publication Types:

319: Comput Methods Programs Biomed. 2007 May;86(2):191-6. Epub 2007 Apr 2.
Scientific production of electronic health record research, 1991-

2005.
Wen HC, Ho YS, Jian WS, Li HC, Hsu YH.
School of Health Care Administration, Taipei Medical University, Taipei,

Taiwan.
PURPOSE: The increasing numbers of publications on electronic health record

(EHR) indicate its increasing importance in the world. This study attempted to
quantify the scientific production of EHR research articles, and how they have
changed over time, in an effort to investigate changes in the trends cited in these
critical evaluations. METHOD: The articles were based on the science citation
index (SCI) from 1991 to 2005. A descriptive study was performed using the
1803 documents published in the SCI from 39 countries in America, Europe,
Africa, Asia, and Oceania. The evaluation was based on parameters including
document type, language, first author's country of origin, number of citations and
citations per publication. RESULTS: Of all publications, 1455 (80.7%) were
articles, followed by meeting abstracts which represented about one-tenth of all
types of EHR publications. Numbers of published articles have significantly
increased when compared by each 5-year period. Most articles were published in
English (98%) and were from the region of America (57%). The top 10 of the 374
journals accounted for 41% of the number of published articles. The US
dominates publication production (57%) with a cumulative impact factor (IF) of
2227 and followed by the UK (8.5%, with a cumulative IF of 257.0) and the
Netherlands (7.8%, with a cumulative IF of 211.1). An analysis of the number of
articles related to population revealed a high publication output for relative small
countries like Switzerland, the Netherlands, and Norway. CONCLUSIONS:
Research production in EHR showed a considerable increase during 1991-2005.
The production was dominated by articles, those from the US, and those
published in English. The production came from many countries, denoting the
devotion to this field in different areas around the world.
320: J Vasc Access. 2007 Jan-Mar;8(1):21-7.

Increased use of catheters as vascular access: is it justified by

patients' clinical conditions?
Di Benedetto A, Basci A, Cesare S, Marcelli D, Ponce P, Richards N.
NephroCare-Italy, Naples, Italy. attilio.dibenedetto@fmc-ag.com
BACKGROUND: Over the last years many technical improvements have been
made in hemodialysis treatment. Vascular access (VA) still remains an important
problem. Although the use of indwelling vascular catheters is discouraged, in
Europe there is an increasing use of them. The K/DOQI Guidelines recommend a
native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there
is considerable geographic variation in the distribution of type of VA used
amongst hemodialysis patients. The aim of this study was to evaluate the time
patients in four European countries have to wait before undergoing their first
surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD
clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics
network between October 1, 2002 and September 30, 2004 were considered. Data
were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients
(males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy
and Portugal had a higher proportion of elderly patients. At time of admission, the
proportion of patients starting dialysis with AVF ranged between 23% and 60%
from Turkey to Italy respectively. Patients with an indwelling catheter at
admission are expected to undergo VA surgery as soon as possible. After 3
months of follow-up, about 75% of all patients had undergone surgery, however
in the UK less than 50% of the patients had had a VA procedure. Overall, males
have significantly higher probability of undergoing surgery, whilst elderly
patients have a lower probability (27% and 14% respectively). CONCLUSION:
Significant differences exist between countries in the time interval from referral to
creation of VA. Health care system related problems seem to be the major reason
to explain such differences. Patients in the UK have longer waiting times than the
other countries studied.
Publication Types:
321: IEEE Trans Inf Technol Biomed. 2007 Mar;11(2):141-52.

SAKURA-viewer: intelligent order history viewer based on two-

viewpoint architecture.
Toyoda S, Niki N, Nishitani H.
Department of Health Service, International University of Health and Welfare,

Tochigi 324-8501, Japan. toyoda@jobu.ac.jp
We propose a new intelligent order history viewer applied to consolidating and

visualizing data. SAKURA-viewer is a highly effective tool, as: 1) it visualizes
both the semantic viewpoint and the temporal viewpoint of patient records
simultaneously; 2) it promotes awareness of contextual information among the
daily data; and 3) it implements patient-centric data entry methods. This viewer
contributes to decrease the user's workload in an order entry system. This viewer
is now incorporated into an order entry system being run on an experimental
basis. We describe the evaluation of this system using results of a user satisfaction
survey, analysis of information consolidation within the database, and analysis of
the frequency of use of data entry methods.
322: Malar J. 2007 Mar 27;6:37.

Large-scale malaria survey in Cambodia: novel insights on species

distribution and risk factors.
Incardona S, Vong S, Chiv L, Lim P, Nhem S, Sem R, Khim N, Doung S,

Mercereau-Puijalon O, Fandeur T.
Laboratory of Molecular Epidemiology, Institut Pasteur du Cambodge, Phnom
Penh, Cambodia. sandra.incardona@yahoo.fr <sandra.incardona@yahoo.fr>
BACKGROUND: In Cambodia, estimates of the malaria burden rely on a public

health information system that does not record cases occurring among remote
populations, neither malaria cases treated in the private sector nor asymptomatic
carriers. A global estimate of the current malaria situation and associated risk
factors is, therefore, still lacking. METHODS: A large cross-sectional survey was
carried out in three areas of multidrug resistant malaria in Cambodia, enrolling
11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence,
parasite densities and spatial distribution of infection were determined to identify
parasitological profiles and the associated risk factors useful for improving
malaria control programmes in the country. RESULTS: Malaria prevalence was
3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas.
Prevalences and Plasmodium species were heterogeneously distributed, with
higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable
fevers accounted only for 10-33% of malaria cases, and 23-33% of parasite
carriers were febrile. Multivariate multilevel regression analysis identified adults
and males, mostly involved in forest activities, as high risk groups in
Sampovloun, with additional risks for children in forest-fringe villages in the
other areas along with an increased risk with distance from health facilities.
CONCLUSION: These observations point to a more complex malaria situation
than suspected from official reports. A large asymptomatic reservoir was
observed. The rates of P. vivax infections were higher than recorded in several
areas. In remote areas, malaria prevalence was high. This indicates that additional
health facilities should be implemented in areas at higher risk, such as remote
rural and forested parts of the country, which are not adequately served by health
services. Precise malaria risk mapping all over the country is needed to assess the
extensive geographical heterogeneity of malaria endemicity and risk populations,
so that current malaria control measures can be reinforced accordingly.
PMCID: PMC1847522
323: J Urban Health. 2007 May;84(3 Suppl):i98-108.

The design of housing and shelter programs: the social and

environmental determinants of inequalities.
Sheuya S, Howden-Chapman P, Patel S.
University College of Lands and Architectural Studies, Dar es Salaam, Tanzania.

sheuya@yahoo.com
Both developed and less developed countries are becoming increasingly

urbanized. The earlier industrialized countries have developed more infrastructure
to support the building of healthy housing, in neighborhoods that are strongly
linked to municipal and global health initiatives, but to some degree housing and
neighborhood issues vary only in degree between the developing and developed
worlds. Overall, a billion people, a third of people living in urban areas, live in
slums, where environmental determinants lead to disease. Although
communicable diseases predominate in the developing world and have reemerged
in the developed world, noncommunicable diseases are also growing
disproportionately in the developing world. At a global level, the Millennium
Development Goals explicitly focus on an integrated approach to slum upgrading.
The per capita cost of slum upgrading is almost twice the cost of providing new
affordable housing at the outset. It is argued that to improve health and well-being
in the slums we need to have interventions that reduce urban poverty in the
broadest sense and improve the deficiencies associated with slums. There is an
urgent need to scale up the best-practice interventions. Examples are given of
successful local community initiatives that have been set up under national
strategies in Tanzania and by Indian women's collectives that are globally linked
and have helped develop housing and sanitation improvements. The unit costs for
such interventions are within the reach of all the key stakeholders. Global
commitment is the only missing link.
Publication Types:
PMCID: PMC1891646
324: Nagoya J Med Sci. 2007 Jan;69(1-2):61-70.

Avoidable mortality measured by years of potential life lost (YPLL)

aged 5 before 65 years in Kyrgyzstan, 1989-2003.
Bozgunchievz M, Ito K.
Young Leaders' Program, Nagoya University Graduate School of Medicine,

Nagoya 466-8550, Japan. taramcar@mail.ru
There is considerable willingness in the entire medical society of Kyrgyzstan,

which was directly involved in the reform process, to obtain reliable information
about changes in population health that have occurred in the last decade, as well
as about changes in mortality, which is the basic component of population health.
The objective of this paper is to introduce the Year of Potential Life Lost (YPLL)
in Kyrgyzstan caused by avoidable mortality in the population between 5 and 65
years of age during 1989-2003, and to provide a basis for setting the priorities for
the reducing YPLL in the coming years. YPLL was calculated using data from the
annual mortality tables according to causes of deaths and age for 1989, 1996,
1999 and 2003. YPLL is defined as the summation of the difference between 65
years of age and the age at death from the age of 5 and before 65. In 2003, the
total number of YPLL due to avoidable mortality among those who died was
216,860, which represents a decline of 5.0% in comparison with 228,266 in 1989.
During the study years, the largest proportion of YPLL in the population between
5 and 65 years of age resulted from injury and poisoning. In 2003, this proportion
represented 41.5% of the total amount of YPLL due to all the causes studied here,
followed by infections and parasitic diseases (12.0%), circulatory disturbance of
the brain (11.5%), chronic liver diseases and cirrhosis (11.4%), diseases of the
respiratory system (9.2%), and malignant neoplasm of the upper airways and
digestive tract (4.6%). The decline in avoidable mortality caused by injury and
poisoning, infections disease, malignant neoplasm of the female breast and uterus
has to be priority-driven direction for developing Health Policy in the coming
years in Kyrgyzstan. Attention also has to be given to reducing of avoidable
mortality caused by malignant neoplasm of the female breast by implementing
screening programs.
325: Environ Manage. 2007 May;39(5):737-48. Epub 2007 Mar 20.

Multinational, freshwater biomonitoring programs in the developing

world: lessons learned from African and Southeast Asian river
surveys.
Resh VH.
Department of Environmental Science, Policy & Management, University of

California, 137 Mulford Hall, Berkeley, CA 94720-3114, USA.
vresh@nature.berkeley.edu
Biomonitoring programs are widely used in developed countries. They also offer
many advantages in assessing ecological consequences of perturbations in
developing countries, including reducing the equipment-operation, maintenance,
and training costs associated with physicochemical monitoring. Three case
histories of river biomonitoring using freshwater organisms (fish, benthic
macroinvertebrates, diatoms, zooplankton) are described that involve (1)
documentation of environmental effects from long-term, large-scale applications
of insecticides to control insect-vectors of river blindness (onchocerciasis) in 11
West African countries; (2) water quality assessments and restoration planning in
and around national parks in three East African countries; and (3) evaluation of
overall ecological health of the Lower Mekong River in four Southeast Asian
countries. As in developed countries, benthic macroinvertebrates are the
organisms most widely used in biomonitoring in developing countries.
Conflicting opinions of system resilience and whether expected changes are
within natural variation may result in differences in underlying hypotheses
proposed, study designs implemented, and study execution; each may lead to
uncorrectable bias. Direct transfers of approaches used from developed to
developing countries are often appropriate; however, techniques dependent on
pollution-tolerance values are often region specific and not transferable. Typically
expressed concerns about applications of biomonitoring in developing countries
include poor coordination among agencies; lack of legislation, identification keys,
and trained personnel; and incomplete information on how tropical rivers
function. Problems are real but solvable, as evident from accomplishments in
several multicountry programs in developing countries. Developed countries
requiring coordinated monitoring of international rivers may benefit from
examining successful programs under way in developing countries.
Publication Types:
326: Comput Med Imaging Graph. 2007 Jun-Jul;31(4-5):285-98. Epub 2007 Mar 21.
Computer aided detection of small acute intracranial hemorrhage

on computer tomography of brain.
Chan T.
Department of Health Technology and Informatics, The Hong Kong Polytechnic

University, Hong Kong SAR, China. tao.chan@polyu.edu.hk
INTRODUCTION: Detection of acute intracranial hemorrhage (AIH) is a primary

task in image interpretation of computer tomography (CT) of brain for patients
suffering from acute neurological disturbance or head injury. Although CT readily
depicts AIH, interpretation can be difficult especially when the lesion is
inconspicuous or the reader is inexperienced. OBJECTIVE: To develop a
computer aided detection system that improves diagnostic accuracy of small AIH
on brain CT. MATERIALS AND METHODS: Intracranial contents are first
segmented by thresholding and morphological operations, which are then
subjected to denoising and adjustment for CT cupping artifacts. The brain is then
automatically realigned into normal position. AIH candidates are extracted based
on top-hat transformation and left-right asymmetry. AIH candidates are registered
against a normalized coordinate system such that the candidates are rendered
anatomical information. True AIH is differentiated from mimicking normal
variants or artifacts by a knowledge-based classification system incorporating
rules that make use of quantified imaging features and anatomical information. A
total of 186 clinical cases, including 62 CT studies showing small (<1cm) AIH,
and 124 controls, were retrospectively collected. Forty positive cases and 80
controls were used for the training of the CAD. Twenty-two positive cases and 44
controls were used in the validation of the CAD system. Regions of AIH
identified by two experienced radiologists were used as gold standard. The size of
individual AIH volume was also recorded. RESULTS: On a per patient basis, the
system achieved sensitivity of 95% (38/40) and specificity of 88.8% (71/80) in
the training dataset. The sensitivity and specificity were 100% (22/22) and 84.1%
(37/44) respectively for the diagnosis of AIH in the validation cases. Individual
cases contained variable number of AIH volumes. There were 77 lesions in the 40
training cases and 46 lesions in the 22 validation cases. On a per lesion basis, the
sensitivities were 84.4% (65/77) and 82.6% (38/46) for all lesions 10mm or
smaller for the training and validation datasets, respectively. False positive rates
were 0.19 (23/120) and 0.29 (19/66) false positive lesion per case for the training
and validation datasets, respectively. CONCLUSION: This study demonstrated
that CAD is valuable for detection of small AIH on brain CT.
327: Vaccine. 2007 May 10;25(19):3827-33. Epub 2007 Feb 12.

Who gets hospitalized for influenza pneumonia in Thailand?

Implications for vaccine policy.
Katz MA, Tharmaphornpilas P, Chantra S, Dowell SF, Uyeki T, Lindstrom

S, Balish A, Peret TC, Chittaganpitch M, Simmerman JM, Olsen SJ.
Epidemic Intelligence Service, Office of Workforce and Career Development,

Atlanta, GA 30333, United States. makatz@cdc.gov
Risk factor information for severe complications of interpandemic influenza is

needed to inform vaccine policy in Thailand. We identified patients with lab-
confirmed influenza who were hospitalized with pneumonia during September
2003 to August 2004. Among the 80 case-patients identified through a
population-based pneumonia surveillance system in eastern Thailand, cases were
6.2 and 11.1 times more likely to be among persons<1 year old and >75 years old,
respectively, compared with the overall population. Cases were also 7.6 times
more likely to have chronic respiratory disease. In Thailand, the young, elderly,
and those with chronic disease were at high risk for hospitalized pneumonia from
influenza.
328: AIDS Care. 2007;19 Suppl 1:S44-53.

Expanding community through ARV provision in Thailand.
Lyttleton C, Beesey A, Sitthikriengkrai M.
Department of Anthropology, Macquarie University, Sydney, Australia.

Chris.Lyttleton@mq.edu.au
Anti-retrovirals (ARVs) have altered the complexion of HIV/AIDS management

in Thailand. In 2005, ARVs were included within a subsidised health scheme
making provision widespread. Increased access has been brought about through
the legal and political advocacy of the Thai Network for People Living with
HIV/AIDS (TNP+) who now play a central role in expanded ARV provision.
HIV-infected volunteers help the state deliver comprehensive services and assist
with follow-up and adherence programs. Alongside improvements in drug
provision, a focus on pharmaceutical treatment has left other issues, such as
community support of orphans and the social responses to living with HIV, less
central within community responses. As they take on new responsibilities, people
living with HIV/AIDS (PLHA) groups move from activities focused on reversing
local stigma to constitute a new social movement that is increasingly prominent in
Thai civil society. Networks of PLHA confront new social and political
challenges as they also seek to broaden access to marginalised groups who remain
excluded from these services. Many ethnic minority groups without full Thai
citizenship have been denied access to subsidised health services including ARVs.
As part of a broadening advocacy profile, the PLHA movement is now engaging
in a politics of difference defined not simply by presence or absence of HIV but
also by wider issues of national identity and belonging.
Publication Types:
329: East Mediterr Health J. 2006;12 Suppl 2:S253-7.

Handsearching the EMHJ for reports of randomized controlled

trials by U.K. Cochrane Centre (Bahrain).
Al Hajeri A, Al Sayyad J, Eisinga A.
Bahrain Branch of U.K. Cochrane Centre, The Cochrane Collaboration, Bahrain.

(Correspondence to A. Al alhajeriamani@gmail.com
This study used handsearching to find reports of randomized controlled trials in

the Eastern Mediterranean Health Journal (EMHJ). EMBASE and MEDLINE
were also searched electronically to identify if the reports found by the
handsearch were already included in either of these databases. Nine reports were
identified: 7 randomized controlled trials and 2 controlled clinical trials. The
added value of the handsearch over EMBASE was 6 additional reports and over
MEDLINE was 4. Reports identified were sent to the UK Cochrane Centre for
verification and publication in The Cochrane Central Register of Controlled Trials
(CENTRAL).
Publication Types:
330: Phys Rev Lett. 2007 Jan 12;98(2):024102. Epub 2007 Jan 11.
Data synchronization in a network of coupled phase oscillators.
Miyano T, Tsutsui T.
Department of Micro System Technology, Ritsumeikan University 1-1-1, Noji-

higashi, Kusatsu, Shiga 525-8577, Japan. tmiyano@se.ritsumei.ac.jp
We devised a new method of data mining for a large-scale database. In the

method, a network of locally coupled phase oscillators subject to Kuramoto's
model substitutes for given multivariate data to generate major features through
phase locking of the oscillators, i.e., phase transition of the data set. We applied
the method to the national database of care needs certification for the Japanese
public long-term care insurance program, and found three major patterns in the
aging process of the frail elderly. This work revealed the latent utility of
Kuramoto's model for data processing.
Publication Types:
331: MCN Am J Matern Child Nurs. 2007 Mar-Apr;32(2):81-6; quiz 87-8.

Requesting perinatal autopsy: multicultural considerations.
Chichester M.
Christiana Care Health System, Newark, DE, USA.

mchichester@christianacare.org
The subject of perinatal autopsy is not frequently seen in the literature. Perinatal
loss, particularly stillbirth, frequently remains unexplained, despite current
technology and diagnostic procedures. Parents may automatically refuse an
autopsy, despite the potentially valuable information it could provide about the
current pregnancy and subsequent pregnancies and despite the possible comfort
the results could provide for relatives. Other reasons for declining an autopsy
could be cultural or religious prohibitions. In addition, healthcare providers
sometimes lack the knowledge of circumstances under which a postmortem
examination is permitted, and fail to use culturally sensitive and culturally
competent discussions about the reasons a postmortem examination is important
and permissible. This purpose of this article is to provide information on selected
cultural and religious groups to assist the nurse who is seeking consent for a
perinatal autopsy.
Publication Types:
• Review

332: Isr Med Assoc J. 2007 Feb;9(2):90-3.
Differences between soldiers, with and without emotional distress, in

number of primary care medical visits and type of presenting
complaints.
Heymann AD, Shilo Y, Tirosh A, Valinsky L, Vinker S.
Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.

heymann_t@mac.org.il
BACKGROUND: In 2003 a total of 43 soldiers in the Israel Defense Forces

committed suicide; only 20% of them were known to the IDF mental health
services. Somatic symptoms are often the only presentation of emotional distress
during the primary care visit and may be the key to early identification and
treatment. OBJECTIVES: To examine whether the information in the medical
records of soldiers can be used to identify those suffering from anxiety, affective
or somatoform disorder. METHODS: We conducted a case-control study using
the information in the electronic medical records of soldiers who during their 3
year service developed affective disorder, anxiety, or somatoform disorder. A
control group was matched for recruitment date, type of unit and occupation in the
service, and the Performance Prediction Score. The number and reasons for
physician visits were collated. RESULTS: The files of 285 soldiers were
examined: 155 cases and 130 controls. The numbers of visits (mean +/- SD)
during the 3 and 6 month periods in the case and control groups were 4.7 +/- 3.3
and 7.1 +/- 5.0, and 4.1 +/- 2.9 and 5.9 +/- 4.6 respectively. The difference was
statistically significant only for the 6 month period (P < 0.05). The variables that
remained significant, after stepwise multivariate regression were the Performance
Prediction Score and the presenting complaints of back pain and diarrhea.
CONCLUSIONS: These findings may spur the development of a computer-
generated warning for the primary care physician who will then be able to
interview his or her patient appropriately and identify mental distress earlier.
333: Mod Healthc. 2007 Feb 26;37(9):30.

IT goes global. Learning from what works and what doesn't--

around the world.
Lieber S.
Healthcare Information and Management Systems Society, Chicago, USA.
334: Comput Biol Med. 2007 Oct;37(10):1414-25. Epub 2007 Mar 7.

An integrated approach to breast diseases and breast cancer registry

and research: BDRS as a web-based multi-institutional model.
Koçgil OD, Baykal N.
Middle East Technical University, Informatics Institute, Ankara, Turkey.

oyadk@ii.metu.edu.tr
Accurate, complete, and timely health data sources are essential for progress in
health care. Registry and research systems are foundations for conducting clinical
and epidemiological research. Developing countries lack these systems due to the
scarcity of the resources allocated for health information systems. In this study,
we provide an integrated model for Turkey in order to optimize the utilization of
resources. The Breast Diseases Registry system (BDRS) is implemented as an
integrated disease-specific system for breast diseases in order to obtain a
comprehensive use of patient health data for research and Breast Cancer Registry
as well as an ancillary clinical tool.
Publication Types:
335: Nippon Hoshasen Gijutsu Gakkai Zasshi. 2007 Jan 20;63(1):97-105.

[Survey of the current state of order-entry systems in the nuclear

medicine field]
Hara N, Onoguchi M, Takayama T, Honda M.
Department of Health Sciences, Graduate School of Medical Science, Kanazawa

University.
BACKGROUND AND OBJECTIVES: In the "Grand Design for
Computerization of the Medical Field" of December, 2001, the Ministry of
Health, Labour and Welfare set a numerical target for the adoption of electronic
medical charts nationwide in at least 60% hospitals with 400 or more beds.
Therefore, the introduction and operation of an order-entry system, which is
necessary for establishing electronic medical charts, became essential for each of
these medical facilities. We surveyed the current state of order-entry systems for
nuclear medicine, which are considered difficult to introduce owing to the
particulars of their operation, and herewith report the results. METHODS:
Questionnaires with a request for cooperation were sent by mail to 119 facilities
nationwide that are engaged in nuclear medicine. The questionnaire surveyed 21
items, including operational status and restrictions of the order-entry system.
RESULTS: The absolutely essential restriction settings for the introduction and
operation of an order-entry system were not being used, and the scheduling of
tests was being conducted on the basis of human judgment. CONCLUSION: The
development of an order-entry system that includes standardization of basic
specifications (restrictions) according to the content and work are necessary for
nuclear scans, for which the introduction and operation of an order-entry system
can cause concern owing to the particulars of operation in the field of radiation.
Publication Types:
336: N Z Med J. 2007 Mar 2;120(1250):U2445.

Comment in:
• N Z Med J. 2007;120(1250):U2443.
Assessing Māori/non-Māori differences in cardiovascular disease

risk and risk management in routine primary care practice using
web-based clinical decision support: (PREDICT CVD-2).
Riddell T, Jackson RT, Wells S, Broad J, Bannink L.
Section of Epidemiology and Biostatistics, School of Population Health,

University of Auckland, Auckland. t.riddell@auckland.ac.nz
AIM: To describe the cardiovascular disease risk factor status and risk
management of Māori compared with non-Māori patients opportunistically
assessed in routine practice using PREDICT-CVD, an electronic clinical decision
support programme. METHODS: In August 2002, a primary healthcare
organisation, ProCare, implemented PREDICT-CVD as an opportunistic
cardiovascular risk assessment and management programme. Between 2002 and
February 2006, over 20,000 cardiovascular risk assessments were undertaken on
Māori and non-Māori patients. Odds ratios and mean differences in
cardiovascular risk factors and risk management for Māori compared to non-
Māori (European and other, Pacific, Indian, and other Asian) patients were
calculated. RESULTS: Baseline risk assessments were completed for 1450 (7%)
Māori patients and 19, 164 (93%) non-Māori patients. On average, Māori were
risk assessed 3 years younger than non-Māori. Māori patients were three times
more likely to be smokers, had higher blood pressure and TC/HDL levels, and
twice the prevalence of diabetes and history of cardiovascular disease as non-
Māori. Among patients with a personal history of cardiovascular disease, Māori
were more likely than non-Māori to receive anticoagulants, blood pressure-
lowering and lipid-lowering medications. However, of those patients with a
history of ischaemic heart disease, Māori were only half as likely as non-Māori to
have had a revascularisation procedure. CONCLUSION: An electronic decision
support programme can be used to systematically generate cardiovascular disease
risk burden and risk management data for Māori and non-Māori populations in
routine clinical practice in real-time. Moreover, the PREDICT-CVD programme
has established one of the largest cohorts of Māori and non-Māori ever assembled
in New Zealand. Initial findings suggest that Māori are more likely than non-
Māori to receive drug-based cardiovascular risk management if they have a
personal history of cardiovascular disease. In contrast, among the subgroup of
patients with a history of ischaemic heart disease, Māori appear to receive
significantly fewer revascularisations than non-Māori.
Publication Types:
337: Genetics. 2007 May;176(1):351-9. Epub 2007 Mar 4.

Genetic similarities within and between human populations.
Witherspoon DJ, Wooding S, Rogers AR, Marchani EE, Watkins WS, Batzer
MA, Jorde LB.
Department of Human Genetics, University of Utah Health Sciences Center, Salt
Lake City, Utah 84112, USA.
The proportion of human genetic variation due to differences between populations

is modest, and individuals from different populations can be genetically more
similar than individuals from the same population. Yet sufficient genetic data can
permit accurate classification of individuals into populations. Both findings can
be obtained from the same data set, using the same number of polymorphic loci.
This article explains why. Our analysis focuses on the frequency, omega, with
which a pair of random individuals from two different populations is genetically
more similar than a pair of individuals randomly selected from any single
population. We compare omega to the error rates of several classification
methods, using data sets that vary in number of loci, average allele frequency,
populations sampled, and polymorphism ascertainment strategy. We demonstrate
that classification methods achieve higher discriminatory power than omega
because of their use of aggregate properties of populations. The number of loci
analyzed is the most critical variable: with 100 polymorphisms, accurate
classification is possible, but omega remains sizable, even when using populations
as distinct as sub-Saharan Africans and Europeans. Phenotypes controlled by a
dozen or fewer loci can therefore be expected to show substantial overlap between
human populations. This provides empirical justification for caution when using
population labels in biomedical settings, with broad implications for personalized
medicine, pharmacogenetics, and the meaning of race.
Publication Types:
• Research Support, N.I.H., Intramural
PMCID: PMC1893020
338: Prev Med. 2007 Dec;45(6):424-31. Epub 2007 Feb 9.

Physical activity levels of children in special schools.
Sit CH, McManus A, McKenzie TL, Lian J.

The University of Hong Kong, Institute of Human Performance, Pokfulam, Hong
Kong. sithp@hku.hk
OBJECTIVE: Children's physical activity (PA) has been studied extensively, but
little information is available on those with disabilities. We sought to examine the
PA of children with disabilities during physical education (PE) and recess while
simultaneously documenting environmental conditions. METHOD: Five schools
designed for students with four types of special needs (physical disability, mild
intellectual disability, hearing impairment, and visual impairment) participated.
We used the System for Observing Fitness Instruction Time (SOFIT) to code the
PA of children in grades 4 to 6 during both PE and recess and to document
teacher behavior and lesson context in PE. Observations were conducted during 2
school days over a 2-week period. RESULTS: Children accrued little moderate-
to-vigorous physical activity (MVPA) during PE (7.8 min) and recess (8.9 min).
Activity levels varied across disability types, with differences attributed to lesson
context and teacher behavior. Children with physical disabilities were the least
active during both PE and recess. CONCLUSIONS: Children with disabilities
accrue little PA at school. Increased PE frequency and lesson intensity, more PA
opportunities during non-structured school time, and collaborations with home
and community agencies are needed to reach PA recommendations.
Publication Types:
339: BMC Health Serv Res. 2007 Mar 3;7:37.

Urban health insurance reform and coverage in China using data

from National Health Services Surveys in 1998 and 2003.
Xu L, Wang Y, Collins CD, Tang S.
Centre of Health Statistics and Information, Ministry of Health, 1 Xizhimen

Nanlu, Beijing, The People's Republic of China. xuling@moh.gov.cn
<xuling@moh.gov.cn>
BACKGROUND: In 1997 there was a major reform of the government run urban
health insurance system in China. The principal aims of the reform were to widen
coverage of health insurance for the urban employed and contain medical costs.
Following this reform there has been a transition from the dual system of the
Government Insurance Scheme (GIS) and Labour Insurance Scheme (LIS) to the
new Urban Employee Basic Health Insurance Scheme (BHIS). METHODS: This
paper uses data from the National Health Services Surveys of 1998 and 2003 to
examine the impact of the reform on population coverage. Particular attention is
paid to coverage in terms of gender, age, employment status, and income levels.
Following a description of the data between the two years, the paper will discuss
the relationship between the insurance reform and the growing inequities in
population coverage. RESULTS: An examination of the data reveals a number of
key points: a) The overall coverage of the newly established scheme has
decreased from 1998 to 2003. b) The proportion of the urban population without
any type of health insurance arrangement remained almost the same between
1998 and 2003 in spite of the aim of the 1997 reform to increase the population
coverage. c) Higher levels of participation in mainstream insurance schemes (i.e.
GIS-LIS and BHIS) were identified among older age groups, males and high
income groups. In some cases, the inequities in the system are increasing. d)
There has been an increase in coverage of the urban population by non-
mainstream health insurance schemes, including non-commercial and commercial
ones. The paper discusses three important issues in relation to urban insurance
coverage: institutional diversity in the forms of insurance, labour force policy and
the non-mainstream forms of commercial and non-commercial forms of
insurance. CONCLUSION: The paper concludes that the huge economic
development and expansion has not resulted in a reduced disparity in health
insurance coverage, and that limited cross-group subsidy and regional inequality
is possible. Unless effective measures are taken, vulnerable groups such as
women, low income groups, employees based on short-term contracts and rural-
urban migrant workers may well be left out of sharing the social and economic
development.
Publication Types:
PMCID: PMC1828155
340: Southeast Asian J Trop Med Public Health. 2006 Sep;37(5):1034-9.

Clinical severity and financial burden among road traffic injury

patients in Kunming, China.
Jianping Z, Chongsuvivatwong V, Geater A.
Department of Social Medicine, Faculty of Public Health, Kunming Medical

College, Yunnan, People's Republic of China.
This study aimed to describe the severity of injury (RTI), length of stay, costs,
financial burden, and sources of payment for RTI patients in the Kunming area,
Yunnan Province, China. Information was collected from interviewing 420
patients admitted with RTI during January to May 2005 and from medical records
reviewed of all the patients admitted from January to 30 May 2005. The costs and
financial burden of road casualties on the medical sector resources were found to
be large (median = RMB 94,496) compared to the average per capita monthly
income of the Yunnan population (RMB 798). Most patients had injuries of
moderate severity. Pedestrians and passengers had the highest Injury Severity
Score (ISS). The mean payments out-of-pocket, from the government and by
compensation were RMB 5320, 10,190 and 11,190, respectively. In addition to
prevention of RTI, a suitable insurance system is needed in the country.
Publication Types:
341: Am J Respir Crit Care Med. 2007 May 15;175(10):1086-93. Epub 2007 Mar 1.
Comment in:
• Am J Respir Crit Care Med. 2007 Dec 15;176(12):1289; author reply

1289-90.
A worldwide perspective of atypical pathogens in community-

acquired pneumonia.
Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, Blasi
F, Fernandez P, File TM Jr, Rello J, Menendez R, Marzoratti L, Luna CM,
Ramirez JA; Community-Acquired Pneumonia Organization (CAPO)
Investigators.
Division of Infectious Diseases, University of Louisville, Louisville, KY 40292,

USA. f.arnold@louisville.edu
RATIONALE: Controversy still exists in the international literature regarding the

need to use antimicrobials covering atypical pathogens when initially treating
hospitalized patients with community-acquired pneumonia (CAP). In different
regions of the world, monotherapy with a beta-lactam antimicrobial is common.
OBJECTIVES: We sought to correlate the incidence of CAP due to atypical
pathogens in different regions of the world with the proportion of patients treated
with an atypical regimen in those same regions. In addition, we sought to compare
clinical outcomes of patients with CAP treated with and without atypical
coverage. METHODS: A secondary analysis was performed using two
comprehensive international databases. World regions were defined as North
America (I), Europe (II), Latin America (III), and Asia and Africa (IV). Time to
reach clinical stability, length of hospital stay, and mortality were compared
between patients treated with and without atypical coverage. MEASUREMENTS
AND MAIN RESULTS: The incidence of CAP due to atypical pathogens from
4,337 patients was 22, 28, 21, and 20% in regions I-IV, respectively. The
proportion of patients treated with atypical coverage from 2,208 patients was 91,
74, 53, and 10% in regions I-IV, respectively. Patients treated with atypical
coverage had decreased time to clinical stability (3.7 vs. 3.2 d, p < 0.001),
decreased length of stay (7.1 vs. 6.1 d, p < 0.01), decreased total mortality (11.1
vs. 7%, p < 0.01), and decreased CAP-related mortality (6.4 vs. 3.8%, p = 0.05).
CONCLUSIONS: The significant global presence of atypical pathogens and the
better outcomes associated with antimicrobial regimens with atypical coverage
support empiric therapy for all hospitalized patients with CAP with a regimen that
covers atypical pathogens.
342: Yakugaku Zasshi. 2007 Mar;127(3):515-26.

Study on variations in price of prescription medicines in Thailand.
Burapadaja S, Kawasaki N, Kittipongpatana O, Ogata F.
Faculty of Pharmacy, Chiang Mai University, Thailand.
There are evidences describing that the prices of prescription medicines can affect
users, suppliers, and, in particular, payers in the health care system. Despite the
significant effects of prices, the information regarding their characteristics is
scarce. The objective of this study was to examine the prices and price variations
of prescription medicines in an actual setting. A cross-sectional study on the
prices of prescription medicines listed in a hospital formulary was undertaken.
The medicines (n=1531) listed in the formulary were recorded according to the
category of the medicine (essential or non-essential medicines), manufacturer
types (local or foreign), dosage forms, therapeutic classifications (classes), and
prices per unit in Baht. This study used coefficients of relative variations (CRVs)
to determine the extent of price variations. Results revealed that the mean prices
of non-essential and foreign medicines were significantly greater than those of its
counterparts by 1.7 and 21.2 times, respectively. On an average, the classes with
the highest prices were blood-related, antineoplastic, and endocrinological agents,
while those with the lowest prices were the psychotherapeutic, CNS, and
cardiovascular agents. The majority of the medicines (37%) were in the price
range of >10-100 Baht. The price variations of different classes of medicines
varied from about 100% to 600%. The mean price and CRV levels (low and high)
formed four groups of medicines with different risks of high prices and variations
to payers. In conclusion, the prices are associated with the category and
manufacturer type. The prices and their variations could be used to distinguish the
classes of medicines that possess different risks of high prices and variations to
payers. Identifying the classes with high prices and high variations, high prices
and low variations, and low prices and high variations is necessary for careful
intervention to reduce the effect of prices and their variations on payers.
Publication Types:
343: Cancer Treat Rev. 2007 Nov;33(7):631-45. Epub 2007 Feb 27.
International patterns of cancer incidence in adolescents.
Stiller CA.
Childhood Cancer Research Group, Department of Paediatrics, University of

Oxford, 57 Woodstock Road, Oxford OX2 6HJ, UK.
charles.stiller@ccrg.ox.ac.uk
International patterns of childhood cancer incidence are well documented but

equivalent information relating to adolescence is scarce. This article synthesizes
international data on cancer in adolescents from population based cancer
registries. Total incidence ranged from 95 to 255 per million person years in the
series studied. The highest rates were in Australia and among Jews in Israel and
the lowest in India and Japan. Lymphomas were the most frequent cancers in
western industrialised countries of the northern hemisphere and in the Middle
East, and occurred in substantial numbers in all other regions. Hodgkin lymphoma
outnumbered non-Hodgkin in western industrialised countries but was relatively
rare in most developing countries and in Japan. Leukaemias were the most
frequent diagnostic group in India, East Asia and Latin America. Melanoma was
the commonest cancer of adolescents in Australia and New Zealand and
moderately frequent in many other predominantly white populations but rarely
seen elsewhere. Kaposi sarcoma was the most frequent cancer in both sub-
Saharan African series studied. The highest rates for nasopharyngeal carcinoma
were in Algeria and Hong Kong and for liver carcinoma in Hong Kong and sub-
Saharan Africa. Testicular germ cell tumours were relatively frequent in
predominantly white populations. Central nervous system tumours and thyroid
carcinoma were most often registered in countries with higher standard of living.
Osteosarcoma was moderately frequent almost everywhere. Characteristic
embryonal tumours of childhood and the most common carcinomas of adulthood
were rarely seen. Only osteosarcoma, ovarian germ cell tumours and, in some
populations, nasopharyngeal carcinoma have their highest incidence at age 15-19
years. Total cancer incidence was higher in adolescent males than females, but
there was often a female excess in melanoma and thyroid carcinoma, and
Hodgkin lymphoma was at least as frequent among females as males in several
countries with relatively high incidence. More complete delineation of worldwide
patterns of cancer in adolescence would be facilitated by availability of more data
classified in a standard way to take account of morphology.
Publication Types:
344: Sex Transm Dis. 2007 Aug;34(8):592-7.

Relationship between syphilis and HIV infections among men who

have sex with men in Beijing, China.
Ruan Y, Li D, Li X, Qian HZ, Shi W, Zhang X, Yang Z, Zhang X, Wang C,

Liu Y, Yu M, Xiao D, Hao C, Xing H, Hong K, Shao Y.
State Key Laboratory for Infectious Disease Prevention and Control, and National
Center for AIDS/STD Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing, China.
BACKGROUND: Little is known about risk of HIV and other STDs among men
who have sex with men (MSM) in China. OBJECTIVE: To survey the prevalence
and risk factors of HIV and syphilis and evaluate correlation of two infections
among MSM in the Chinese capital city. METHODS: A community-based
sample of 526 MSM was recruited in 2005 through Internet advertising,
community outreach, and peer referring. Interviewer-administered interviews
were conducted to collect information on demographics and sexual and other risk
behaviors, and blood samples were collected to test for syphilis and HIV
infections. RESULTS: Seventeen (3.2%) participants were HIV seropositive and
59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants
who did not have Beijing residence. Forty percent had >10 lifetime male sex
partners and 28.8% reported having ever had sex with women. Consistent condom
use with primary male sex partners ranged from 21% to 24%, with nonprimary
male sex partners from 35% to 42%, and with female partners around 33%. Illicit
drug use was not common; only 2.5% reported using Ecstasy or ketamine in the
past 6 months. Multivariate logistic regression analyses demonstrated that >10
lifetime male sex partners were independently associated with seropositivity of
both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In
addition, HIV infection is significantly associated with syphilis seropositivity
(OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS: High mobility, multiple sexual
partners, and high prevalence of unprotected sex behaviors and syphilis infection
suggest a potential rapid spread of HIV in Chinese MSM.
Publication Types:

345: J Interv Card Electrophysiol. 2006 Dec;17(3):211-4. Epub 2007 Feb 24.
The world survey of cardiac pacing and cardioverter-defibrillators:

lessons learnt.
Mond HG.
Department of Epidemiology and Preventive Medicine, Monash University,

Victoria, Australia. hmond@bigpond.net.au
A world-wide survey of cardiac pacing and implantable cardioverter-defibrillator

(ICD) practices is held each 4 years. For the most recent survey held in 2001, 50
countries, 22 from Europe, 16 from the Asia Pacific region, 9 from the Americas
and 3 from the Middle East and Africa participated. This was the first survey,
where all countries completed a similar format allowing comparisons between
countries. The European contribution came from the expanding European
pacemaker registry. For countries outside Europe, the survey was based on a
questionnaire completed by selected coordinators and conducted predominantly
from hospital implants. In some large implanting countries such as the United
States of America (USA) and Australia, the surveys were conducted using the
sales figures of pacemaker and ICD companies. The major criticism of this
method is the limited clinical information obtained. An alternative system would
be an ongoing pacemaker and ICD registry in each country similar to the
European model, which in the USA would be an expensive and logistical
nightmare to organise and administer. With smaller implanting countries, the
current system of a dedicated coordinator to conduct the hospital survey works
well although there is still much recruiting work to do in Central America, the
Middle East, Africa and to a lesser extent, South America.
Publication Types:
• Review
346: Comput Methods Programs Biomed. 2007 Apr;86(1):73-86. Epub 2007 Feb 22.
MedicoPort: a medical search engine for all.
Can AB, Baykal N.
METU Informatics Institute, Inönü Bulvari, 06531 Ankara, Turkey.

aysu@ii.metu.edu.tr
We present a new next generation domain search engine called MedicoPort.

MedicoPort is a medical search engine designed for the users with no medical
expertise. It is enhanced with the domain knowledge obtained from Unified
Medical Language System (UMLS) to increase the effectiveness of the searches.
The power of the system is based on the ability to understand the semantics of
web pages and the user queries. MedicoPort transforms a keyword search into a
conceptual search. Through our system we present a topical web crawling
technique and indexing techniques empowered by the semantics information.
MedicoPort aims to generate maximum output with semantic value using
minimum input from the user. Since MedicoPort is designed to help people
seeking information about health on the web, our target users are not medical
specialists who can effectively use the special jargon of medicine and access
medical databases. Medical experts have the advantage of shrinking the answer
set by expressing several terms using medical terminology. MedicoPort provides
the same advantage to its users through the automated use of the medical domain
knowledge in the background. The results of our experiments indicate that,
expanding the queries with domain knowledge, such as using the synonyms and
partially or contextually relevant terms from UMLS, increase dramatically the
relevance of an answer set produced by MedicoPort and the number of retrieved
web pages that are relevant to the user request.
Publication Types:
347: BMC Health Serv Res. 2007 Feb 23;7:26.

Use frequency of traditional Chinese medicine in Taiwan.
Chen FP, Chen TJ, Kung YY, Chen YC, Chou LF, Chen FJ, Hwang SJ.
Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei 112
Taiwan. fpchen@vghtpe.gov.tw <fpchen@vghtpe.gov.tw>
BACKGROUND: Use of Traditional Chinese medicine (TCM), an important

category of complementary and alternative medicine (CAM), has increased
substantially in Western countries during the past decade. Use of TCM is also
widespread in the Chinese population. However, few informative data have been
obtained to date by large-scale investigations of TCM use in the Chinese
population. This study was aimed at elucidating the demographics and patterns of
TCM use in Taiwan. METHODS: We employed the complete datasets of TCM
outpatient reimbursement claims from 1996 to 2001, including the use of Chinese
herbal remedies, acupuncture and traumatology manipulative therapy, to analyse
use frequencies, the characteristics of TCM users, and the disease categories that
were treated by TCM in Taiwan. RESULTS: At the end of 2001, 6,142,829
(28.4%) among the 21,653,555 valid beneficiaries of the National Health
Insurance in Taiwan had used TCM during the year. However, 13,536,266
subjects (62.5%) had used TCM at least once during the whole 6-year period from
1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The
mean number of TCM users per annum was 5,733,602, with a mean increment of
1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher
than male (female:male = 1.13:1), and the age distribution displayed a peak at
around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%)
were the most common TCM modality used by this population, followed by
acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private
TCM clinics provided most of the TCM care (82.6%), followed by private TCM
hospitals (12.0%). The top ten major disease categories for TCM visits were
diseases of the respiratory system, musculoskeletal system and connective tissue;
symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the
digestive system, genitourinary system, skin and subcutaneous tissue, nervous
system and sense organs, circulatory and endocrine system; nutritional and
metabolic diseases; and immunological disorders. CONCLUSION: TCM was
popular among the Chinese population in Taiwan during the period studied. More
than 60% of all subjects had used TCM during the 6-year interval. TCM was
widely used by the Chinese population to treat problems and diseases of major
human organ systems recognised by western medicine. This study provides
information about the use frequencies of TCM and the disease categories treated
by TCM, which should be useful for health policy makers and for those
considering the integration of TCM and Western medicine.
Publication Types:
PMCID: PMC1810531
348: Public Health Nurs. 2007 Mar-Apr;24(2):101-10.

Child-rearing anxiety and its correlates among Japanese mothers

screened at 18-month infant health checkups.
Arimoto A, Murashima S.
Department of Community Health Nursing, Graduate School of Medicine, The

University of Tokyo, Tokyo, Japan. azusay-tky@umin.ac.jp
OBJECTIVE: To examine the level of child-rearing anxiety and to explore the

variables correlated with child-rearing anxiety in a city in Japan. DESIGN: Cross-
sectional study. SAMPLE: From July to September 2003, 371 mothers who
visited community health centers in a city in Tokyo Metropolis for their child's
18-month health checkups. MEASUREMENTS: Child-rearing anxiety was
measured by the child-rearing anxiety scale. Questions in a self-reported
questionnaire were on maternal variables, including maternal background
information, child variables, and family system variables such as the presence of
social support, and utilization of parenting support services. Also included within
the questionnaire was the General Health Questionnaire-12. RESULTS:
Hierarchical multiple linear regression analysis revealed that mothers with higher
child-rearing anxiety had less childcare satisfaction, more depressive symptoms,
more worries about the child, less support from the husband, and less social
support. CONCLUSION: To identify mothers with high child-rearing anxiety in
Japan, the infant health checkups should be utilized as an opportunity for
screening, focusing on variables regarding mothers. Public health nurses can
provide the necessary support after gaining an understanding of issues confronting
mothers to prevent child-rearing anxiety and child abuse.
Publication Types:
349: Public Health. 2007 Apr;121(4):287-95. Epub 2007 Feb 21.

The effect of unusual social experience on the global health of North

Korean asylum seekers.
Kim DS, Cho Y, Moon OR.
School of Public Health, Seoul National University, 28 Yeongun-dong, Jongro-

ku, Seoul, South Korea.
OBJECTIVES: This study examined the risk factors associated with a negative
self-rating of subjective health among North Korean asylum seekers, paying
particular attention to the unusual social experiences of this population. STUDY
DESIGN: This study utilized the North Korean Health Care System Data Set
(NKHCS). This data set is comprised of information on 221 North Korean asylum
seekers (aged 20 years and over) who were housed in Hanawon, a South Korean
government facility. We specifically examined the effect of three separate risk
factors (major country of residence after exiting North Korea, duration of stay in
country, and whom they were accompanied by during their migration event)
associated with the unusual social experiences of North Korean asylum seekers on
their global health. METHODS: Multivariate logistic regression analyses were
carried out in order to assess the consistency and validity of extant hypotheses and
general expectations. RESULTS: North Korean asylum seekers who entered
South Korea within one year of their defection or were accompanied by non-
family members tended to negatively self-report their health status. However,
major intermediate country of residence after exiting North Korea showed no
effect. Higher educational attainment and membership of the Labour Party of
North Korea were negatively associated with the global health of this population,
though this was not statistically significant. CONCLUSIONS: We found that the
unusual social experiences of North Korean asylum-seekers, particularly
intermediate country duration and companionship characteristics, were
significantly associated with their health. Future studies need to examine the
relationship between diverse social experiences during residence in intermediate
countries and the health of this population.
Publication Types:
350: J Paediatr Child Health. 2007 Mar;43(3):134-8.

Effectiveness of a nurse-led management programme for paediatric

asthma in Taiwan.
Weng HC, Yuan BC, Su YT, Perng DS, Chen WH, Lin LJ, Chi SC, Chou
CH.
I-Shou University, Ping Tung, Taiwan.
AIM: The aim of this study was to carry out a preliminary analysis of the impact
of a government-sponsored disease management programme for paediatric asthma
on economic outcomes and patient satisfaction. METHODS: Of the 398 patients
who participated in the programme, 249 (62.56%) who had at least two medical
care encounters with an ICD-9 code of 493 were classified as 'already diagnosed
cases'; and 129 (34.12%) who had a single or no medical care encounter with an
ICD-9 code of 493 were classified as 'newly diagnosed cases'. A retrospective 1:4
(intervention vs. control group) matched cohort study design was conducted, with
the control group randomly drawn from 236 637 paediatric asthmatics who were
not enrolled the programme. Questionnaires were collected from 105 (26.3%) of
the patients. RESULTS: Comparison results of 1 year pre/post tests of utilisation
of health care resources indicated that the intervention group of already diagnosed
cases had 77.97% fewer emergency department visits, 80.77% fewer inpatient
visits, and 75.65% fewer stays of significant length. For the newly diagnosed
group, the intervention group had 35.11% fewer emergency department visits than
the control group. The majority of the patients had substantial adherence to
physicians' suggestions, more accurate knowledge and better self-care skills
concerning asthma. CONCLUSION: A nurse-led management programme has
proved useful in managing paediatric asthma in Taiwan. Simplification of
paperwork, some reorganisation of the practitioner's daily responsibilities and
provision of a fail-safe information system may make the programme even more
beneficial.
Publication Types:
351: J Prev Med Pub Health. 2007 Jan;40(1):64-70.

[A study on facilitators and inhibitors to the introduction of

outsourcing in the hospital information systems in Korea]
[Article in Korean]
Choy S, Shin HS, Choi I, Kim S.
Department of Preventive Medicine, College of Medicine, The Catholic

University of Korea.
OBJECTIVES: This study was conducted to investigate the current status of

outsourcing in Korean hospital information systems and the factors influencing its
introduction. METHODS: The authors surveyed 136 hospitals located in Seoul
and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and
inhibitors to outsourcing in hospital information systems were derived from
literature and expert reviews. Multiple logistic regression analysis was applied to
identify the major influencing factors on outsourcing in hospital information
systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which
were mainly tertiary hospitals, responded to using outsourcing for their hospital
information systems. "Hardware and software maintenance and support,"
"application development," and "management of service and staff" were the major
areas of outsourcing. Outsourcing had been employed for 4-7 years by 45.5% of
the hospitals and the proportion of the budget used for outsourcing was less than
20%. A need for an extension in outsourcing was agreed on by 76.5% of the
hospitals. The multiple logistic regression analysis showed that both consumer
satisfaction and security risk have an influence on hospital information system
outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is
expected to increase just as in other industries. One primary facilitator to
outsourcing in other industries is consumer satisfaction. We found that this was
also a facilitator to outsourcing in hospital information systems. Security risk,
which is usually considered an inhibitor to information technology outsourcing,
was proven to be an inhibitor here as well. The results of this study may help
hospital information systems establish a strategy and management plan for
outsourcing.
Publication Types:
352: Bull World Health Organ. 2007 Feb;85(2):146-51.

A balanced scorecard for health services in Afghanistan.
Peters DH, Noor AA, Singh LP, Kakar FK, Hansen PM, Burnham G.
Department of International Health, Johns Hopkins Bloomberg School of Public

Health, Baltimore, MD, USA. dpeters@jhsph.edu
The Ministry of Public Health (MOPH) in Afghanistan has developed a balanced

scorecard (BSC) to regularly monitor the progress of its strategy to deliver a basic
package of health services. Although frequently used in other health-care settings,
this represents the first time that the BSC has been employed in a developing
country. The BSC was designed via a collaborative process focusing on
translating the vision and mission of the MOPH into 29 core indicators and
benchmarks representing six different domains of health services, together with
two composite measures of performance. In the absence of a routine health
information system, the 2004 BSC for Afghanistan was derived from a stratified
random sample of 617 health facilities, 5719 observations of patient-provider
interactions, and interviews with 5597 patients, 1553 health workers, and 13,843
households. Nationally, health services were found to be reaching more of the
poor than the less-poor population, and providing for more women than men, both
key concerns of the government. However, serious deficiencies were found in five
domains, and particularly in counselling patients, providing delivery care during
childbirth, monitoring tuberculosis treatment, placing staff and equipment, and
establishing functional village health councils. The BSC also identified wide
variations in performance across provinces; no province performed better than the
others across all domains. The innovative adaptation of the BSC in Afghanistan
has provided a useful tool to summarize the multidimensional nature of health-
services performance, and is enabling managers to benchmark performance and
identify strengths and weaknesses in the Afghan context.
Publication Types:
353: Med Princ Pract. 2007;16(2):107-9.

Drug information resources at private community pharmacies in

Kuwait.
Ball DE, Al-Othman F.
Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University,

Kuwait. dball@hsc.edu.kw
OBJECTIVE: To investigate the drug information resources available in private

community pharmacies in Kuwait. MATERIALS AND METHODS: Pharmacists
at a sample of 20 private community (retail) pharmacies completed a self-
administered questionnaire of available information resources and perceived
appropriate information resources to answer five drug information questions.
RESULTS: All pharmacies had at least one reference book but they were
outdated. The Middle East Medical Index was most commonly found and three
pharmacies had internet access. Half of the respondents reported getting
medicines information directly from the pharmaceutical companies, usually
through pharmaceutical representatives. Most pharmacists could identify
appropriate information resources for drug dosing and drug interactions but did
not fare well for medicine identification and primary research evidence.
CONCLUSION: The poor quality and outdated drug information resources in
private community pharmacies will affect the quality of information provided to
clients and prescribers and have an adverse effect on the role pharmacists can play
in the health system in Kuwait. Copyright 2007 S. Karger AG, Basel.
354: J Intellect Disabil Res. 2007 Mar;51(Pt 3):173-83.

Carer reports of health status among adults with

intellectual/developmental disabilities in Taiwan living at home and
in institutions.
Wang KY, Hsieh K, Heller T, Davidson PW, Janicki MP.
Department of Social Welfare, National Chung Cheng University, Ming-Hsiung,

Chia-yi. Taiwan. lisa@sw.ccu.edu.tw
BACKGROUND: The aim of the present study was to assess the health status of a
cohort of adults with intellectual/developmental disabilities (I/DD) residing in
family homes or institutions in Taiwan and to examine whether morbidity varied
with age, sex, existing diagnosis [Down syndrome (DS), seizures, cerebral palsy
(CP), intellectual disability (ID) level] and residential status. METHODS:
Systematic randomization based on geographic areas was employed for sampling
selection. Primary carers were interviewed to provide health-related information
on individuals with I/DD aged 33 years or older living in institutions (n = 614) or
living with their family (n = 514) in Taiwan. RESULTS: Cardiovascular,
neurological, visual and hearing impairments increased with age; while
gastrointestinal, endocrine, infectious and dermatological diseases did not, after
adjusting for sex, level of ID, presence of DS, seizures or CP, across settings.
Institution cohorts were more likely to have infectious diseases, skin diseases,
hepatitis or to be hepatitis carriers, and to have psychiatric disorders.
CONCLUSIONS: Organ system morbidity increased with age and generally was
influenced by the same factors as have been reported for cohorts in western
countries. The results also suggest that disease/condition outcomes may vary or be
influenced differentially by residential setting.
Publication Types:

355: Prehosp Disaster Med. 2006 Sep-Oct;21(5):s82-6.

Health aspects of disaster preparedness and response--panel session

2: seismic risks including tsunamis.
Southeast Asia Regional Office/World Health Organization.
This Panel Session consisted of five country reports (India, Indonesia, Maldives,
Thailand, and Nepal) and the common issues identified during the Panel
discussions relative to seismic events in the Southeast Asia Region. Important
issues identified included the needs for: (1) a legal framework upon which to base
preparedness and response; (2) coordination between the many organizations
involved; (3) early warning systems within and between countries; (4) command
and control; (5) access to resources including logistics; (6) strengthening the
health infrastructure; (7) professionalizing the field of disaster medicine and
management; (8) management of communications and information; (9)
management of dead bodies; and (10) mental health of the survivors and health
workers.


1: water-related hazards.
This Panel Session consisted of three country reports (Bagladesh, Bhutan, and
Myanmar) and the common issues identified during the Panel discussions relative
to water-related hazards and events in the Southeast Asia Region. The primary
event discussed regardless of the hazards encountered was flooding. The merits of
the responses generated in Bangladesh before, during, and following the 2004
floods provide evidence of what can be accomplished in community and national
levels of preparedness. Many key issues arose in the discussions: (1) command
and control systems and SOPs; (2) ready resources; (3) public information and
education and human resource development; (4) community-level preparedness;
(5) accessibility to health care; (6) increased focus on disease prevention and
control; (7) management of dead bodies; (8) need for a legal framework; (9)
funding and the management of funds; and (10) relationships with the media.

Health aspects of disaster preparedness and response. Report from a

regional meeting of countries of South East Asia; Bangkok,
Thailand, 21-23 November 2005.
Regional Office for South East Asia World Health Organization.
INTRODUCTION: This Supplement is a Report of the Conference convened by

the South East Asia Regional Office (SEARO) of the World Health Organization
(WHO). The Conference was a follow-up to the WHO Conference of May 2005
in Phuket, Thailand on the Earthquake and Tsunami of 26 December 2004. The
invitational meeting brought together representatives of 11 countries impacted by
the events. The goal of the Conference was to produce a plan of action that meets
the specific needs of the countries and ensure that the countries of the Region will
be better equipped to cope with any future event. OBJECTIVES: The objectives
of the Conference were to: (1) identify gaps in the health needs of the affected and
vulnerable populations for preparedness, responses, recovery, and rehabilitation;
(2) determine the next steps in addressing these gaps; and (3) develop benchmarks
and a corresponding framework for action that must be achieved to solidify the
capacities and capabilities of the health sector to meet emergencies. METHODS:
Presentations of background papers, panel discussions, and Working Groups were
used. Based, in part, on the materials presented, the Working Groups drafted
benchmarks that could mark the progress in achieving the overall goal and
proposed strategies that could be used to reach the benchmarks. Representatives
of the participating countries summarized the current status of their respective
countries relative to each of the defined benchmarks. RESULTS: The benchmarks
relate to: (1) legal framework for preparedness and response; (2) national disaster
plan for preparedness and response; (3) budget; (4) rules of engagement for
external actors; (5) community plan based on risk identification and vulnerability
assessment; (6)community-based capacities; (7) local capacity for provision of
essential services and supplies; (8) awareness and advocacy programs; (9)
identification of hazards, risks, and vulnerabilities; (10) education and training;
(11) "safe" health facilities; and (12) surveillance and early warning systems.
There exists a wide range in the levels of preparedness at all levels in the affected
countries particularly at the community level. The country representatives agreed
that community-level preparedness, legal frameworks, local and national disaster
plans, surveillance and early warning systems, and advocacy and awareness
programs demand more attention. The strategies and mechanisms that will
facilitate achievement of the benchmarks were grouped into seven categories: (1)
monitoring, evaluation, surveillance, and assessments; (2) education and training
(human resource development); (3) information and communications; (4)
legislation, policies, and authority; (5) funding; (6) planning and preparedness;
and (7) coordination and control. Any or all of the strategies suggested could be
implemented by the countries in the Region. CONCLUSION: The Conference
delivered an important set of benchmarks and strategies that, when implemented,
will facilitate the countries and the communities within them reaching better
levels of preparedness and response to future events. Attaining the benchmarks
will decrease the number of lives lost and minimize the pain and suffering
associated with such events.
358: Prehosp Disaster Med. 2006 Sep-Oct;21(5):345-52.

Erratum in:
• Prehospital Disaster Med. 2006 Nov-Dec;21(6):ii. Rosborogh, Stephanie

N [corrected to Rosborough, Stephanie N].
Express railway disaster in Amagasaki: a review of urban disaster
response capacity in Japan.
Nagata T, Rosborough SN, VanRooyen MJ, Kozawa S, Ukai T, Nakayama S.
Takemi Program in International Health, Harvard School of Public Health,

Boston, Massachusetts, USA.
INTRODUCTION: On the morning of 25 April 2005, a Japan Railway express

train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst
rail disaster in 40 years. This study chronicles the rescue efforts and highlights the
capacity of Japan's urban disaster response. METHODS: Public reports were
gathered from the media, Internet, government, fire department, and railway
company. Four key informants, who were close to the disaster response, were
interviewed to corroborate public data and highlight challenges facing the
response. RESULTS: The crash left 107 passengers dead and 549 injured. First
responders, most of whom were volunteers, were helpful in the rescue effort, and
no lives were lost due to transport delays or faulty triage. Responders criticized an
early decision to withdraw rescue efforts, a delay in heliport set-up, the
inefficiency of the information and instruction center, and emphasized the need
for training in confined space medicine. Communication and chain-of-command
problems created confusion at the scene. CONCLUSIONS: The urban disaster
response to the train crash in Amagasaki was rapid and effective. The Kobe
Earthquake and other incidents sparked changes that improved disaster
preparedness in Amagasaki. However, communication and cooperation among
responders were hampered, as in previous disasters, by the lack of a structured
command system. Application of an incident command system may improve
disaster coordination in Japan.

Disaster healthcare system management and crisis intervention

leadership in Thailand--lessons learned from the 2004 Tsunami
disaster.
Peltz R, Ashkenazi I, Schwartz D, Shushan O, Nakash G, Leiba A, Levi Y,

Goldberg A, Bar-Dayan Y.
Israeli Defense Forces Home Front Command.
INTRODUCTION: Quarantelli established criteria for evaluating the

effectiveness of disaster management. OBJECTIVES: The objectives of this study
were to analyze the response of the healthcare system to the Tsunami disaster
according to the Quarantelli principles, and to validate these principles in a
scenario of a disaster due to natural hazards. METHODS: The Israeli Defense
Forces (IDF) Home Front Command Medical Department sent a research team to
study the response of the Thai medical system to the disaster. The analysis of the
disaster management was based on Quarantelli's 10 criteria for evaluating the
management of community disasters. Data were collected through personal and
group interviews. RESULTS: The three most important elements for effective
disaster management were: (1) the flow of information; (2) overall coordination;
and (3) leadership. Although pre-event preparedness was for different and smaller
scenarios, medical teams repeatedly reported a better performance in hospitals
that recently conducted drills. CONCLUSIONS: In order to increase
effectiveness, disaster management response should focus on: (1) the flow of
information; (2) overall coordination; and (3) leadership.
360: Environ Monit Assess. 2007 Aug;131(1-3):421-37. Epub 2007 Feb 13.
Assessment for salinized wasteland expansion and land use change

using GIS and remote sensing in the west part of northeast China.
Li X, Wang Z, Song K, Zhang B, Liu D, Guo Z.
School of Earth Science, Jilin University, Changchun, Jilin Province, 130061,

China.
Due to human impact under climatic variations, western part of Northeast China
has suffered substantial land degradation during past decades. This paper presents
an integrated study of expansion process of salinized wasteland in Da'an County,
a typical salt-affected area in Northeast China, by using Geographic Information
Systems (GIS) and remote sensing. The study explores the temporal and spatial
characteristics of salinized wasteland expansion from 1954 to 2004, and land
use/cover changes during this period. During the past 50 years, the salinized
wasteland in study area have increased by 135,995 ha, and in 2004 covers 32.31%
of the total area, in the meantime grassland has decreased by 104,697 ha and in
2004 covers only 13.15% of the study area. Grasslands, croplands and
swamplands were found the three main land use types converted into salinized
wasteland. Land use/cover changes shows that between 1954 and 2004, 48.6% of
grasslands, 42.5% of swamplands, and 14.1% of croplands were transformed into
salinized wasteland, respectively. Lastly, the major factors influencing salinized
wasteland expansion and land use/cover changes were also explored. In general,
climatic factors supplied a potential environment for soil salinization. Human-
related factors, such as policy, population, overgrazing, and intensified and
unreasonable utilization of land and water resources are the main causes of
salinized wasteland expansion.
Publication Types:
361: Harefuah. 2007 Jan;146(1):22-5, 79.

[Medical students' knowledge and attitudes towards costs of tests

and treatments]
[Article in Hebrew]
Toker A, Reuveni H, Perry ZH, Doron Y.
Department of Health Systems Management, Ben-Gurion University of the

Negev, Beer Sheva, Israel. atoker@bgu.ac.il
OBJECTIVES: 1) To examine medical students' knowledge about costs of

laboratory tests, imaging procedures, and treatments. 2) To examine medical
students' attitudes regarding receiving information about costs, and its effect on
their future clinical behavior. DESIGN: This was a cross-sectional study using an
anonymous three-part questionnaire that was distributed to all students of the Ben
Gurion University Medical School. Responses were received from 269 students
(approximately 70%). RESULTS: According to the results, most students did not
estimate the costs correctly. It was found that: 69.5% of the students did not
receive any information about costs during their studies; 81.4% of the students
expressed interest in receiving such information; 66.2% thought that knowing the
costs would change their future clinical decision making. CONCLUSIONS AND
RECOMMENDATIONS: Medical students lack information regarding the cost of
laboratory tests and medical treatments. Providing information to medical
students about costs may help reduce future health care expenses. Our
recommendations are: 1. To include economic content in the medical curriculum;
2. To perform periodic updates and continuing medical education in this area; 3.
To combine this educational program with other intervention methods in order to
effectively reduce health care expenses.
Publication Types:
362: Promot Educ. 2006;13(3):203-7.

New horizons for public health in Kazakhstan.
Aringazina A, Macdonald G.
School of Public Health, Almaty, Kazakhstan. Correspondence to Dr. Altyn

Aringazina, School of Public Health, Almaty 050060, Kazakhstan. altyn@ksph.kz
This paper, the first ever to review and critique public health developments in
Kazakhstan, suggests ways in which public health can be improved strategically.
The paper outlines the main threats to health in a dynamic economically
developing country, but argues that with a health care reform agenda in place, and
the Governments apparent support of public health policy initiatives, the time is
right for new opportunities in the promotion of health. The paper utilises the
Ottawa Charter, but suggests novel, more appropriate headings for Kazakhstan, to
galvanise policy makers and professionals into tackling the growing burden of
disease. It concludes by calling for greater transparency in relation to Government
policy initiatives, and the need for greater national and international collaboration.
Publication Types:

Record linkage research and informed consent: who consents?
Huang N, Shih SF, Chang HY, Chou YJ.
Institute of Public Health, School of Medicine, National Yang-Ming University,

Taipei 112, Taiwan, ROC. syhuang@ym.edu.tw <syhuang@ym.edu.tw>
BACKGROUND: Linking computerized health insurance records with routinely

collected survey data is becoming increasingly popular in health services
research. However, if consent is not universal, the requirement of written
informed consent may introduce a number of research biases. The participants of
a national health survey in Taiwan were asked to have their questionnaire results
linked to their national health insurance records. This study compares those who
consented with those who refused. METHODS: A national representative sample
(n = 14,611 adults) of the general adult population aged 20 years or older who
participated in the Taiwan National Health Interview Survey (NHIS) and who
provided complete survey information were used in this study. At the end of the
survey, the respondents were asked if they would give permission to access their
National Health Insurance records. Information given by the interviewees in the
survey was used to analyze who was more likely to consent to linkage and who
wasn't. RESULTS: Of the 14,611 NHIS participants, 12,911 (88%) gave consent,
and 1,700 (12%) denied consent. The elderly, the illiterate, those with a lower
income, and the suburban area residents were significantly more likely to deny
consent. The aborigines were significantly less likely to refuse. No discrepancy in
gender and self-reported health was found between individuals who consented
and those who refused. CONCLUSION: This study is the first population-based
study in assessing the consent pattern in a general Asian population. Consistent
with people in Western societies, in Taiwan, a typical Asian society, a high
percentage of adults gave consent for their health insurance records and
questionnaire results to be linked. Consenters differed significantly from non-
consenters in important aspects such as age, ethnicity, and educational
background. Consequently, having a high consent rate (88%) may not fully
eliminate the possibility of selection bias. Researchers should take this source of
bias into consideration in their study design and investigate any potential impact
of this source of bias on their results.
Publication Types:
PMCID: PMC1802736
364: J Adv Nurs. 2007 Feb;57(4):375-81.

Factors influencing nurses' attitudes towards the use of

computerized health information systems in Kuwaiti hospitals.
Alquraini H, Alhashem AM, Shah MA, Chowdhury RI.
Department of Health Information Administration, Faculty of Allied Health

Sciences, Kuwait University, Kuwait. hquraini@hsc.edu.kw
AIM: This paper reports a survey of nurses' attitudes towards computerized health
information systems, the characteristics that influence these attitudes and the level
of nurses' skills in computer use. BACKGROUND: The use of such systems in
developed countries and in some developing countries has already become a
reality. However, nurses as a group of care providers have been found to resist
computerization, seeing computerized health information systems as
dehumanizing, confusing and uncaring. Nurses with more computer experience
tend to have more positive views; education and training positively influence
attitudes; and younger and less experienced nurses may have more positive
attitudes. METHODS: A structured questionnaire was used to measure the
attitudes of nurses working in Kuwait towards computerization. A random sample
of 574 nurses working in Ministry of Health hospitals were sent a questionnaire,
and 530 replies were received (response rate 92.3%). The data were collected
from November 2002 to January 2003. FINDINGS: Respondents generally had
positive attitudes toward computerized health information systems. Analysis of
variance revealed statistically significant differences in attitudes in relation to
nationality, level of education, previous experience in computer use, and
computer skills (P < 0.05). Multiple regression analysis showed that gender,
nationality, education levels, and duration of computer use were statistically
significant predictors of attitudes toward computerized health information systems
(P < 0.05). CONCLUSION: With adequate computerized health information
system training, the implementation of computerized health information systems
could be effective for nurses in providing quality health care, as found in other
studies.
365: Health Policy. 2007 Sep;83(1):84-93. Epub 2007 Feb 6.

Reconstruction of health service systems in the post-conflict

Northern Province in Sri Lanka.
Nagai M, Abraham S, Okamoto M, Kita E, Aoyama A.
Department of International Health, Nagoya University School of Medicine,

Japan. mnagai@med.nagoya-u.ac.jp
Public health problems in armed conflicts have been well documented, however,
effective national health policies and international assistance strategies in
transition periods from conflict to peace have not been well established. After the
long lasted conflicts in Sri Lanka, the Government and the rebel LTTE signed a
cease-fire agreement in February 2002. As the peace negotiation has been
disrupted since April 2003, a long-term prospect for peace is yet uncertain at
present. The objective of this research is to detect unmet needs in health services
in Northern Province in Sri Lanka, and to recommend fair and effective health
strategies for post-conflict reconstruction. First, we compared a 20-year trend of
health services and health status between the post-conflict Northern Province and
other areas not directly affected by conflict in Sri Lanka by analyzing data
published by Sri Lankan government and other agencies. Then, we conducted
open-ended self-administered questionnaires to health care providers and
inhabitants in Northern Province, and key informant interviews in Northern
Province and other areas. The major health problems in Northern Province were
high maternal mortality, significant shortage of human resources for health
(HRH), and inadequate water and sanitation systems. Poor access to health
facilities, lack of basic health knowledge, insufficient health awareness programs
for inhabitants, and mental health problems among communities were pointed by
the questionnaire respondents. Shortage of HRH and people's negligence for
health were perceived as the major obstacles to improving the current health
situation in Northern Province. The key informant interviews revealed that Sri
Lankan HRH outside Northern Province had only limited information about the
health issues in Northern Province. It is required to develop and allocate HRH
strategically for the effective reconstruction of health service systems in Northern
Province. The empowerment of inhabitants and communities through health
awareness programs and the development of a systematic mental health strategy
at the state level are also important. It is necessary to provide with the objective
information of gaps in health indicators by region for promoting mutual
understanding between Tamil and Sinhalese. International assistance should be
provided not only for the post-conflict area but also for other underprivileged
areas to avoid unnecessary grievance.
Publication Types:
366: Environ Monit Assess. 2007 Oct;133(1-3):87-98. Epub 2007 Feb 8.

Assessing spatial occurrence of ground level ozone around coal

mining areas of Chandrapur District, Maharashtra, India.
Salve PR, Satapathy DR, Katpatal YB, Wate SR.
Environmental Impact and Risk Assessment Division, National Environmental

Engineering Research Institute, Nehru Marg, Nagpur 440020 (M.S), India.
salvepr1@rediffmail.com
Stratospheric input and photochemical ozone formation in the troposphere are the
two main sources determining the ozone levels in the surface layer of the
atmosphere. Because of the importance of ozone in controlling the atmospheric
chemistry and its decisive role in the heat balance of atmosphere, leading to
climate change, the examination of its formation and destruction are of great
interest. This study characterized the distribution of Ground level Ozone (GLO) in
Chandrapur district is lying between 19 degrees 25'N to 20 degrees 45'N and 78
degrees 50'E to 80 degrees 10'E. Continuous ozone analyzer was used to quantify
GLO at thirteen locations fixed by Global Positioning System (GPS) during the
winter of 2005-2006. The daily GLO at all the locations ranged between 6.4 and
24.8 ppbv with an average and standard deviation of 14.9 +/- 6.5 ppbv. The
maximum and minimum concentration occurs during 1300-1600 h and 0300-0500
h may be due to high solar radiation facilitating photochemical production of O(3)
and downward mixing from the overlying air mass and in situ destruction of
ozone by deposition and/or the reaction between O(3) and NO. GIS based spatial
distribution of GLO in Chandrapur district is indicates that the central core of the
district and southern sites experienced elevated levels of GLO relative to the
northern and western areas. The sites near by Chandrapur city are particularly
affected by elevated GLO. The average variation of GLO with temperature shows
a significant correlation of r = 0.55 indicating a direct relationship between GLO
and temperature. Similarly an attempt has been made to compare the GLO
monitored data in Chandrapur district with the reported values for other locations
in Indian cities. This generated database helps regulatory agencies to identify
locations where the natural resources and human health could be at risk.
367: Ann Acad Med Singapore. 2007 Jan;36(1):3-10.

Results from a prospective acute inpatient rehabilitation database:

clinical characteristics and functional outcomes using the Functional
Independence Measure.
Ng YS, Jung H, Tay SS, Bok CW, Chiong Y, Lim PA.
Department of Rehabilitation Medicine, Singapore General Hospital, Singapore.

ng.yee.sien@sgh.com.sg
INTRODUCTION: Rehabilitation improves functional outcomes, but there is

little data on the profiles and outcomes of patients undergoing inpatient
rehabilitation in Singapore. The aims of this paper were to document the clinical
characteristics and functional outcomes, using the Functional Independence
Measure (FIM), of all patients admitted to an inpatient rehabilitation unit in a
tertiary teaching hospital, and to identify and analyse factors significantly
associated with better discharge functional scores and higher functional gains.
MATERIALS AND METHODS: In this prospective cohort study over a 4-year
period, clinical and functional data for 1502 patients admitted consecutively to the
Singapore General Hospital inpatient rehabilitation unit were charted into a
custom-designed rehabilitation database. The primary outcome measures were the
discharge total FIM scores, FIM gain and FIM efficiency. Multiple linear
regression analysis was used to identify independent variables associated with
better discharge FIM scores and FIM gain. RESULTS: The mean age was 61.3
+/- 15.0 years and 57.2% of the patients were male. Stroke (57.9%) followed by
spinal cord injury (9.7%) were the most common diagnoses. The average
rehabilitation length of stay was 21.5 +/- 19.0 days. The mean admission total
FIM score was 70.3 +/- 23.2 and the mean discharge total FIM score was 87.3 +/-
23.0, with this gain being highly significant (P <0.001). The mean FIM gain was
17.0 +/- 13.4 and FIM efficiency was 0.95 +/- 0.90 points/day. Factors associated
with better functional outcomes were higher admission motor and cognitive FIM
scores, male gender, a longer rehabilitation length of stay and the use of
acupuncture. Factors associated with poorer functional outcomes were older age,
clinical deconditioning, ischaemic heart disease, depression, pressure sores and
the presence of a domestic worker as a caregiver. CONCLUSIONS: The FIM is
an easy-to-use, standardised and robust general measure of functional disability.
Multiple demographic, clinical and socio-cultural variables are associated with the
primary functional outcomes and should be taken into account in rehabilitation
and discharge planning. Nevertheless, rehabilitation improves functional
outcomes across a wide range of diagnoses. Further research should be aimed at
evaluating long-term disability postdischarge from inpatient rehabilitation and
translating these findings into improving rehabilitation and healthcare resource
utilisation.
368: J Adv Nurs. 2007 Mar;57(5):522-34.

Participation in health-promoting behaviour: influences on

community-dwelling older Chinese people.
Kwong EW, Kwan AY.
School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong

Kong. hsenid@inet.polyu.edu.hk
AIM: This paper reports a study to determine the factors affecting community-
dwelling older Chinese people's health-promoting behaviour in the domains of
physical activity, healthy dietary practices and stress management, and to identify
any barriers to these behaviours. BACKGROUND: Previous studies have
identified factors affecting different types of health-promoting behaviours,
including perceived self-efficacy, perceived benefits and five individual
characteristics (age, sex, marital status, education and perceived health) of older
non-Chinese people. However, few studies have simultaneously taken these
factors into account in examining community-dwelling Chinese older people's
health-promoting behaviour. METHOD: Individual face-to-face interviews were
completed in 2002-2003 with a convenience sample of 896 community-dwelling
older Chinese people in Hong Kong aged between the ages of 60 and 98 (years
mean 76). Participants had no apparent communication and cognition
impairments. A structured interview schedule was used to collect the data.
RESULTS: Multiple regression analysis showed that perceived self-efficacy,
perceived benefits and sex together explained 38.4% of health-promoting
behaviour among community-dwelling older Chinese people in Hong Kong.
Fatigue during and after physical activity, enjoyment of unhealthy foods and
inadequate family and peer support were the most frequently reported barriers to
health-promoting behaviour. CONCLUSION: When developing health promotion
programmes to motivate community-dwelling older Chinese clients to participate
in health-promoting behaviour and to minimize barriers, community nurses
should include some activities to increase both the perceived self-efficacy and
perceived benefits of health-promoting behaviour. Future studies should include
more critical factors based on theories, empirical evidence and knowledge of
culture with samples that are random and from more diverse community settings.
369: J Med Syst. 2007 Feb;31(1):17-24.

Analysis of yearly variations in drug expenditure for one patient

using data warehouse in a hospital.
Chen Y, Matsumura Y, Nakagawa K, Ji S, Nakano H, Teratani T, Zhang Q,

Mineno T, Takeda H.
Department of Integrated Medicine, Medical Informatics, Osaka University,

Graduate School of Medicine 2-2, Yamada-oka, Japan.
Medical expense has grown rapidly in Japan. It could be caused by the increase of
the patient number and the increase of medical expense per patient. We studied
the latter factor on drug expenditure from 1996 to 2002 using the prescription data
stored in the data warehouse of one hospital. We found that the drug expenditure
per patient had increased 1.32 times. The mean number of prescriptions per
patient increased 1.23 times and the mean expenditure of one medicine increased
1.08 times. These results demonstrated that drug expenditure for one patient had
gradually increased. This was caused by both the rise in the number of medicines
taken by one patient and the rise in the prices of medicines. The data warehouse in
the hospital was useful for the analysis of the trends in medical expenditure for
one patient.
370: J Formos Med Assoc. 2007 Jan;106(1):58-68.

Applying a multiple screening program aided by a guideline-driven

computerized decision support system - a pilot experience in Yun-
Lin, Taiwan.
Lin JW, Chu PL, Liou JM, Hwang JJ.
National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan.
BACKGROUND/PURPOSE: Although preventive tools decrease morbidity and

mortality and promote health, these services are often underutilized. The purpose
of this study was to create a workflow for an outpatient setting that incorporated a
computerized decision support system to implement preventive recommendations
as well as to evaluate its impacts on facilitating preventive care. METHODS:
Subjects visiting National Taiwan University Hospital Yun-Lin Branch were
evaluated by a questionnaire, which contained items to trigger production rules to
check the eligibility of screening for high coronary risk, diabetes mellitus, lipid
disorder, hypertension, obesity, tobacco use, depression, colorectal cancer, breast
cancer, cervical cancer, and osteoporosis. Patients were given health information
about the diseases they were at risk for and the merits of preventive measures,
scheduled for a clinic visit, and arranged to have access to screening tools.
Physicians were prompted with clinical reminders on the encounter. The over-all
effectiveness of 11 components in this screening program was evaluated in terms
of expected life saving. The cost-effectiveness ratio was represented in US dollars
per life-year saved. RESULTS: A total of 283 men and 199 women were
identified to need one to six preventive interventions during a 2-month period.
Preventive consultation was arranged and screening tools were performed. It was
estimated that 412-1014 subjects would be needed to attend the program so as to
save one life. The cost-effectiveness ratio ranged from 30,000 US dollars to
40,000 US dollars per life-year saved. CONCLUSION: A computer-aided
screening program driven by the US Preventive Services Task Force
recommendations has been successfully implemented in Yun-Lin, Taiwan, and
provided useful information about local epidemiology and implications for future
health policy making.
Publication Types:

Importance of dental records for victim identification following the

Indian Ocean tsunami disaster in Thailand.
Petju M, Suteerayongprasert A, Thongpud R, Hassiri K.
Dental Department, Phangnga Provincial Public Health Office, 649 Petchkasem

Road, Muang District, Phangnga 82000, Thailand. smiledenta@yahoo.com
OBJECTIVES: To determine the usefulness of dental records for victim

identification following the Indian Ocean tsunami disaster in Thailand, and to
evaluate the dental identification system in Thailand, the homeland of a large
number of the victims. STUDY DESIGN: A descriptive study conducted at the
Thai Tsunami Repatriation Centre in Phangnga Province one year after the
tsunami hit Thailand on the 26th December 2004. METHODS: The dental records
of 3750 dead bodies and 3547 missing persons in the Thai Tsunami Victim
Identification (TTVI) database, updated on 12th December 2005, were analysed.
RESULTS: The identification rate of missing persons with dental records was
significantly higher than that of those without (P<0.01). Most victims identified
by dental records were returned home within the first four months after the
disaster. Dental records were the primary identifier in 46.2% of those identified.
However, among the Thai citizens reported missing, only 2.0% used dental
identification, 18.1% had dental charts and 0.8% had dental X-rays. In addition,
only 7.4% of Thai dental records could be used for dental identification and one-
third of Thai victims remained the majority of those unidentified.
CONCLUSIONS: Based on this study, the usefulness of dental records for victim
identification in a disaster was confirmed. The dental identification system for
nationals of Thailand could not work efficiently due to lack of dental records and
insufficient recorded detail.
Publication Types:
372: Nippon Koshu Eisei Zasshi. 2006 Dec;53(12):889-98.

[Volunteers' recognition of problems in meal distribution service

and their expectation for information concerning health and welfare
in less-favoured areas]
Yanagisawa H, Yoshimoto T, Namikawa K, Abe Y.
Gifu University, School of Nursing, Faculty of Medicine
OBJECTIVE: This study aimed to clarify problems perceived by volunteers of a

meal distribution service (MDS) in Less-Favoured Areas and the content of
information expected to be provided by the administration and social welfare
council. METHODS: We chose three municipalities (A, B, and C) with a
population of less than 4,000 and an elderly population rate of 25% or higher.
Volunteers involved in MDS in the municipalities were 28, 11, and 22 people in
A, B, and C, respectively. We interviewed each group after explaining our
purpose in writing, and made word-for-word records. Survey items were as
follows; what you try and aim to do, what is your burden and pleasure, what are
your problems and the solutions, and what are your demands for future activity in
the MDS. The study period was from March to November, 2003. RESULTS: The
information that the volunteers expected the administration and social welfare
council to provide encompassed 3 categories, each of which contained 2
subcategories. They expected (information to allow elderly people to use the
service on their own initiative> and <education to improve the understanding of
the residents about the MDS> as [information to improve understanding of the
users and residents about the aims and contents of the MDS], <responsible
recruiting of volunteers by the administration and social welfare council> and
<recruiting to secure motivated volunteers> as [information to ensure the quality
and quantity of volunteers], and <support for smooth delivery of meals> and
<support for the service in terms of evaluation> as [information to improve the
relationships between the volunteers and users]. CONCLUSIONS: The volunteers
expected education to improve the understanding of the residents so that elderly
people can use the MDS on their own initiative, recruiting of motivated
volunteers to ensure continuation of the service, and support for the smooth
execution of the service and a system for such support. These were perceived by
the subjects as problems to be solved for effective implementation of the service,
and are considered to represent the meaning and state of the MDS that the
volunteers wanted to share with the administration, social welfare council, and
residents. The information that should be shared among the administration, social
welfare council, residents, and volunteers can be clarified by evaluation of the
expectations of the volunteers which must be met to promote their cooperation to
support the service.
Publication Types:
373: Isr Med Assoc J. 2007 Jan;9(1):8-11.

Comment in:
• Isr Med Assoc J. 2007 Jan;9(1):42-3.

• Isr Med Assoc J. 2007 May;9(5):416; author reply 416.
Pre-hypertension is a common phenomenon: national database

study.
Kitai E, Vinker S, Halperin L, Meidan A, Grossman E.
Department of Family Medicine, Leumit Health Services, Tel Aviv, Israel.
BACKGROUND: Recently the Joint National Committee (7th report) introduced

the term "pre-hypertension." Little is known on its prevalence in the general
population. OBJECTIVES: To assess the prevalence of pre-hypertension in a
large national cohort. METHODS: We analyzed the database of all > or = 18 year
old members of Leumit Health Services, one of the four health management
organizations in Israel, from which we retrieved the recorded blood pressure
levels. Pre-hypertension was defined according to the JNC-7 criteria. RESULTS:
Of the 426,033 subjects 18.6% had a diagnosis of hypertension or used
antihypertensive medications. Only 40.8% of the other 346,799 subjects had had
their BP measured in the preceding 2 years. BP recording rates were higher in
females than in males (45.1% vs. 36.3%) and higher in elderly subjects than in
young subjects (56% aged 66-75 years vs. 32% aged 18-25). Pre-hypertension
was observed in 80,625 (23.2%) of the 346,799 while only 56,113 (16.2%) had
normal BP records. The prevalence of pre-hypertension increased with age
(13.3% aged 18-25 vs. 44.8% aged 66-75), and was more prevalent in men than in
women (24.0% vs. 22.5%). CONCLUSIONS: BP levels among young people are
low, even though the prevalence of pre-hypertension in this population may be
high. Thus, more emphasis should be given to routine BP measurements and
confirmation of the findings in all age groups.
Publication Types:

Evaluation of a syndromic surveillance system using the WSARE

algorithm for early detection of an unusual, localized summer
outbreak of influenza B: implications for bioterrorism surveillance.
Kaufman Z, Wong WK, Peled-Leviatan T, Cohen E, Lavy C, Aharonowitz

G, Dichtiar R, Bromberg M, Havkin O, Kokia E, Green MS.
Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.
zalman.k@icdc.health.gov.il
BACKGROUND: Syndromic surveillance systems have been developed for early

detection of bioterrorist attacks, but few validation studies exist for these systems
and their efficacy has been questioned. OBJECTIVES: To assess the capabilities
of a syndromic surveillance system based on community clinics in conjunction
with the WSARE algorithm in identifying early signals of a localized unusual
influenza outbreak. METHODS: This retrospective study used data on a
documented influenza B outbreak in an elementary school in central Israel. The
WSARE algorithm for anomalous pattern detection was applied to individual
records of daily patient visits to clinics of one of the four health management
organizations in the country. RESULTS: Two successive significant anomalies
were detected in the HMO's data set that could signal the influenza outbreak. If
data were available for analysis in real time, the first anomaly could be detected
on day 3 of the outbreak, 1 day after the school principal reported the outbreak to
the public health authorities. CONCLUSIONS: Early detection is difficult in this
type of fast-developing institutionalized outbreak. However, the information
derived from WSARE could help define the outbreak in terms of time, place and
the population at risk.
Publication Types:
375: Avian Dis. 2006 Dec;50(4):508-15.

Spatiotemporal distributions of reported cases of the avian influenza

H5N1 (bird flu) in Southern China in early 2004.
Oyana TJ, Dai D, Scott KE.
Department of Geography & Environmental Resource, Southern Illinois

University, 1000 Faner Drive, MC 4514, Carbondale, IL 62901-4514, USA.
This study investigates spatiotemporal distributions of reported cases of the avian

influenza H5N1 (bird flu) in Southern China in early 2004. Forty-nine cases of the
avian influenza H5N1 covering a 6-week period (January 19, 2004, through
March 9, 2004) were compiled from the Chinese Ministry of Agriculture and the
World Health Organization. Geographic information systems (GIS) techniques
combined with statistical techniques were used to analyze the spatiotemporal
variation of reported cases of avian influenza. Using Oden's direction method, we
also explored the spatiotemporal interaction of individual-level avian influenza
cases during the study duration. The peak period (temporal clustering) for the
epidemiological avian influenza outbreak occurred between the third and fourth
weeks. Although we observed a major northeast-southwest distribution of the
avian influenza H5N1 cases, there was no significant spatiotemporal association
in average "direction of advance" of these cases. The directional finding is very
consistent with the major migratory bird routes in East Asia, but owing to weak
surveillance and reporting systems in the region, the study findings warrant
further evaluation.
Publication Types:
376: Mil Med. 2007 Jan;172(1):75-8.

Civilian doctors in military clinics--outsourcing for better medicine.
Dankner R, Rieck J, Bentacur AG, Bar Dayan Y, Shahar A.

The Gertner Institute for Epidemiology and Health Policy Research, Tel-
Hashomer, 52621, Israel.
OBJECTIVES: To determine whether outsourcing of medical consulting services

could improve the quality of medical treatment in military primary care clinics.
METHODS: Data were collected prospectively over 2 months in two regular
army clinics manned by ordinary army doctors and in two intervention clinics also
staffed with senior civilian doctors. The causes for doctor visits, diagnoses, and
other patient data were collected. RESULTS: Information was recorded from
4970 soldier visits in the four clinics. Although a prescription of rest days was
similar in both types of clinics, the level of tertiary referrals was lower by one-
third in the intervention clinics compared to the regular clinics. Surrogate markers
for quality of care, such as increased use of planned follow-up and reduced
antibiotic use, were significantly better in the intervention clinics, and so was
overall patient satisfaction. CONCLUSIONS: Integration of specialist civilian
physicians in the military primary care system is highly beneficial and provides
better care and saves costs.
Publication Types:
377: Ophthalmology. 2007 Feb;114(2):278-82.

Cataract surgery is associated with a higher rate of photodynamic

therapy for age-related macular degeneration.
Kaiserman I, Kaiserman N, Elhayany A, Vinker S.
Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel.

Igor@Dr-Kaiserman.com
PURPOSE: To investigate the association between cataract surgery and the rate of
photodynamic therapy (PDT) for age-related macular degeneration (AMD).
DESIGN: Observational population-based retrospective case-control study.
PARTICIPANTS: All members in a district of the largest health maintenance
organization (HMO) in Israel > 50 years old on January 1, 2001, who did not
terminate their membership through May 31, 2005 (139 894 members).
METHODS: All PDT procedures for AMD performed in the study population
between January 1, 2001 and May 31, 2005 (283 patients) and all cataract
surgeries performed between January 1, 2001 and December 31, 2003 (5913
patients) were documented. We extracted clinical information from the chronic
disease registry of the HMO as well as demographic and socioeconomic
information. For each patient that underwent cataract surgery, 5 HMO members
matched in age, gender, chronic diseases (systemic hypertension, diabetes,
hyperlipemia, and ischemic heart disease), place of residence, country of birth and
socioeconomic status, who did not undergo cataract surgery, were randomly
chosen as controls (n = 29 565). MAIN OUTCOME MEASURES: The rate for
undergoing PDT at different time periods after cataract surgery. RESULTS: Fifty
(0.85%) cataract patients and 94 control cases (0.32%) underwent PDT after
cataract surgery (P<0.0001, chi-square test). A significant rise in PDT rate was
noticed in cataract patients compared to controls during the first 6 months after
surgery (P = 0.004, chi-square test). Between 6 and 12 months postoperatively,
the PDT rates were similar in both groups. However, a more significant rise in
PDT rates occurred between 1 and 1.5 years after surgery (P<0.0001, chi-square
test). The Kaplan-Meier PDT-free survival curve of cataract patients was
significantly worse than that of the controls (P<0.0001, chi-square test; P = 33.7,
log-rank test). The hazard ratio for cataract patients compared to controls to
undergo PDT after surgery was 2.7 (confidence interval = 2.4-5.7). The most
significant factors to reduce the time to PDT were advanced age followed by
having had cataract surgery, place of birth, socioeconomic status, and
hyperlipidemia (Cox proportional hazards survival regression). CONCLUSIONS:
We identified an increased rate of PDT, presumably for subfoveal AMD, 1 to 1.5
years after cataract surgery.
378: Vaccine. 2007 Mar 30;25(14):2630-3. Epub 2006 Dec 26.

Evaluation of the National Notifiable Disease Surveillance System in

Taiwan: an example of varicella reporting.
Tan HF, Chang CK, Tseng HF, Lin W.
Department of Healthcare Administration, Chang-Jung Christian University,

Taiwan.
Despite the mandatory reporting by laws, the incompleteness of notifiable

infectious disease reporting is well-documented in many countries for various
diseases. The purpose of this study is to investigate the completeness of varicella
reporting in Taiwan. Annual reports of National Notifiable Disease Surveillance
System in Taiwan were compared to the annual outpatient claims of National
Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and area-
specific reporting rates of varicella were calculated by dividing the respective
reported cases by the number of incidence cases. The reporting rate was the
highest in aged 0 year in all years, followed by the 20-29- and 30-39-year groups.
The reporting rate in each age group increased gradually during the study period.
Other than Taipei City, the reporting rates in all regions were below 9% during
this period. This study suggested that varicella reporting rate is very low in
Taiwan. In addition, the reporting rates were inconsistent in 2000-2002, making
the estimation of prevalence and vaccine efficacy using data from the National
Notifiable Disease Surveillance System almost impossible. This study indicated
that the physicians in Taiwan should improve their knowledge and attitude toward
notifiable infectious diseases.
Publication Types:
379: Environ Int. 2007 Jul;33(5):603-8. Epub 2007 Jan 30.

Association between esophageal cancer and drought in China by

using Geographic Information System.
Wu K, Li K.
Department of Preventive Medicine, Shantou University Medical College,

Shantou 515031, PR China. kswu@stu.edu.cn
The objective of this ecological study was to discover associations between

selected climate variables and esophageal cancer (EC) mortality in China using a
Geographic Information System (GIS). A digital distribution map of EC mortality
in China was established in GIS, which was based on one-tenth of nationwide
population cause-of-death surveys conducted in mainland China in 1990-1992.
Selected climate variables such as 30-year annual average precipitation and
evaporation data of the sample areas were extracted from the environmental
databases by zonal statistics finished in Spatial Analyst module of ArcInfo 9.0.
Drought Indexes were calculated by using the precipitation and evaporation data
and a digital distribution map of them was created to compare with the
distribution of EC mortality. Correlation and regression analyses were applied to
evaluate associations between the EC mortality rates defined at the sample areas
and selected climate variables from the raster datasets. The results of the digital
GIS maps of EC mortality and Drought Index show that the high EC mortality
mostly occurred in areas with high Drought Index. Correlation and regression
analyses also show weak negative correlation between precipitation and EC
mortality (p<0.001), and weak positive correlation between Drought Index and
EC mortality (p<0.001). This study presented a unique model for the link of
cancer and climate using a GIS. The study suggests that drought plays a role in
the occurrence and development of EC in China, however, other environmental,
biological and genetic factors should not be ignored. There is need for further
studies using multiple factors and more accurate and detailed environmental and
health data.
380: Trans R Soc Trop Med Hyg. 2007 Jun;101(6):587-93. Epub 2007 Jan 30.
Epidemiological investigation of an outbreak of acute diarrhoeal

disease using geographic information systems.
Sarkar R, Prabhakar AT, Manickam S, Selvapandian D, Raghava MV, Kang

G, Balraj V.
Department of Community Health, Christian Medical College, Vellore 632 002,

Tamil Nadu, India.
An outbreak of acute diarrhoeal disease in a village in southern India was

investigated through personal interviews of all households. Maps were drawn
using geographic information system (GIS) tools of the water supply system,
sewage channels and areas with observed faecal contamination of soil within and
around the village. Geographic coordinates for each house in the village were
extracted from a central database from the healthcare service provider for the
village. Geographical clustering of cases was looked for using the SaTScan
software, and diarrhoeal disease attack rates were calculated. Diarrhoeal disease
occurred uniformly throughout the village without clustering in any area. All ages
and both sexes were affected, but extremes of ages were at higher risk. Water
samples collected for microbiological examination after instituting control
measures showed high coliform counts. Chlorine levels in the water tested were
found to be inadequate to decontaminate common pathogens. Local cultural
practices such as indiscriminate defecation in public places, washing clothes and
cleaning utensils from water taps where the community collected its drinking
water, and poor engineering design and maintenance of the water supply system
were the risk factors that could have contributed to this outbreak.
381: Mil Med. 2006 Dec;171(12):1229-34.

Reorganization of secondary medical care in the Israeli Defense

Forces Medical Corps: A cost-effect analysis.
Yagil Y, Arnon R, Ezra V, Ashkenazi I.
Medical Services and Supply Center, Medical Corps, Israeli Defense Forces,
Beer-Sheba, Israel.
OBJECTIVE: To increase accessibility and availability of secondary medical

care, 10 secondary unit specialist clinics were established side-by-side with five
existing regional specialist centers, thus achieving decentralization. The purpose
was to analyze the impact of this reorganization on overall consumption of
secondary medical care and expenditures. METHODS: Consumption of
secondary medical care was analyzed by using computerized clinic and Medical
Corps databases. Functional efficiency and budgetary expenditures were
evaluated in four representative unit specialist clinics. RESULTS: The
reorganization resulted in an 8% increase in total secondary care consumption
over 2.5 years. The establishment of unit specialist clinics did not achieve
increased accessibility or availability for military personnel. Functional analysis
of representative unit specialist clinics showed diversity in efficiency, differences
in physicians' performance, and excess expenditures. CONCLUSION: The
decentralizing reorganization of secondary medical care generated an increase in
medical care consumption, possibly because of supply-induced demand. The
uniform inefficiency of the unit specialist clinics might have been related to
incorrect planning and management. The decentralization of secondary medical
care within the Israeli Defense Forces has not proved to be cost-efficient.
382: Int J Clin Pharmacol Ther. 2007 Jan;45(1):30-5.

Prescription of benzodiazepines and antidepressants to outpatients

attending a Japanese university hospital.
Nakao M, Takeuchi T, Yano E.
Department of Hygiene and Public Health, Teikyo University School of

Medicine, Tokyo, Japan. mnakao@med.teikyo-u.ac.jp
OBJECTIVE: Excessive benzodiazepine use is a public health concern from

clinical and economical perspectives. Although more benzodiazepines are
prescribed in Japan than in any other country, no hospital-based report has
documented this phenomenon. Therefore, this study compared the prescription
frequency of benzodiazepines with that of selective serotonin reuptake inhibitors
(SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and other
antidepressants in a single Japanese hospital over 1 year. MATERIAL: The
annual prescription of benzodiazepines was assessed with that of antidepressants
using an electronic database of medical records for outpatients at a Japanese
tertiary care hospital affiliated with a private university with approximately
600,000 outpatient visits annually. METHOD: Groups of departments were
analyzed separately (i.e. internal medicine, surgery, neurology, psychiatry, and
others). The ratio of the number of prescriptions of anxiolytic benzodiazepines to
that of SSRI and SNRI was calculated among the department groups and used as
one of indicators comparing the prescriptions of benzodiazepines with those of
antidepressants. RESULTS: Of 644,444 hospital prescriptions, 6.1% were for
anxiolytic benzodiazepines, and 5.8% were for hypnotic benzodiazepines.
Regarding antidepressants, 1.6% of prescriptions were for SSRIs/SNRIs, 0.8%
were for tricyclic antidepressants, and 1.5% were for other antidepressants. Of the
benzodiazepine prescriptions, 26.8% were written by the internal medicine group.
The ratio of the number of prescriptions for anxiolytic benzodiazepines to that for
SSRI and SNRI was highest in the department of internal medicine (ratio = 13.0),
followed by surgery (7.6), neurology (4.8), and psychiatry (2.5). With the
department of psychiatry as the reference, the tendency to prescribe an anxiolytic
benzodiazepine rather than an SSRI or SNRI was statistically significant in the
remaining four department groups, after controlling for the effects of patient age
and sex in a multiple logistic regression analysis. CONCLUSIONS:
Benzodiazepine prescriptions in the Japanese hospital were far more common
than prescriptions for antidepressants such as SSRIs and SNRIs, especially in
internal medicine. Multi-institutional studies are needed to address this issue in
Japanese hospitals, as well as in hospitals in other countries.
Publication Types:
383: Health Place. 2007 Sep;13(3):577-87. Epub 2007 Jan 24.

Geographic analysis of vaccine uptake in a cluster-randomized

controlled trial in Hue, Vietnam.
Ali M, Thiem VD, Park JK, Ochiai RL, Canh do G, Danovaro-Holliday MC,
Kaljee LM, Clemens JD, Acosta CJ.
International Vaccine Institute, San 4-8, Bongcheon-7 dong, Kwanak-ku, Seoul

151-818, Republic of Korea. mali@ivi.int
This paper identifies spatial patterns and predictors of vaccine uptake in a cluster-
randomized controlled trial in Hue, Vietnam. Data for this study result from the
integration of demographic surveillance, vaccine record, and geographic data of
the study area. A multi-level cross-classified (non-hierarchical) model was used
for analyzing the non-nested nature of individual's ecological data. Vaccine
uptake was unevenly distributed in space and there was spatial variability among
predictors of vaccine uptake. Vaccine uptake was higher among students with
younger, male, or not literate family heads. Students from households with higher
per-capita income were less likely to participate in the trial. Residency south of
the river or further from a hospital/polyclinic was associated with higher vaccine
uptake. Younger students were more likely to be vaccinated than older students in
high- or low-risk areas, but not in the entire study area. The findings are important
for the management of vaccine campaigns during a trial and for interpretation of
disease patterns during vaccine-efficacy evaluation.
Publication Types:

384: Twin Res Hum Genet. 2006 Dec;9(6):832-7.

Population-based database of multiples in childhood of Ishikawa

Prefecture, Japan.
Ooki S.
Department of Health Science, Ishikawa Prefectural Nursing University, Tsu 7-1

Nakanuma, Kahoku, Ishikawa 929-1212, Japan. sooki@kj8.so-net.ne.jp
A new type of population-based database of multiples in childhood at the

prefecture level was initiated in 2004 in Ishikawa Prefecture, Japan. We
conducted an exhaustive search for demographic information concerning families
with multiples, family support provided by governmental and medical institutions
by mailed questionnaire, and at the same time tried to organize a human network
to support such families. This registry aims not only to aid research on human
genetics and maternal and child health, but also to contribute to the development
of welfare programs for families with multiples.
Publication Types:


Twin database of the secondary school attached to the Faculty of

Education of the University of Tokyo.
Ooki S, Asaka A.

This article profiles the historical twin databases of the secondary education
school attached to the Faculty of Education at the University of Tokyo. The
school was established in 1948. Every year, about 50 pairs of twins of all sex and
zygosity combinations and aged 11 to 12 years take an examination, and about 10
to 20 pairs are admitted based on the results. Three independent datasets exist:
one for applicants (11-12 years), one for students (12-18 years), and one for
graduates (18-72 years). These three historical databases and research
perspectives are introduced herein.
Publication Types:
386: Pharmacoepidemiol Drug Saf. 2007 Apr;16(4):412-21.

Trends in the use of antihypertensive drugs by outpatients with

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

Kaohsiung, Taiwan.
PURPOSE: To analyze trends in AHD-use by diabetic outpatients in Taiwan over

a 7-year period (1997-2003) and to see whether the trends are consistent with
clinical trial outcomes and published guidelines. METHODS: A cross-sectional
survey was implemented using National Health Insurance Research Database
between January 1997 and December 2003. Adult outpatients who had diagnoses
of diabetes and hypertension and who had concurrent antidiabetic and
antihypertensive drug claim were identified. The prescribing trends were
described in terms of the prescribing rates and patterns of AHDs in each study
year. RESULTS: Of the AHDs, CCBs were the most widely prescribed class
throughout the study period but the prescribing rates declined considerably over
the study period. A significant downward trend was also observed for beta-
blockers and other classes. Drugs acting on the RAS were the only one class
showing a significant increase in prescribing rates with time. The prescribing
patterns for monotherapy regimen decreased over time while those for two-,
three-, and four or more drug regimens increased over time. Monotherapies
maintained with CCBs, beta-blockers, diuretics, and other classes steadily
declined but those maintained with drugs acting on the RAS markedly increased.
CONCLUSIONS: The use of drugs acting on the RAS showed a marked
increasing trend over the course of the study. Physicians' prescribing patterns for
AHD are increasingly involving multi-drug regimens. These findings may imply
that management of hypertension in patients with diabetes had a positive trend
toward to new clinical trial outcomes and guideline's recommendation.
387: Pediatr Int. 2007 Feb;49(1):48-52.

Health-care utilization and costs in Taiwanese pediatric patients

with asthma.
Sun HL, Kao YH, Lu TH, Chou MC, Lue KH.
Department of Pediatrics, Chung Shan Medical University Hospital, Taichung,

Taiwan.
BACKGROUND: In many countries, the burden of asthma is sufficient to warrant

recognition as a high-priority disorder in governmental health strategies.
However, the components of the total health-care costs for pediatric patients with
asthma have not been well studied, and an overall understanding of health-care
utilization patterns in this population is lacking in Taiwan. METHODS: A total of
33 461 patients aged 3-17 years who were enrolled in the National Health
Insurance Research database from 1 January to 31 December 2002 were
evaluated. Health-care utilization and costs, including those related to office,
outpatient hospital, emergency department, and inpatient hospital visits were
compared between pediatric patients with and without asthma. RESULTS: In
2002, the period prevalence of treated asthma was 6.0%. Pediatric patients with
asthma used substantially more services than did those without asthma in all
categories. Hospital outpatient visits and overall health-care expenditure for
patients with asthma were 2.2-fold higher than those of patients without asthma.
Asthma care represented 20% of all health-care services that patients with asthma
received, while the remaining 80% were for non-asthma care. Almost three-
fourths of all asthma-related costs were attributable to office and hospital
outpatient visits; one-fourth was attributable to urgent care and hospitalizations.
CONCLUSIONS: These findings may serve as baseline data for future evaluation
of changes in health-care utilization and expenditure among pediatric patients
with asthma.
388: Telemed J E Health. 2006 Dec;12(6):691-7.

On the evaluation of economic benefits of Japanese telemedicine and

factors for its promotion.
Miyahara S, Tsuji M, Iizuka C, Hasegawa T, Taoka F.
Department of Economics, Aoyama Gakuin University, Tokyo, Japan.
This paper attempts to estimate economic values of telemedicine and to extract

factors that promote telemedicine through the use of survey data. This is the first
analysis aimed at evaluating telemedicine in Japan. We utilized the Contingent
Valuation Method and estimated demand functions of telemedicine. Because the
number of institutions replying with willingness to pay (WTP) and willingness to
undertake (WTU) is relatively small, the Kernel Estimation Method was applied.
After estimating WTP and WTU, by multiplying the number of medical
institutions currently implementing telemedicine, the whole value in Japan was
obtained. By using the Tobit Model, factors that influence WTP and WTU were
extracted. Estimated WTP was 35.23 dollars for teleradiology and 162.89 dollars
for telepathology. WTU estimated was 39.81 dollars for teleradiology and 86.59
dollars for telepathology. Estimated economic benefits in Japan for 1 year were
1.27 million dollars for WTP of teleradiology and 278,600 dollars for
telepathology. WTU is 10 million dollars for teleradiology and 393,400 dollars
for telepathology. Medical institutions with the following characteristics tend to
reply larger WTP: (1) university hospitals, (2) internal medicine, (3) radiology,
and (4) use of video conference systems. Regarding WTU, the following
characteristics influence WTU: (1) use of a personal computer, (2) use of
telepathology equipment, (3) high satisfaction with the quality of telemedicine,
and (4) experience base of telemedicine. Based on the nationwide survey on
telemedicine, the total value of telemedicine in Japan was estimated. In addition
to the evaluation, quantitative aspects of implementation of telemedicine, such as
factors to promote telemedicine, are analyzed. These can provide useful
information for further implementation of telemedicine not only in Japan but in
other countries as well.
Publication Types:
389: IEEE Trans Inf Technol Biomed. 2007 Jan;11(1):14-6.

Understanding PACS development in context: the case of China.
Xue Y, Liang H.
University of Rhode Island, Kingston, RI 02881, USA. yxue@fau.edu
This paper describes the evolution of picture archiving and communication

systems (PACS) in China and identifies several obstacles to its development,
including vendors' opportunism, hospital administrators' IT ignorance,
mindlessness in IT adoption, lack of system integration, and misfits between
foreign PACS and local hospitals. Lessons learned from these obstacles are
provided, which are of value to developing countries where PACS has just started
diffusing.
Publication Types:
• Review
390: BMC Health Serv Res. 2007 Jan 23;7:11.

Resource allocation within the National AIDS Control Program of

Pakistan: a qualitative assessment of decision maker's opinions.
Husain S, Kadir M, Fatmi Z.
Health Systems Division, Department of Community Health Sciences, Aga Khan

University, Pakistan. sara.sharih@aku.edu
BACKGROUND: Limited resources, whether public or private, demand

prioritisation among competing needs to maximise productivity. With a
substantial increase in the number of reported HIV cases, little work has been
done to understand how resources have been distributed and what factors may
have influenced allocation within the newly introduced Enhanced National AIDS
Control Program of Pakistan. The objective of this study was to identify
perceptions of decision makers about the process of resource allocation within
Pakistan's Enhanced National AIDS Control Program. METHODS: A qualitative
study was undertaken and in-depth interviews of decision makers at provincial
and federal levels responsible to allocate resources within the program were
conducted. RESULTS: HIV was not considered a priority issue by all study
participants and external funding for the program was thought to have been
accepted because of poor foreign currency reserves and donor agency influence
rather than local need. Political influences from the federal government and donor
agencies were thought to manipulate distribution of funds within the program.
These influences were thought to occur despite the existence of a well-laid out
procedure to determine allocation of public resources. Lack of collaboration
among departments involved in decision making, a pervasive lack of technical
expertise, paucity of information and an atmosphere of ad hoc decision making
were thought to reduce resistance to external pressures. CONCLUSION:
Development of a unified program vision through a consultative process and
advocacy is necessary to understand goals to be achieved, to enhance program
ownership and develop consensus about how money and effort should be directed.
Enhancing public sector expertise in planning and budgeting is essential not just
for the program, but also to reduce reliance on external agencies for technical
support. Strengthening available databases for effective decision making is
required to make financial allocations based on real, rather than perceived needs.
With a large part of HIV program funding dedicated to public-private
partnerships, it becomes imperative to develop public sector capacity to
administer contracts, coordinate and monitor activities of the non-governmental
sector.
PMCID: PMC1784085
391: Public Health. 2007 Mar;121(3):231-6. Epub 2007 Jan 22.

Determining aspects of ethnicity amongst persons of South Asian

origin: the use of a surname-classification programme (Nam
Pehchan).
Macfarlane GJ, Lunt M, Palmer B, Afzal C, Silman AJ, Esmail A.
Aberdeen Pain Research Collaboration, Epidemiology Group, Department of

Public Health, University of Aberdeen, Polwarth Building, Foresterhill,
Aberdeen, AB25 2ZD, UK. g.j.macfarlane@abdn.ac.uk
OBJECTIVE: Name-based classification systems are potentially useful in

identifying study samples based on probable ethnic minority group. The aim of
the current study was to assess the validity of the Nam Pehchan name
classification programme of religion and language against subject self-report.
STUDY DESIGN AND SETTING: A population-based cross-sectional survey
conducted in areas of the North-West and West Midland regions of England with
a relatively high density of South Asian ethnic minority groups. The sampling
frame was age-sex registers of selected general practices and subjects were
classified according to language and religion using the Nam Pehchan programme.
These were compared with responses by subjects on a self-complete postal
questionnaire. RESULTS: One thousand nine hundred and forty-nine subjects
who participated, classified themselves as South Asian. Sensitivity in identifying
religion was high amongst Muslims (92%) and Sikhs (86%), and somewhat lower
in Hindus (62%). Specificity exceeded 95% for all ethnic groups. The vast
majority of subjects assigned Punjabi or Gujarati as their main South Asian
language indicated that they did in fact speak these languages (97% and 94%,
respectively). Subjects assigned Urdu or Bengali, however, were less likely to do
so (61% and 35%, respectively). CONCLUSIONS: The name-based classification
system Nam Pehchan has demonstrated high levels of accuracy in some sub-
groups of the South Asian population in determining subjects likely language
spoken and religion-and is likely to be a useful additional tool when information
on ethnicity is not already available.
Publication Types:
• Validation Studies
392: AMIA Annu Symp Proc. 2006:1152.

NSC (New Songdo City: newly developed city as free economic zone
in South Korea) ubiquitous healthcare project--developing
prospective health management model, integrating on-line and off-
line healthcare service.
Yoon DH, Park MJ, Kim DH, Park JH, Choi SH, Choi SY, Jeong IK, Sim
WH, Shin CS, Cho SH, Oh BH.
Seoul National University Hospital Healthcare System Gangnam Center, Seoul,

Korea.
PMCID: PMC1839565

A snapshot of the electronic transmission and processing of

prescriptions project in the Iranian Social Security Organization.
Moghaddam R, Badredine H.
Medical Informatics Department, Social Security Organization, Tehran, Iran.
Iranian Social Security Organization (ISSO) is going to enable the sharing of

health related information in a secure environment by means of reliable data in
the right time to improve health of insured people throughout the country. There
are around 7000 pharmacy throughout the country that ISSO contracted with them
in order to deliver seamless services to 30 million insured people. The
management of the huge amount of prescriptions based on a scientific basis with
considering the financial issues of rising the cost of medicaments certainly needs
a sophisticated business process re-engineering using ICT; the work that is going
to be completed in the ISSO in next few months.
PMCID: PMC1839728

Successful transfer of a Web-based TB medical record from Peru to

the Philippines.
Fraser H, Choi SS, Galipot M, Jazayeri D, Mangubat N.

Partners In Health, Boston, USA.
Publication Types:

PMCID: PMC1839702

User-customizing HIS interface by light programming tool: the case

of redesigning the nursing Kardex with InfoPath2003.
Chang TR, Chang P.
Institute of Health Informatics and Decision Making, National Yang-Mine

University, Taipei, Taiwan / R.O.C.
Due to lack of IT resources, the End-User Computing strategy seems useful for
the front-end users to develop and customize their own information application.
We taught the nurses to use the InfoPath 2003 to design their own card-filing
Kardex system and observed promising results.
PMCID: PMC1839363
396: AMIA Annu Symp Proc. 2006:424-8.

Are health centers in Thailand ready for health information

technology? : a national survey.
Kijsanayotin B, Speedie S.
Health Informatics, Medical School, University of Minnesota, Minneapolis,
Minnesota, USA.
The Thailand universal health care coverage scheme was instituted in 2001 and
The Thailand Ministry of Public Health (MOPH) is restructuring its information
systems to support this reform. The MOPH anticipates developing computerized
health information systems which can provide information for administration
tasks and can improve both healthcare delivery and public health services. To
achieve these target goals, knowledge about users and organizations is vital. The
knowledge of how health center workers currently use information technology
(IT), their knowledge of IT, and acceptance of IT are not only beneficial to policy
makers but also to system designers and implementers. The primary objective of
this study is to learn how health centers in Thailand use IT, the level of basic IT
knowledge among their workers, and their acceptance of health IT. We surveyed a
random cross sectional sample of 1,607 health centers representing the total of
9,806 in Thailand in 2005. With an 82% response rate, the preliminary results
indicate that information technology usage is pervasive in health centers. The
respondents showed a moderately high degree of health information technology
acceptance with a modest level of basic IT knowledge. There were no differences
in degrees of acceptance among the four geographic regions. The mean score of
"intention to use IT" was 5.6 on a scale of 7 and the average basic IT knowledge
score was 13 out of 20. These results suggests the possibility of project success if
the national health center information system projects are developed and
implemented.
Publication Types:
PMCID: PMC1839384
397: Saudi J Kidney Dis Transpl. 2007 Mar;18(1):60-4.

Organ donation after brain-death: experience over five-years in a

tertiary hospital.
Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA.
Critical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
aldawooda@hotmail.com
Organ transplantation is the treatment of choice for end-stage organ failure. The
main challenge for organ transplantation continues to be organ shortage. The
purpose of our study was to evaluate the success rate of organ donation after
brain-death, as documented in a tertiary closed intensive care unit in Saudi
Arabia. Data was obtained from a collected database from Jan 2001- Dec 2005.
Brain death was documented in 162 patients, most of whom were young (median
age was 28 +/- 17 years). The group consisted predominantly of males, 149 (92%)
and Saudis 109 (67%). Only 24 (17%) positive consents to organ donation were
obtained and the majority of them [21 (87%)] were from non-Saudis. Positive
consent was obtained from only three percent of Saudi potential organ donors in
comparison to the 40% positive rate among non-Saudis (40%) (p<0.05). In
conclusion, we believe that misconceptions about brain-death are the likely causes
behind this unfavorable view towards organ donations among Saudis.
Publication Types:
398: Can J Clin Pharmacol. 2007 Winter;14(1):e40-4. Epub 2007 Jan 19.
Building a structured monitoring and evaluating system of

postmarketing drug use in Shanghai.
Du W, Levine M, Wang L, Zhang Y, Yi C, Wang H, Wang X, Xie H, Xu J,

Jin H, Wang T, Huang G, Wu Y.
Shanghai Center for Adverse Drug Reaction Monitoring, Shanghai, China.
In order to understand a drug's full profile in the post-marketing environment,

information is needed regarding utilization patterns, beneficial effects, ADRs and
economic value. China, the most populated country in the world, has the largest
number of people who are taking medications. To begin to appreciate the impact
of these medications, a multifunctional evaluation and surveillance system was
developed, the Shanghai Drug Monitoring and Evaluative System (SDMES). Set
up by the Shanghai Center for Adverse Drug Reaction Monitoring in 2001, the
SDMES contains three databases: a population health data base of middle aged
and elderly persons; hospital patient medical records; and a spontaneous ADR
reporting database. Each person has a unique identification and Medicare number,
which permits record-linkage within and between these three databases. After
more than three years in development, the population health database has
comprehensive data for more than 320,000 residents. The hospital database has
two years of inpatient medical records from five major hospitals, and will be
increasing to 10 hospitals in 2007. The spontaneous reporting ADR database has
collected 20,205 cases since 2001 from approximately 295 sources, including
hospitals, pharmaceutical companies, drug wholesalers and pharmacies. The
SDMES has the potential to become an important national and international
pharmacoepidemiology resource for drug evaluation.
399: Health Policy Plan. 2007 Jan;22(1):13-20.

From the field side of the binoculars: a different view on global

public health surveillance.
Calain P.
philippe_calain@hotmail.com
It is generally assumed by the donor community that the targeted funding of

global, regional or cross-border surveillance programmes is an efficient way to
support resource-poor countries in developing their own national public health
surveillance infrastructure, to encourage national authorities to share outbreak
intelligence, and ultimately to ensure compliance of World Health Organization
(WHO) Member States with the revised (2005) International Health Regulations.
At country level, a number of factors and constraints appear to contradict this
view. Global or regional surveillance initiatives, including syndromic surveillance
and rumour surveillance projects, have been conceived in neglect of fragile health
systems, from which they extract scarce human resources. In contradiction with a
rightful stance promoting 'integrated surveillance' by WHO, the nurturing of
donor-driven, poorly coordinated and redundant surveillance networks generally
adds further fragmentation to national health priorities set up by developing
countries. In their current categorical format, ignoring the overwhelming deficits
in governance and health care capacity, global surveillance strategies seem bound
to benefit mainly the most industrially developed nations through the provision of
early warning information or scientific data. In lower-income countries, a focus of
resources on strengthening the health system first would ultimately be a more
efficient way to achieve proper detection and response to outbreaks at national or
sub-national level. As documented in several pilot initiatives at sub-national level
(India, South Africa, Tuvalu and Cambodia), the empowerment of frontline health
workers and communities is a key element for an efficient surveillance system.
Such simple measures centred on human resources and community values appear
to be more beneficial than massive and conditional monetary inputs.
400: Bone. 2007 Apr;40(4):1066-72. Epub 2007 Jan 22.

Vertebral fracture risk and impact of database selection on

identifying elderly Lebanese with osteoporosis.
Baddoura R, Arabi A, Haddad-Zebouni S, Khoury N, Salamoun M, Ayoub

G, Okais J, Awada H, El-Hajj Fuleihan G.
Division of Rheumatology, Saint Joseph University, Beirut, Lebanon.

rbaddoura@usj.edu.lb
The International Osteoporosis Foundation recommends using a universal

database i.e. the NHANES database for the diagnosis of osteoporosis. Population-
based databases for T-score calculation are still debated in terms of clinical and
public health relevance. The current study aimed at estimating the prevalence of
vertebral fractures in the Lebanese elderly, determining BMD-fracture
relationship, and assessing the effect of database selection on osteoporosis
prevalence and fracture risk assessment. Apparently healthy subjects were
randomly selected from the Greater Beirut area - one-third of the Lebanese
population at large - using a multilevel cluster technique. Subjects with medical
conditions likely to affect bone metabolism i.e. history of major chronic disease,
intake of medications that affect bone metabolism were excluded. Presence of
vertebral fracture was estimated by a semi-quantitative assessment. Bone density
was measured by central DXA. Clinical risk factors included age, gender, height,
weight, body mass index, smoking, exercise, falls, previous fragility fracture and
family history of fragility fracture. Impact of database selection was assessed by:
(1) Comparison of sensitivity and specificity for prevalent vertebral fractures of
the T-score <or= - 2.5 threshold using local versus NHANES database. (2)
Comparison of estimates for fracture risk (RR/SD decrease in BMD) using local
versus NHANES database. Prevalence of vertebral fractures was estimated at
19.9% [15.4-25.0] in women and at 12.0% [7.3-18.3] in men. Prevalence of
osteoporosis by DXA using total hip was 33.0% [27.5-38.8] in women and 22.7%
[16.2-30.2] in men. The NHANES database provided higher sensitivity for
vertebral fracture than our population-specific database. RR of vertebral fracture
per SD decrease in BMD remained unchanged across the two databases. In
women, RR/SD were 1.61 [1.17-2.23] and 1.49 [1.14-1.95] in the NHANES and
the local database, respectively, and in men 1.59 [0.94-2.72] and 1.43 [0.95-2.16].
In conclusion, our findings were in concordance with the IOF recommendations
for the use of a universal database and could be used for the implementation of a
unified fracture risk assessment paradigm along with the WHO initiative.
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301: MedGenMed. 2007 Jan 18;9(1):12.
Assessing the effectiveness of informational video clips on Iranian

immigrants' attitudes toward and intention to use the BC
HealthGuide Program in the greater Vancouver area.
Poureslami I, Rootman I, Balka E.
Institute of Health Promotion Research, University of British Columbia,

Vancouver, British Columbia, Canada. pouresla@interchange.ubc.ca
BACKGROUND: Consumer-directed health information resources hold great

potential for improving public health and easing the demand on health systems.
Their value, however, depends largely on the ability of their intended users to
access and use them effectively. Little is known about whether British Columbia's
ethnocultural communities are using the British Columbia (BC) Ministry of
Health's BC HealthGuide (BCHG) program, and if so, when and for what
purposes they use the services, as well as level of satisfaction with and users'
perceptions of the resources. This study investigated attitudes toward and
perceptions of the BCHG program, as well as use patterns and satisfaction levels,
within the Iranian community of the Greater Vancouver Area (GVA)--among
BC's largest and fastest-growing Middle Eastern immigrant communities--and
explored a model for introducing the BCHG program to ethnic communities in the
GVA and BC. METHODS: In a 2-stage quasi-experimental design, with a
combination of quantitative and qualitative research methods, data obtained from
structured telephone surveys, in-person interviews, and focus groups involving a
randomly selected sample of the target population were analyzed before and after
intervention with audiovisual health information: a series of culturally relevant
informative video clips developed by direct participation of the community and
aired on local television channels in the fall of 2004. KEY FINDINGS: There was
low awareness and low utilization of the BCHG program among participants at
the beginning of this study. Furthermore, many participants in the initial stage of
this study cautioned that self-care resources in general are unsuited to Iranian
culture, due to widespread distrust of health advice received via telephone or the
Internet, and due to the strong value placed on health advice received directly
from a professional medical doctor. Nonetheless, attitudes, perceptions, and self-
reported utilization rates of the BCHG program improved substantially among the
participants of this study following the screening of culturally appropriate,
targeted promotional videos. Participants almost unanimously reported that
watching the videos had encouraged them to use the BCHG program, and that
they intended to promote the resources to others. In addition, the majority of
participants who had accessed at least one of the BCHG program resources
reported being satisfied with the services that they had received, and improved
utilization rates were maintained at the follow-up focus group stage. At the same
time, participants cautioned that gaining the confidence of the wider Iranian
community in BC and increasing service utilization will require considerable time
and effort. In particular, they suggested using a variety of media and
communication channels, carefully selecting the health messengers, and targeting
messages to specific community subgroups. Conclusions: The findings of this
study strongly suggest that Iranians living in the GVA are open to alternatives to
routine healthcare services, including the use of preventive and self-care
resources. However, awareness levels and utilization rates of the BCHG program
among the GVA's Iranian immigrant population have until now been low. The
noticeable and sustained improvement to attitudes, perceptions, and self-reported
utilization rates of the BCHG program among Iranian participants in this study
after watching culturally appropriate promotional videos indicates the potential to
modify cultural beliefs in regard to the delivery of preventive health information
if the relevant messages are delivered appropriately. By carefully considering the
demographic and cultural characteristics of the various ethnic communities living
in BC, and by targeting promotional activities and services directly to these
individual communities, the BCHG program could improve awareness and
utilization rates within these communities.
PMCID: PMC1924987
302: J Physiol Anthropol. 2007 Mar;26(2):109-12.

Human variation and body mass index: a review of the universality

of BMI cut-offs, gender and urban-rural differences, and secular
changes.
Mascie-Taylor CG, Goto R.
Department of Biological Anthropology, University of Cambridge, UK.

nmt1@cam.ac.uk
Use of BMI as a surrogate for body fat percentage is debatable and universal BMI
cut-off points do not seem appropriate; lower cut-off points than currently
recommended by WHO should be used in some populations, especially in Asia.
The adult WHO BMI database indicates that, on average, women are more obese
than men, while men are more likely to be pre-obese than women. Urban rates of
overweight and obesity are generally higher than rural rates in both sexes. The
trend in pre-obesity and obesity over time is generally upward, with very marked
increases in the USA and UK in both sexes over the last 10 years.
Publication Types:
• Review
303: Int J Environ Res Public Health. 2007 Mar;4(1):45-52.

Remote sensing and GIS techniques for evaluation of groundwater

quality in municipal corporation of Hyderabad (Zone-V), India.
Asadi SS, Vuppala P, Reddy MA.
Centre for Environment, Institute of Science & Technology, Jawaharlal Nehru

Technological University, Hyderabad-500072, A.P, India.
ssvp_envi@yahoo.co.in
Groundwater quality in Hyderabad has special significance and needs great

attention of all concerned since it is the major alternate source of domestic,
industrial and drinking water supply. The present study monitors the ground water
quality, relates it to the land use / land cover and maps such quality using Remote
sensing and GIS techniques for a part of Hyderabad metropolis. Thematic maps
for the study are prepared by visual interpretation of SOI toposheets and linearly
enhanced fused data of IRS-ID PAN and LISS-III imagery on 1:50,000 scale
using AutoCAD and ARC/INFO software. Physico-chemical analysis data of the
groundwater samples collected at predetermined locations forms the attribute
database for the study, based on which, spatial distribution maps of major water
quality parameters are prepared using curve fitting method in Arc View GIS
software. Water Quality Index (WQI) was then calculated to find the suitability of
water for drinking purpose. The overall view of the water quality index of the
present study area revealed that most of the study area with >50 standard rating of
water quality index exhibited poor, very poor and unfit water quality except in
places like Banjara Hills, Erragadda and Tolichowki. Appropriate methods for
improving the water quality in affected areas have been suggested.
Publication Types:

304: BMC Infect Dis. 2007 Apr 11;7:26.
Geographic prediction of tuberculosis clusters in Fukuoka, Japan,

using the space-time scan statistic.
Onozuka D, Hagihara A.
Department of Information Science, Fukuoka Institute of Health and

Environmental Sciences, 39 Mukaizano, Dazaifu, Fukuoka 818-0135, Japan.
onozuka@fihes.pref.fukuoka.jp
BACKGROUND: Tuberculosis (TB) has reemerged as a global public health

epidemic in recent years. Although evaluating local disease clusters leads to
effective prevention and control of TB, there are few, if any, spatiotemporal
comparisons for epidemic diseases. METHODS: TB cases among residents in
Fukuoka Prefecture between 1999 and 2004 (n = 9,119) were geocoded at the
census tract level (n = 109) based on residence at the time of diagnosis. The
spatial and space-time scan statistics were then used to identify clusters of census
tracts with elevated proportions of TB cases. RESULTS: In the purely spatial
analyses, the most likely clusters were in the Chikuho coal mining area (in 1999,
2002, 2003, 2004), the Kita-Kyushu industrial area (in 2000), and the Fukuoka
urban area (in 2001). In the space-time analysis, the most likely cluster was the
Kita-Kyushu industrial area (in 2000). The north part of Fukuoka Prefecture was
the most likely to have a cluster with a significantly high occurrence of TB.
CONCLUSION: The spatial and space-time scan statistics are effective ways of
describing circular disease clusters. Since, in reality, infectious diseases might
form other cluster types, the effectiveness of the method may be limited under
actual practice. The sophistication of the analytical methodology, however, is a
topic for future study.
PMCID: PMC1853096
305: J Prev Med Pub Health. 2007 Mar;40(2):122-9.

[Ethical considerations in genomic cohort study]
[Article in Korean]
Choi EK, Kim OJ.

Department of History of Medicine and Medical Humanities, College of
Medicine, Seoul National University, Korea.
During the last decade, genomic cohort study has been developed in many
countries by linking health data and genetic data in stored samples. Genomic
cohort study is expected to find key genetic components that contribute to
common diseases, thereby promising great advance in genome medicine. While
many countries endeavor to build biobank systems, biobank-based genome
research has raised important ethical concerns including genetic privacy,
confidentiality, discrimination, and informed consent. Informed consent for
biobank poses an important question: whether true informed consent is possible in
population-based genomic cohort research where the nature of future studies is
unforeseeable when consent is obtained. Due to the sensitive character of genetic
information, protecting privacy and keeping confidentiality become important
topics. To minimize ethical problems and achieve scientific goals to its maximum
degree, each country strives to build population-based genomic cohort research
project, by organizing public consultation, trying public and expert consensus in
research, and providing safeguards to protect privacy and confidentiality.
Publication Types:
306: Crit Care Med. 2007 May;35(5):1312-7.

Comment in:
• Crit Care Med. 2007 May;35(5):1429.
Healthcare climate: a framework for measuring and improving

patient safety.
Zohar D, Livne Y, Tenne-Gazit O, Admi H, Donchin Y.
Faculty of Management, Technion Institute of Technology, Haifa, Israel.

dzohar@tx.technion.ac.il
OBJECTIVES: Reviews of patient safety efforts suggest that

technical/administrative change must be augmented by global factors such as
organizational culture and climate. The objective was to outline a comprehensive
model for healthcare climate and test one of its elements, the nursing subclimate,
in terms of several patient safety outcomes. DESIGN: Measure organizational
climate in nursing units, followed by random sampling of patient safety practices
in each unit 6 months later. SETTING: Sixty-nine inpatient units in three
hospitals that make up the entire tertiary care system in one metropolitan area.
SUBJECTS: A total of 955 nurses. INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: A two-part Nursing Climate Scale
referring to hospital- and unit-level climates, followed by five randomly timed
observations of patient safety practices covering routine and emergency care in
each unit. Climate scales met the criteria of internal reliability, within-unit
agreement, and between-unit variability, using standard statistics of climate
research. Both the hospital and unit nursing climates exhibited significant
variation, which predicted the routine medication safety scores (Z = 2.65 and 2.93
accordingly, p < .01), with similar results for emergency safety scores. A
significant interaction (Z = 2.78, p < .01) indicated that best/worst safety is
obtained when the unit and hospital climates are aligned (for better or worse) and
that positive unit climate can compensate for the detrimental effect of poor
hospital climate. Furthermore, climate's strength increased its predictive power
with regard to patient safety practices (Z = 3.64 for medication and 2.28 for
emergency safety; p < .01). The small number of participating hospitals limits
organization-level analyses. CONCLUSIONS: The nursing climate identifies
units where the likelihood of adverse events is greater or lower than the hospital's
average. Such information can guide prevention efforts in selected units. These
data encourage the development of additional climate subscales subsumed under
the healthcare climate model (e.g., physicians subclimate).
Publication Types:
307: AIDS. 2007 Apr;21 Suppl 2:S99-102.

Role of the data safety and monitoring board in an international

trial.
OBJECTIVE: To describe the composition and role of the data safety and
monitoring board (DSMB) for the National Institute of Mental Health (NIMH)
Collaborative HIV/STD Prevention Trial. DESIGN: NIMH appointed to the
DSMB nine members representing the following areas of expertise: prevention
science, ethnography, infectious diseases (especially HIV and sexually
transmitted diseases), laboratory diagnostics, clinical practice, methodology,
international trial experience, statistics, and ethics. METHODS: The DSMB
assessed the overall study for any concern about plans or implementation and
reviewed cumulative study data to evaluate the safety of study participants, the
ongoing conduct of the study, and the scientific validity and integrity of the Trial.
Because of the Trial's international scope, the DSMB examined the effects of
cultural differences on study implementation and fidelity. RESULTS: Among the
DSMB recommendations that strengthened the Trial was one to conduct initial
epidemiological studies of the venues selected for the intervention to verify risk
and to establish intraclass correlation coefficients that could be used to calculate
appropriate sample sizes. CONCLUSIONS: The DSMB played a critical role in
this Trial. Because members have the expertise required to monitor the Trial, are
not involved in the daily management of the Trial, and can review interim
analyses and adverse event reports, they are in an excellent position to provide
expert advice to ensure that the Trial's goals are achieved and that NIH funds are
well invested.
308: AIDS. 2007 Apr;21 Suppl 2:S91-8.

Formative study conducted in five countries to adapt the community

popular opinion leader intervention.
OBJECTIVE: To obtain information about the social and cultural factors related
to health behaviors influencing HIV/sexually transmitted disease (STD)
transmission in study communities in China, India, Peru, Russia, and Zimbabwe
so that the assessment and intervention of the National Institute for Mental Health
(NIMH) Collaborative HIV/STD Prevention Trial could be adapted appropriately.
METHODS: Field observations, focus groups, in-depth interviews with key
informants, and an observation of community social dynamics were conducted as
part of a rapid ethnographic assessment. RESULTS: All five sites reported a
power dynamic tilted towards men, which rendered women particularly
vulnerable to HIV and other STDs. Women's relative lack of power was
exemplified by a double standard for extramarital sex, women's limited ability to
negotiate sex or condom use, and sexual and physical violence against women. In
all sites except Russia, extramarital sex is tolerated for men but proscribed for
women. In Peru, power dynamics between men who have sex with men were
tilted towards men who self-identified as heterosexual. Condom use (reported to
be low across all sites) was often linked to having sex with only those perceived
as high-risk partners. Regardless of site or study population, participants agreed
on the following characteristics of an ideal community popular opinion leader (C-
POL): respectable, credible, experienced (life and sexual), trustworthy,
empathetic, well-spoken, and self-confident. CONCLUSION: The ethnographic
studies provided critical information that enabled the study teams to adapt
elements of the Trial in culturally appropriate ways in diverse international
settings.
309: AIDS. 2007 Apr;21 Suppl 2:S81-90.

Sexually transmitted disease and HIV prevalence and risk factors in

concentrated and generalized HIV epidemic settings.
BACKGROUND: In many developing countries, the threat of nascent HIV

epidemics expanding rapidly requires immediate and appropriate HIV prevention
activities. Inexpensive and sustainable interventions are especially relevant in
resource-constrained environments. In 2001, we assessed the prevalence and
behavioral risk of sexually transmitted disease (STD) and HIV among at-risk
populations in five developing countries in preparation for a community-
randomized controlled trial, the NIMH Collaborative HIV/STD Prevention Trial.
METHODS: Using a standardized protocol, more than 1000 participants in each
country (China, India, Peru, Russia, and Zimbabwe) were selected by random
sampling methods, completed a behavioral risk assessment, and provided
biological specimens using a common laboratory protocol. Sample characteristics
were studied within each country, and risk factors for HIV/STD acquisition were
evaluated using logistic regression models. RESULTS: HIV rates were low (<1%)
in China, India, Peru, and Russia but were high (26%) in rural Zimbabwe. STDs
were generally twice as common in women as men, and serological evidence of
herpes simplex virus type 2 infection was the most frequently detected STD.
Behavioral data showed high rates of multiple partners in the Russian sample, and
very low condom use rates in India and China. Among participants who reported
ever having sex, female sex and having two or more sex partners were the factors
most frequently associated with an increased risk of prevalent STD.
CONCLUSION: Behavioral or biological risks were of sufficient magnitude in
the locations selected in China, Russia, and Zimbabwe to implement the
community-based randomized trial. Higher-risk subsets of community residents in
India and Peru were identified before beginning the Trial.

310: AIDS. 2007 Apr;21 Suppl 2:S69-80.
Ethical issues in the NIMH Collaborative HIV/STD Prevention

Trial.
OBJECTIVE: To develop decision rules regarding key ethical dimensions in

scientific protocols for the National Institute for Mental Health (NIMH)
Collaborative HIV/STD Prevention Trial taking place in five countries (China,
India, Peru, Russia, and Zimbabwe). DESIGN: Countries had HIV rates from 27
to 0.1%, the standard of care varied from access to antiretroviral drugs to no
availability, and the reporting of sexually transmitted diseases (STD) to
government agencies was mandatory in some countries and not in others. These
variations presented challenges when developing decision rules that could be
uniformly adopted across countries and simultaneously follow the ethical
principles of beneficence, respect, and justice. METHODS: We used several
strategies to identify and resolve ethical dilemmas for this international HIV
prevention trial. First, we identified key principles, especially those derived for
clinical therapeutic, biomedical preventive, or device trials. We convened a
'workgroup on protecting human participants' and charged them with identifying
and implementing optimal procedures for ensuring the ethical and equitable
treatment of participants and making recommendations to minimize physical,
psychological, and social harm to the participants. Each site had a community
advisory board, essential in identifying local ethical issues and possible
resolutions to them. The NIMH established a data safety and monitoring board
with ultimate responsibility for adjudicating ethical dilemmas and decisions. The
protocols were deliberated thoroughly by the Trial steering committee, and
approved by nine United States and five in-country institutional review boards.
RESULTS: We summarize the decision rules adopted to resolve the ethical
dilemmas identified. Especially important were the translation of clinical trials
principles for a behavioral intervention trial, strategies for ensuring confidentiality
and informed consent, dilemmas relating to partner notification of sexually
transmitted infections including HIV, minimizing the risks of social harm,
establishing community partnerships, ensuring equity among United States and
in-country principal investigators, and building capacity for additional research.
CONCLUSION: We document our processes and decisions, and their underlying
rationales, and hope they contribute to the development of further thinking and
practice regarding the ethics of social and behavioral HIV and STD prevention
trials in resource-poor settings.

311: AIDS. 2007 Apr;21 Suppl 2:S59-68.
The community popular opinion leader HIV prevention

programme: conceptual basis and intervention procedures.
OBJECTIVE: To describe the community popular opinion leader (C-POL)

intervention employed in the NIMH Collaborative HIV/STD Prevention Trial,
including its theoretical, conceptual, and empirical basis, intervention procedures
and methods, core elements, and how its content was culturally tailored to address
the needs of varied populations. DESIGN: The programme is designed to identify,
recruit, train, and intensively engage C-POLs of a target population to convey
HIV risk reduction messages to people in their communities, with the intention of
reducing high-risk behavior at a population level. METHODS: Based on the
diffusion of innovation theory, the intervention identified, trained, and engaged C-
POL within a high-risk community population to advocate, recommend, and
endorse the importance of safer behavior to other members of the same
population. Nine core elements of the intervention are discussed. Data collected
during rapid ethnography were used to adapt the content of the intervention for
food market owners and workers in China, male patrons of wine shops and at-risk
women congregating nearby in India, young people in social gathering venues in
Peruvian barrios, dormitory students in Russia, and people congregating in
commercial areas of growth points in Zimbabwe. RESULTS: The C-POL
intervention model taps into community strengths, altruism, and people's desire to
do something to help fight against AIDS. With few exceptions, C-POLs
participated enthusiastically in the training sessions and reported having
conversations in the community. CONCLUSION: Rapid ethnography can be used
to tailor an intervention to diverse settings while maintaining fidelity to the core
elements of the intervention.
312: AIDS. 2007 Apr;21 Suppl 2:S49-58.

The feasibility of audio computer-assisted self-interviewing in

international settings.
OBJECTIVE: To determine the feasibility of using audio computer-assisted self-

interviewing (ACASI) for data collection in developing countries, and to compare
responses to questions eliciting sensitive information about sexual behavior using
ACASI versus computer-assisted personal interviewing (CAPI) in five developing
countries. DESIGN: A feasibility study determined whether ACASI could be used
in populations in developing countries. A follow-up, randomized crossover study
compared responses to questions eliciting sensitive information about sexual
behavior using ACASI versus CAPI. METHODS: The NIMH Collaborative
HIV/STD Prevention Trial conducted a feasibility study of ACASI in
convenience samples in China, India, Peru, and Russia, then a randomized
crossover ACASI versus CAPI study among volunteers in these countries plus
Zimbabwe. RESULTS: Approximately equal numbers of men and women
completed the feasibility study; the results suggested a high comfort level among
participants. Married respondents in China and India appeared to give unreliable
responses on sexual activity. In the crossover study, the pattern of responses to
sensitive questions showed few differences. In China, higher rates of sexual risk
were reported on CAPI. In Peru and Russia, differences by mode were found in
the number of partners in the past year. CONCLUSION: Despite variable
computer experience and literacy, feasibility study participants reported ease in
completing ACASI, and preferred a computer to an interviewer for answering
sensitive questions, or had no preference. In the crossover study, most participants
gave similar responses on both modes of survey administration. ACASI appears
to be feasible in these settings, although low literacy may pose problems if
participants cannot clarify questions.
313: AIDS. 2007 Apr;21 Suppl 2:S37-48.

Design and integration of ethnography within an international

behavior change HIV/sexually transmitted disease prevention trial.
OBJECTIVE: To use a common ethnographic study protocol across five countries

to provide data to confirm social and risk settings and risk behaviors, develop the
assessment instruments, tailor the intervention, design a process evaluation of the
intervention, and design an understandable informed consent process. DESIGN:
Methods determined best for capturing the core data elements were selected.
Standards for data collection methods were established to enable comparable
implementation of the ethnographic study across the five countries. METHODS:
The methods selected were participant observation, focus groups, open-ended
interviews, and social mapping. Standards included adhering to core data
elements, number of participants, mode of data collection, type of data collection
instrument, number of data collectors at each type of activity, duration of each
type of activity, and type of informed consent administered. Sites had discretion
in selecting which methods to use to obtain specific data. RESULTS: The
ethnographic studies provided input to the Trial's methods for data collection,
described social groups in the target communities, depicted sexual practices, and
determined core opinion leader characteristics; thus providing information that
drove the adaptation of the intervention and facilitated the selection of venues,
behavioral outcomes, and community popular opinion leaders (C-POLs).
CONCLUSION: The described rapid ethnographic approach worked well across
the five countries, where findings allowed local adaptation of the intervention.
When introducing the C-POL intervention in new areas, local non-governmental
and governmental community and health workers can use this rapid ethnographic
approach to identify the communities, social groups, messages, and C-POLs best
suited for local implementation.
314: AIDS. 2007 Apr;21 Suppl 2:S3-18.

Methodological overview of a five-country community-level

HIV/sexually transmitted disease prevention trial.
OBJECTIVE: To provide an overview of the National Institute of Mental Health

(NIMH) Collaborative HIV/STD Prevention Trial taking place in five populations
at risk of HIV and sexually transmitted diseases in China, India, Peru, Russia, and
Zimbabwe, including the rationale, study management, methods, and proposed
data analyses. DESIGN: The Trial will scientifically evaluate the effectiveness of
the community popular opinion leader (C-POL) community-level HIV prevention
intervention that was adapted for use in the various cultures within the resource
limitations faced by service providers in world regions threatened by high rates of
HIV infection. METHODS: The study phases consist of an ethnographic study,
pilot studies, an epidemiological study, and a community-randomized trial. The
Trial uses the C-POL intervention, which researchers selected on the basis of
research that shows the intervention's success in populations vulnerable to HIV
risk behavior in the United States, and has the potential to be applied in a variety
of international settings. RESULTS: Trial results will be tabulated by and across
country by randomization assignment. Results will include a careful review of
data to substantiate original assumptions used in the study design. Data collection
will not conclude until August 2007. CONCLUSION: Although data collection is
incomplete, researchers have learned lessons throughout the development of the
study. These include the importance of preliminary epidemiological studies; the
close monitoring of biological testing, follow-up rates and process measures at
international sites; the tailoring of assessments and interventions to various
cultures; regular communication; and a review of the timeline to accommodate
Institutional Review Board clearances.
315: AIDS. 2007 Apr;21 Suppl 2:S29-36.

Challenges and processes of selecting outcome measures for the

OBJECTIVE: To review the challenges of designing behavioral and biological

outcome measures for the multinational NIMH Collaborative HIV/STD
Prevention Trial and provide the rationale for selecting these measures. DESIGN:
Although many different evidence-based prevention programmes have been
developed, few have been evaluated in different countries, cultures, and
populations. One issue in evaluating the generalized efficacy of any prevention
approach is to identify a set of common outcome measures useful across diverse
settings and peoples. The Trial is designed to evaluate whether the community
popular opinion leader intervention can be adapted cross-nationally and cross-
culturally for different populations and still retain its efficacy. METHODS:
Literature reviews, investigator experience, ethnographic study, pilot studies, and
epidemiological studies were used to select the endpoints for the Trial. RESULTS
AND CONCLUSION: Both biological and behavioral data will be obtained at
baseline and 12 and 24 months post-baseline. Communities that receive the
intervention will be compared with matched control communities on two primary
outcomes: (i) a change in self-reported unprotected sexual acts with non-spousal,
non-live-in partners; and (ii) the incidence of sexually transmitted disease (STD),
defined as a composite index of viral and bacterial STD.
316: AIDS. 2007 Apr;21 Suppl 2:S19-28.

Selection of populations represented in the NIMH Collaborative

HIV/STD Prevention Trial.
OBJECTIVE: To identify venues with vulnerable populations suitable for testing

the community popular opinion leader intervention in each of the five countries
(China, India, Peru, Russia, and Zimbabwe) participating in the National Institute
of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial. DESIGN:
HIV epidemiology and vulnerable populations differ considerably across the
countries. Therefore, different community populations were targeted in the five
countries. METHODS: Venues and populations were chosen on the basis of
specific selection criteria (investigated during the Trial's ethnographic research
phase): the willingness of stakeholders and gatekeepers of the venues to
cooperate; geographical boundaries defining each venue; population stability
within venues; the independence of venues and non-overlap of population
members across multiple venues; population size within each venue; social
interaction opportunities; and either a high level of sexual risk behavior or a high
prevalence of sexually transmitted diseases (STDs) or HIV. RESULTS: Venues
and populations selected were food market stall owners and workers in China,
male patrons of wine shops and at-risk women congregating near the shops in
India, young men and women in social gathering points in neighborhoods in Peru,
trade and vocational school dormitory residents in Russia, and people
congregating in growth points in Zimbabwe. CONCLUSION: Although the target
populations differed across countries, they shared in common high behavioral or
biological risk at baseline and suitability for a randomized trial of a community-
level HIV/STD prevention behavioral intervention.
317: Am J Public Health. 2007 Apr;97 Suppl 1:S146-51. Epub 2007 Apr 5.
Tsunami mortality estimates and vulnerability mapping in Aceh,

Indonesia.
Doocy S, Gorokhovich Y, Burnham G, Balk D, Robinson C.
Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg
School of Public Health, Baltimore, Md 21205, USA. sdoocy@jhsph.edu
OBJECTIVES: We aimed to quantify tsunami mortality and compare approaches

to mortality assessment in the emergency context in Aceh, Indonesia, where the
impact of the 2004 tsunami was greatest. METHODS: Mortality was estimated
using geographic information systems-based vulnerability models and
demographic methods from surveys of tsunami-displaced populations. RESULTS:
Tsunami mortality in Aceh as estimated by demographic models was 131066 and
was similar to official figures of 128063; however, it was a conservative estimate
of actual mortality and is substantially less than official estimates of 168561
presumed dead, which included those classified as missing. Tsunami impact was
greatest in the district of Aceh Jaya, where an estimated 27.0% (n=23862) of the
population perished; Aceh Besar and Banda Aceh were also severely affected,
with mortality at 21.0% (n = 61 650) and 11.5% (n = 25 903), respectively.
Mortality was estimated at 23.7% for the population at risk and 5.6% overall.
CONCLUSIONS: Mortality estimates were derived using methodologies that can
be applied in future disasters when predisaster demographic data are not available.
Models could be useful in the early stages of disaster response by facilitating
geographic targeting and management of humanitarian assistance.
PMCID: PMC1854998 [Available on 04/01/09]
318: Eur J Public Health. 2007 Dec;17(6):593-9. Epub 2007 Apr 2.

Estimating mortality and causes of death in Turkey: methods,

results and policy implications.
Akgün S, Rao C, Yardim N, Basara BB, Aydin O, Mollahaliloglu S, Lopez

AD.
Baskent University School of Medicine, Ankara, Turkey.
BACKGROUND: Cause-specific mortality statistics are primary evidence for

health policy formulation, programme evaluation, and epidemiological research.
In Turkey, a partially functioning vital registration system in urban areas yields
fragmentary evidence on levels and causes of mortality. This article discusses the
application of innovative methods to develop national mortality estimates in
Turkey, and their implications for national health development policies.
METHODS: Child mortality levels from the Demography and Health Survey
(DHS) were applied to model life tables to estimate age-specific death rates.
Reported causes of death from urban areas were adjusted using re-distribution
algorithms from the Global Burden of Disease (GBD) Study. Rural cause
structure was estimated from epidemiological models. Local epidemiological data
was used to adjust model-based estimates. RESULTS: Life expectancy at birth in
2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10
years lower than in Western Europe. Leading causes of death include major
vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths,
chronic obstructive lung disease and lung cancer in men, but also perinatal causes,
lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of
deaths, although this may be an underestimate. CONCLUSIONS: Mortality
estimates are uncertain in Turkey, given the poor quality of death registration
systems. Application of burden of disease methods suggests that there has been
progress along the epidemiological transition. Key health development strategies
for Turkey include improved access to communicable disease control
technologies, and urgent attention to the development of a reliable, nationally
representative health information system.
Publication Types:

319: Comput Methods Programs Biomed. 2007 May;86(2):191-6. Epub 2007 Apr 2.
Scientific production of electronic health record research, 1991-

2005.
Wen HC, Ho YS, Jian WS, Li HC, Hsu YH.
School of Health Care Administration, Taipei Medical University, Taipei,

Taiwan.
PURPOSE: The increasing numbers of publications on electronic health record

(EHR) indicate its increasing importance in the world. This study attempted to
quantify the scientific production of EHR research articles, and how they have
changed over time, in an effort to investigate changes in the trends cited in these
critical evaluations. METHOD: The articles were based on the science citation
index (SCI) from 1991 to 2005. A descriptive study was performed using the
1803 documents published in the SCI from 39 countries in America, Europe,
Africa, Asia, and Oceania. The evaluation was based on parameters including
document type, language, first author's country of origin, number of citations and
citations per publication. RESULTS: Of all publications, 1455 (80.7%) were
articles, followed by meeting abstracts which represented about one-tenth of all
types of EHR publications. Numbers of published articles have significantly
increased when compared by each 5-year period. Most articles were published in
English (98%) and were from the region of America (57%). The top 10 of the 374
journals accounted for 41% of the number of published articles. The US
dominates publication production (57%) with a cumulative impact factor (IF) of
2227 and followed by the UK (8.5%, with a cumulative IF of 257.0) and the
Netherlands (7.8%, with a cumulative IF of 211.1). An analysis of the number of
articles related to population revealed a high publication output for relative small
countries like Switzerland, the Netherlands, and Norway. CONCLUSIONS:
Research production in EHR showed a considerable increase during 1991-2005.
The production was dominated by articles, those from the US, and those
published in English. The production came from many countries, denoting the
devotion to this field in different areas around the world.
320: J Vasc Access. 2007 Jan-Mar;8(1):21-7.

Increased use of catheters as vascular access: is it justified by

patients' clinical conditions?
Di Benedetto A, Basci A, Cesare S, Marcelli D, Ponce P, Richards N.
NephroCare-Italy, Naples, Italy. attilio.dibenedetto@fmc-ag.com
BACKGROUND: Over the last years many technical improvements have been
made in hemodialysis treatment. Vascular access (VA) still remains an important
problem. Although the use of indwelling vascular catheters is discouraged, in
Europe there is an increasing use of them. The K/DOQI Guidelines recommend a
native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there
is considerable geographic variation in the distribution of type of VA used
amongst hemodialysis patients. The aim of this study was to evaluate the time
patients in four European countries have to wait before undergoing their first
surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD
clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics
network between October 1, 2002 and September 30, 2004 were considered. Data
were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients
(males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy
and Portugal had a higher proportion of elderly patients. At time of admission, the
proportion of patients starting dialysis with AVF ranged between 23% and 60%
from Turkey to Italy respectively. Patients with an indwelling catheter at
admission are expected to undergo VA surgery as soon as possible. After 3
months of follow-up, about 75% of all patients had undergone surgery, however
in the UK less than 50% of the patients had had a VA procedure. Overall, males
have significantly higher probability of undergoing surgery, whilst elderly
patients have a lower probability (27% and 14% respectively). CONCLUSION:
Significant differences exist between countries in the time interval from referral to
creation of VA. Health care system related problems seem to be the major reason
to explain such differences. Patients in the UK have longer waiting times than the
other countries studied.
Publication Types:

321: IEEE Trans Inf Technol Biomed. 2007 Mar;11(2):141-52.
SAKURA-viewer: intelligent order history viewer based on two-

viewpoint architecture.
Toyoda S, Niki N, Nishitani H.
Department of Health Service, International University of Health and Welfare,

Tochigi 324-8501, Japan. toyoda@jobu.ac.jp
We propose a new intelligent order history viewer applied to consolidating and

visualizing data. SAKURA-viewer is a highly effective tool, as: 1) it visualizes
both the semantic viewpoint and the temporal viewpoint of patient records
simultaneously; 2) it promotes awareness of contextual information among the
daily data; and 3) it implements patient-centric data entry methods. This viewer
contributes to decrease the user's workload in an order entry system. This viewer
is now incorporated into an order entry system being run on an experimental
basis. We describe the evaluation of this system using results of a user satisfaction
survey, analysis of information consolidation within the database, and analysis of
the frequency of use of data entry methods.
322: Malar J. 2007 Mar 27;6:37.

Large-scale malaria survey in Cambodia: novel insights on species

distribution and risk factors.
Incardona S, Vong S, Chiv L, Lim P, Nhem S, Sem R, Khim N, Doung S,

Mercereau-Puijalon O, Fandeur T.
Laboratory of Molecular Epidemiology, Institut Pasteur du Cambodge, Phnom

Penh, Cambodia. sandra.incardona@yahoo.fr <sandra.incardona@yahoo.fr>
BACKGROUND: In Cambodia, estimates of the malaria burden rely on a public

health information system that does not record cases occurring among remote
populations, neither malaria cases treated in the private sector nor asymptomatic
carriers. A global estimate of the current malaria situation and associated risk
factors is, therefore, still lacking. METHODS: A large cross-sectional survey was
carried out in three areas of multidrug resistant malaria in Cambodia, enrolling
11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence,
parasite densities and spatial distribution of infection were determined to identify
parasitological profiles and the associated risk factors useful for improving
malaria control programmes in the country. RESULTS: Malaria prevalence was
3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas.
Prevalences and Plasmodium species were heterogeneously distributed, with
higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable
fevers accounted only for 10-33% of malaria cases, and 23-33% of parasite
carriers were febrile. Multivariate multilevel regression analysis identified adults
and males, mostly involved in forest activities, as high risk groups in
Sampovloun, with additional risks for children in forest-fringe villages in the
other areas along with an increased risk with distance from health facilities.
CONCLUSION: These observations point to a more complex malaria situation
than suspected from official reports. A large asymptomatic reservoir was
observed. The rates of P. vivax infections were higher than recorded in several
areas. In remote areas, malaria prevalence was high. This indicates that additional
health facilities should be implemented in areas at higher risk, such as remote
rural and forested parts of the country, which are not adequately served by health
services. Precise malaria risk mapping all over the country is needed to assess the
extensive geographical heterogeneity of malaria endemicity and risk populations,
so that current malaria control measures can be reinforced accordingly.
PMCID: PMC1847522
323: J Urban Health. 2007 May;84(3 Suppl):i98-108.

The design of housing and shelter programs: the social and

environmental determinants of inequalities.
Sheuya S, Howden-Chapman P, Patel S.
University College of Lands and Architectural Studies, Dar es Salaam, Tanzania.

sheuya@yahoo.com
Both developed and less developed countries are becoming increasingly

urbanized. The earlier industrialized countries have developed more infrastructure
to support the building of healthy housing, in neighborhoods that are strongly
linked to municipal and global health initiatives, but to some degree housing and
neighborhood issues vary only in degree between the developing and developed
worlds. Overall, a billion people, a third of people living in urban areas, live in
slums, where environmental determinants lead to disease. Although
communicable diseases predominate in the developing world and have reemerged
in the developed world, noncommunicable diseases are also growing
disproportionately in the developing world. At a global level, the Millennium
Development Goals explicitly focus on an integrated approach to slum upgrading.
The per capita cost of slum upgrading is almost twice the cost of providing new
affordable housing at the outset. It is argued that to improve health and well-being
in the slums we need to have interventions that reduce urban poverty in the
broadest sense and improve the deficiencies associated with slums. There is an
urgent need to scale up the best-practice interventions. Examples are given of
successful local community initiatives that have been set up under national
strategies in Tanzania and by Indian women's collectives that are globally linked
and have helped develop housing and sanitation improvements. The unit costs for
such interventions are within the reach of all the key stakeholders. Global
commitment is the only missing link.
Publication Types:
PMCID: PMC1891646
324: Nagoya J Med Sci. 2007 Jan;69(1-2):61-70.

Avoidable mortality measured by years of potential life lost (YPLL)

aged 5 before 65 years in Kyrgyzstan, 1989-2003.
Bozgunchievz M, Ito K.
Young Leaders' Program, Nagoya University Graduate School of Medicine,

Nagoya 466-8550, Japan. taramcar@mail.ru
There is considerable willingness in the entire medical society of Kyrgyzstan,

which was directly involved in the reform process, to obtain reliable information
about changes in population health that have occurred in the last decade, as well
as about changes in mortality, which is the basic component of population health.
The objective of this paper is to introduce the Year of Potential Life Lost (YPLL)
in Kyrgyzstan caused by avoidable mortality in the population between 5 and 65
years of age during 1989-2003, and to provide a basis for setting the priorities for
the reducing YPLL in the coming years. YPLL was calculated using data from the
annual mortality tables according to causes of deaths and age for 1989, 1996,
1999 and 2003. YPLL is defined as the summation of the difference between 65
years of age and the age at death from the age of 5 and before 65. In 2003, the
total number of YPLL due to avoidable mortality among those who died was
216,860, which represents a decline of 5.0% in comparison with 228,266 in 1989.
During the study years, the largest proportion of YPLL in the population between
5 and 65 years of age resulted from injury and poisoning. In 2003, this proportion
represented 41.5% of the total amount of YPLL due to all the causes studied here,
followed by infections and parasitic diseases (12.0%), circulatory disturbance of
the brain (11.5%), chronic liver diseases and cirrhosis (11.4%), diseases of the
respiratory system (9.2%), and malignant neoplasm of the upper airways and
digestive tract (4.6%). The decline in avoidable mortality caused by injury and
poisoning, infections disease, malignant neoplasm of the female breast and uterus
has to be priority-driven direction for developing Health Policy in the coming
years in Kyrgyzstan. Attention also has to be given to reducing of avoidable
mortality caused by malignant neoplasm of the female breast by implementing
screening programs.
325: Environ Manage. 2007 May;39(5):737-48. Epub 2007 Mar 20.

Multinational, freshwater biomonitoring programs in the developing

world: lessons learned from African and Southeast Asian river
surveys.
Resh VH.
Department of Environmental Science, Policy & Management, University of

California, 137 Mulford Hall, Berkeley, CA 94720-3114, USA.
vresh@nature.berkeley.edu
Biomonitoring programs are widely used in developed countries. They also offer
many advantages in assessing ecological consequences of perturbations in
developing countries, including reducing the equipment-operation, maintenance,
and training costs associated with physicochemical monitoring. Three case
histories of river biomonitoring using freshwater organisms (fish, benthic
macroinvertebrates, diatoms, zooplankton) are described that involve (1)
documentation of environmental effects from long-term, large-scale applications
of insecticides to control insect-vectors of river blindness (onchocerciasis) in 11
West African countries; (2) water quality assessments and restoration planning in
and around national parks in three East African countries; and (3) evaluation of
overall ecological health of the Lower Mekong River in four Southeast Asian
countries. As in developed countries, benthic macroinvertebrates are the
organisms most widely used in biomonitoring in developing countries.
Conflicting opinions of system resilience and whether expected changes are
within natural variation may result in differences in underlying hypotheses
proposed, study designs implemented, and study execution; each may lead to
uncorrectable bias. Direct transfers of approaches used from developed to
developing countries are often appropriate; however, techniques dependent on
pollution-tolerance values are often region specific and not transferable. Typically
expressed concerns about applications of biomonitoring in developing countries
include poor coordination among agencies; lack of legislation, identification keys,
and trained personnel; and incomplete information on how tropical rivers
function. Problems are real but solvable, as evident from accomplishments in
several multicountry programs in developing countries. Developed countries
requiring coordinated monitoring of international rivers may benefit from
examining successful programs under way in developing countries.
Publication Types:
326: Comput Med Imaging Graph. 2007 Jun-Jul;31(4-5):285-98. Epub 2007 Mar 21.
Computer aided detection of small acute intracranial hemorrhage

on computer tomography of brain.
Chan T.
Department of Health Technology and Informatics, The Hong Kong Polytechnic

University, Hong Kong SAR, China. tao.chan@polyu.edu.hk
INTRODUCTION: Detection of acute intracranial hemorrhage (AIH) is a primary

task in image interpretation of computer tomography (CT) of brain for patients
suffering from acute neurological disturbance or head injury. Although CT readily
depicts AIH, interpretation can be difficult especially when the lesion is
inconspicuous or the reader is inexperienced. OBJECTIVE: To develop a
computer aided detection system that improves diagnostic accuracy of small AIH
on brain CT. MATERIALS AND METHODS: Intracranial contents are first
segmented by thresholding and morphological operations, which are then
subjected to denoising and adjustment for CT cupping artifacts. The brain is then
automatically realigned into normal position. AIH candidates are extracted based
on top-hat transformation and left-right asymmetry. AIH candidates are registered
against a normalized coordinate system such that the candidates are rendered
anatomical information. True AIH is differentiated from mimicking normal
variants or artifacts by a knowledge-based classification system incorporating
rules that make use of quantified imaging features and anatomical information. A
total of 186 clinical cases, including 62 CT studies showing small (<1cm) AIH,
and 124 controls, were retrospectively collected. Forty positive cases and 80
controls were used for the training of the CAD. Twenty-two positive cases and 44
controls were used in the validation of the CAD system. Regions of AIH
identified by two experienced radiologists were used as gold standard. The size of
individual AIH volume was also recorded. RESULTS: On a per patient basis, the
system achieved sensitivity of 95% (38/40) and specificity of 88.8% (71/80) in
the training dataset. The sensitivity and specificity were 100% (22/22) and 84.1%
(37/44) respectively for the diagnosis of AIH in the validation cases. Individual
cases contained variable number of AIH volumes. There were 77 lesions in the 40
training cases and 46 lesions in the 22 validation cases. On a per lesion basis, the
sensitivities were 84.4% (65/77) and 82.6% (38/46) for all lesions 10mm or
smaller for the training and validation datasets, respectively. False positive rates
were 0.19 (23/120) and 0.29 (19/66) false positive lesion per case for the training
and validation datasets, respectively. CONCLUSION: This study demonstrated
that CAD is valuable for detection of small AIH on brain CT.
327: Vaccine. 2007 May 10;25(19):3827-33. Epub 2007 Feb 12.

Who gets hospitalized for influenza pneumonia in Thailand?

Implications for vaccine policy.
Katz MA, Tharmaphornpilas P, Chantra S, Dowell SF, Uyeki T, Lindstrom

S, Balish A, Peret TC, Chittaganpitch M, Simmerman JM, Olsen SJ.
Epidemic Intelligence Service, Office of Workforce and Career Development,

Atlanta, GA 30333, United States. makatz@cdc.gov
Risk factor information for severe complications of interpandemic influenza is

needed to inform vaccine policy in Thailand. We identified patients with lab-
confirmed influenza who were hospitalized with pneumonia during September
2003 to August 2004. Among the 80 case-patients identified through a
population-based pneumonia surveillance system in eastern Thailand, cases were
6.2 and 11.1 times more likely to be among persons<1 year old and >75 years old,
respectively, compared with the overall population. Cases were also 7.6 times
more likely to have chronic respiratory disease. In Thailand, the young, elderly,
and those with chronic disease were at high risk for hospitalized pneumonia from
influenza.
328: AIDS Care. 2007;19 Suppl 1:S44-53.

Expanding community through ARV provision in Thailand.
Lyttleton C, Beesey A, Sitthikriengkrai M.
Department of Anthropology, Macquarie University, Sydney, Australia.

Chris.Lyttleton@mq.edu.au
Anti-retrovirals (ARVs) have altered the complexion of HIV/AIDS management

in Thailand. In 2005, ARVs were included within a subsidised health scheme
making provision widespread. Increased access has been brought about through
the legal and political advocacy of the Thai Network for People Living with
HIV/AIDS (TNP+) who now play a central role in expanded ARV provision.
HIV-infected volunteers help the state deliver comprehensive services and assist
with follow-up and adherence programs. Alongside improvements in drug
provision, a focus on pharmaceutical treatment has left other issues, such as
community support of orphans and the social responses to living with HIV, less
central within community responses. As they take on new responsibilities, people
living with HIV/AIDS (PLHA) groups move from activities focused on reversing
local stigma to constitute a new social movement that is increasingly prominent in
Thai civil society. Networks of PLHA confront new social and political
challenges as they also seek to broaden access to marginalised groups who remain
excluded from these services. Many ethnic minority groups without full Thai
citizenship have been denied access to subsidised health services including ARVs.
As part of a broadening advocacy profile, the PLHA movement is now engaging
in a politics of difference defined not simply by presence or absence of HIV but
also by wider issues of national identity and belonging.
Publication Types:
329: East Mediterr Health J. 2006;12 Suppl 2:S253-7.

Handsearching the EMHJ for reports of randomized controlled

trials by U.K. Cochrane Centre (Bahrain).
Al Hajeri A, Al Sayyad J, Eisinga A.
Bahrain Branch of U.K. Cochrane Centre, The Cochrane Collaboration, Bahrain.

(Correspondence to A. Al alhajeriamani@gmail.com
This study used handsearching to find reports of randomized controlled trials in

the Eastern Mediterranean Health Journal (EMHJ). EMBASE and MEDLINE
were also searched electronically to identify if the reports found by the
handsearch were already included in either of these databases. Nine reports were
identified: 7 randomized controlled trials and 2 controlled clinical trials. The
added value of the handsearch over EMBASE was 6 additional reports and over
MEDLINE was 4. Reports identified were sent to the UK Cochrane Centre for
verification and publication in The Cochrane Central Register of Controlled Trials
(CENTRAL).
Publication Types:
330: Phys Rev Lett. 2007 Jan 12;98(2):024102. Epub 2007 Jan 11.
Data synchronization in a network of coupled phase oscillators.
Miyano T, Tsutsui T.
Department of Micro System Technology, Ritsumeikan University 1-1-1, Noji-

higashi, Kusatsu, Shiga 525-8577, Japan. tmiyano@se.ritsumei.ac.jp
We devised a new method of data mining for a large-scale database. In the

method, a network of locally coupled phase oscillators subject to Kuramoto's
model substitutes for given multivariate data to generate major features through
phase locking of the oscillators, i.e., phase transition of the data set. We applied
the method to the national database of care needs certification for the Japanese
public long-term care insurance program, and found three major patterns in the
aging process of the frail elderly. This work revealed the latent utility of
Kuramoto's model for data processing.
Publication Types:

331: MCN Am J Matern Child Nurs. 2007 Mar-Apr;32(2):81-6; quiz 87-8.
Requesting perinatal autopsy: multicultural considerations.
Chichester M.
Christiana Care Health System, Newark, DE, USA.

mchichester@christianacare.org
The subject of perinatal autopsy is not frequently seen in the literature. Perinatal
loss, particularly stillbirth, frequently remains unexplained, despite current
technology and diagnostic procedures. Parents may automatically refuse an
autopsy, despite the potentially valuable information it could provide about the
current pregnancy and subsequent pregnancies and despite the possible comfort
the results could provide for relatives. Other reasons for declining an autopsy
could be cultural or religious prohibitions. In addition, healthcare providers
sometimes lack the knowledge of circumstances under which a postmortem
examination is permitted, and fail to use culturally sensitive and culturally
competent discussions about the reasons a postmortem examination is important
and permissible. This purpose of this article is to provide information on selected
cultural and religious groups to assist the nurse who is seeking consent for a
perinatal autopsy.
Publication Types:
• Review
332: Isr Med Assoc J. 2007 Feb;9(2):90-3.

Differences between soldiers, with and without emotional distress, in

number of primary care medical visits and type of presenting
complaints.
Heymann AD, Shilo Y, Tirosh A, Valinsky L, Vinker S.
Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.

heymann_t@mac.org.il
BACKGROUND: In 2003 a total of 43 soldiers in the Israel Defense Forces
committed suicide; only 20% of them were known to the IDF mental health
services. Somatic symptoms are often the only presentation of emotional distress
during the primary care visit and may be the key to early identification and
treatment. OBJECTIVES: To examine whether the information in the medical
records of soldiers can be used to identify those suffering from anxiety, affective
or somatoform disorder. METHODS: We conducted a case-control study using
the information in the electronic medical records of soldiers who during their 3
year service developed affective disorder, anxiety, or somatoform disorder. A
control group was matched for recruitment date, type of unit and occupation in the
service, and the Performance Prediction Score. The number and reasons for
physician visits were collated. RESULTS: The files of 285 soldiers were
examined: 155 cases and 130 controls. The numbers of visits (mean +/- SD)
during the 3 and 6 month periods in the case and control groups were 4.7 +/- 3.3
and 7.1 +/- 5.0, and 4.1 +/- 2.9 and 5.9 +/- 4.6 respectively. The difference was
statistically significant only for the 6 month period (P < 0.05). The variables that
remained significant, after stepwise multivariate regression were the Performance
Prediction Score and the presenting complaints of back pain and diarrhea.
CONCLUSIONS: These findings may spur the development of a computer-
generated warning for the primary care physician who will then be able to
interview his or her patient appropriately and identify mental distress earlier.
333: Mod Healthc. 2007 Feb 26;37(9):30.

IT goes global. Learning from what works and what doesn't--

around the world.
Lieber S.
Healthcare Information and Management Systems Society, Chicago, USA.
334: Comput Biol Med. 2007 Oct;37(10):1414-25. Epub 2007 Mar 7.

An integrated approach to breast diseases and breast cancer registry

and research: BDRS as a web-based multi-institutional model.
Koçgil OD, Baykal N.

Middle East Technical University, Informatics Institute, Ankara, Turkey.
oyadk@ii.metu.edu.tr
Accurate, complete, and timely health data sources are essential for progress in
health care. Registry and research systems are foundations for conducting clinical
and epidemiological research. Developing countries lack these systems due to the
scarcity of the resources allocated for health information systems. In this study,
we provide an integrated model for Turkey in order to optimize the utilization of
resources. The Breast Diseases Registry system (BDRS) is implemented as an
integrated disease-specific system for breast diseases in order to obtain a
comprehensive use of patient health data for research and Breast Cancer Registry
as well as an ancillary clinical tool.
Publication Types:
335: Nippon Hoshasen Gijutsu Gakkai Zasshi. 2007 Jan 20;63(1):97-105.

[Survey of the current state of order-entry systems in the nuclear

medicine field]
Hara N, Onoguchi M, Takayama T, Honda M.
Department of Health Sciences, Graduate School of Medical Science, Kanazawa

University.
BACKGROUND AND OBJECTIVES: In the "Grand Design for

Computerization of the Medical Field" of December, 2001, the Ministry of
Health, Labour and Welfare set a numerical target for the adoption of electronic
medical charts nationwide in at least 60% hospitals with 400 or more beds.
Therefore, the introduction and operation of an order-entry system, which is
necessary for establishing electronic medical charts, became essential for each of
these medical facilities. We surveyed the current state of order-entry systems for
nuclear medicine, which are considered difficult to introduce owing to the
particulars of their operation, and herewith report the results. METHODS:
Questionnaires with a request for cooperation were sent by mail to 119 facilities
nationwide that are engaged in nuclear medicine. The questionnaire surveyed 21
items, including operational status and restrictions of the order-entry system.
RESULTS: The absolutely essential restriction settings for the introduction and
operation of an order-entry system were not being used, and the scheduling of
tests was being conducted on the basis of human judgment. CONCLUSION: The
development of an order-entry system that includes standardization of basic
specifications (restrictions) according to the content and work are necessary for
nuclear scans, for which the introduction and operation of an order-entry system
can cause concern owing to the particulars of operation in the field of radiation.
Publication Types:
336: N Z Med J. 2007 Mar 2;120(1250):U2445.

Comment in:
• N Z Med J. 2007;120(1250):U2443.
Assessing Māori/non-Māori differences in cardiovascular disease

risk and risk management in routine primary care practice using
web-based clinical decision support: (PREDICT CVD-2).
Riddell T, Jackson RT, Wells S, Broad J, Bannink L.
Section of Epidemiology and Biostatistics, School of Population Health,

University of Auckland, Auckland. t.riddell@auckland.ac.nz
AIM: To describe the cardiovascular disease risk factor status and risk
management of Māori compared with non-Māori patients opportunistically
assessed in routine practice using PREDICT-CVD, an electronic clinical decision
support programme. METHODS: In August 2002, a primary healthcare
organisation, ProCare, implemented PREDICT-CVD as an opportunistic
cardiovascular risk assessment and management programme. Between 2002 and
February 2006, over 20,000 cardiovascular risk assessments were undertaken on
Māori and non-Māori patients. Odds ratios and mean differences in
cardiovascular risk factors and risk management for Māori compared to non-
Māori (European and other, Pacific, Indian, and other Asian) patients were
calculated. RESULTS: Baseline risk assessments were completed for 1450 (7%)
Māori patients and 19, 164 (93%) non-Māori patients. On average, Māori were
risk assessed 3 years younger than non-Māori. Māori patients were three times
more likely to be smokers, had higher blood pressure and TC/HDL levels, and
twice the prevalence of diabetes and history of cardiovascular disease as non-
Māori. Among patients with a personal history of cardiovascular disease, Māori
were more likely than non-Māori to receive anticoagulants, blood pressure-
lowering and lipid-lowering medications. However, of those patients with a
history of ischaemic heart disease, Māori were only half as likely as non-Māori to
have had a revascularisation procedure. CONCLUSION: An electronic decision
support programme can be used to systematically generate cardiovascular disease
risk burden and risk management data for Māori and non-Māori populations in
routine clinical practice in real-time. Moreover, the PREDICT-CVD programme
has established one of the largest cohorts of Māori and non-Māori ever assembled
in New Zealand. Initial findings suggest that Māori are more likely than non-
Māori to receive drug-based cardiovascular risk management if they have a
personal history of cardiovascular disease. In contrast, among the subgroup of
patients with a history of ischaemic heart disease, Māori appear to receive
significantly fewer revascularisations than non-Māori.
Publication Types:
337: Genetics. 2007 May;176(1):351-9. Epub 2007 Mar 4.

Genetic similarities within and between human populations.
Witherspoon DJ, Wooding S, Rogers AR, Marchani EE, Watkins WS, Batzer
MA, Jorde LB.
Department of Human Genetics, University of Utah Health Sciences Center, Salt

Lake City, Utah 84112, USA.
The proportion of human genetic variation due to differences between populations

is modest, and individuals from different populations can be genetically more
similar than individuals from the same population. Yet sufficient genetic data can
permit accurate classification of individuals into populations. Both findings can
be obtained from the same data set, using the same number of polymorphic loci.
This article explains why. Our analysis focuses on the frequency, omega, with
which a pair of random individuals from two different populations is genetically
more similar than a pair of individuals randomly selected from any single
population. We compare omega to the error rates of several classification
methods, using data sets that vary in number of loci, average allele frequency,
populations sampled, and polymorphism ascertainment strategy. We demonstrate
that classification methods achieve higher discriminatory power than omega
because of their use of aggregate properties of populations. The number of loci
analyzed is the most critical variable: with 100 polymorphisms, accurate
classification is possible, but omega remains sizable, even when using populations
as distinct as sub-Saharan Africans and Europeans. Phenotypes controlled by a
dozen or fewer loci can therefore be expected to show substantial overlap between
human populations. This provides empirical justification for caution when using
population labels in biomedical settings, with broad implications for personalized
medicine, pharmacogenetics, and the meaning of race.
Publication Types:
• Research Support, N.I.H., Intramural
PMCID: PMC1893020
338: Prev Med. 2007 Dec;45(6):424-31. Epub 2007 Feb 9.

Physical activity levels of children in special schools.
Sit CH, McManus A, McKenzie TL, Lian J.
The University of Hong Kong, Institute of Human Performance, Pokfulam, Hong

Kong. sithp@hku.hk
OBJECTIVE: Children's physical activity (PA) has been studied extensively, but
little information is available on those with disabilities. We sought to examine the
PA of children with disabilities during physical education (PE) and recess while
simultaneously documenting environmental conditions. METHOD: Five schools
designed for students with four types of special needs (physical disability, mild
intellectual disability, hearing impairment, and visual impairment) participated.
We used the System for Observing Fitness Instruction Time (SOFIT) to code the
PA of children in grades 4 to 6 during both PE and recess and to document
teacher behavior and lesson context in PE. Observations were conducted during 2
school days over a 2-week period. RESULTS: Children accrued little moderate-
to-vigorous physical activity (MVPA) during PE (7.8 min) and recess (8.9 min).
Activity levels varied across disability types, with differences attributed to lesson
context and teacher behavior. Children with physical disabilities were the least
active during both PE and recess. CONCLUSIONS: Children with disabilities
accrue little PA at school. Increased PE frequency and lesson intensity, more PA
opportunities during non-structured school time, and collaborations with home
and community agencies are needed to reach PA recommendations.
Publication Types:
339: BMC Health Serv Res. 2007 Mar 3;7:37.

Urban health insurance reform and coverage in China using data

from National Health Services Surveys in 1998 and 2003.
Xu L, Wang Y, Collins CD, Tang S.
Centre of Health Statistics and Information, Ministry of Health, 1 Xizhimen

Nanlu, Beijing, The People's Republic of China. xuling@moh.gov.cn
<xuling@moh.gov.cn>
BACKGROUND: In 1997 there was a major reform of the government run urban
health insurance system in China. The principal aims of the reform were to widen
coverage of health insurance for the urban employed and contain medical costs.
Following this reform there has been a transition from the dual system of the
Government Insurance Scheme (GIS) and Labour Insurance Scheme (LIS) to the
new Urban Employee Basic Health Insurance Scheme (BHIS). METHODS: This
paper uses data from the National Health Services Surveys of 1998 and 2003 to
examine the impact of the reform on population coverage. Particular attention is
paid to coverage in terms of gender, age, employment status, and income levels.
Following a description of the data between the two years, the paper will discuss
the relationship between the insurance reform and the growing inequities in
population coverage. RESULTS: An examination of the data reveals a number of
key points: a) The overall coverage of the newly established scheme has
decreased from 1998 to 2003. b) The proportion of the urban population without
any type of health insurance arrangement remained almost the same between
1998 and 2003 in spite of the aim of the 1997 reform to increase the population
coverage. c) Higher levels of participation in mainstream insurance schemes (i.e.
GIS-LIS and BHIS) were identified among older age groups, males and high
income groups. In some cases, the inequities in the system are increasing. d)
There has been an increase in coverage of the urban population by non-
mainstream health insurance schemes, including non-commercial and commercial
ones. The paper discusses three important issues in relation to urban insurance
coverage: institutional diversity in the forms of insurance, labour force policy and
the non-mainstream forms of commercial and non-commercial forms of
insurance. CONCLUSION: The paper concludes that the huge economic
development and expansion has not resulted in a reduced disparity in health
insurance coverage, and that limited cross-group subsidy and regional inequality
is possible. Unless effective measures are taken, vulnerable groups such as
women, low income groups, employees based on short-term contracts and rural-
urban migrant workers may well be left out of sharing the social and economic
development.
Publication Types:
PMCID: PMC1828155
340: Southeast Asian J Trop Med Public Health. 2006 Sep;37(5):1034-9.

Clinical severity and financial burden among road traffic injury

patients in Kunming, China.
Jianping Z, Chongsuvivatwong V, Geater A.
Department of Social Medicine, Faculty of Public Health, Kunming Medical

College, Yunnan, People's Republic of China.
This study aimed to describe the severity of injury (RTI), length of stay, costs,
financial burden, and sources of payment for RTI patients in the Kunming area,
Yunnan Province, China. Information was collected from interviewing 420
patients admitted with RTI during January to May 2005 and from medical records
reviewed of all the patients admitted from January to 30 May 2005. The costs and
financial burden of road casualties on the medical sector resources were found to
be large (median = RMB 94,496) compared to the average per capita monthly
income of the Yunnan population (RMB 798). Most patients had injuries of
moderate severity. Pedestrians and passengers had the highest Injury Severity
Score (ISS). The mean payments out-of-pocket, from the government and by
compensation were RMB 5320, 10,190 and 11,190, respectively. In addition to
prevention of RTI, a suitable insurance system is needed in the country.
Publication Types:
341: Am J Respir Crit Care Med. 2007 May 15;175(10):1086-93. Epub 2007 Mar 1.
Comment in:
• Am J Respir Crit Care Med. 2007 Dec 15;176(12):1289; author reply

1289-90.
A worldwide perspective of atypical pathogens in community-

acquired pneumonia.
Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, Blasi
F, Fernandez P, File TM Jr, Rello J, Menendez R, Marzoratti L, Luna CM,
Ramirez JA; Community-Acquired Pneumonia Organization (CAPO)
Investigators.
Division of Infectious Diseases, University of Louisville, Louisville, KY 40292,

USA. f.arnold@louisville.edu
RATIONALE: Controversy still exists in the international literature regarding the

need to use antimicrobials covering atypical pathogens when initially treating
hospitalized patients with community-acquired pneumonia (CAP). In different
regions of the world, monotherapy with a beta-lactam antimicrobial is common.
OBJECTIVES: We sought to correlate the incidence of CAP due to atypical
pathogens in different regions of the world with the proportion of patients treated
with an atypical regimen in those same regions. In addition, we sought to compare
clinical outcomes of patients with CAP treated with and without atypical
coverage. METHODS: A secondary analysis was performed using two
comprehensive international databases. World regions were defined as North
America (I), Europe (II), Latin America (III), and Asia and Africa (IV). Time to
reach clinical stability, length of hospital stay, and mortality were compared
between patients treated with and without atypical coverage. MEASUREMENTS
AND MAIN RESULTS: The incidence of CAP due to atypical pathogens from
4,337 patients was 22, 28, 21, and 20% in regions I-IV, respectively. The
proportion of patients treated with atypical coverage from 2,208 patients was 91,
74, 53, and 10% in regions I-IV, respectively. Patients treated with atypical
coverage had decreased time to clinical stability (3.7 vs. 3.2 d, p < 0.001),
decreased length of stay (7.1 vs. 6.1 d, p < 0.01), decreased total mortality (11.1
vs. 7%, p < 0.01), and decreased CAP-related mortality (6.4 vs. 3.8%, p = 0.05).
CONCLUSIONS: The significant global presence of atypical pathogens and the
better outcomes associated with antimicrobial regimens with atypical coverage
support empiric therapy for all hospitalized patients with CAP with a regimen that
covers atypical pathogens.
342: Yakugaku Zasshi. 2007 Mar;127(3):515-26.

Study on variations in price of prescription medicines in Thailand.
Burapadaja S, Kawasaki N, Kittipongpatana O, Ogata F.
Faculty of Pharmacy, Chiang Mai University, Thailand.
There are evidences describing that the prices of prescription medicines can affect
users, suppliers, and, in particular, payers in the health care system. Despite the
significant effects of prices, the information regarding their characteristics is
scarce. The objective of this study was to examine the prices and price variations
of prescription medicines in an actual setting. A cross-sectional study on the
prices of prescription medicines listed in a hospital formulary was undertaken.
The medicines (n=1531) listed in the formulary were recorded according to the
category of the medicine (essential or non-essential medicines), manufacturer
types (local or foreign), dosage forms, therapeutic classifications (classes), and
prices per unit in Baht. This study used coefficients of relative variations (CRVs)
to determine the extent of price variations. Results revealed that the mean prices
of non-essential and foreign medicines were significantly greater than those of its
counterparts by 1.7 and 21.2 times, respectively. On an average, the classes with
the highest prices were blood-related, antineoplastic, and endocrinological agents,
while those with the lowest prices were the psychotherapeutic, CNS, and
cardiovascular agents. The majority of the medicines (37%) were in the price
range of >10-100 Baht. The price variations of different classes of medicines
varied from about 100% to 600%. The mean price and CRV levels (low and high)
formed four groups of medicines with different risks of high prices and variations
to payers. In conclusion, the prices are associated with the category and
manufacturer type. The prices and their variations could be used to distinguish the
classes of medicines that possess different risks of high prices and variations to
payers. Identifying the classes with high prices and high variations, high prices
and low variations, and low prices and high variations is necessary for careful
intervention to reduce the effect of prices and their variations on payers.
Publication Types:
343: Cancer Treat Rev. 2007 Nov;33(7):631-45. Epub 2007 Feb 27.
International patterns of cancer incidence in adolescents.
Stiller CA.
Childhood Cancer Research Group, Department of Paediatrics, University of

Oxford, 57 Woodstock Road, Oxford OX2 6HJ, UK.
charles.stiller@ccrg.ox.ac.uk
International patterns of childhood cancer incidence are well documented but

equivalent information relating to adolescence is scarce. This article synthesizes
international data on cancer in adolescents from population based cancer
registries. Total incidence ranged from 95 to 255 per million person years in the
series studied. The highest rates were in Australia and among Jews in Israel and
the lowest in India and Japan. Lymphomas were the most frequent cancers in
western industrialised countries of the northern hemisphere and in the Middle
East, and occurred in substantial numbers in all other regions. Hodgkin lymphoma
outnumbered non-Hodgkin in western industrialised countries but was relatively
rare in most developing countries and in Japan. Leukaemias were the most
frequent diagnostic group in India, East Asia and Latin America. Melanoma was
the commonest cancer of adolescents in Australia and New Zealand and
moderately frequent in many other predominantly white populations but rarely
seen elsewhere. Kaposi sarcoma was the most frequent cancer in both sub-
Saharan African series studied. The highest rates for nasopharyngeal carcinoma
were in Algeria and Hong Kong and for liver carcinoma in Hong Kong and sub-
Saharan Africa. Testicular germ cell tumours were relatively frequent in
predominantly white populations. Central nervous system tumours and thyroid
carcinoma were most often registered in countries with higher standard of living.
Osteosarcoma was moderately frequent almost everywhere. Characteristic
embryonal tumours of childhood and the most common carcinomas of adulthood
were rarely seen. Only osteosarcoma, ovarian germ cell tumours and, in some
populations, nasopharyngeal carcinoma have their highest incidence at age 15-19
years. Total cancer incidence was higher in adolescent males than females, but
there was often a female excess in melanoma and thyroid carcinoma, and
Hodgkin lymphoma was at least as frequent among females as males in several
countries with relatively high incidence. More complete delineation of worldwide
patterns of cancer in adolescence would be facilitated by availability of more data
classified in a standard way to take account of morphology.
Publication Types:
344: Sex Transm Dis. 2007 Aug;34(8):592-7.

Relationship between syphilis and HIV infections among men who

have sex with men in Beijing, China.
Ruan Y, Li D, Li X, Qian HZ, Shi W, Zhang X, Yang Z, Zhang X, Wang C,

Liu Y, Yu M, Xiao D, Hao C, Xing H, Hong K, Shao Y.
State Key Laboratory for Infectious Disease Prevention and Control, and National
Center for AIDS/STD Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing, China.
BACKGROUND: Little is known about risk of HIV and other STDs among men
who have sex with men (MSM) in China. OBJECTIVE: To survey the prevalence
and risk factors of HIV and syphilis and evaluate correlation of two infections
among MSM in the Chinese capital city. METHODS: A community-based
sample of 526 MSM was recruited in 2005 through Internet advertising,
community outreach, and peer referring. Interviewer-administered interviews
were conducted to collect information on demographics and sexual and other risk
behaviors, and blood samples were collected to test for syphilis and HIV
infections. RESULTS: Seventeen (3.2%) participants were HIV seropositive and
59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants
who did not have Beijing residence. Forty percent had >10 lifetime male sex
partners and 28.8% reported having ever had sex with women. Consistent condom
use with primary male sex partners ranged from 21% to 24%, with nonprimary
male sex partners from 35% to 42%, and with female partners around 33%. Illicit
drug use was not common; only 2.5% reported using Ecstasy or ketamine in the
past 6 months. Multivariate logistic regression analyses demonstrated that >10
lifetime male sex partners were independently associated with seropositivity of
both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In
addition, HIV infection is significantly associated with syphilis seropositivity
(OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS: High mobility, multiple sexual
partners, and high prevalence of unprotected sex behaviors and syphilis infection
suggest a potential rapid spread of HIV in Chinese MSM.
Publication Types:

345: J Interv Card Electrophysiol. 2006 Dec;17(3):211-4. Epub 2007 Feb 24.
The world survey of cardiac pacing and cardioverter-defibrillators:

lessons learnt.
Mond HG.
Department of Epidemiology and Preventive Medicine, Monash University,

Victoria, Australia. hmond@bigpond.net.au
A world-wide survey of cardiac pacing and implantable cardioverter-defibrillator

(ICD) practices is held each 4 years. For the most recent survey held in 2001, 50
countries, 22 from Europe, 16 from the Asia Pacific region, 9 from the Americas
and 3 from the Middle East and Africa participated. This was the first survey,
where all countries completed a similar format allowing comparisons between
countries. The European contribution came from the expanding European
pacemaker registry. For countries outside Europe, the survey was based on a
questionnaire completed by selected coordinators and conducted predominantly
from hospital implants. In some large implanting countries such as the United
States of America (USA) and Australia, the surveys were conducted using the
sales figures of pacemaker and ICD companies. The major criticism of this
method is the limited clinical information obtained. An alternative system would
be an ongoing pacemaker and ICD registry in each country similar to the
European model, which in the USA would be an expensive and logistical
nightmare to organise and administer. With smaller implanting countries, the
current system of a dedicated coordinator to conduct the hospital survey works
well although there is still much recruiting work to do in Central America, the
Middle East, Africa and to a lesser extent, South America.
Publication Types:
• Review
346: Comput Methods Programs Biomed. 2007 Apr;86(1):73-86. Epub 2007 Feb 22.
MedicoPort: a medical search engine for all.
Can AB, Baykal N.
METU Informatics Institute, Inönü Bulvari, 06531 Ankara, Turkey.

aysu@ii.metu.edu.tr
We present a new next generation domain search engine called MedicoPort.

MedicoPort is a medical search engine designed for the users with no medical
expertise. It is enhanced with the domain knowledge obtained from Unified
Medical Language System (UMLS) to increase the effectiveness of the searches.
The power of the system is based on the ability to understand the semantics of
web pages and the user queries. MedicoPort transforms a keyword search into a
conceptual search. Through our system we present a topical web crawling
technique and indexing techniques empowered by the semantics information.
MedicoPort aims to generate maximum output with semantic value using
minimum input from the user. Since MedicoPort is designed to help people
seeking information about health on the web, our target users are not medical
specialists who can effectively use the special jargon of medicine and access
medical databases. Medical experts have the advantage of shrinking the answer
set by expressing several terms using medical terminology. MedicoPort provides
the same advantage to its users through the automated use of the medical domain
knowledge in the background. The results of our experiments indicate that,
expanding the queries with domain knowledge, such as using the synonyms and
partially or contextually relevant terms from UMLS, increase dramatically the
relevance of an answer set produced by MedicoPort and the number of retrieved
web pages that are relevant to the user request.
Publication Types:

Use frequency of traditional Chinese medicine in Taiwan.
Chen FP, Chen TJ, Kung YY, Chen YC, Chou LF, Chen FJ, Hwang SJ.
Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei 112
Taiwan. fpchen@vghtpe.gov.tw <fpchen@vghtpe.gov.tw>
BACKGROUND: Use of Traditional Chinese medicine (TCM), an important

category of complementary and alternative medicine (CAM), has increased
substantially in Western countries during the past decade. Use of TCM is also
widespread in the Chinese population. However, few informative data have been
obtained to date by large-scale investigations of TCM use in the Chinese
population. This study was aimed at elucidating the demographics and patterns of
TCM use in Taiwan. METHODS: We employed the complete datasets of TCM
outpatient reimbursement claims from 1996 to 2001, including the use of Chinese
herbal remedies, acupuncture and traumatology manipulative therapy, to analyse
use frequencies, the characteristics of TCM users, and the disease categories that
were treated by TCM in Taiwan. RESULTS: At the end of 2001, 6,142,829
(28.4%) among the 21,653,555 valid beneficiaries of the National Health
Insurance in Taiwan had used TCM during the year. However, 13,536,266
subjects (62.5%) had used TCM at least once during the whole 6-year period from
1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The
mean number of TCM users per annum was 5,733,602, with a mean increment of
1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher
than male (female:male = 1.13:1), and the age distribution displayed a peak at
around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%)
were the most common TCM modality used by this population, followed by
acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private
TCM clinics provided most of the TCM care (82.6%), followed by private TCM
hospitals (12.0%). The top ten major disease categories for TCM visits were
diseases of the respiratory system, musculoskeletal system and connective tissue;
symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the
digestive system, genitourinary system, skin and subcutaneous tissue, nervous
system and sense organs, circulatory and endocrine system; nutritional and
metabolic diseases; and immunological disorders. CONCLUSION: TCM was
popular among the Chinese population in Taiwan during the period studied. More
than 60% of all subjects had used TCM during the 6-year interval. TCM was
widely used by the Chinese population to treat problems and diseases of major
human organ systems recognised by western medicine. This study provides
information about the use frequencies of TCM and the disease categories treated
by TCM, which should be useful for health policy makers and for those
considering the integration of TCM and Western medicine.
Publication Types:
PMCID: PMC1810531
348: Public Health Nurs. 2007 Mar-Apr;24(2):101-10.

Child-rearing anxiety and its correlates among Japanese mothers

screened at 18-month infant health checkups.
Arimoto A, Murashima S.
Department of Community Health Nursing, Graduate School of Medicine, The

University of Tokyo, Tokyo, Japan. azusay-tky@umin.ac.jp
OBJECTIVE: To examine the level of child-rearing anxiety and to explore the

variables correlated with child-rearing anxiety in a city in Japan. DESIGN: Cross-
sectional study. SAMPLE: From July to September 2003, 371 mothers who
visited community health centers in a city in Tokyo Metropolis for their child's
18-month health checkups. MEASUREMENTS: Child-rearing anxiety was
measured by the child-rearing anxiety scale. Questions in a self-reported
questionnaire were on maternal variables, including maternal background
information, child variables, and family system variables such as the presence of
social support, and utilization of parenting support services. Also included within
the questionnaire was the General Health Questionnaire-12. RESULTS:
Hierarchical multiple linear regression analysis revealed that mothers with higher
child-rearing anxiety had less childcare satisfaction, more depressive symptoms,
more worries about the child, less support from the husband, and less social
support. CONCLUSION: To identify mothers with high child-rearing anxiety in
Japan, the infant health checkups should be utilized as an opportunity for
screening, focusing on variables regarding mothers. Public health nurses can
provide the necessary support after gaining an understanding of issues confronting
mothers to prevent child-rearing anxiety and child abuse.
Publication Types:

The effect of unusual social experience on the global health of North

Korean asylum seekers.
Kim DS, Cho Y, Moon OR.
School of Public Health, Seoul National University, 28 Yeongun-dong, Jongro-

ku, Seoul, South Korea.
OBJECTIVES: This study examined the risk factors associated with a negative
self-rating of subjective health among North Korean asylum seekers, paying
particular attention to the unusual social experiences of this population. STUDY
DESIGN: This study utilized the North Korean Health Care System Data Set
(NKHCS). This data set is comprised of information on 221 North Korean asylum
seekers (aged 20 years and over) who were housed in Hanawon, a South Korean
government facility. We specifically examined the effect of three separate risk
factors (major country of residence after exiting North Korea, duration of stay in
country, and whom they were accompanied by during their migration event)
associated with the unusual social experiences of North Korean asylum seekers on
their global health. METHODS: Multivariate logistic regression analyses were
carried out in order to assess the consistency and validity of extant hypotheses and
general expectations. RESULTS: North Korean asylum seekers who entered
South Korea within one year of their defection or were accompanied by non-
family members tended to negatively self-report their health status. However,
major intermediate country of residence after exiting North Korea showed no
effect. Higher educational attainment and membership of the Labour Party of
North Korea were negatively associated with the global health of this population,
though this was not statistically significant. CONCLUSIONS: We found that the
unusual social experiences of North Korean asylum-seekers, particularly
intermediate country duration and companionship characteristics, were
significantly associated with their health. Future studies need to examine the
relationship between diverse social experiences during residence in intermediate
countries and the health of this population.
Publication Types:
350: J Paediatr Child Health. 2007 Mar;43(3):134-8.

Effectiveness of a nurse-led management programme for paediatric
asthma in Taiwan.
Weng HC, Yuan BC, Su YT, Perng DS, Chen WH, Lin LJ, Chi SC, Chou
CH.
I-Shou University, Ping Tung, Taiwan.
AIM: The aim of this study was to carry out a preliminary analysis of the impact
of a government-sponsored disease management programme for paediatric asthma
on economic outcomes and patient satisfaction. METHODS: Of the 398 patients
who participated in the programme, 249 (62.56%) who had at least two medical
care encounters with an ICD-9 code of 493 were classified as 'already diagnosed
cases'; and 129 (34.12%) who had a single or no medical care encounter with an
ICD-9 code of 493 were classified as 'newly diagnosed cases'. A retrospective 1:4
(intervention vs. control group) matched cohort study design was conducted, with
the control group randomly drawn from 236 637 paediatric asthmatics who were
not enrolled the programme. Questionnaires were collected from 105 (26.3%) of
the patients. RESULTS: Comparison results of 1 year pre/post tests of utilisation
of health care resources indicated that the intervention group of already diagnosed
cases had 77.97% fewer emergency department visits, 80.77% fewer inpatient
visits, and 75.65% fewer stays of significant length. For the newly diagnosed
group, the intervention group had 35.11% fewer emergency department visits than
the control group. The majority of the patients had substantial adherence to
physicians' suggestions, more accurate knowledge and better self-care skills
concerning asthma. CONCLUSION: A nurse-led management programme has
proved useful in managing paediatric asthma in Taiwan. Simplification of
paperwork, some reorganisation of the practitioner's daily responsibilities and
provision of a fail-safe information system may make the programme even more
beneficial.
Publication Types:
351: J Prev Med Pub Health. 2007 Jan;40(1):64-70.

[A study on facilitators and inhibitors to the introduction of

outsourcing in the hospital information systems in Korea]
[Article in Korean]
Choy S, Shin HS, Choi I, Kim S.
Department of Preventive Medicine, College of Medicine, The Catholic

University of Korea.
OBJECTIVES: This study was conducted to investigate the current status of

outsourcing in Korean hospital information systems and the factors influencing its
introduction. METHODS: The authors surveyed 136 hospitals located in Seoul
and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and
inhibitors to outsourcing in hospital information systems were derived from
literature and expert reviews. Multiple logistic regression analysis was applied to
identify the major influencing factors on outsourcing in hospital information
systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which
were mainly tertiary hospitals, responded to using outsourcing for their hospital
information systems. "Hardware and software maintenance and support,"
"application development," and "management of service and staff" were the major
areas of outsourcing. Outsourcing had been employed for 4-7 years by 45.5% of
the hospitals and the proportion of the budget used for outsourcing was less than
20%. A need for an extension in outsourcing was agreed on by 76.5% of the
hospitals. The multiple logistic regression analysis showed that both consumer
satisfaction and security risk have an influence on hospital information system
outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is
expected to increase just as in other industries. One primary facilitator to
outsourcing in other industries is consumer satisfaction. We found that this was
also a facilitator to outsourcing in hospital information systems. Security risk,
which is usually considered an inhibitor to information technology outsourcing,
was proven to be an inhibitor here as well. The results of this study may help
hospital information systems establish a strategy and management plan for
outsourcing.
Publication Types:
352: Bull World Health Organ. 2007 Feb;85(2):146-51.

A balanced scorecard for health services in Afghanistan.

Peters DH, Noor AA, Singh LP, Kakar FK, Hansen PM, Burnham G.
Department of International Health, Johns Hopkins Bloomberg School of Public

Health, Baltimore, MD, USA. dpeters@jhsph.edu
The Ministry of Public Health (MOPH) in Afghanistan has developed a balanced

scorecard (BSC) to regularly monitor the progress of its strategy to deliver a basic
package of health services. Although frequently used in other health-care settings,
this represents the first time that the BSC has been employed in a developing
country. The BSC was designed via a collaborative process focusing on
translating the vision and mission of the MOPH into 29 core indicators and
benchmarks representing six different domains of health services, together with
two composite measures of performance. In the absence of a routine health
information system, the 2004 BSC for Afghanistan was derived from a stratified
random sample of 617 health facilities, 5719 observations of patient-provider
interactions, and interviews with 5597 patients, 1553 health workers, and 13,843
households. Nationally, health services were found to be reaching more of the
poor than the less-poor population, and providing for more women than men, both
key concerns of the government. However, serious deficiencies were found in five
domains, and particularly in counselling patients, providing delivery care during
childbirth, monitoring tuberculosis treatment, placing staff and equipment, and
establishing functional village health councils. The BSC also identified wide
variations in performance across provinces; no province performed better than the
others across all domains. The innovative adaptation of the BSC in Afghanistan
has provided a useful tool to summarize the multidimensional nature of health-
services performance, and is enabling managers to benchmark performance and
identify strengths and weaknesses in the Afghan context.
Publication Types:
353: Med Princ Pract. 2007;16(2):107-9.

Drug information resources at private community pharmacies in

Kuwait.
Ball DE, Al-Othman F.
Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University,

Kuwait. dball@hsc.edu.kw
OBJECTIVE: To investigate the drug information resources available in private

community pharmacies in Kuwait. MATERIALS AND METHODS: Pharmacists
at a sample of 20 private community (retail) pharmacies completed a self-
administered questionnaire of available information resources and perceived
appropriate information resources to answer five drug information questions.
RESULTS: All pharmacies had at least one reference book but they were
outdated. The Middle East Medical Index was most commonly found and three
pharmacies had internet access. Half of the respondents reported getting
medicines information directly from the pharmaceutical companies, usually
through pharmaceutical representatives. Most pharmacists could identify
appropriate information resources for drug dosing and drug interactions but did
not fare well for medicine identification and primary research evidence.
CONCLUSION: The poor quality and outdated drug information resources in
private community pharmacies will affect the quality of information provided to
clients and prescribers and have an adverse effect on the role pharmacists can play
in the health system in Kuwait. Copyright 2007 S. Karger AG, Basel.
354: J Intellect Disabil Res. 2007 Mar;51(Pt 3):173-83.

Carer reports of health status among adults with

intellectual/developmental disabilities in Taiwan living at home and
in institutions.
Wang KY, Hsieh K, Heller T, Davidson PW, Janicki MP.
Department of Social Welfare, National Chung Cheng University, Ming-Hsiung,

Chia-yi. Taiwan. lisa@sw.ccu.edu.tw
BACKGROUND: The aim of the present study was to assess the health status of a
cohort of adults with intellectual/developmental disabilities (I/DD) residing in
family homes or institutions in Taiwan and to examine whether morbidity varied
with age, sex, existing diagnosis [Down syndrome (DS), seizures, cerebral palsy
(CP), intellectual disability (ID) level] and residential status. METHODS:
Systematic randomization based on geographic areas was employed for sampling
selection. Primary carers were interviewed to provide health-related information
on individuals with I/DD aged 33 years or older living in institutions (n = 614) or
living with their family (n = 514) in Taiwan. RESULTS: Cardiovascular,
neurological, visual and hearing impairments increased with age; while
gastrointestinal, endocrine, infectious and dermatological diseases did not, after
adjusting for sex, level of ID, presence of DS, seizures or CP, across settings.
Institution cohorts were more likely to have infectious diseases, skin diseases,
hepatitis or to be hepatitis carriers, and to have psychiatric disorders.
CONCLUSIONS: Organ system morbidity increased with age and generally was
influenced by the same factors as have been reported for cohorts in western
countries. The results also suggest that disease/condition outcomes may vary or be
influenced differentially by residential setting.
Publication Types:



2: seismic risks including tsunamis.
This Panel Session consisted of five country reports (India, Indonesia, Maldives,
Thailand, and Nepal) and the common issues identified during the Panel
discussions relative to seismic events in the Southeast Asia Region. Important
issues identified included the needs for: (1) a legal framework upon which to base
preparedness and response; (2) coordination between the many organizations
involved; (3) early warning systems within and between countries; (4) command
and control; (5) access to resources including logistics; (6) strengthening the
health infrastructure; (7) professionalizing the field of disaster medicine and
management; (8) management of communications and information; (9)
management of dead bodies; and (10) mental health of the survivors and health
workers.


1: water-related hazards.

This Panel Session consisted of three country reports (Bagladesh, Bhutan, and
Myanmar) and the common issues identified during the Panel discussions relative
to water-related hazards and events in the Southeast Asia Region. The primary
event discussed regardless of the hazards encountered was flooding. The merits of
the responses generated in Bangladesh before, during, and following the 2004
floods provide evidence of what can be accomplished in community and national
levels of preparedness. Many key issues arose in the discussions: (1) command
and control systems and SOPs; (2) ready resources; (3) public information and
education and human resource development; (4) community-level preparedness;
(5) accessibility to health care; (6) increased focus on disease prevention and
control; (7) management of dead bodies; (8) need for a legal framework; (9)
funding and the management of funds; and (10) relationships with the media.

Health aspects of disaster preparedness and response. Report from a

regional meeting of countries of South East Asia; Bangkok,
Thailand, 21-23 November 2005.
Regional Office for South East Asia World Health Organization.
INTRODUCTION: This Supplement is a Report of the Conference convened by

the South East Asia Regional Office (SEARO) of the World Health Organization
(WHO). The Conference was a follow-up to the WHO Conference of May 2005
in Phuket, Thailand on the Earthquake and Tsunami of 26 December 2004. The
invitational meeting brought together representatives of 11 countries impacted by
the events. The goal of the Conference was to produce a plan of action that meets
the specific needs of the countries and ensure that the countries of the Region will
be better equipped to cope with any future event. OBJECTIVES: The objectives
of the Conference were to: (1) identify gaps in the health needs of the affected and
vulnerable populations for preparedness, responses, recovery, and rehabilitation;
(2) determine the next steps in addressing these gaps; and (3) develop benchmarks
and a corresponding framework for action that must be achieved to solidify the
capacities and capabilities of the health sector to meet emergencies. METHODS:
Presentations of background papers, panel discussions, and Working Groups were
used. Based, in part, on the materials presented, the Working Groups drafted
benchmarks that could mark the progress in achieving the overall goal and
proposed strategies that could be used to reach the benchmarks. Representatives
of the participating countries summarized the current status of their respective
countries relative to each of the defined benchmarks. RESULTS: The benchmarks
relate to: (1) legal framework for preparedness and response; (2) national disaster
plan for preparedness and response; (3) budget; (4) rules of engagement for
external actors; (5) community plan based on risk identification and vulnerability
assessment; (6)community-based capacities; (7) local capacity for provision of
essential services and supplies; (8) awareness and advocacy programs; (9)
identification of hazards, risks, and vulnerabilities; (10) education and training;
(11) "safe" health facilities; and (12) surveillance and early warning systems.
There exists a wide range in the levels of preparedness at all levels in the affected
countries particularly at the community level. The country representatives agreed
that community-level preparedness, legal frameworks, local and national disaster
plans, surveillance and early warning systems, and advocacy and awareness
programs demand more attention. The strategies and mechanisms that will
facilitate achievement of the benchmarks were grouped into seven categories: (1)
monitoring, evaluation, surveillance, and assessments; (2) education and training
(human resource development); (3) information and communications; (4)
legislation, policies, and authority; (5) funding; (6) planning and preparedness;
and (7) coordination and control. Any or all of the strategies suggested could be
implemented by the countries in the Region. CONCLUSION: The Conference
delivered an important set of benchmarks and strategies that, when implemented,
will facilitate the countries and the communities within them reaching better
levels of preparedness and response to future events. Attaining the benchmarks
will decrease the number of lives lost and minimize the pain and suffering
associated with such events.

Erratum in:
• Prehospital Disaster Med. 2006 Nov-Dec;21(6):ii. Rosborogh, Stephanie

N [corrected to Rosborough, Stephanie N].
Express railway disaster in Amagasaki: a review of urban disaster

response capacity in Japan.
Nagata T, Rosborough SN, VanRooyen MJ, Kozawa S, Ukai T, Nakayama S.
Takemi Program in International Health, Harvard School of Public Health,

Boston, Massachusetts, USA.
INTRODUCTION: On the morning of 25 April 2005, a Japan Railway express

train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst
rail disaster in 40 years. This study chronicles the rescue efforts and highlights the
capacity of Japan's urban disaster response. METHODS: Public reports were
gathered from the media, Internet, government, fire department, and railway
company. Four key informants, who were close to the disaster response, were
interviewed to corroborate public data and highlight challenges facing the
response. RESULTS: The crash left 107 passengers dead and 549 injured. First
responders, most of whom were volunteers, were helpful in the rescue effort, and
no lives were lost due to transport delays or faulty triage. Responders criticized an
early decision to withdraw rescue efforts, a delay in heliport set-up, the
inefficiency of the information and instruction center, and emphasized the need
for training in confined space medicine. Communication and chain-of-command
problems created confusion at the scene. CONCLUSIONS: The urban disaster
response to the train crash in Amagasaki was rapid and effective. The Kobe
Earthquake and other incidents sparked changes that improved disaster
preparedness in Amagasaki. However, communication and cooperation among
responders were hampered, as in previous disasters, by the lack of a structured
command system. Application of an incident command system may improve
disaster coordination in Japan.

Disaster healthcare system management and crisis intervention

leadership in Thailand--lessons learned from the 2004 Tsunami
disaster.
Peltz R, Ashkenazi I, Schwartz D, Shushan O, Nakash G, Leiba A, Levi Y,

Goldberg A, Bar-Dayan Y.
Israeli Defense Forces Home Front Command.
INTRODUCTION: Quarantelli established criteria for evaluating the

effectiveness of disaster management. OBJECTIVES: The objectives of this study
were to analyze the response of the healthcare system to the Tsunami disaster
according to the Quarantelli principles, and to validate these principles in a
scenario of a disaster due to natural hazards. METHODS: The Israeli Defense
Forces (IDF) Home Front Command Medical Department sent a research team to
study the response of the Thai medical system to the disaster. The analysis of the
disaster management was based on Quarantelli's 10 criteria for evaluating the
management of community disasters. Data were collected through personal and
group interviews. RESULTS: The three most important elements for effective
disaster management were: (1) the flow of information; (2) overall coordination;
and (3) leadership. Although pre-event preparedness was for different and smaller
scenarios, medical teams repeatedly reported a better performance in hospitals
that recently conducted drills. CONCLUSIONS: In order to increase
effectiveness, disaster management response should focus on: (1) the flow of
information; (2) overall coordination; and (3) leadership.
360: Environ Monit Assess. 2007 Aug;131(1-3):421-37. Epub 2007 Feb 13.
Assessment for salinized wasteland expansion and land use change

using GIS and remote sensing in the west part of northeast China.
Li X, Wang Z, Song K, Zhang B, Liu D, Guo Z.
School of Earth Science, Jilin University, Changchun, Jilin Province, 130061,

China.
Due to human impact under climatic variations, western part of Northeast China
has suffered substantial land degradation during past decades. This paper presents
an integrated study of expansion process of salinized wasteland in Da'an County,
a typical salt-affected area in Northeast China, by using Geographic Information
Systems (GIS) and remote sensing. The study explores the temporal and spatial
characteristics of salinized wasteland expansion from 1954 to 2004, and land
use/cover changes during this period. During the past 50 years, the salinized
wasteland in study area have increased by 135,995 ha, and in 2004 covers 32.31%
of the total area, in the meantime grassland has decreased by 104,697 ha and in
2004 covers only 13.15% of the study area. Grasslands, croplands and
swamplands were found the three main land use types converted into salinized
wasteland. Land use/cover changes shows that between 1954 and 2004, 48.6% of
grasslands, 42.5% of swamplands, and 14.1% of croplands were transformed into
salinized wasteland, respectively. Lastly, the major factors influencing salinized
wasteland expansion and land use/cover changes were also explored. In general,
climatic factors supplied a potential environment for soil salinization. Human-
related factors, such as policy, population, overgrazing, and intensified and
unreasonable utilization of land and water resources are the main causes of
salinized wasteland expansion.
Publication Types:
361: Harefuah. 2007 Jan;146(1):22-5, 79.

[Medical students' knowledge and attitudes towards costs of tests
and treatments]
[Article in Hebrew]
Toker A, Reuveni H, Perry ZH, Doron Y.
Department of Health Systems Management, Ben-Gurion University of the

Negev, Beer Sheva, Israel. atoker@bgu.ac.il
OBJECTIVES: 1) To examine medical students' knowledge about costs of

laboratory tests, imaging procedures, and treatments. 2) To examine medical
students' attitudes regarding receiving information about costs, and its effect on
their future clinical behavior. DESIGN: This was a cross-sectional study using an
anonymous three-part questionnaire that was distributed to all students of the Ben
Gurion University Medical School. Responses were received from 269 students
(approximately 70%). RESULTS: According to the results, most students did not
estimate the costs correctly. It was found that: 69.5% of the students did not
receive any information about costs during their studies; 81.4% of the students
expressed interest in receiving such information; 66.2% thought that knowing the
costs would change their future clinical decision making. CONCLUSIONS AND
RECOMMENDATIONS: Medical students lack information regarding the cost of
laboratory tests and medical treatments. Providing information to medical
students about costs may help reduce future health care expenses. Our
recommendations are: 1. To include economic content in the medical curriculum;
2. To perform periodic updates and continuing medical education in this area; 3.
To combine this educational program with other intervention methods in order to
effectively reduce health care expenses.
Publication Types:
362: Promot Educ. 2006;13(3):203-7.

New horizons for public health in Kazakhstan.
Aringazina A, Macdonald G.
School of Public Health, Almaty, Kazakhstan. Correspondence to Dr. Altyn

Aringazina, School of Public Health, Almaty 050060, Kazakhstan. altyn@ksph.kz
This paper, the first ever to review and critique public health developments in
Kazakhstan, suggests ways in which public health can be improved strategically.
The paper outlines the main threats to health in a dynamic economically
developing country, but argues that with a health care reform agenda in place, and
the Governments apparent support of public health policy initiatives, the time is
right for new opportunities in the promotion of health. The paper utilises the
Ottawa Charter, but suggests novel, more appropriate headings for Kazakhstan, to
galvanise policy makers and professionals into tackling the growing burden of
disease. It concludes by calling for greater transparency in relation to Government
policy initiatives, and the need for greater national and international collaboration.
Publication Types:

Record linkage research and informed consent: who consents?
Huang N, Shih SF, Chang HY, Chou YJ.
Institute of Public Health, School of Medicine, National Yang-Ming University,

Taipei 112, Taiwan, ROC. syhuang@ym.edu.tw <syhuang@ym.edu.tw>
BACKGROUND: Linking computerized health insurance records with routinely

collected survey data is becoming increasingly popular in health services
research. However, if consent is not universal, the requirement of written
informed consent may introduce a number of research biases. The participants of
a national health survey in Taiwan were asked to have their questionnaire results
linked to their national health insurance records. This study compares those who
consented with those who refused. METHODS: A national representative sample
(n = 14,611 adults) of the general adult population aged 20 years or older who
participated in the Taiwan National Health Interview Survey (NHIS) and who
provided complete survey information were used in this study. At the end of the
survey, the respondents were asked if they would give permission to access their
National Health Insurance records. Information given by the interviewees in the
survey was used to analyze who was more likely to consent to linkage and who
wasn't. RESULTS: Of the 14,611 NHIS participants, 12,911 (88%) gave consent,
and 1,700 (12%) denied consent. The elderly, the illiterate, those with a lower
income, and the suburban area residents were significantly more likely to deny
consent. The aborigines were significantly less likely to refuse. No discrepancy in
gender and self-reported health was found between individuals who consented
and those who refused. CONCLUSION: This study is the first population-based
study in assessing the consent pattern in a general Asian population. Consistent
with people in Western societies, in Taiwan, a typical Asian society, a high
percentage of adults gave consent for their health insurance records and
questionnaire results to be linked. Consenters differed significantly from non-
consenters in important aspects such as age, ethnicity, and educational
background. Consequently, having a high consent rate (88%) may not fully
eliminate the possibility of selection bias. Researchers should take this source of
bias into consideration in their study design and investigate any potential impact
of this source of bias on their results.
Publication Types:
PMCID: PMC1802736
364: J Adv Nurs. 2007 Feb;57(4):375-81.

Factors influencing nurses' attitudes towards the use of

computerized health information systems in Kuwaiti hospitals.
Alquraini H, Alhashem AM, Shah MA, Chowdhury RI.
Department of Health Information Administration, Faculty of Allied Health

Sciences, Kuwait University, Kuwait. hquraini@hsc.edu.kw
AIM: This paper reports a survey of nurses' attitudes towards computerized health
information systems, the characteristics that influence these attitudes and the level
of nurses' skills in computer use. BACKGROUND: The use of such systems in
developed countries and in some developing countries has already become a
reality. However, nurses as a group of care providers have been found to resist
computerization, seeing computerized health information systems as
dehumanizing, confusing and uncaring. Nurses with more computer experience
tend to have more positive views; education and training positively influence
attitudes; and younger and less experienced nurses may have more positive
attitudes. METHODS: A structured questionnaire was used to measure the
attitudes of nurses working in Kuwait towards computerization. A random sample
of 574 nurses working in Ministry of Health hospitals were sent a questionnaire,
and 530 replies were received (response rate 92.3%). The data were collected
from November 2002 to January 2003. FINDINGS: Respondents generally had
positive attitudes toward computerized health information systems. Analysis of
variance revealed statistically significant differences in attitudes in relation to
nationality, level of education, previous experience in computer use, and
computer skills (P < 0.05). Multiple regression analysis showed that gender,
nationality, education levels, and duration of computer use were statistically
significant predictors of attitudes toward computerized health information systems
(P < 0.05). CONCLUSION: With adequate computerized health information
system training, the implementation of computerized health information systems
could be effective for nurses in providing quality health care, as found in other
studies.
365: Health Policy. 2007 Sep;83(1):84-93. Epub 2007 Feb 6.

Reconstruction of health service systems in the post-conflict

Northern Province in Sri Lanka.
Nagai M, Abraham S, Okamoto M, Kita E, Aoyama A.
Department of International Health, Nagoya University School of Medicine,

Japan. mnagai@med.nagoya-u.ac.jp
Public health problems in armed conflicts have been well documented, however,
effective national health policies and international assistance strategies in
transition periods from conflict to peace have not been well established. After the
long lasted conflicts in Sri Lanka, the Government and the rebel LTTE signed a
cease-fire agreement in February 2002. As the peace negotiation has been
disrupted since April 2003, a long-term prospect for peace is yet uncertain at
present. The objective of this research is to detect unmet needs in health services
in Northern Province in Sri Lanka, and to recommend fair and effective health
strategies for post-conflict reconstruction. First, we compared a 20-year trend of
health services and health status between the post-conflict Northern Province and
other areas not directly affected by conflict in Sri Lanka by analyzing data
published by Sri Lankan government and other agencies. Then, we conducted
open-ended self-administered questionnaires to health care providers and
inhabitants in Northern Province, and key informant interviews in Northern
Province and other areas. The major health problems in Northern Province were
high maternal mortality, significant shortage of human resources for health
(HRH), and inadequate water and sanitation systems. Poor access to health
facilities, lack of basic health knowledge, insufficient health awareness programs
for inhabitants, and mental health problems among communities were pointed by
the questionnaire respondents. Shortage of HRH and people's negligence for
health were perceived as the major obstacles to improving the current health
situation in Northern Province. The key informant interviews revealed that Sri
Lankan HRH outside Northern Province had only limited information about the
health issues in Northern Province. It is required to develop and allocate HRH
strategically for the effective reconstruction of health service systems in Northern
Province. The empowerment of inhabitants and communities through health
awareness programs and the development of a systematic mental health strategy
at the state level are also important. It is necessary to provide with the objective
information of gaps in health indicators by region for promoting mutual
understanding between Tamil and Sinhalese. International assistance should be
provided not only for the post-conflict area but also for other underprivileged
areas to avoid unnecessary grievance.
Publication Types:
366: Environ Monit Assess. 2007 Oct;133(1-3):87-98. Epub 2007 Feb 8.

Assessing spatial occurrence of ground level ozone around coal

mining areas of Chandrapur District, Maharashtra, India.
Salve PR, Satapathy DR, Katpatal YB, Wate SR.
Environmental Impact and Risk Assessment Division, National Environmental

Engineering Research Institute, Nehru Marg, Nagpur 440020 (M.S), India.
salvepr1@rediffmail.com
Stratospheric input and photochemical ozone formation in the troposphere are the
two main sources determining the ozone levels in the surface layer of the
atmosphere. Because of the importance of ozone in controlling the atmospheric
chemistry and its decisive role in the heat balance of atmosphere, leading to
climate change, the examination of its formation and destruction are of great
interest. This study characterized the distribution of Ground level Ozone (GLO) in
Chandrapur district is lying between 19 degrees 25'N to 20 degrees 45'N and 78
degrees 50'E to 80 degrees 10'E. Continuous ozone analyzer was used to quantify
GLO at thirteen locations fixed by Global Positioning System (GPS) during the
winter of 2005-2006. The daily GLO at all the locations ranged between 6.4 and
24.8 ppbv with an average and standard deviation of 14.9 +/- 6.5 ppbv. The
maximum and minimum concentration occurs during 1300-1600 h and 0300-0500
h may be due to high solar radiation facilitating photochemical production of O(3)
and downward mixing from the overlying air mass and in situ destruction of
ozone by deposition and/or the reaction between O(3) and NO. GIS based spatial
distribution of GLO in Chandrapur district is indicates that the central core of the
district and southern sites experienced elevated levels of GLO relative to the
northern and western areas. The sites near by Chandrapur city are particularly
affected by elevated GLO. The average variation of GLO with temperature shows
a significant correlation of r = 0.55 indicating a direct relationship between GLO
and temperature. Similarly an attempt has been made to compare the GLO
monitored data in Chandrapur district with the reported values for other locations
in Indian cities. This generated database helps regulatory agencies to identify
locations where the natural resources and human health could be at risk.
367: Ann Acad Med Singapore. 2007 Jan;36(1):3-10.

Results from a prospective acute inpatient rehabilitation database:

clinical characteristics and functional outcomes using the Functional
Independence Measure.
Ng YS, Jung H, Tay SS, Bok CW, Chiong Y, Lim PA.
Department of Rehabilitation Medicine, Singapore General Hospital, Singapore.

ng.yee.sien@sgh.com.sg
INTRODUCTION: Rehabilitation improves functional outcomes, but there is

little data on the profiles and outcomes of patients undergoing inpatient
rehabilitation in Singapore. The aims of this paper were to document the clinical
characteristics and functional outcomes, using the Functional Independence
Measure (FIM), of all patients admitted to an inpatient rehabilitation unit in a
tertiary teaching hospital, and to identify and analyse factors significantly
associated with better discharge functional scores and higher functional gains.
MATERIALS AND METHODS: In this prospective cohort study over a 4-year
period, clinical and functional data for 1502 patients admitted consecutively to the
Singapore General Hospital inpatient rehabilitation unit were charted into a
custom-designed rehabilitation database. The primary outcome measures were the
discharge total FIM scores, FIM gain and FIM efficiency. Multiple linear
regression analysis was used to identify independent variables associated with
better discharge FIM scores and FIM gain. RESULTS: The mean age was 61.3
+/- 15.0 years and 57.2% of the patients were male. Stroke (57.9%) followed by
spinal cord injury (9.7%) were the most common diagnoses. The average
rehabilitation length of stay was 21.5 +/- 19.0 days. The mean admission total
FIM score was 70.3 +/- 23.2 and the mean discharge total FIM score was 87.3 +/-
23.0, with this gain being highly significant (P <0.001). The mean FIM gain was
17.0 +/- 13.4 and FIM efficiency was 0.95 +/- 0.90 points/day. Factors associated
with better functional outcomes were higher admission motor and cognitive FIM
scores, male gender, a longer rehabilitation length of stay and the use of
acupuncture. Factors associated with poorer functional outcomes were older age,
clinical deconditioning, ischaemic heart disease, depression, pressure sores and
the presence of a domestic worker as a caregiver. CONCLUSIONS: The FIM is
an easy-to-use, standardised and robust general measure of functional disability.
Multiple demographic, clinical and socio-cultural variables are associated with the
primary functional outcomes and should be taken into account in rehabilitation
and discharge planning. Nevertheless, rehabilitation improves functional
outcomes across a wide range of diagnoses. Further research should be aimed at
evaluating long-term disability postdischarge from inpatient rehabilitation and
translating these findings into improving rehabilitation and healthcare resource
utilisation.
368: J Adv Nurs. 2007 Mar;57(5):522-34.

Participation in health-promoting behaviour: influences on

community-dwelling older Chinese people.
Kwong EW, Kwan AY.
School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong

Kong. hsenid@inet.polyu.edu.hk
AIM: This paper reports a study to determine the factors affecting community-
dwelling older Chinese people's health-promoting behaviour in the domains of
physical activity, healthy dietary practices and stress management, and to identify
any barriers to these behaviours. BACKGROUND: Previous studies have
identified factors affecting different types of health-promoting behaviours,
including perceived self-efficacy, perceived benefits and five individual
characteristics (age, sex, marital status, education and perceived health) of older
non-Chinese people. However, few studies have simultaneously taken these
factors into account in examining community-dwelling Chinese older people's
health-promoting behaviour. METHOD: Individual face-to-face interviews were
completed in 2002-2003 with a convenience sample of 896 community-dwelling
older Chinese people in Hong Kong aged between the ages of 60 and 98 (years
mean 76). Participants had no apparent communication and cognition
impairments. A structured interview schedule was used to collect the data.
RESULTS: Multiple regression analysis showed that perceived self-efficacy,
perceived benefits and sex together explained 38.4% of health-promoting
behaviour among community-dwelling older Chinese people in Hong Kong.
Fatigue during and after physical activity, enjoyment of unhealthy foods and
inadequate family and peer support were the most frequently reported barriers to
health-promoting behaviour. CONCLUSION: When developing health promotion
programmes to motivate community-dwelling older Chinese clients to participate
in health-promoting behaviour and to minimize barriers, community nurses
should include some activities to increase both the perceived self-efficacy and
perceived benefits of health-promoting behaviour. Future studies should include
more critical factors based on theories, empirical evidence and knowledge of
culture with samples that are random and from more diverse community settings.
369: J Med Syst. 2007 Feb;31(1):17-24.

Analysis of yearly variations in drug expenditure for one patient

using data warehouse in a hospital.
Chen Y, Matsumura Y, Nakagawa K, Ji S, Nakano H, Teratani T, Zhang Q,

Mineno T, Takeda H.
Department of Integrated Medicine, Medical Informatics, Osaka University,

Graduate School of Medicine 2-2, Yamada-oka, Japan.
Medical expense has grown rapidly in Japan. It could be caused by the increase of
the patient number and the increase of medical expense per patient. We studied
the latter factor on drug expenditure from 1996 to 2002 using the prescription data
stored in the data warehouse of one hospital. We found that the drug expenditure
per patient had increased 1.32 times. The mean number of prescriptions per
patient increased 1.23 times and the mean expenditure of one medicine increased
1.08 times. These results demonstrated that drug expenditure for one patient had
gradually increased. This was caused by both the rise in the number of medicines
taken by one patient and the rise in the prices of medicines. The data warehouse in
the hospital was useful for the analysis of the trends in medical expenditure for
one patient.
370: J Formos Med Assoc. 2007 Jan;106(1):58-68.

Applying a multiple screening program aided by a guideline-driven

computerized decision support system - a pilot experience in Yun-
Lin, Taiwan.
Lin JW, Chu PL, Liou JM, Hwang JJ.
National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan.
BACKGROUND/PURPOSE: Although preventive tools decrease morbidity and

mortality and promote health, these services are often underutilized. The purpose
of this study was to create a workflow for an outpatient setting that incorporated a
computerized decision support system to implement preventive recommendations
as well as to evaluate its impacts on facilitating preventive care. METHODS:
Subjects visiting National Taiwan University Hospital Yun-Lin Branch were
evaluated by a questionnaire, which contained items to trigger production rules to
check the eligibility of screening for high coronary risk, diabetes mellitus, lipid
disorder, hypertension, obesity, tobacco use, depression, colorectal cancer, breast
cancer, cervical cancer, and osteoporosis. Patients were given health information
about the diseases they were at risk for and the merits of preventive measures,
scheduled for a clinic visit, and arranged to have access to screening tools.
Physicians were prompted with clinical reminders on the encounter. The over-all
effectiveness of 11 components in this screening program was evaluated in terms
of expected life saving. The cost-effectiveness ratio was represented in US dollars
per life-year saved. RESULTS: A total of 283 men and 199 women were
identified to need one to six preventive interventions during a 2-month period.
Preventive consultation was arranged and screening tools were performed. It was
estimated that 412-1014 subjects would be needed to attend the program so as to
save one life. The cost-effectiveness ratio ranged from 30,000 US dollars to
40,000 US dollars per life-year saved. CONCLUSION: A computer-aided
screening program driven by the US Preventive Services Task Force
recommendations has been successfully implemented in Yun-Lin, Taiwan, and
provided useful information about local epidemiology and implications for future
health policy making.
Publication Types:

Importance of dental records for victim identification following the

Indian Ocean tsunami disaster in Thailand.
Petju M, Suteerayongprasert A, Thongpud R, Hassiri K.
Dental Department, Phangnga Provincial Public Health Office, 649 Petchkasem

Road, Muang District, Phangnga 82000, Thailand. smiledenta@yahoo.com
OBJECTIVES: To determine the usefulness of dental records for victim

identification following the Indian Ocean tsunami disaster in Thailand, and to
evaluate the dental identification system in Thailand, the homeland of a large
number of the victims. STUDY DESIGN: A descriptive study conducted at the
Thai Tsunami Repatriation Centre in Phangnga Province one year after the
tsunami hit Thailand on the 26th December 2004. METHODS: The dental records
of 3750 dead bodies and 3547 missing persons in the Thai Tsunami Victim
Identification (TTVI) database, updated on 12th December 2005, were analysed.
RESULTS: The identification rate of missing persons with dental records was
significantly higher than that of those without (P<0.01). Most victims identified
by dental records were returned home within the first four months after the
disaster. Dental records were the primary identifier in 46.2% of those identified.
However, among the Thai citizens reported missing, only 2.0% used dental
identification, 18.1% had dental charts and 0.8% had dental X-rays. In addition,
only 7.4% of Thai dental records could be used for dental identification and one-
third of Thai victims remained the majority of those unidentified.
CONCLUSIONS: Based on this study, the usefulness of dental records for victim
identification in a disaster was confirmed. The dental identification system for
nationals of Thailand could not work efficiently due to lack of dental records and
insufficient recorded detail.
Publication Types:
372: Nippon Koshu Eisei Zasshi. 2006 Dec;53(12):889-98.

[Volunteers' recognition of problems in meal distribution service

and their expectation for information concerning health and welfare
in less-favoured areas]
Yanagisawa H, Yoshimoto T, Namikawa K, Abe Y.

Gifu University, School of Nursing, Faculty of Medicine
OBJECTIVE: This study aimed to clarify problems perceived by volunteers of a

meal distribution service (MDS) in Less-Favoured Areas and the content of
information expected to be provided by the administration and social welfare
council. METHODS: We chose three municipalities (A, B, and C) with a
population of less than 4,000 and an elderly population rate of 25% or higher.
Volunteers involved in MDS in the municipalities were 28, 11, and 22 people in
A, B, and C, respectively. We interviewed each group after explaining our
purpose in writing, and made word-for-word records. Survey items were as
follows; what you try and aim to do, what is your burden and pleasure, what are
your problems and the solutions, and what are your demands for future activity in
the MDS. The study period was from March to November, 2003. RESULTS: The
information that the volunteers expected the administration and social welfare
council to provide encompassed 3 categories, each of which contained 2
subcategories. They expected (information to allow elderly people to use the
service on their own initiative> and <education to improve the understanding of
the residents about the MDS> as [information to improve understanding of the
users and residents about the aims and contents of the MDS], <responsible
recruiting of volunteers by the administration and social welfare council> and
<recruiting to secure motivated volunteers> as [information to ensure the quality
and quantity of volunteers], and <support for smooth delivery of meals> and
<support for the service in terms of evaluation> as [information to improve the
relationships between the volunteers and users]. CONCLUSIONS: The volunteers
expected education to improve the understanding of the residents so that elderly
people can use the MDS on their own initiative, recruiting of motivated
volunteers to ensure continuation of the service, and support for the smooth
execution of the service and a system for such support. These were perceived by
the subjects as problems to be solved for effective implementation of the service,
and are considered to represent the meaning and state of the MDS that the
volunteers wanted to share with the administration, social welfare council, and
residents. The information that should be shared among the administration, social
welfare council, residents, and volunteers can be clarified by evaluation of the
expectations of the volunteers which must be met to promote their cooperation to
support the service.
Publication Types:

Comment in:
• Isr Med Assoc J. 2007 Jan;9(1):42-3.

• Isr Med Assoc J. 2007 May;9(5):416; author reply 416.
Pre-hypertension is a common phenomenon: national database

study.
Kitai E, Vinker S, Halperin L, Meidan A, Grossman E.
Department of Family Medicine, Leumit Health Services, Tel Aviv, Israel.
BACKGROUND: Recently the Joint National Committee (7th report) introduced

the term "pre-hypertension." Little is known on its prevalence in the general
population. OBJECTIVES: To assess the prevalence of pre-hypertension in a
large national cohort. METHODS: We analyzed the database of all > or = 18 year
old members of Leumit Health Services, one of the four health management
organizations in Israel, from which we retrieved the recorded blood pressure
levels. Pre-hypertension was defined according to the JNC-7 criteria. RESULTS:
Of the 426,033 subjects 18.6% had a diagnosis of hypertension or used
antihypertensive medications. Only 40.8% of the other 346,799 subjects had had
their BP measured in the preceding 2 years. BP recording rates were higher in
females than in males (45.1% vs. 36.3%) and higher in elderly subjects than in
young subjects (56% aged 66-75 years vs. 32% aged 18-25). Pre-hypertension
was observed in 80,625 (23.2%) of the 346,799 while only 56,113 (16.2%) had
normal BP records. The prevalence of pre-hypertension increased with age
(13.3% aged 18-25 vs. 44.8% aged 66-75), and was more prevalent in men than in
women (24.0% vs. 22.5%). CONCLUSIONS: BP levels among young people are
low, even though the prevalence of pre-hypertension in this population may be
high. Thus, more emphasis should be given to routine BP measurements and
confirmation of the findings in all age groups.
Publication Types:

Evaluation of a syndromic surveillance system using the WSARE
algorithm for early detection of an unusual, localized summer
outbreak of influenza B: implications for bioterrorism surveillance.
Kaufman Z, Wong WK, Peled-Leviatan T, Cohen E, Lavy C, Aharonowitz

G, Dichtiar R, Bromberg M, Havkin O, Kokia E, Green MS.
Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.
zalman.k@icdc.health.gov.il
BACKGROUND: Syndromic surveillance systems have been developed for early

detection of bioterrorist attacks, but few validation studies exist for these systems
and their efficacy has been questioned. OBJECTIVES: To assess the capabilities
of a syndromic surveillance system based on community clinics in conjunction
with the WSARE algorithm in identifying early signals of a localized unusual
influenza outbreak. METHODS: This retrospective study used data on a
documented influenza B outbreak in an elementary school in central Israel. The
WSARE algorithm for anomalous pattern detection was applied to individual
records of daily patient visits to clinics of one of the four health management
organizations in the country. RESULTS: Two successive significant anomalies
were detected in the HMO's data set that could signal the influenza outbreak. If
data were available for analysis in real time, the first anomaly could be detected
on day 3 of the outbreak, 1 day after the school principal reported the outbreak to
the public health authorities. CONCLUSIONS: Early detection is difficult in this
type of fast-developing institutionalized outbreak. However, the information
derived from WSARE could help define the outbreak in terms of time, place and
the population at risk.
Publication Types:
375: Avian Dis. 2006 Dec;50(4):508-15.

Spatiotemporal distributions of reported cases of the avian influenza

H5N1 (bird flu) in Southern China in early 2004.
Oyana TJ, Dai D, Scott KE.

Department of Geography & Environmental Resource, Southern Illinois
University, 1000 Faner Drive, MC 4514, Carbondale, IL 62901-4514, USA.
This study investigates spatiotemporal distributions of reported cases of the avian

influenza H5N1 (bird flu) in Southern China in early 2004. Forty-nine cases of the
avian influenza H5N1 covering a 6-week period (January 19, 2004, through
March 9, 2004) were compiled from the Chinese Ministry of Agriculture and the
World Health Organization. Geographic information systems (GIS) techniques
combined with statistical techniques were used to analyze the spatiotemporal
variation of reported cases of avian influenza. Using Oden's direction method, we
also explored the spatiotemporal interaction of individual-level avian influenza
cases during the study duration. The peak period (temporal clustering) for the
epidemiological avian influenza outbreak occurred between the third and fourth
weeks. Although we observed a major northeast-southwest distribution of the
avian influenza H5N1 cases, there was no significant spatiotemporal association
in average "direction of advance" of these cases. The directional finding is very
consistent with the major migratory bird routes in East Asia, but owing to weak
surveillance and reporting systems in the region, the study findings warrant
further evaluation.
Publication Types:
376: Mil Med. 2007 Jan;172(1):75-8.

Civilian doctors in military clinics--outsourcing for better medicine.
Dankner R, Rieck J, Bentacur AG, Bar Dayan Y, Shahar A.
The Gertner Institute for Epidemiology and Health Policy Research, Tel-
Hashomer, 52621, Israel.
OBJECTIVES: To determine whether outsourcing of medical consulting services

could improve the quality of medical treatment in military primary care clinics.
METHODS: Data were collected prospectively over 2 months in two regular
army clinics manned by ordinary army doctors and in two intervention clinics also
staffed with senior civilian doctors. The causes for doctor visits, diagnoses, and
other patient data were collected. RESULTS: Information was recorded from
4970 soldier visits in the four clinics. Although a prescription of rest days was
similar in both types of clinics, the level of tertiary referrals was lower by one-
third in the intervention clinics compared to the regular clinics. Surrogate markers
for quality of care, such as increased use of planned follow-up and reduced
antibiotic use, were significantly better in the intervention clinics, and so was
overall patient satisfaction. CONCLUSIONS: Integration of specialist civilian
physicians in the military primary care system is highly beneficial and provides
better care and saves costs.
Publication Types:
377: Ophthalmology. 2007 Feb;114(2):278-82.

Cataract surgery is associated with a higher rate of photodynamic

therapy for age-related macular degeneration.
Kaiserman I, Kaiserman N, Elhayany A, Vinker S.
Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel.

Igor@Dr-Kaiserman.com
PURPOSE: To investigate the association between cataract surgery and the rate of
photodynamic therapy (PDT) for age-related macular degeneration (AMD).
DESIGN: Observational population-based retrospective case-control study.
PARTICIPANTS: All members in a district of the largest health maintenance
organization (HMO) in Israel > 50 years old on January 1, 2001, who did not
terminate their membership through May 31, 2005 (139 894 members).
METHODS: All PDT procedures for AMD performed in the study population
between January 1, 2001 and May 31, 2005 (283 patients) and all cataract
surgeries performed between January 1, 2001 and December 31, 2003 (5913
patients) were documented. We extracted clinical information from the chronic
disease registry of the HMO as well as demographic and socioeconomic
information. For each patient that underwent cataract surgery, 5 HMO members
matched in age, gender, chronic diseases (systemic hypertension, diabetes,
hyperlipemia, and ischemic heart disease), place of residence, country of birth and
socioeconomic status, who did not undergo cataract surgery, were randomly
chosen as controls (n = 29 565). MAIN OUTCOME MEASURES: The rate for
undergoing PDT at different time periods after cataract surgery. RESULTS: Fifty
(0.85%) cataract patients and 94 control cases (0.32%) underwent PDT after
cataract surgery (P<0.0001, chi-square test). A significant rise in PDT rate was
noticed in cataract patients compared to controls during the first 6 months after
surgery (P = 0.004, chi-square test). Between 6 and 12 months postoperatively,
the PDT rates were similar in both groups. However, a more significant rise in
PDT rates occurred between 1 and 1.5 years after surgery (P<0.0001, chi-square
test). The Kaplan-Meier PDT-free survival curve of cataract patients was
significantly worse than that of the controls (P<0.0001, chi-square test; P = 33.7,
log-rank test). The hazard ratio for cataract patients compared to controls to
undergo PDT after surgery was 2.7 (confidence interval = 2.4-5.7). The most
significant factors to reduce the time to PDT were advanced age followed by
having had cataract surgery, place of birth, socioeconomic status, and
hyperlipidemia (Cox proportional hazards survival regression). CONCLUSIONS:
We identified an increased rate of PDT, presumably for subfoveal AMD, 1 to 1.5
years after cataract surgery.
378: Vaccine. 2007 Mar 30;25(14):2630-3. Epub 2006 Dec 26.

Evaluation of the National Notifiable Disease Surveillance System in

Taiwan: an example of varicella reporting.
Tan HF, Chang CK, Tseng HF, Lin W.
Department of Healthcare Administration, Chang-Jung Christian University,

Taiwan.
Despite the mandatory reporting by laws, the incompleteness of notifiable

infectious disease reporting is well-documented in many countries for various
diseases. The purpose of this study is to investigate the completeness of varicella
reporting in Taiwan. Annual reports of National Notifiable Disease Surveillance
System in Taiwan were compared to the annual outpatient claims of National
Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and area-
specific reporting rates of varicella were calculated by dividing the respective
reported cases by the number of incidence cases. The reporting rate was the
highest in aged 0 year in all years, followed by the 20-29- and 30-39-year groups.
The reporting rate in each age group increased gradually during the study period.
Other than Taipei City, the reporting rates in all regions were below 9% during
this period. This study suggested that varicella reporting rate is very low in
Taiwan. In addition, the reporting rates were inconsistent in 2000-2002, making
the estimation of prevalence and vaccine efficacy using data from the National
Notifiable Disease Surveillance System almost impossible. This study indicated
that the physicians in Taiwan should improve their knowledge and attitude toward
notifiable infectious diseases.
Publication Types:
379: Environ Int. 2007 Jul;33(5):603-8. Epub 2007 Jan 30.

Association between esophageal cancer and drought in China by

using Geographic Information System.
Wu K, Li K.
Department of Preventive Medicine, Shantou University Medical College,

Shantou 515031, PR China. kswu@stu.edu.cn
The objective of this ecological study was to discover associations between

selected climate variables and esophageal cancer (EC) mortality in China using a
Geographic Information System (GIS). A digital distribution map of EC mortality
in China was established in GIS, which was based on one-tenth of nationwide
population cause-of-death surveys conducted in mainland China in 1990-1992.
Selected climate variables such as 30-year annual average precipitation and
evaporation data of the sample areas were extracted from the environmental
databases by zonal statistics finished in Spatial Analyst module of ArcInfo 9.0.
Drought Indexes were calculated by using the precipitation and evaporation data
and a digital distribution map of them was created to compare with the
distribution of EC mortality. Correlation and regression analyses were applied to
evaluate associations between the EC mortality rates defined at the sample areas
and selected climate variables from the raster datasets. The results of the digital
GIS maps of EC mortality and Drought Index show that the high EC mortality
mostly occurred in areas with high Drought Index. Correlation and regression
analyses also show weak negative correlation between precipitation and EC
mortality (p<0.001), and weak positive correlation between Drought Index and
EC mortality (p<0.001). This study presented a unique model for the link of
cancer and climate using a GIS. The study suggests that drought plays a role in
the occurrence and development of EC in China, however, other environmental,
biological and genetic factors should not be ignored. There is need for further
studies using multiple factors and more accurate and detailed environmental and
health data.
380: Trans R Soc Trop Med Hyg. 2007 Jun;101(6):587-93. Epub 2007 Jan 30.
Epidemiological investigation of an outbreak of acute diarrhoeal
disease using geographic information systems.
Sarkar R, Prabhakar AT, Manickam S, Selvapandian D, Raghava MV, Kang

G, Balraj V.
Department of Community Health, Christian Medical College, Vellore 632 002,

Tamil Nadu, India.
An outbreak of acute diarrhoeal disease in a village in southern India was

investigated through personal interviews of all households. Maps were drawn
using geographic information system (GIS) tools of the water supply system,
sewage channels and areas with observed faecal contamination of soil within and
around the village. Geographic coordinates for each house in the village were
extracted from a central database from the healthcare service provider for the
village. Geographical clustering of cases was looked for using the SaTScan
software, and diarrhoeal disease attack rates were calculated. Diarrhoeal disease
occurred uniformly throughout the village without clustering in any area. All ages
and both sexes were affected, but extremes of ages were at higher risk. Water
samples collected for microbiological examination after instituting control
measures showed high coliform counts. Chlorine levels in the water tested were
found to be inadequate to decontaminate common pathogens. Local cultural
practices such as indiscriminate defecation in public places, washing clothes and
cleaning utensils from water taps where the community collected its drinking
water, and poor engineering design and maintenance of the water supply system
were the risk factors that could have contributed to this outbreak.
381: Mil Med. 2006 Dec;171(12):1229-34.

Reorganization of secondary medical care in the Israeli Defense

Forces Medical Corps: A cost-effect analysis.
Yagil Y, Arnon R, Ezra V, Ashkenazi I.
Medical Services and Supply Center, Medical Corps, Israeli Defense Forces,
Beer-Sheba, Israel.
OBJECTIVE: To increase accessibility and availability of secondary medical

care, 10 secondary unit specialist clinics were established side-by-side with five
existing regional specialist centers, thus achieving decentralization. The purpose
was to analyze the impact of this reorganization on overall consumption of
secondary medical care and expenditures. METHODS: Consumption of
secondary medical care was analyzed by using computerized clinic and Medical
Corps databases. Functional efficiency and budgetary expenditures were
evaluated in four representative unit specialist clinics. RESULTS: The
reorganization resulted in an 8% increase in total secondary care consumption
over 2.5 years. The establishment of unit specialist clinics did not achieve
increased accessibility or availability for military personnel. Functional analysis
of representative unit specialist clinics showed diversity in efficiency, differences
in physicians' performance, and excess expenditures. CONCLUSION: The
decentralizing reorganization of secondary medical care generated an increase in
medical care consumption, possibly because of supply-induced demand. The
uniform inefficiency of the unit specialist clinics might have been related to
incorrect planning and management. The decentralization of secondary medical
care within the Israeli Defense Forces has not proved to be cost-efficient.
382: Int J Clin Pharmacol Ther. 2007 Jan;45(1):30-5.

Prescription of benzodiazepines and antidepressants to outpatients

attending a Japanese university hospital.
Nakao M, Takeuchi T, Yano E.
Department of Hygiene and Public Health, Teikyo University School of

Medicine, Tokyo, Japan. mnakao@med.teikyo-u.ac.jp
OBJECTIVE: Excessive benzodiazepine use is a public health concern from

clinical and economical perspectives. Although more benzodiazepines are
prescribed in Japan than in any other country, no hospital-based report has
documented this phenomenon. Therefore, this study compared the prescription
frequency of benzodiazepines with that of selective serotonin reuptake inhibitors
(SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and other
antidepressants in a single Japanese hospital over 1 year. MATERIAL: The
annual prescription of benzodiazepines was assessed with that of antidepressants
using an electronic database of medical records for outpatients at a Japanese
tertiary care hospital affiliated with a private university with approximately
600,000 outpatient visits annually. METHOD: Groups of departments were
analyzed separately (i.e. internal medicine, surgery, neurology, psychiatry, and
others). The ratio of the number of prescriptions of anxiolytic benzodiazepines to
that of SSRI and SNRI was calculated among the department groups and used as
one of indicators comparing the prescriptions of benzodiazepines with those of
antidepressants. RESULTS: Of 644,444 hospital prescriptions, 6.1% were for
anxiolytic benzodiazepines, and 5.8% were for hypnotic benzodiazepines.
Regarding antidepressants, 1.6% of prescriptions were for SSRIs/SNRIs, 0.8%
were for tricyclic antidepressants, and 1.5% were for other antidepressants. Of the
benzodiazepine prescriptions, 26.8% were written by the internal medicine group.
The ratio of the number of prescriptions for anxiolytic benzodiazepines to that for
SSRI and SNRI was highest in the department of internal medicine (ratio = 13.0),
followed by surgery (7.6), neurology (4.8), and psychiatry (2.5). With the
department of psychiatry as the reference, the tendency to prescribe an anxiolytic
benzodiazepine rather than an SSRI or SNRI was statistically significant in the
remaining four department groups, after controlling for the effects of patient age
and sex in a multiple logistic regression analysis. CONCLUSIONS:
Benzodiazepine prescriptions in the Japanese hospital were far more common
than prescriptions for antidepressants such as SSRIs and SNRIs, especially in
internal medicine. Multi-institutional studies are needed to address this issue in
Japanese hospitals, as well as in hospitals in other countries.
Publication Types:
383: Health Place. 2007 Sep;13(3):577-87. Epub 2007 Jan 24.

Geographic analysis of vaccine uptake in a cluster-randomized

controlled trial in Hue, Vietnam.
Ali M, Thiem VD, Park JK, Ochiai RL, Canh do G, Danovaro-Holliday MC,
Kaljee LM, Clemens JD, Acosta CJ.
International Vaccine Institute, San 4-8, Bongcheon-7 dong, Kwanak-ku, Seoul

151-818, Republic of Korea. mali@ivi.int
This paper identifies spatial patterns and predictors of vaccine uptake in a cluster-
randomized controlled trial in Hue, Vietnam. Data for this study result from the
integration of demographic surveillance, vaccine record, and geographic data of
the study area. A multi-level cross-classified (non-hierarchical) model was used
for analyzing the non-nested nature of individual's ecological data. Vaccine
uptake was unevenly distributed in space and there was spatial variability among
predictors of vaccine uptake. Vaccine uptake was higher among students with
younger, male, or not literate family heads. Students from households with higher
per-capita income were less likely to participate in the trial. Residency south of
the river or further from a hospital/polyclinic was associated with higher vaccine
uptake. Younger students were more likely to be vaccinated than older students in
high- or low-risk areas, but not in the entire study area. The findings are important
for the management of vaccine campaigns during a trial and for interpretation of
disease patterns during vaccine-efficacy evaluation.
Publication Types:


Population-based database of multiples in childhood of Ishikawa

Prefecture, Japan.
Ooki S.

A new type of population-based database of multiples in childhood at the

prefecture level was initiated in 2004 in Ishikawa Prefecture, Japan. We
conducted an exhaustive search for demographic information concerning families
with multiples, family support provided by governmental and medical institutions
by mailed questionnaire, and at the same time tried to organize a human network
to support such families. This registry aims not only to aid research on human
genetics and maternal and child health, but also to contribute to the development
of welfare programs for families with multiples.
Publication Types:

Twin database of the secondary school attached to the Faculty of

Education of the University of Tokyo.
Ooki S, Asaka A.
This article profiles the historical twin databases of the secondary education
school attached to the Faculty of Education at the University of Tokyo. The
school was established in 1948. Every year, about 50 pairs of twins of all sex and
zygosity combinations and aged 11 to 12 years take an examination, and about 10
to 20 pairs are admitted based on the results. Three independent datasets exist:
one for applicants (11-12 years), one for students (12-18 years), and one for
graduates (18-72 years). These three historical databases and research
perspectives are introduced herein.
Publication Types:
386: Pharmacoepidemiol Drug Saf. 2007 Apr;16(4):412-21.

Trends in the use of antihypertensive drugs by outpatients with

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

Kaohsiung, Taiwan.
PURPOSE: To analyze trends in AHD-use by diabetic outpatients in Taiwan over

a 7-year period (1997-2003) and to see whether the trends are consistent with
clinical trial outcomes and published guidelines. METHODS: A cross-sectional
survey was implemented using National Health Insurance Research Database
between January 1997 and December 2003. Adult outpatients who had diagnoses
of diabetes and hypertension and who had concurrent antidiabetic and
antihypertensive drug claim were identified. The prescribing trends were
described in terms of the prescribing rates and patterns of AHDs in each study
year. RESULTS: Of the AHDs, CCBs were the most widely prescribed class
throughout the study period but the prescribing rates declined considerably over
the study period. A significant downward trend was also observed for beta-
blockers and other classes. Drugs acting on the RAS were the only one class
showing a significant increase in prescribing rates with time. The prescribing
patterns for monotherapy regimen decreased over time while those for two-,
three-, and four or more drug regimens increased over time. Monotherapies
maintained with CCBs, beta-blockers, diuretics, and other classes steadily
declined but those maintained with drugs acting on the RAS markedly increased.
CONCLUSIONS: The use of drugs acting on the RAS showed a marked
increasing trend over the course of the study. Physicians' prescribing patterns for
AHD are increasingly involving multi-drug regimens. These findings may imply
that management of hypertension in patients with diabetes had a positive trend
toward to new clinical trial outcomes and guideline's recommendation.
387: Pediatr Int. 2007 Feb;49(1):48-52.

Health-care utilization and costs in Taiwanese pediatric patients

with asthma.
Sun HL, Kao YH, Lu TH, Chou MC, Lue KH.
Department of Pediatrics, Chung Shan Medical University Hospital, Taichung,

Taiwan.
BACKGROUND: In many countries, the burden of asthma is sufficient to warrant

recognition as a high-priority disorder in governmental health strategies.
However, the components of the total health-care costs for pediatric patients with
asthma have not been well studied, and an overall understanding of health-care
utilization patterns in this population is lacking in Taiwan. METHODS: A total of
33 461 patients aged 3-17 years who were enrolled in the National Health
Insurance Research database from 1 January to 31 December 2002 were
evaluated. Health-care utilization and costs, including those related to office,
outpatient hospital, emergency department, and inpatient hospital visits were
compared between pediatric patients with and without asthma. RESULTS: In
2002, the period prevalence of treated asthma was 6.0%. Pediatric patients with
asthma used substantially more services than did those without asthma in all
categories. Hospital outpatient visits and overall health-care expenditure for
patients with asthma were 2.2-fold higher than those of patients without asthma.
Asthma care represented 20% of all health-care services that patients with asthma
received, while the remaining 80% were for non-asthma care. Almost three-
fourths of all asthma-related costs were attributable to office and hospital
outpatient visits; one-fourth was attributable to urgent care and hospitalizations.
CONCLUSIONS: These findings may serve as baseline data for future evaluation
of changes in health-care utilization and expenditure among pediatric patients
with asthma.
388: Telemed J E Health. 2006 Dec;12(6):691-7.

On the evaluation of economic benefits of Japanese telemedicine and

factors for its promotion.
Miyahara S, Tsuji M, Iizuka C, Hasegawa T, Taoka F.
Department of Economics, Aoyama Gakuin University, Tokyo, Japan.
This paper attempts to estimate economic values of telemedicine and to extract

factors that promote telemedicine through the use of survey data. This is the first
analysis aimed at evaluating telemedicine in Japan. We utilized the Contingent
Valuation Method and estimated demand functions of telemedicine. Because the
number of institutions replying with willingness to pay (WTP) and willingness to
undertake (WTU) is relatively small, the Kernel Estimation Method was applied.
After estimating WTP and WTU, by multiplying the number of medical
institutions currently implementing telemedicine, the whole value in Japan was
obtained. By using the Tobit Model, factors that influence WTP and WTU were
extracted. Estimated WTP was 35.23 dollars for teleradiology and 162.89 dollars
for telepathology. WTU estimated was 39.81 dollars for teleradiology and 86.59
dollars for telepathology. Estimated economic benefits in Japan for 1 year were
1.27 million dollars for WTP of teleradiology and 278,600 dollars for
telepathology. WTU is 10 million dollars for teleradiology and 393,400 dollars
for telepathology. Medical institutions with the following characteristics tend to
reply larger WTP: (1) university hospitals, (2) internal medicine, (3) radiology,
and (4) use of video conference systems. Regarding WTU, the following
characteristics influence WTU: (1) use of a personal computer, (2) use of
telepathology equipment, (3) high satisfaction with the quality of telemedicine,
and (4) experience base of telemedicine. Based on the nationwide survey on
telemedicine, the total value of telemedicine in Japan was estimated. In addition
to the evaluation, quantitative aspects of implementation of telemedicine, such as
factors to promote telemedicine, are analyzed. These can provide useful
information for further implementation of telemedicine not only in Japan but in
other countries as well.
Publication Types:

389: IEEE Trans Inf Technol Biomed. 2007 Jan;11(1):14-6.
Understanding PACS development in context: the case of China.
Xue Y, Liang H.
University of Rhode Island, Kingston, RI 02881, USA. yxue@fau.edu
This paper describes the evolution of picture archiving and communication

systems (PACS) in China and identifies several obstacles to its development,
including vendors' opportunism, hospital administrators' IT ignorance,
mindlessness in IT adoption, lack of system integration, and misfits between
foreign PACS and local hospitals. Lessons learned from these obstacles are
provided, which are of value to developing countries where PACS has just started
diffusing.
Publication Types:
• Review
390: BMC Health Serv Res. 2007 Jan 23;7:11.

Resource allocation within the National AIDS Control Program of

Pakistan: a qualitative assessment of decision maker's opinions.
Husain S, Kadir M, Fatmi Z.
Health Systems Division, Department of Community Health Sciences, Aga Khan

University, Pakistan. sara.sharih@aku.edu
BACKGROUND: Limited resources, whether public or private, demand

prioritisation among competing needs to maximise productivity. With a
substantial increase in the number of reported HIV cases, little work has been
done to understand how resources have been distributed and what factors may
have influenced allocation within the newly introduced Enhanced National AIDS
Control Program of Pakistan. The objective of this study was to identify
perceptions of decision makers about the process of resource allocation within
Pakistan's Enhanced National AIDS Control Program. METHODS: A qualitative
study was undertaken and in-depth interviews of decision makers at provincial
and federal levels responsible to allocate resources within the program were
conducted. RESULTS: HIV was not considered a priority issue by all study
participants and external funding for the program was thought to have been
accepted because of poor foreign currency reserves and donor agency influence
rather than local need. Political influences from the federal government and donor
agencies were thought to manipulate distribution of funds within the program.
These influences were thought to occur despite the existence of a well-laid out
procedure to determine allocation of public resources. Lack of collaboration
among departments involved in decision making, a pervasive lack of technical
expertise, paucity of information and an atmosphere of ad hoc decision making
were thought to reduce resistance to external pressures. CONCLUSION:
Development of a unified program vision through a consultative process and
advocacy is necessary to understand goals to be achieved, to enhance program
ownership and develop consensus about how money and effort should be directed.
Enhancing public sector expertise in planning and budgeting is essential not just
for the program, but also to reduce reliance on external agencies for technical
support. Strengthening available databases for effective decision making is
required to make financial allocations based on real, rather than perceived needs.
With a large part of HIV program funding dedicated to public-private
partnerships, it becomes imperative to develop public sector capacity to
administer contracts, coordinate and monitor activities of the non-governmental
sector.
PMCID: PMC1784085
391: Public Health. 2007 Mar;121(3):231-6. Epub 2007 Jan 22.

Determining aspects of ethnicity amongst persons of South Asian

origin: the use of a surname-classification programme (Nam
Pehchan).
Macfarlane GJ, Lunt M, Palmer B, Afzal C, Silman AJ, Esmail A.
Aberdeen Pain Research Collaboration, Epidemiology Group, Department of

Public Health, University of Aberdeen, Polwarth Building, Foresterhill,
Aberdeen, AB25 2ZD, UK. g.j.macfarlane@abdn.ac.uk
OBJECTIVE: Name-based classification systems are potentially useful in

identifying study samples based on probable ethnic minority group. The aim of
the current study was to assess the validity of the Nam Pehchan name
classification programme of religion and language against subject self-report.
STUDY DESIGN AND SETTING: A population-based cross-sectional survey
conducted in areas of the North-West and West Midland regions of England with
a relatively high density of South Asian ethnic minority groups. The sampling
frame was age-sex registers of selected general practices and subjects were
classified according to language and religion using the Nam Pehchan programme.
These were compared with responses by subjects on a self-complete postal
questionnaire. RESULTS: One thousand nine hundred and forty-nine subjects
who participated, classified themselves as South Asian. Sensitivity in identifying
religion was high amongst Muslims (92%) and Sikhs (86%), and somewhat lower
in Hindus (62%). Specificity exceeded 95% for all ethnic groups. The vast
majority of subjects assigned Punjabi or Gujarati as their main South Asian
language indicated that they did in fact speak these languages (97% and 94%,
respectively). Subjects assigned Urdu or Bengali, however, were less likely to do
so (61% and 35%, respectively). CONCLUSIONS: The name-based classification
system Nam Pehchan has demonstrated high levels of accuracy in some sub-
groups of the South Asian population in determining subjects likely language
spoken and religion-and is likely to be a useful additional tool when information
on ethnicity is not already available.
Publication Types:
• Validation Studies

NSC (New Songdo City: newly developed city as free economic zone
in South Korea) ubiquitous healthcare project--developing
prospective health management model, integrating on-line and off-
line healthcare service.
Yoon DH, Park MJ, Kim DH, Park JH, Choi SH, Choi SY, Jeong IK, Sim
WH, Shin CS, Cho SH, Oh BH.
Seoul National University Hospital Healthcare System Gangnam Center, Seoul,

Korea.
PMCID: PMC1839565
A snapshot of the electronic transmission and processing of

prescriptions project in the Iranian Social Security Organization.
Moghaddam R, Badredine H.
Medical Informatics Department, Social Security Organization, Tehran, Iran.
Iranian Social Security Organization (ISSO) is going to enable the sharing of

health related information in a secure environment by means of reliable data in
the right time to improve health of insured people throughout the country. There
are around 7000 pharmacy throughout the country that ISSO contracted with them
in order to deliver seamless services to 30 million insured people. The
management of the huge amount of prescriptions based on a scientific basis with
considering the financial issues of rising the cost of medicaments certainly needs
a sophisticated business process re-engineering using ICT; the work that is going
to be completed in the ISSO in next few months.
PMCID: PMC1839728

Successful transfer of a Web-based TB medical record from Peru to

the Philippines.
Fraser H, Choi SS, Galipot M, Jazayeri D, Mangubat N.
Partners In Health, Boston, USA.
Publication Types:


PMCID: PMC1839702

User-customizing HIS interface by light programming tool: the case

of redesigning the nursing Kardex with InfoPath2003.
Chang TR, Chang P.
Institute of Health Informatics and Decision Making, National Yang-Mine

University, Taipei, Taiwan / R.O.C.
Due to lack of IT resources, the End-User Computing strategy seems useful for
the front-end users to develop and customize their own information application.
We taught the nurses to use the InfoPath 2003 to design their own card-filing
Kardex system and observed promising results.
PMCID: PMC1839363
396: AMIA Annu Symp Proc. 2006:424-8.

Are health centers in Thailand ready for health information

technology? : a national survey.
Kijsanayotin B, Speedie S.
Health Informatics, Medical School, University of Minnesota, Minneapolis,

Minnesota, USA.
The Thailand universal health care coverage scheme was instituted in 2001 and
The Thailand Ministry of Public Health (MOPH) is restructuring its information
systems to support this reform. The MOPH anticipates developing computerized
health information systems which can provide information for administration
tasks and can improve both healthcare delivery and public health services. To
achieve these target goals, knowledge about users and organizations is vital. The
knowledge of how health center workers currently use information technology
(IT), their knowledge of IT, and acceptance of IT are not only beneficial to policy
makers but also to system designers and implementers. The primary objective of
this study is to learn how health centers in Thailand use IT, the level of basic IT
knowledge among their workers, and their acceptance of health IT. We surveyed a
random cross sectional sample of 1,607 health centers representing the total of
9,806 in Thailand in 2005. With an 82% response rate, the preliminary results
indicate that information technology usage is pervasive in health centers. The
respondents showed a moderately high degree of health information technology
acceptance with a modest level of basic IT knowledge. There were no differences
in degrees of acceptance among the four geographic regions. The mean score of
"intention to use IT" was 5.6 on a scale of 7 and the average basic IT knowledge
score was 13 out of 20. These results suggests the possibility of project success if
the national health center information system projects are developed and
implemented.
Publication Types:
PMCID: PMC1839384
397: Saudi J Kidney Dis Transpl. 2007 Mar;18(1):60-4.

Organ donation after brain-death: experience over five-years in a

tertiary hospital.
Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA.
Critical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
aldawooda@hotmail.com
Organ transplantation is the treatment of choice for end-stage organ failure. The
main challenge for organ transplantation continues to be organ shortage. The
purpose of our study was to evaluate the success rate of organ donation after
brain-death, as documented in a tertiary closed intensive care unit in Saudi
Arabia. Data was obtained from a collected database from Jan 2001- Dec 2005.
Brain death was documented in 162 patients, most of whom were young (median
age was 28 +/- 17 years). The group consisted predominantly of males, 149 (92%)
and Saudis 109 (67%). Only 24 (17%) positive consents to organ donation were
obtained and the majority of them [21 (87%)] were from non-Saudis. Positive
consent was obtained from only three percent of Saudi potential organ donors in
comparison to the 40% positive rate among non-Saudis (40%) (p<0.05). In
conclusion, we believe that misconceptions about brain-death are the likely causes
behind this unfavorable view towards organ donations among Saudis.
Publication Types:
398: Can J Clin Pharmacol. 2007 Winter;14(1):e40-4. Epub 2007 Jan 19.
Building a structured monitoring and evaluating system of

postmarketing drug use in Shanghai.
Du W, Levine M, Wang L, Zhang Y, Yi C, Wang H, Wang X, Xie H, Xu J,

Jin H, Wang T, Huang G, Wu Y.
Shanghai Center for Adverse Drug Reaction Monitoring, Shanghai, China.
In order to understand a drug's full profile in the post-marketing environment,

information is needed regarding utilization patterns, beneficial effects, ADRs and
economic value. China, the most populated country in the world, has the largest
number of people who are taking medications. To begin to appreciate the impact
of these medications, a multifunctional evaluation and surveillance system was
developed, the Shanghai Drug Monitoring and Evaluative System (SDMES). Set
up by the Shanghai Center for Adverse Drug Reaction Monitoring in 2001, the
SDMES contains three databases: a population health data base of middle aged
and elderly persons; hospital patient medical records; and a spontaneous ADR
reporting database. Each person has a unique identification and Medicare number,
which permits record-linkage within and between these three databases. After
more than three years in development, the population health database has
comprehensive data for more than 320,000 residents. The hospital database has
two years of inpatient medical records from five major hospitals, and will be
increasing to 10 hospitals in 2007. The spontaneous reporting ADR database has
collected 20,205 cases since 2001 from approximately 295 sources, including
hospitals, pharmaceutical companies, drug wholesalers and pharmacies. The
SDMES has the potential to become an important national and international
pharmacoepidemiology resource for drug evaluation.
399: Health Policy Plan. 2007 Jan;22(1):13-20.

From the field side of the binoculars: a different view on global

public health surveillance.
Calain P.
philippe_calain@hotmail.com
It is generally assumed by the donor community that the targeted funding of

global, regional or cross-border surveillance programmes is an efficient way to
support resource-poor countries in developing their own national public health
surveillance infrastructure, to encourage national authorities to share outbreak
intelligence, and ultimately to ensure compliance of World Health Organization
(WHO) Member States with the revised (2005) International Health Regulations.
At country level, a number of factors and constraints appear to contradict this
view. Global or regional surveillance initiatives, including syndromic surveillance
and rumour surveillance projects, have been conceived in neglect of fragile health
systems, from which they extract scarce human resources. In contradiction with a
rightful stance promoting 'integrated surveillance' by WHO, the nurturing of
donor-driven, poorly coordinated and redundant surveillance networks generally
adds further fragmentation to national health priorities set up by developing
countries. In their current categorical format, ignoring the overwhelming deficits
in governance and health care capacity, global surveillance strategies seem bound
to benefit mainly the most industrially developed nations through the provision of
early warning information or scientific data. In lower-income countries, a focus of
resources on strengthening the health system first would ultimately be a more
efficient way to achieve proper detection and response to outbreaks at national or
sub-national level. As documented in several pilot initiatives at sub-national level
(India, South Africa, Tuvalu and Cambodia), the empowerment of frontline health
workers and communities is a key element for an efficient surveillance system.
Such simple measures centred on human resources and community values appear
to be more beneficial than massive and conditional monetary inputs.
400: Bone. 2007 Apr;40(4):1066-72. Epub 2007 Jan 22.

Vertebral fracture risk and impact of database selection on identifying

elderly Lebanese with osteoporosis.
Baddoura R, Arabi A, Haddad-Zebouni S, Khoury N, Salamoun M, Ayoub G,

Okais J, Awada H, El-Hajj Fuleihan G.
Division of Rheumatology, Saint Joseph University, Beirut, Lebanon.
rbaddoura@usj.edu.lb
The International Osteoporosis Foundation recommends using a universal database i.e.

the NHANES database for the diagnosis of osteoporosis. Population-based databases for
T-score calculation are still debated in terms of clinical and public health relevance. The
current study aimed at estimating the prevalence of vertebral fractures in the Lebanese
elderly, determining BMD-fracture relationship, and assessing the effect of database
selection on osteoporosis prevalence and fracture risk assessment. Apparently healthy
subjects were randomly selected from the Greater Beirut area - one-third of the Lebanese
population at large - using a multilevel cluster technique. Subjects with medical
conditions likely to affect bone metabolism i.e. history of major chronic disease, intake of
medications that affect bone metabolism were excluded. Presence of vertebral fracture
was estimated by a semi-quantitative assessment. Bone density was measured by central
DXA. Clinical risk factors included age, gender, height, weight, body mass index,
smoking, exercise, falls, previous fragility fracture and family history of fragility fracture.
Impact of database selection was assessed by: (1) Comparison of sensitivity and
specificity for prevalent vertebral fractures of the T-score <or= - 2.5 threshold using local
versus NHANES database. (2) Comparison of estimates for fracture risk (RR/SD
decrease in BMD) using local versus NHANES database. Prevalence of vertebral
fractures was estimated at 19.9% [15.4-25.0] in women and at 12.0% [7.3-18.3] in men.
Prevalence of osteoporosis by DXA using total hip was 33.0% [27.5-38.8] in women and
22.7% [16.2-30.2] in men. The NHANES database provided higher sensitivity for
vertebral fracture than our population-specific database. RR of vertebral fracture per SD
decrease in BMD remained unchanged across the two databases. In women, RR/SD were
1.61 [1.17-2.23] and 1.49 [1.14-1.95] in the NHANES and the local database,
respectively, and in men 1.59 [0.94-2.72] and 1.43 [0.95-2.16]. In conclusion, our
findings were in concordance with the IOF recommendations for the use of a universal
database and could be used for the implementation of a unified fracture risk assessment
paradigm along with the WHO initiative.
PMID: 17236834

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201: Bull World Health Organ. 2007 Jul;85(7):561-6.

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