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1501: Int J Med Inform. 2001 May;61(2-3):175-87. Related Articles , Links Int J Med Inform. 2001 May;61(2-3):175-87. Related Articles, Links

Inform. 2001 May;61(2-3):175-87. Related Articles , Links Implementation and evaluation of a multifunctional

Implementation and evaluation of a multifunctional telemedicine system in NTUH.

Lin CC, Chen HS, Chen CY, Hou SM.

Department of Medical Informatics, Collage of Medicine, National Taiwan University, Taipei, Taiwan.

In this article, we proposed a multifunctional telemedicine system supporting both telediagnosis and teleconsultation services. We attempted not only to insure that the implementation of this system satisfied most requirements, but also to evaluate the impact of the system. With regard to system architecture, we designed a unified multimedia database to store all types of data and used two kinds of network (ATM and ISDN) for different possible applications. As for data transmission, the REFRESH and PREFETCH mechanisms were implemented to enhance data transfer efficiency. A total of 1107 consultations employing the telemedicine system were performed during the past 3 years. This technology was used most frequently for radiology consultation (32.7%, n = 362) and ultrasonic examination (19.5%, n = 216). An evaluation of the impact on diagnosis (507 valid cases) indicated that the diagnosis in 80 cases (15.78%) were altered on the basis of second opinions from a medical center; and the number of patients transferred to the medical center was reduced from 24 (4.7%) to eight cases. Most of the rural-site physicians (97%) thought that they did benefit from specialists' experience and knowledge via the telemedicine system. Based on 431 valid questionnaires, the number of the patients with confidence in the telemedicine system at their local healthcare center increased from 72.6% to 87.5%. Overall, more than 90% of patients and physicians believed that the system was valuable and provided satisfactory services.

Publication Types:

Evaluation Studies

Research Support, Non-U.S. Gov't

PMID: 11311672 [PubMed - indexed for MEDLINE]

1502: Int J Med Inform. 2001 May;61(2-3):117-29. Int J Med Inform. 2001 May;61(2-3):117-29.

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Review of telemedicine projects in Taiwan. Chen HS , Guo FR , Chen CY ,

Review of telemedicine projects in Taiwan.

Chen HS, Guo FR, Chen CY, Chen JH, Kuo TS.

Department of Medical Informatics, Section 1, 1 Jen-Ai Road, 100, Taipei, Taiwan. chenhs@me.ee.ntu.edu.tw

Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11311666 [PubMed - indexed for MEDLINE]

Gov't PMID: 11311666 [PubMed - indexed for MEDLINE] 1503: Int J Med Inform. 2001 May;61(2-3):113-6. Related

1503: Int J Med Inform. 2001 May;61(2-3):113-6.

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Inform. 2001 May;61(2-3):113-6. Related Articles , Links The Ministry of Public Health telemedicine network of

The Ministry of Public Health telemedicine network of Thailand.

Kasitipradith N.

Ministry of Public Health, 11000, Nonthaburi, Thailand. narong@health.moph.go.th

The concept of telemedicine is rather new in Thailand and initially, the introduction of telemedicine into the country was hampered by technological limitations. The problem was further aggravated by the inadequacy of telecommunications infrastructures in the rural areas. However, recent rapid advances in info-communications technology, together with the launch of Thailand's first communication satellite, THAICOM I in December 1993, have made it possible for health care to be delivered to remote areas of the country via telemedicine. This paper documents the experience of implementing Thailand's nationwide Telemedicine Network by the Ministry of Public Health (MOPH), beginning with a pilot project in 1994 to the current system, launched in January 1998, that links the Information Technology Office of the MOPH and 19 hospitals with health facilities all over the country via satellite and computer networks.

PMID: 11311665 [PubMed - indexed for MEDLINE]

networks. PMID: 11311665 [PubMed - indexed for MEDLINE] 1504: Cancer Epidemiol Biomarkers Prev. 2001

1504: Cancer Epidemiol Biomarkers Prev. 2001 Mar;10(3):237-42.

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Prev. 2001 Mar;10(3):237-42. Related Articles , Links Epidemiological study of urinary 6beta-hydroxycortisol to

Epidemiological study of urinary 6beta-hydroxycortisol to cortisol ratios and breast cancer risk.

Zheng W, Jin F, Dunning LA, Shu XO, Dai Q, Wen WQ, Gao YT, Holtzman JL.

Vanderbilt Center for Health Services Research and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee 37232-8300, USA.

The ratio of urinary 6beta-hydroxycortisol:cortisol is a measure of the activity of cytochrome p450 3A4 (CYP3A4). CYP3A4 catalyzes the formation of the genotoxic estrogen, 16alpha-hydroxyestrone. It is also involved in the activation of many other mammary carcinogens, such as the polycyclic aromatic hydrocarbons and heterocyclic amines. We evaluated the association between urinary cortisol ratios and breast cancer risk in a subgroup of women who participated in a population-based case-control study in Shanghai. Overnight urine samples from 246 case-control pairs were assayed for 6beta-hydroxycortisol (6beta-OHC) to cortisol. The urine samples from all of the breast cancer patients were collected before any chemotherapy or radiotherapy. In-person interviews were conducted to obtain comprehensive information on dietary habits, reproductive history, and other lifestyle factors. The median levels of 6beta- OHC:cortisol ratios were 2.61 in cases and 2.16 in controls, a 20.8% difference (P

< 0.001). The case-control difference was larger in women over 45 years of age (31.3% difference; P < 0.001) than younger women (6.0%; P = 0.45). After adjusting for confounding variables, the risks of breast cancer were increased from 1.0 (reference) to 1.6 [95% confidence interval (CI), 0.9-3.1], 2.2 (95% CI, 1.1-4.2), and 3.7 (95% CI, 1.9-7.4; P for trend, <0.001) with increasing levels of 6beta-OHC:cortisol ratios. The positive association was more pronounced among older women (>45 years) than among younger women (< or = 45 years). The adjusted odds ratios associated with the highest cortisol ratio were 6.0 (95%CI, 2.2-16.1) among older women and 2.2 (95%CI, 0.8-6.1) among younger women. The association of the 6beta-OHC:cortisol ratio was stronger among older women who had a high body mass index, late age at menopause, and early age at menarche (factors related to high endogenous estrogen exposure) than those who did not have these factors. These findings are consistent with the role of CYP3A4 in estrogen and carcinogen metabolism and suggest that high CYP3A4 activity may be a risk factor for breast cancer risk.

Publication Types:

Comparative Study

Research Support, U.S. Gov't, P.H.S.

PMID: 11303593 [PubMed - indexed for MEDLINE]

P.H.S. PMID: 11303593 [PubMed - indexed for MEDLINE] 1505: JAMA. 2001 Mar 28;285(12):1632-40. Related Articles

1505: JAMA. 2001 Mar 28;285(12):1632-40.

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JAMA. 2001 Mar 28;285(12):1632-40. Related Articles , Links Medical malpractice and legal resolution systems in Japan.

Medical malpractice and legal resolution systems in Japan.

Nakajima K, Keyes C, Kuroyanagi T, Tatara K.

Department of Social and Environmental Health F2, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita-shi, Osaka 565-0871, Japan. kazuen@pbhel.med.osaka-u.ac.jp

Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars).

Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-of- court review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians.

PMID: 11268273 [PubMed - indexed for MEDLINE]

physicians. PMID: 11268273 [PubMed - indexed for MEDLINE] 1506: J Oral Rehabil. 2001 Jan;28(1):78-87. Related

1506: J Oral Rehabil. 2001 Jan;28(1):78-87.

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Rehabil. 2001 Jan;28(1):78-87. Related Articles , Links On-line computerized diagnosis of pain-related disability

On-line computerized diagnosis of pain-related disability and psychological status of TMD patients: a pilot study.

Yap AU, Tan KB, Hoe JK, Yap RH, Jaffar J.

Department of Restorative Dentistry, Faculty of Dentistry, National University of Singapore, Republic of Singapore. rsdyapuj@nus.edu.sg

Temporomandibular disorders (TMD) is a collective term embracing a number of clinical problems, which involve the masticatory musculature, the temporomandibular joint or both. Virtually all theories dealing with the aetiology and treatment of TMD have recognized the importance of psychological factors. This paper reports the development of a computerized on-line program (NUS TMD v1.1) for the diagnosis of pain-related disability and psychological status of TMD patients based on Axis II of the research diagnostic criteria (RDC)/TMD (Dworkin, S.F. & LeResche, L. 1992. Journal of Craniomandibular Disorders:

Facial Oral Pain, 6, 301), which was developed to redress the lack of diagnostic criteria in TMD research. Methods adopted by RDC/TMD for use in assessing Axis II status include a seven-item questionnaire for grading chronic pain severity, the Symptom Checklist 90 Revised (SCL-90-R) and a jaw disability checklist. A pilot study, based on 37 new TMD patient records, was conducted to study the pain-related disability and psychological status of TMD patients using this newly developed program. The mean age of the predominantly Chinese

population (86.5%) was 32.19 years (range 20-72 years) with a sex distribution of 24 females and 13 males. Most patients (78%) had low disability, with 12 patients having low intensity and 17 patients having high intensity pain. Approximately 73% of the sample population were moderately or severely depressed. Patients that were moderately and severely depressed had significantly higher scores for limitation related to mandibular functioning than normal patients. The three most frequent jaw disabilities were: eating hard foods (84%), yawning (78%) and chewing (65%).

PMID: 11298913 [PubMed - indexed for MEDLINE]

chewing (65%). PMID: 11298913 [PubMed - indexed for MEDLINE] 1507: J Indian Med Assoc. 2000 Sep;98(9):559-60,

1507: J Indian Med Assoc. 2000 Sep;98(9):559-60, 562-6, 571.

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Integrated child development services scheme (ICDS) in India: its activities, present status and future strategy to reduce malnutrition.

Kapil U, Pradhan R.

Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi.

Integrated Child Development Services Scheme (ICDS) provides an integrated approach for converging all the basic services for improved child care, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. Its objectives are: To improve nutritional and health status of children of 0-6 years; to reduce the incidence of mortality, morbidity, malnutrition and school dropout; to achieve effective co-ordination amongst various departments to promote child development; to lay foundation of proper psychological,physical and social development of the child; to enahance mother's capability to look after normal health and nutritional needs of the child. ICDS services are provided through a village based centre ie, the Anganwadicentre for the services of: Supplementary nutrition, immunisation, health check-up, referral services, treatment of minor illnesses, nutrition and health education to women, preschool education to children and supports for water supply, sanitation, etc. Several government departments and their services are co-ordinated at village, block, district, state and central levels. The Anganwadiworker is the most peripheral functionary which implements the programme services at the village/community level. In projects where able leadership has been provided, ICDS has been reported to be better. Though there are some shortcomings in ICDS, till future thrust of the programme is necessary for aiming of the upliftment of underprivileged section of the population. Operative research in various areas is suggested which can help in improving the efficiency of ICDS.

Publication Types:

Review

PMID: 11291790 [PubMed - indexed for MEDLINE]

• Review PMID: 11291790 [PubMed - indexed for MEDLINE] 1508: Soc Sci Med. 2001 May;52(9):1313-27. Related

1508: Soc Sci Med. 2001 May;52(9):1313-27.

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Sci Med. 2001 May;52(9):1313-27. Related Articles , Links Older people and AIDS: quantitative evidence of the

Older people and AIDS: quantitative evidence of the impact in Thailand.

Knodel J, VanLandingham M, Saengtienchai C, Im-em W.

Population Studies Center and Department of Sociology, Institute for Social Research, University of Michigan, Ann Arbor 48106-1248, USA. jknodel@umich.edu

Discussions of the AIDS epidemic rarely consider the impact on older people except as infected persons. Virtually no systematic quantitative assessments exist of the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in either the West or the developing world. We assess the extent of such types of involvement in Thailand, a country where substantial proportions of elderly parents depend on adult children for support and where co-residence with an adult child is common. Interviews with local key informants in the public health system in rural and urban communities provided quantitative information on a total of 963 adult cases who either had died of AIDS or were currently symptomatic. The results indicate that a substantial proportion of persons with AIDS move back to their communities of origin at some stage of the illness. Two-thirds of the adults who died of an AIDS-related disease either lived with or adjacent to a parent by the terminal stage of illness and a parent, usually the mother, acted as a main caregiver for about half. For 70%, either a parent or other older generation relative provided at least some care. The vast majority of the parents were aged 50 or more and many were aged 60 or older. This extent of older generation involvement appears to be far greater than in Western countries such as the US. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situations in Thailand and the West. The fact that older people in Thailand, and probably many other developing countries, are extensively impacted by the AIDS epidemic through their involvement with their infected adult children has important implications for public health programs that address caretaker education and social and economic support.

Publication Types:

Evaluation Studies

Research Support, U.S. Gov't, P.H.S.

PMID: 11286358 [PubMed - indexed for MEDLINE]

P.H.S. PMID: 11286358 [PubMed - indexed for MEDLINE] 1509: Biosci Biotechnol Biochem. 2001 Jan;65(1):1-13.

1509: Biosci Biotechnol Biochem. 2001 Jan;65(1):1-13.

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Biochem. 2001 Jan;65(1):1-13. Related Articles , Links A mainstay of functional food science in Japan--history,

A mainstay of functional food science in Japan--history, present status, and future outlook.

Arai S, Osawa T, Ohigashi H, Yoshikawa M, Kaminogawa S, Watanabe M, Ogawa T, Okubo K, Watanabe S, Nishino H, Shinohara K, Esashi T, Hirahara T.

Department of Nutritional Science, Tokyo University of Agriculture, Japan.

The development of food science in the near future probably depends on the advance in functional food science, the concept of which was proposed first in Japan nearly 15 years ago. The new science has been internationally distributed and accepted as conceptually being beyond nutrition. In Japan, however, it traced a unique path of progress in the form of a product-driven rather than concept- driven science. Actually, a number of substances and products with potential for disease risk reduction rather than simply for health maintenance have been investigated for their body-modulating functions. Some of them have been applied in practice to the industrialization of functional foods in terms of "foods for specified health uses" legally defined by new legislation. A variety of sophisticated methods have been introduced as well, including the so-called "XYZ" evaluation system, database construction for assessment of the function, and even the DNA microarray technique. The Ministry of Agriculture, Forestry, and Fisheries (MAFF) and the Ministry of Health and Welfare (MHW) also commenced their scientific as well as political activity, with its spread to industries which almost simultaneously began to vigorously investigate functional food products for enlargement of the food market. With all of this as a background, the Japan Liaison of the International Union of Food Science and Technology (IUFoST) hold a function food science symposium on behalf of related scientific bodies including the Japan Section of the International Life Science Institute (ILSI). This paper is an overview compiled from 12 presentations made in the symposium, with the aim of internationally publicizing the activity of functional food science in Japan.

Publication Types:

Review

PMID: 11272811 [PubMed - indexed for MEDLINE]

• Review PMID: 11272811 [PubMed - indexed for MEDLINE] 1510: Health Promot Int. 2001 Mar;16(1):87-94. Related

1510: Health Promot Int. 2001 Mar;16(1):87-94.

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Promot Int. 2001 Mar;16(1):87-94. Related Articles , Links Health literacy in health systems: perspectives on patient

Health literacy in health systems: perspectives on patient self- management in Israel.

Levin-Zamir D, Peterburg Y.

Department of Health Education and Promotion, Clalit Health Services, 101 Arlozorov Street, Tel Aviv 62098, Israel.

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in:

(i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in- service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-

management capabilities and advocate for improved health services, can be very beneficial.

PMID: 11257858 [PubMed - indexed for MEDLINE]

1511: J Air Waste Manag Assoc. 2001 Feb;51(2):264-72. J Air Waste Manag Assoc. 2001 Feb;51(2):264-72.

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Remedial strategies for municipal solid waste management in China.

Wang H, Nie Y.

Department of Environmental Science and Engineering, Tsinghua University, Beijing, China. wanght@dns.ep.tsinghua.edu.cn

The purpose of this investigation is to evaluate the current status and to identify the problems of municipal solid waste (MSW) management in China to determine appropriate remedial strategies. This is the second of two papers proposed on this topic. Major problems or difficulties identified in MSW management in China include MSW land, air, and water pollution, commingled collection, poor administration, shortage of funds, lack of facilities, and problems of training and public awareness. In order to solve these problems and to improve MSW management in China, remedial strategies in three areas are recommended:

institutional reform, technology development, and legislation and administrative improvement. The primary principle involved in institutional reform is unifying legislative responsibilities into one body and developing a market mechanism for handling MSW. Composting, landfills, and incineration should be equally developed in accordance with China's needs. The feasibility of developing technology to handle MSW in China is discussed. Also recommended is the establishment of sound regulatory systems, including a service fee system, a source separation system, and a training program. China is presently undergoing economic and institutional reform at the national and local levels. Results of this study will provide useful information on MSW management in China.

PMID: 11256501 [PubMed - indexed for MEDLINE]

1512: J Adv Nurs. 2001 Feb;33(4):467-74. J Adv Nurs. 2001 Feb;33(4):467-74.

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J Adv Nurs. 2001 Feb;33(4):467-74. Related Articles , Links Nursing competencies: personal characteristics contributing

Nursing competencies: personal characteristics contributing to effective nursing performance.

Zhang Z, Luk W, Arthur D, Wong T.

Guanghua School of Management, Peking University, Beijing, China. zxzhang@gsm.pku.edu.cn

AIMS OF THE STUDY: Core competencies are important in enabling an individual to adapt to new environments and perform superior professional practice. This study was to identify the underlying competencies which contributed to effective nursing performance. BACKGROUND: Most of the previous competencies are either derived from researchers' conceptual analysis or based on practitioners' direct report. Competencies derived from these methods either are subject to bias or are unable to identify the essential elements for effective nursing care. METHOD: Following the McBer method, 50 experienced nurses in China were asked to report 82 valid critical incidents in their jobs. Two individuals coded the scripts and decided the presence of each competency according to a pre-established coding system. RESULTS: Ten competencies including interpersonal understanding, commitment, information gathering, etc. were identified. Each competency was illustrated by behavioural indicators. CONCLUSIONS: Skills, traits, motives and attitudes all contribute to effective nursing performance. The findings assist in the delineation and development of nursing competencies and thus provide realistic working behaviours for nursing education and management.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11251734 [PubMed - indexed for MEDLINE]

Gov't PMID: 11251734 [PubMed - indexed for MEDLINE] 1513: Bull World Health Organ. 2001;79(2):142-9. Related

1513: Bull World Health Organ. 2001;79(2):142-9.

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Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh.

Routh S, el Arifeen S, Jahan SA, Begum A, Thwin AA, Baqui AH.

Operations Research Project, Health and Population Extension Division, ICDDR,B-Centre for Health and Population Research, Mohakhali, Dhaka 1212, Bangladesh.

The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour-intensive and costly. More cost-

effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinic- based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services.

Publication Types:

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11242821 [PubMed - indexed for MEDLINE]

1514: Int J Radiat Biol. 2001 Feb;77(2):254. Int J Radiat Biol. 2001 Feb;77(2):254.

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International cooperation post-Chernobyl. Scientific Project Panel of the International Cooperation to Establish Post Chernobyl Thyroid Tissue, Nucleic Acid and Databanks.

Thomas GA, Williams ED.

Publication Types:

Letter

PMID: 11236933 [PubMed - indexed for MEDLINE]

1515: Ann Trop Med Parasitol. 2001 Jan;95(1):41-6. Ann Trop Med Parasitol. 2001 Jan;95(1):41-6.

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Resistance of Plasmodium falciparum malaria to chloroquine is widespread in eastern Afghanistan.

Rab MA, Freeman TW, Durrani N, de Poerck D, Rowland MW.

HealthNet International, 11-A Circular Lane, University Town, P.O. Box 889, Peshawar, Pakistan. marab@pes.comsats.net.pk

After two decades of war and conflict in Afghanistan, the public-health system is in disarray and malaria has re-emerged as a major disease, with Plasmodium falciparum malaria becoming increasingly common. The limited healthcare services that are available are mainly delivered by non-governmental organizations in collaboration with the Ministry of Health. Although chloroquine (CQ) remains the official first-line treatment against P. falciparum malaria, there is little information on the severity or distribution of resistance to this drug in Afghanistan. In-vivo surveys, co-ordinated by the Malaria Reference Centre in Jalalabad, were therefore performed to determine the frequency and grades of CQ resistance in the three eastern provinces of Kunar, Nangarhar and Laghman. Of the 142 cases enrolled in the study, only 47 (33%) were sensitive. Most of the cases (55%) showed RI resistance but RII/RIII resistance was not uncommon (11%). The prevalence of resistance appeared similar in children and adults, in males and females, and in each of the three provinces investigated. Gametocyte carriage post-treatment was elevated in the resistant cases. As in neighbouring Pakistan, the resurgence of P. falciparum in Afghanistan is probably associated with the transmission and spread of chloroquine-resistant strains. The first-line therapy used against P. falciparum malaria must be changed in order to reverse this trend.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11235552 [PubMed - indexed for MEDLINE]

Gov't PMID: 11235552 [PubMed - indexed for MEDLINE] 1516: J Trauma. 2001 Jan;50(1):20-3. Links Related

1516: J Trauma. 2001 Jan;50(1):20-3.

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Do accidents happen accidentally? A study of trauma registry and periodical examination database.

Avi A, Yehonatan S, Alon S, Alexandra H, Arieh E.

Israel Defense Force-Medical Corps.

BACKGROUND: Health profile of trauma victims might affect accident involvement. Information linking medical data to accident epidemiology is lacking. This study aims to identify health factors that increase risk of accident

involvement. METHODS: The Israeli Defense Forces maintains two databases:

records of periodical health examination of military personnel and a trauma registry including emergency department referrals of personnel resulting from injury. We identified 5,578 subjects who were examined in the Periodical Health Examination Center and were victims of trauma. We analyzed relation between injuries and various health parameters. RESULTS: Results shows cigarette smoking is more frequent among the population involved in trauma (40% in motor vehicle crash, 37% in fall injury, and 31% in blunt contusion compared with 28% in Periodical Health Examination Center population not involved in trauma, p < 0.05). Odds ratio of smokers involvement in motor vehicle crash is 1.82 (95% confidence interval, 1.25-2.67, p < 0.005). Younger age is relatively more frequent among trauma victims. CONCLUSION: We conclude that cigarette smokers and younger subjects might be at greater risk of being involved in accidental injuries.

PMID: 11231664 [PubMed - indexed for MEDLINE]

injuries. PMID: 11231664 [PubMed - indexed for MEDLINE] 1517: Health Policy. 2001 Apr;56(1):1-20. Related Articles

1517: Health Policy. 2001 Apr;56(1):1-20.

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Policy. 2001 Apr;56(1):1-20. Related Articles , Links Reforming the Israeli health system: findings of a 3-year

Reforming the Israeli health system: findings of a 3-year evaluation.

Gross R, Rosen B, Shirom A.

JDC-Brookdale Institute, P.O.B. 13087, 91130, Jerusalem, Israel. revital@jdc.org.il

Israel, like many other European countries, has recently reformed its health care system. The regulated market created by the National Health Insurance (NHI) law embodies many of the principles of managed competition. The purpose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of the reform and the extent to which it has achieved its main goals. The evaluation was conducted using multiple quantitative and qualitative research tools: interviews with key informants; analysis of documents and sick fund financial statements; analysis of trends in sick fund membership; and population surveys conducted in 1995 and 1997 to assess the impact of the reform on outcome measures related to level of services to the public. Data from the evaluation show that the NHI law achieved a considerable number of its goals: to provide insurance coverage for the entire population, to ensure freedom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of the weaker populations. From the financial perspective, concerns that NHI would lead to a rise in the national health expenditure were not realized as of 1997. In

the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. However, the Israeli experience shows that regulating competition does not necessarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health system including level of resources allocated to health, organizational structure of the hospital system, manpower planning and the extent of government involvement in system. Additional policy changes may be needed to resolve these issues. Up-to-date information is essential in helping policymakers track the process of reform implementation and results, and identify problems which need to be addressed in the future.

Publication Types:

Evaluation Studies

PMID: 11230905 [PubMed - indexed for MEDLINE]

Studies PMID: 11230905 [PubMed - indexed for MEDLINE] 1518: Nippon Rinsho. 2001 Feb;59(2):381-90. Related

1518: Nippon Rinsho. 2001 Feb;59(2):381-90.

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[The Cochrane Collaboration: the present and the future]

[Article in Japanese]

Nakayama T, Tsutani K.

Department of Medical System Informatics, School of Public Health, Kyoto University.

The Cochrane Collaboration has developed in response to the call for systematic, up-to-date reviews of all relevant randomized controlled trials (RCTs) of health care. Both evidence-based medicine (EBM) and the Cochrane Collaboration have been gaining attention of healthcare professionals in Japan recently. Ways for Japanese people to contribute to the Cochrane Collaboration are as follows:

participating in a collaborative review group as a reviewer; increasing registry number of Japanese RCT articles; and Japanese translation of their outputs and its dissemination. Establishment of Japan Cochrane Center will integrate and promote the related activities. Furthermore, the positive recognitions for the Cochrane Collaboration and EBM among Japanese people can improve environments for conducting clinical trials and epidemiological studies in Japan.

Publication Types:

English Abstract

Review

PMID: 11218416 [PubMed - indexed for MEDLINE]

1519: Rinsho Byori. 2000 Oct;48(10):931-4. Rinsho Byori. 2000 Oct;48(10):931-4.

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[Results of a questionnaire survey about "standardization" of connection methods in Laboratory Automation System or Laboratory Information System by the National University Hospital Clinical Laboratory Divisions]

[Article in Japanese]

Kambe M.

Department of Clinical Laboratory Medicine, Hiroshima University, Faculty of Medicine, Hiroshima 734-8551.

"Standardization" is very important in the field of clinical laboratory medicine. Enzyme reference materials(ERM) and standard plasma proteins(CRM470) have already been developed. Reference methods for some clinical chemical tests have also been developed. We are studying "standardization" of electric communication methods between computers and automatic analyzers in Laboratory Automation System(LAS) or Laboratory Information System(LIS). We present the results of a questionnaire survey of 73 LAS or LIS making Companies in this paper. Although "standardization" of electric communications or local area network in LAS or LIS has been done in only 22 companies(34.9%), we are planning more functional standard electric communication methods such as Health Level 7(HL7) or American Society for Testing and Materials(ASTM).

Publication Types:

English Abstract

PMID: 11215106 [PubMed - indexed for MEDLINE]

1520: Rinsho Byori. 2000 Oct;48(10):910-4. Rinsho Byori. 2000 Oct;48(10):910-4.

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[Development of perinatal management system using optical card and regional health information network]

[Article in Japanese]

Hara K.

Department of Perinato-Gynecology, Kagawa Medical University, Kagawa 761-

0793.

In Kagawa Prefecture, a perinatal management system using the optical medical card and the information network has been introduced since October 1998. Four hospitals(Kagawa Medical University, Sakaide Municipal Hospital, Uchinomi Town Hospital and Tsuda Prefectural Hospital) are connected with each other through the health information network(Kagawa Health and Welfare Information Network) organized by Kagawa Prefecture. (http://www.hw.kagawa- swc.or.jp/net/) Patients' clinical data are described on the optical card based on the "standard format of the Japan Association of Obstetricians and Gynecologists(JAOG).

(http://www.jaog.or.jp/JAPANESE/MEMBERS/JOUHOU/H10/index.htm).

Clinical information including the fetal heart rate(FHR) and sonography (JPG) can be easily transmitted through this network(on line). Without the network, patient data can also be transmitted using the optical card(off line). There are still many technical and social problems to be solved in the future, research into the use of medical information network should be continued.

Publication Types:

English Abstract

Research Support, Non-U.S. Gov't

Review

PMID: 11215102 [PubMed - indexed for MEDLINE]

• Review PMID: 11215102 [PubMed - indexed for MEDLINE] 1521: Rinsho Byori. 2000 Oct;48(10):906-9. Related

1521: Rinsho Byori. 2000 Oct;48(10):906-9.

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[Past, present and future of optical cards for medical use]

[Article in Japanese]

Shiina S.

Tokyo Medical and Dental University, Hachioji 192-0066.

In the hospital, the chart is an important medical information record. However, it is not easy to refer to chart records. Although a computer is useful in referring to the chart, the most critical defect is the lack of exchangeability between hospitals.

An optical card is a new medium for medical use. It has a large capacity for electronic storage, low price and high security. Therefore, the author considers this card a second medical chart. As another card, there is the IC card, which has some limitations in medical use. Although both systems are being examined experimentally, there is no actual practice in the medical field. The reason for this lack of wide use, it is thought that these systems are not yet supported by national health insurance.

Publication Types:

English Abstract

Review

PMID: 11215101 [PubMed - indexed for MEDLINE]

• Review PMID: 11215101 [PubMed - indexed for MEDLINE] 1522: J Am Diet Assoc. 2001 Jan;101(1):47-52.

1522: J Am Diet Assoc. 2001 Jan;101(1):47-52.

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Diet Assoc. 2001 Jan;101(1):47-52. Related Articles , Links Comparison of visual estimates of children's portion

Comparison of visual estimates of children's portion sizes under both shared-plate and individual-plate conditions.

Shankar AV, Gittelsohn J, Stallings R, West KP Jr, Gnywali T, Dhungel C, Dahal B.

Division of Community Health and Health Systems, E8009, Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD 21205, USA.

OBJECTIVE: This paper compares the accuracy of visual estimations of children's food intake in settings where several children eat together off 1 plate vs individual-plate eating scenarios. DESIGN: Eight trained observers were tested in their ability to estimate food portions consumed by children enacting common eating scenarios. Foods were categorized by food group and according to their presentation by individual-plate and shared-plate. Observed food weight estimates were compared to actual weights. SUBJECTS/SETTING: The 8 observers visually estimated 69 food portions of children eating alone and 26 portions where children were eating from a shared plate. This study was carried out in Sarlahi District, a rural, central lowland region of Nepal. STATISTICAL ANALYSES:

Pearson's correlation coefficients were calculated to examine associations between estimated and actual weights. A fixed effects model was constructed to compare observers. RESULTS: Analyses revealed that observer estimates of food weights under field conditions were well correlated with actual weights for individual-plate (r = 0.89) and for shared-plate (r = 0.84) scenarios. Observers estimated food weights when children ate together on a shared plate less

accurately than they did in settings where children ate alone. With the exception of 1 observer, observers did not differ significantly in their ability to estimate food weights. Accuracy of estimations was influenced by food weight with greater error associated with food quantities of less than 70 g. CONCLUSIONS: Visual estimation is a relatively accurate, valid method of assessing child food intake under rural field conditions, and the only method to obtain accurate information on dietary intake in regions where shared-plate eating is frequent.

Publication Types:

Comparative Study

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, Non-P.H.S.

Research Support, U.S. Gov't, P.H.S.

Validation Studies

PMID: 11209584 [PubMed - indexed for MEDLINE]

Studies PMID: 11209584 [PubMed - indexed for MEDLINE] 1523: Lepr Rev. 2000 Dec;71(4):472-85. Related Articles ,

1523: Lepr Rev. 2000 Dec;71(4):472-85.

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Comment in:

Lepr Rev. 2003 Jun;74(2):175-6.

Making sense of rehabilitation projects: classification by objectives.

Cornielje H, Nicholls PG, Velema J.

Hogeschool Leiden, Department of Public Health, Leiden, The Netherlands.

Rehabilitation of disabled persons can take many different forms according to the socio-cultural and political context in which it is undertaken. Some approaches have emphasized the restoration of the physical function of the client, while others have looked beyond to psychological and social well-being. Some have built on the expertise of professionals while others have emphasized the caring capacity available in the family and the community and sought to reinforce it. Besides providing a wide range of possible services to disabled persons, rehabilitation seeks to change the attitudes that prevail in society as a whole and promote the integration of disabled people into society with equal rights and opportunities. This paper reviews a range of models and approaches which have been put forward in the international debate on rehabilitation. Furthermore, four dimensions are described which can be used to characterize and define classes of rehabilitation projects based on the objectives that are defined for them. Thus

types of rehabilitation projects can be distinguished. Management, evaluation and technical support for rehabilitation projects need to take these essential characteristics into account.

Publication Types:

Review

PMID: 11201902 [PubMed - indexed for MEDLINE]

1524: Int Dent J. 2000 Dec;50(6):371-7. Int Dent J. 2000 Dec;50(6):371-7.

Related Articles,

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Workforce requirements for a primary oral health care system.

van Palenstein Helderman W, Mikx F, Truin GJ, Hoang TH, Pham HL.

WHO Collaborating Centre, Dentistry 117, Postbus 9101, 6500 HB Nijmegen, The Netherlands. w.vanpalenstein@dent.kun.nl

AIM: To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. METHODS:

Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. FINDINGS: Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. CONCLUSION: A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam.

PMID: 11197196 [PubMed - indexed for MEDLINE]

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Related Articles , Links The role of the World Reference Laboratories for Foot-and-Mouth Disease and for

The role of the World Reference Laboratories for Foot-and-Mouth Disease and for Rinderpest.

Kitching RP.

Institute for Animal Health, Surrey, United Kingdom.

The World Reference Laboratories for Foot-and-Mouth Disease and for Rinderpest provide a worldwide diagnostic and surveillance service for these disease for FAO and OIE. Both laboratories are housed within the high security facility of the Institute for Animal Health, Pirbright, UK. Foot-and-mouth disease (FMD) and rinderpest (RP) are OIE List A diseases and historically have caused huge losses to agricultural economies around the world, prompting the establishment of veterinary colleges in Europe and environmentally controversial control programs in Africa. FMD and RP have now been geographically restricted, but the large legal and illegal world trade in live animals and animal products constantly threatens to allow them to spread back into disease-free areas. The Reference Laboratories provide a center of excellence for the development of improved diagnostic techniques and a repository of isolates collected over many years. These libraries provide material for investigations of the molecular epidemiology and evolution of the viruses and a data base against which new isolates can be compared. Thus it is possible to individually characterize new outbreak strains, identify their likely origin and provide the most up-to-date support for their control.

PMID: 11193614 [PubMed - indexed for MEDLINE]

their control. PMID: 11193614 [PubMed - indexed for MEDLINE] 1526: J Pak Med Assoc. 2000 Dec;50(12):405-9.

1526: J Pak Med Assoc. 2000 Dec;50(12):405-9.

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Links

Health care utilization during terminal child illness in squatter settlements of Karachi.

Hasan IJ, Khanum A.

Department of Community Health Sciences, Aga Khan University, Karachi.

OBJECTIVE: Information on health seeking behavior and health care utilization has important policy implications in health systems development. The paper presents some of the issues related to health care utilization and health seeking behavior in case of terminal child illness in seven squatter settlements of Karachi. METHODS: From seven squatter settlements of Karachi, with a population of 100,000 approximately, we collected information, using pretested structured

questionnaire, from the mothers on health care utilization during the final illness of under five children dying during 1995-1996. These deaths were identified from an earlier baseline health and demographic survey in these areas. RESULTS:

Interviews were completed for 259 infant and child deaths of which 57% were boys. Of all deaths 72% were taken to a health care provider, of which 82% went as soon as the child got ill. Private sector is the most preferred first choice i.e., 83%. Of all those who had been to a health care provider, 65% were referred to some other place and 72% of them took more than 12 hours altogether to reach the referred facility. Children in older age categories (OR 4.4 95% CI 2.22-8.67 and OR 5.0, 95% CI 2.09-12.31), boys (OR 2.6, 95% CI 1.46-4.77) and those with appropriate or incomplete immunization (OR 4.1, 95% CI 2.13-7.94) were significantly associated with the health care utilization as compared to their counterparts. CONCLUSION: Living in urban areas does not ensure accessibility to effective health care. In poor urban communities, referral to other facility delay the initiation of effective treatment in case of child illness leading to death which could be prevented otherwise. Private sector constitutes an important segment of our health care system, which requires strengthening and back up support. Furthermore, the study finding is suggestive of gender discrimination in health seeking behavior.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11191439 [PubMed - indexed for MEDLINE]

Gov't PMID: 11191439 [PubMed - indexed for MEDLINE] 1527: Gan To Kagaku Ryoho. 2000 Dec;27 Suppl

1527: Gan To Kagaku Ryoho. 2000 Dec;27 Suppl 3:683-6.

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[Role of national insurance pharmacies in community complete home care networks--home TPN and home care supported by local national insurance pharmacies]

[Article in Japanese]

Tomita I, Ishii S, Yonezawa M, Ito T, Hirai A, Mizuno K.

Sanbu-gun City Pharmacists Association, Chiba Prefecture.

The reforms in the medical system and introduction of home care insurance have brought great changes to national health insurance pharmacies. In April 1998, Dr. Hirai became new director of the Chiba Togane Hospital. The development of a community complete medical system was included in a restructuring of the hospital, and various reforms were begun. A system covering all aspects of the medical/pharmaceutical field was started in August 1998. For its part, the Sanbu-

gun Pharmacists Association began accepting prescriptions outside the hospital, and regular meetings for the exchange of knowledge were held with members of the physicians and pharmacists associations. After building a relationship of trust in this way, a community complete home treatment system was begun in July 1999 with Togane Hospital functioning as its backup support hospital. To date, home TPN terminal care has been provided in cases of terminal cancer, incurable neurological diseases, and for the very aged and patients with cerebrovascular impairments. Any general pharmacy in the region can participate in the program to fill prescriptions for TPN, provided that the pharmacist him or herself so wishes, establishes a clean bench at the pharmacy, and undergoes training at Togane Hospital on the preparation of i.v. medicines in order to function responsibly in this capacity. These pharmacies are called satellite pharmacies, and at present there are four of them located with a good balance within the region. These satellite pharmacies prepare liquid medications for TPN, including narcotics, and oral medicines following the prescriptions written by the physician from the hospital who is serving as the primary home treatment physician. The pharmacy also delivers the medicines to the home of the patient. The pharmacist checks the status of remaining TPN liquids and oral medicines and informs the primary home physician and support hospital by e-mail or fax, so that everyone shares the same information. The success or failure of home TPN from a general pharmacy depends on the formation of a digital network in order to share information using the Internet and a back-up system for unconditional support by the support hospital in times of patient emergency. In our region, these conditions have been fulfilled.

Publication Types:

English Abstract

PMID: 11190321 [PubMed - indexed for MEDLINE]

Abstract PMID: 11190321 [PubMed - indexed for MEDLINE] 1528: Stud Health Technol Inform. 2000;77:663-7. Related

1528: Stud Health Technol Inform. 2000;77:663-7.

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Links

A personalised Healthcare Information Delivery System: pushing customised healthcare information over the WWW.

Abidi SS, Goh A.

Health Informatics Research Group, School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia.

Easier and focused access to healthcare information can empower individuals to make 'informed' choices and judgements about personal health maintenance. To achieve 'optimum' patient empowerment, we need to re-evaluate and potentially

re-design the processes of healthcare information delivery. Our suggestion is that healthcare information should be personalised according to each individual's healthcare needs and it should be pro-actively delivered, i.e. pushed towards the individual. We present an intelligent Personalised Healthcare Information Delivery Systems that aims to enhance patient empowerment by pro-actively pushing customised, based on one's Electronic Medical Record, health maintenance information via the WWW.

PMID: 11187636 [PubMed - indexed for MEDLINE]

1529: Jpn Hosp. 1999 Jul;(18):59-66. Related Articles Jpn Hosp. 1999 Jul;(18):59-66. Related Articles

Development of the local medical service network system. Integration of medical service with the network system between university hospital and other medical institutions.

Sadamoto K, Shiozawa M, Imaizumi S, Miura M, Shiibashi S, Kouhata H, Shibata I.

Dept. of Local Medical Service Network, Toho University Hospital, Tokyo, Japan.

Although every medical institution always make efforts to provide best services for the patients, it tends to be insufficient to send the patient's information and share them with other medical institutions. It is partly because in the Japanese medical care system there is no obligation to inform patients' medical information to other medical institutions. To provide effective and cost-effective medical service, we made a local network system between university hospital and other medical institutions. The system contributes to clarify the role of medical institutions and the continuity of medical service. For the next step, we must construct the home-care information service network towards the total service for the patients.

PMID: 11184924 [PubMed - indexed for MEDLINE]

1530: Jpn Hosp. 1999 Jul;(18):31-45. Jpn Hosp. 1999 Jul;(18):31-45.

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The present state of managed care and the feasibility of its application to Japan. From the standpoint as a provider, an insurer, and consumer.

Kameda T.

Kameda Group/Kameda Medical Center.

PMID: 11184921 [PubMed - indexed for MEDLINE]

Center. PMID: 11184921 [PubMed - indexed for MEDLINE] 1531: Thorax. 2001 Mar;56(3):173-9. Links Related Articles

1531: Thorax. 2001 Mar;56(3):173-9.

Links

Related Articles,

Thorax. 2001 Mar;56(3):173-9. Links Related Articles , Erratum in: • Thorax 2001 Jun;56(6):504. Comment in: •

Erratum in:

Thorax 2001 Jun;56(6):504.

Comment in:

Thorax. 2001 Nov;56(11):897.

Tuberculosis at the end of the 20th century in England and Wales:

results of a national survey in 1998.

Rose AM, Watson JM, Graham C, Nunn AJ, Drobniewski F, Ormerod LP, Darbyshire JH, Leese J; Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK. Arose@phls.org.uk

BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed

since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co- infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11182007 [PubMed - indexed for MEDLINE]

PMCID: PMC1758771

11182007 [PubMed - indexed for MEDLINE] PMCID: PMC1758771 1532: Int J Med Inform. 2000 Nov;60(2):119-25. Related

1532: Int J Med Inform. 2000 Nov;60(2):119-25.

Related Articles,

Links

Med Inform. 2000 Nov;60(2):119-25. Related Articles , Links Health data use and protection policy; based on

Health data use and protection policy; based on differences by cultural and social environment.

Ishikawa K.

Medical Informatics and Systems Management Department, Hiroshima Unirersity Hospital, Kasumi, Japan. kiyonu@ipc.hiroshima.uac.jp

On April 22, 1999, the Japanese Ministry of Health and Welfare proposed

electronic preservation of all clinical records. Simultaneously, deliberations on legislation on data disclosure and privacy protection were held. To promote these movements, electronic use of Personal Health Data (PHD) is indispensable, and the system development is on its way to meet rising demands. Indigenous Japanese did not have a word to describe the concept of privacy. It was only in the 1960s when we became aware of that. In this article, the protection policy for data use will be discussed from a Japanese perspective compared with those in other nations, giving an example of the hospital management system under construction at the Hiroshima University Hospital.

PMID: 11154962 [PubMed - indexed for MEDLINE]

Hospital. PMID: 11154962 [PubMed - indexed for MEDLINE] 1533: Med Law. 2000;19(3):421-31. Related Articles , Links

1533: Med Law. 2000;19(3):421-31.

Related Articles,

Links

The narrative approach in teaching medical ethics: the Turkish experience.

Oguz NY.

Ankara University Faculty of Medicine, Department of Deontology, Ankara, Turkey.

The Deontology and Medical History Departments in Turkey teach Medical Ethics Education. These departments were first established by medical historians and for the time being the staff is primarily interested in deontology. The Department of Deontology in the Faculty of Medicine at Ankara University is the first department in Turkey to teach medical ethics. In 1974, issues including medical ethics were included in the current curriculum for the Medical Deontology and Medical History Course, but without changing the title of the course. Since then, different scholars have used different teaching methods. In this paper, a very new teaching strategy and technique used by the author will be discussed. In Turkey, the main resources being used as teaching materials in medical ethics are books and periodicals of mainly Western European and North American origin. Cultural, religious, and traditional characteristics of Turkey differ a great deal, so these texts need to be modified. This modification is hard to accomplish, because discourse on authentic values and value systems is inadequate. Also, this way of thinking about values is alien to most medical students. A narrative approach in teaching medical ethics aims to introduce local values that affect medical practice to first year medical students of the Faculty of Medicine at Ankara University, by searching for those values in literary texts and case histories. Besides introducing local values, some of our main goals are to encourage students to develop a sensitivity towards ethical issues and to teach them the methodology of ethical thinking. This is still a pilot study that covers only four hours of a thirty-hour program (two-hour sessions, twice in one semester), but some conclusions can be drawn. In this presentation, some

information about the content and the structure of the course will be given, and the positive and negative results about the narrative approach will be discussed, arising from our limited local experience.

PMID: 11143879 [PubMed - indexed for MEDLINE]

experience. PMID: 11143879 [PubMed - indexed for MEDLINE] 1534: Bull World Health Organ. 2000;78(11):1324-9. Related

1534: Bull World Health Organ. 2000;78(11):1324-9.

Related Articles,

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Use of existing data for public health planning: a study of the prevalence of hepatitis B surface antigen and core antibody in Al Ain Medical District, United Arab Emirates.

al-Owais A, al-Suwaidi K, Amiri N, Carter AO, Hossain MM, Sheek-Hussein

MM.

Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates.

INTRODUCTION: Hepatitis B is of major public health importance. Accurate information on its occurrence, with particular reference to the prevalence of immunity and chronic infection (marked by the presence of hepatitis B core antibody and surface antigen, respectively, in serum), is essential for planning public health programmes for the control of the disease. The generation of marker prevalence data through serological surveys is costly and time-consuming. The present study in Al Ain Medical District, United Arab Emirates, investigated the possibility of obtaining sufficiently accurate marker prevalence estimates from existing data to plan public health programmes. METHODS: Two antenatal screening databases, one student serological survey database, one immunization programme database and one pre-marriage screening database containing information on marker prevalence were identified. Epidemiological data were abstracted from these databases and analysed. RESULTS: The data showed that the prevalence of hepatitis B surface antigen and the prevalence of core antibody in young citizens in 1998 were approximately 2% and 14% respectively, that any immunization campaign aimed at citizens of the United Arab Emirates should target teenagers as they had the highest risk of acquiring the disease, and that pre- immunization screening of young adults would be wasteful. However, the data did not yield information on the prevalence of hepatitis B surface antigen and core antibody in other population subgroups of public health significance. DISCUSSION: While data generated by the study are sufficient to support a hepatitis B immunization programme targeted at teenaged citizens, more accurate data, generated by a well-designed serological survey, would be essential for optimal public health planning.

PMID: 11143192 [PubMed - indexed for MEDLINE]

1535: Healthc Inform. 1999 Oct;16(10):33-6. Healthc Inform. 1999 Oct;16(10):33-6.

Related Articles,

Links

India: health informatics begins to grow.

Nadarajah I.

PMID: 11143127 [PubMed - indexed for MEDLINE]

1536: Health Policy. 2001 Jan;55(1):1-18. Health Policy. 2001 Jan;55(1):1-18.

Links

Related Articles,

Policy. 2001 Jan;55(1):1-18. Links Related Articles , Developing financial autonomy in public hospitals in India:

Developing financial autonomy in public hospitals in India:

Rajasthan's model.

Sharma S, Hotchkiss DR.

Carolina Consulting Corporation and The Futures Group International, 1050 17th Street, N.W. Suite 1000, Washington, DC 20036, USA. s.sharma@tfgi.com

In India's state-administered health care system, many government decision- makers are exploring the introduction or expansion of hospital autonomy as a means of improving the efficiency and financial sustainability of the overall public health care system. One initiative that has recently received a considerable amount of attention is the introduction of Medicare Relief Societies (MRS) in the state of Rajasthan. The societies are autonomous organizations that are formed with the objective of complementing and supplementing existing service provision in public hospitals. The state has provided incentives for the formation of MRS by relaxing state-imposed restrictions on the collection and use of revenue by hospitals, thereby encouraging the use of alternative financing mechanisms such as user-fee schemes and in-hospital pharmacies. The purpose of this article is to describe and critically evaluate Rajasthan's experience with MRS. Emphasis is placed on whether and how the introduction of these societies have influenced two key aspects of hospital autonomy - operations and management, and financing. Data for the study come from a survey of representatives from each of the 69 hospitals in Rajasthan that contain 100 or more beds. Information was collected on whether a society was operating within the hospital, the management of the society, the range of activities carried out, and the revenue and expenditures of each activity. The results are used to identify key strengths and weakness of the MRS initiative in Rajasthan, and how future hospital autonomy efforts can be strengthened.

Publication Types:

Comparative Study

Research Support, Non-U.S. Gov't

PMID: 11137185 [PubMed - indexed for MEDLINE]

Gov't PMID: 11137185 [PubMed - indexed for MEDLINE] 1537: Ann Acad Med Singapore. 2000 Sep;29(5):621-7.

1537: Ann Acad Med Singapore. 2000 Sep;29(5):621-7.

Related Articles,

Links

Post-release drug treatment risks: strategies to minimise harm to patients.

Oh VM.

Division of Clinical Pharmacology and Therapeutics, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. mdcohms@nus.edu.sg

This paper examines the perceptions and causes of drug treatment-related error, and suggests some risk reducing strategies. Interest in medical error surged recently, culminating with an estimate by the US Institute of Medicine in 1999 of 44,000 to 98,000 annual care-related deaths. Public media pressure elicited responses from health care providers, purchasers, internists and health professionals' organisations. A search was made using PubMed, focusing on papers from 1980 to date giving data on trends and causes of in-hospital drug- related error. Papers with estimates of prevalence rates of drug-induced injury in large denominator populations were selected. One hundred and seven papers on drug-related error were identified; 36 clearly defined denominators and compared rates in different groups. Occurrence rates of drug-induced harm were similar (2.2% to 6.7%) in the US and British hospital surveys. The Harvard Medical Practice Study first reliably measured the frequency of care-related patient harm. More reliable and accurate information is needed on the base-line rates of drug- related injury. Whereas there are few precise estimates of drug-induced injury, the evidence suggests that between half and two-thirds of hospital-related harmful events are preventable. Most experts agree that hospitals need to change radically their approach to professional error from one of blaming individuals to overhauling the systems for monitoring, detecting and preventing drug-related error. Hospital managers should implement voluntary, non-punitive, and confidential systems for reporting error, and apply methods of safety enhancement which succeed in high-risk industries. A realistic and achievable target could be halving of current risk. Incentives can be given to event monitoring and pharmacotherapy quality assurance, to encourage timely and accurate reporting. On-line doctors' entry of drug orders and computerised adverse event monitoring also promote error reduction.

PMID: 11126698 [PubMed - indexed for MEDLINE]

1538: Transplant Proc. 2000 Nov;32(7):1470-2. Transplant Proc. 2000 Nov;32(7):1470-2.

Related Articles,

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Proc. 2000 Nov;32(7):1470-2. Related Articles , Links Strategies and obstacles in an organ donation program in

Strategies and obstacles in an organ donation program in developing countries: Saudi Arabian experience.

Shaheen FA, Souqiyyeh MZ, Abdullah A.

Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia.

PMID: 11119793 [PubMed - indexed for MEDLINE]

1539: Public Health. 2000 Nov;114(6):488-94. Public Health. 2000 Nov;114(6):488-94.

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Recommendations for water supply in arsenic mitigation: a case study from Bangladesh.

Hoque BA, Mahmood AA, Quadiruzzaman M, Khan F, Ahmed SA, Shafique SA, Rahman M, Morshed G, Chowdhury T, Rahman MM, Khan FH, Shahjahan M, Begum M, Hoque MM.

International Centre for Diarrhoeal Disease Research, Bangladesh. bhoque@worldbank.org

Arsenic problems have been observed in several countries around the world. The challenges of arsenic mitigation are more difficult for developing and poor countries due to resource and other limitations. Bangladesh is experiencing the worst arsenic problem in the world, as about 30 million people are possibly drinking arsenic contaminated water. Lack of knowledge has hampered the mitigation initiatives. This paper presents experience gained during an action research on water supply in arsenic mitigation in rural Singair, Bangladesh. The mitigation has been implemented there through integrated research and development of appropriate water supply options and its use through community participation. Political leaders and women played key roles in the success of the mitigation. More than one option for safe water has been developed and/or identified. The main recommendations include: integration of screening of tubewells and supply of safe water, research on technological and social aspects, community, women and local government participation, education and training of all stakeholders, immediate and appropriate use of the available knowledge, links between intermediate/immediate and long term investment, effective coordination and immediate attention by health, nutrition, agriculture, education, and other programs to this arsenic issue.

PMID: 11114764 [PubMed - indexed for MEDLINE]

1540: Telemed J E Health. 2000 Fall;6(3):315-25. Telemed J E Health. 2000 Fall;6(3):315-25.

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J E Health. 2000 Fall;6(3):315-25. Related Articles , Links Telemedicine at the top of the world:

Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions.

Angood PB, Satava R, Doarn C, Merrell R; E3 Group.

Yale University School of Medicine, New Haven, Connecticut, USA. angoodp@msnotes.wustl.edu

The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings--Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel--including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments--which for some may even be their home environment during/after a medical illness.

PMID: 11110635 [PubMed - indexed for MEDLINE]

[Type 2 diabetes among immigrants]

[Article in Danish]

Vibe-Petersen J, Perrild HJ.

Klinik I, H:S Bispebjerg Hospital.

PMID: 11107973 [PubMed - indexed for MEDLINE]

Hospital. PMID: 11107973 [PubMed - indexed for MEDLINE] 1542: Osteoporos Int. 2000;11(8):688-96. Related Articles

1542: Osteoporos Int. 2000;11(8):688-96.

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Osteoporos Int. 2000;11(8):688-96. Related Articles , Links Comment in: • Osteoporos Int. 2001;12(8):706. Reference

Comment in:

Osteoporos Int. 2001;12(8):706.

Reference database for bone speed of sound measurement by a novel quantitative multi-site ultrasound device.

Weiss M, Ben-Shlomo AB, Hagag P, Rapoport M.

Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel. mweiss@asaf.health.gov.il

The nonuniform skeletal involvement in osteoporosis argues for multi-site evaluation. The Sunlight Omnisense (Sunlight Ultrasound Technologies, Israel) is a multi-site device that measures speed of sound (SOS) at the appendicular skeleton. We report the reference database for SOS at the radius (RAD), tibia (TIB), metatarsus (MTR) and phalanx (PLX). The database was obtained from

1521 healthy Israeli women (age 20-90 years) out of 2051 respondents. SOS was

determined in 97.6% of the participants at the PLX, 96.4% at the TIB, 93.6% at the RAD and 85.1% at the MTR; it was not measurable in 0.5%. Short-term

coefficient of variation was lowest at the RAD and always less than 1%. Maximal SOS was noted at 35-45 years of age in three of the sites (RAD 4169 m/s, MTR

3663 m/s, PLX 4047 m/s, respectively) but 10 years earlier at the TIB (3939 m/s).

In the perimenopausal period (age 46-55 years), SOS was always lower in post- as compared with premenopausal women (p<0.05). Immediately following the menopause, SOS annually declined close to the short-term CV: 16, 34, 37 and 13 m/s at the RAD, PLX, MTR and TIB, respectively. The average age-stratified SOS values at various measurement sites were highly correlated at the population level (0.96-0.99), but less so at the individual level (0.40-0.57). Therefore, multi- site SOS measurements are better than single-site assessment. After 79 years of

age, the average T-score at the RAD and PLX was <--2.5. This is similar to that of dual-energy X-ray absorptiometry (DXA)-determined spine bone mineral density (BMD) and somewhat lower than hip BMD. Equivalent T-score curves obtained by percentile adjustment of SOS at various sites to that of the RAD (at age group 60-69 years) reveal convergence and indicate that 52-68% of women older than 79 years are osteoporotic. In conclusion, multi-site peripheral SOS measurements reveal age-dependent bone changes with a high degree of measurement precision and indicate a prevalence of osteoporosis similar to that obtained by DXA.

PMID: 11095172 [PubMed - indexed for MEDLINE]

by DXA. PMID: 11095172 [PubMed - indexed for MEDLINE] 1543: J Adolesc Health. 2000 Dec;27(6):443-52. Related

1543: J Adolesc Health. 2000 Dec;27(6):443-52.

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Health. 2000 Dec;27(6):443-52. Related Articles , Links Studies on common illnesses and medical care utilization

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong.

Lau JT, Yu A, Cheung JC, Leung SS.

Centre for Clinical Trials and Epidemiological Research, the Chinese University of Hong Kong, Hong Kong.

PURPOSE: To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes. METHODS: A cross-sectional questionnaire survey of 3355 participating secondary school students (response rate = 98%). RESULTS: Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care. CONCLUSIONS: This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students' attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health

care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11090747 [PubMed - indexed for MEDLINE]

Gov't PMID: 11090747 [PubMed - indexed for MEDLINE] 1544: J Hazard Mater. 2000 Dec 15;79(3):229-39. Related

1544: J Hazard Mater. 2000 Dec 15;79(3):229-39.

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Mater. 2000 Dec 15;79(3):229-39. Related Articles , Links Characteristics of heavy metals on particles with different

Characteristics of heavy metals on particles with different sizes from municipal solid waste incineration.

Chang MB, Huang CK, Wu HT, Lin JJ, Chang SH.

Graduate Institute of Environmental Engineering, National Central University, 320, Chungli, Taiwan.

Information on the concentration and size distribution of particles in the flue gas streams is essential for selecting and designing particle removal systems. Two municipal solid waste incinerators (MWIs) were selected for conducting flue gas sampling to determine the particulate distribution and heavy metals concentration on particles with different sizes by US EPA Method 5 sampling train and a cascade impactor. In addition, the characteristics of heavy metals contained on particles were investigated via isokinetic sampling of flue gas stream of air pollution control devices (APCDs). The experimental results indicated that average particulate matter (PM) concentrations at APCDs inlet were 2288.2+/- 825.9 and 3069.2+/-810. 0mg/Nm(3), while the concentrations of PM at stack were 1.51+/-0.20 and 14.81+/-4.52mg/Nm(3) in MWI-A and MWI-B, respectively. The differential mass size distribution of PM and differential elemental size distribution of Zn, Pb, and Cu in front of APCDs were of bimodal forms. Results indicate that Zn>Pb>Cu in order of mass concentration in each stage. The fine particles represent approximately 70% and the coarse particles account for the rest 30% of total particulate matters collected on eight stages for both incinerators. Zn, Pb and Cu on fine particles account for approximately 80% and those on the coarse particles are less than 20% of the total heavy metals collected on eight stages of the cascade impactor for both incinerators.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11077161 [PubMed - indexed for MEDLINE]

1545: Ann Trop Med Parasitol. 2000 Sep;94(6):591-606. Ann Trop Med Parasitol. 2000 Sep;94(6):591-606.

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Mapping of lymphatic filariasis in India.

Sabesan S, Palaniyandi M, Das PK, Michael E.

Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, India. sabesan1@yahoo.com

The derivation of detailed epidemiological maps, at the relevant spatial resolution, is being increasingly recognized as vital to the effective design and implementation of successful programmes for the control of parasites and their vectors. Geographical information systems (GIS) and a recently complied database on the distribution of lymphatic filariasis in India have now been used to develop the first maps at district-level (i.e. the level at which control against this parasite will be enacted in India) of filariasis endemicity in this country. The derived maps indicate both the substantial extent as well as the marked variability in the geographical distribution of this disease in India. The causative infection and/or the symptomatic disease were detected in most (257) of the 289 districts surveyed up to 1995. Currently there may be up to 27.09 million microfilaraemics, 20.83 million cases of symptomatic filariasis, and about 429.32 million individuals potentially at risk of infection in the country. Probability mapping, based on data quantiles, clearly indicates that the risk of filarial infection in India is not constant throughout the country but exhibits strong regional trends. Filariasis in general may be a particular problem of the eastern half of the country. The results indicate the potentially vital role that GIS-based mapping approaches can play in the development of filariasis-control campaigns in India and elsewhere.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11064761 [PubMed - indexed for MEDLINE]

1546: N Z Med J. 2000 Sep 22;113(1118):390-4. N Z Med J. 2000 Sep 22;113(1118):390-4.

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Enhanced surveillance of HIV infections in New Zealand, 1996-1998.

Paul C, Wilson M, Dickson N, Sharples K, Skegg DC.

Department of Preventive and Social Medicine, University of Otago, Dunedin.

AIM: To improve understanding of the HIV epidemic in New Zealand through use of an enhanced voluntary reporting system for new diagnoses of HIV. METHODS: Routine reporting of new HIV diagnoses by the two laboratories that perform confirmatory HIV antibody testing, to the Department of Health and later to the AIDS Epidemiology Group, has been in place since 1985. From January 1996, this was supplemented by a questionnaire about demographic characteristics and circumstances of HIV exposure sent to clinicians requesting the HIV test. RESULTS: From January 1996 to December 1998, 260 new diagnoses of HIV were reported (205 males, 55 females) and extra information was obtained from clinicians for 253 (97.3%) people. HIV diagnosis rate was highest for 'other' ethnicity and similar for European, Maori and Pacific Island ethnic groups. Sexual intercourse between men was the commonest mode of infection (43.5%), followed by heterosexual intercourse (40.0%) and injecting drug use (2.7%). Places of infection were New Zealand (38.5%), Australia (7.7%), 'other' overseas (45.4%) and unknown (8.5%). Heterosexual infections were acquired through contact with a person in or from a high prevalence area (mainly in Africa or Asia) for 86.7% of males and 68.2% of females. Second generation heterosexual transmission was rare. CONCLUSIONS: Introduction of an enhanced surveillance system has been successful. Results confirm continuing spread of HIV in New Zealand amongst men who have sex with men, and suggest low levels of heterosexual and injecting drug use transmission in New Zealand. Of major importance in the occurrence of heterosexual infection is the role of imported HIV.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11062813 [PubMed - indexed for MEDLINE]

Gov't PMID: 11062813 [PubMed - indexed for MEDLINE] 1547: Rinsho Byori. 2000 Jul;48(7):627-31. Related

1547: Rinsho Byori. 2000 Jul;48(7):627-31.

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[The practice of teleconferencing in clinical pathology--networking among cancer-center-hospitals in various parts of Japan]

[Article in Japanese]

Keiyukai Institute of Clinical Pathology and Health Sciences University of Hokkaido, Sapporo.

In the last several years, we have been able to use a telemedicine system on a network among cancer-center-hospitals connected by light fibers(so-called Cancer Network) and attend teleconferences from each site in Japan at the same time using the same images. Every week we have many medical conferences using this network system. On the practical use of teleconferences, the ratio of clinical pathological images is very high, especially histopathological appreciation is important; that is, surgical slide conference, clinico-pathological conference, orthopedic tumor conference, image conferences about digestive organs, presentation of current topics in laboratory medicine and other issues are carried out by clinicopathological images. At present, images on teleconference are still- pictures and images in High Definition Television are clear and high capacity, and of sufficient quality for pathological diagnosis. However, the coincidence-rates of histopathological diagnosis among 15 pathologists between the tele-image method and direct microscopic method varied from 38-80%. It is necessary to try to experience the images of still-picture and also animated cartoon. In the near future, the present network may extend to cover a wide areas and attend to teleconferences in every medical facilities. By attending this network system, we are able to use clinicopathological information for clinical diagnosis, treatment, research and education.

Publication Types:

English Abstract

PMID: 11051787 [PubMed - indexed for MEDLINE]

Abstract PMID: 11051787 [PubMed - indexed for MEDLINE] 1548: Soc Sci Med. 2000 Oct;51(8):1221-9. Related Articles

1548: Soc Sci Med. 2000 Oct;51(8):1221-9.

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Sci Med. 2000 Oct;51(8):1221-9. Related Articles , Links Contract medicine arrangements in Hong Kong: an example

Contract medicine arrangements in Hong Kong: an example of risk- bearing provider networks in an unregulated environment.

Brudevold C, McGhee SM, Ho LM.

University of Hong Kong, Department of Community Medicine, Pok Fu Lam, People's Republic of China. brudevol@singnet.com.sg

It is increasingly common in Hong Kong and elsewhere for employers to contract directly with physician networks to provide medical services to employees. These contracts are known in Hong Kong as contract medicine arrangements. In other countries and areas, managed care organizations are generally required by

regulation or legislation to ensure that services of adequate quality are provided to patients who are locked in to network providers. There are no such requirements in Hong Kong and concerns have been raised about potential quality and cost trade-offs in contract medicine arrangements. Satisfaction surveys were sent to contract medicine enrollees in one large company in Hong Kong. The response rate was 30% and analysis of non-respondent data shows that respondents were representative of their group. Comparison of satisfaction using logistic regression showed that risk-bearing networks paid by capitation had consistently lower satisfaction ratings across all major dimensions including access, interpersonal care, communication with the doctor, choice of doctor, and outcomes. These findings suggest that quality, at least as perceived by the patient, may be lower in these networks. The issue is of concern in Asia where infrastructures and data systems are not well developed to adequately monitor quality of care or protect patient interests. This study highlights the need to structure pre-paid provider networks and managed care organizations so that quality of care is not compromised. At a time when managed care concepts are being applied throughout Asia, we believe attention needs to be drawn to this problem.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 11037212 [PubMed - indexed for MEDLINE]

Gov't PMID: 11037212 [PubMed - indexed for MEDLINE] 1549: Public Health. 2000 Sep;114(5):413-5. Related

1549: Public Health. 2000 Sep;114(5):413-5.

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Erratum in:

Public Health 2001 Jan;115(1):82.

Geographical display of health information: study of hepatitis C infection in Karachi, Pakistan.

Mujeeb SA, Shahab S, Hyder AA.

Blood Transfusion Services, Jinnah Postgraduate Medical Center, Karachi 75510, Pakistan.

The prevalence of hepatitis C and other infections is increasing in urban areas of developing countries. Data on such diseases are often limited to facility-based information. However, even this is not available in a usable form to health care providers, health managers and policy makers. We present a simple technique for visually displaying facility based prevalence information on hepatitis C using

basic geographic information system (GIS) techniques. We display the prevalence of hepatitis C for the city of Karachi, Pakistan for the first time. The distribution tends to indicate that there are areas of higher prevalence located in specific districts. There is also a trend of higher prevalence in less affluent urban areas. Such simple applications of mapping technology are useful for rapidly summarizing and displaying information in a contextually and spatially meaningful fashion, and its use should be encouraged for displaying health indicators in developing countries.

PMID: 11035468 [PubMed - indexed for MEDLINE]

countries. PMID: 11035468 [PubMed - indexed for MEDLINE] 1550: Lupus. 2000;9(7):534-41. Related Articles , Links

1550: Lupus. 2000;9(7):534-41.

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Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus.

Devins GM, Edworthy SM.

Culture, Community, and Health Studies, Centre for Addiction and Mental Health (Clarke Division), University of Toronto, and University Health Network (Princess Margaret Hospital), Toronto, Ontario, Canada. gerald_devins@camh.net

Our objective was to investigate whether quality of life in systemic lupus erythematosus (SLE) differs across ethnoracial groups and to identify factors that may explain race-related differences. Self-administered questionnaire data from 335 White, 40 Black, and 30 Asian women with SLE were obtained from a multi- center database. Measures assessed illness intrusiveness, psychological well- being, depressive symptoms, musculoskeletal pain, and learned helplessness. Extent of SLE disease activity was indexed by self-reported functional-system involvement. Educational attainment was indicated by number of years in school. Principal-components analysis reduced the four psychosocial measures to a single factor score. This represented psychosocial well-being In path analysis. Psychosocial well-being differed significantly across the three groups, with Whites reporting the highest, and Blacks the lowest, levels. Path analysis indicated that illness intrusiveness accounted for this race-related difference. Although disease activity was significantly associated with psychosocial well- being, it did not differ across ethnoracial groups. Illness intrusiveness and educational attainment emerged as independent mediators of the race-related difference in psychosocial well-being. We conclude that race-related quality-of- life differences exist among women with SLE and are mediated independently by illness intrusiveness and educational attainment.

Publication Types:

Comparative Study

Multicenter Study

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, P.H.S.

PMID: 11035420 [PubMed - indexed for MEDLINE]

P.H.S. PMID: 11035420 [PubMed - indexed for MEDLINE] 1551: Sci Total Environ. 2000 Oct 2;259(1-3):31-43.

1551: Sci Total Environ. 2000 Oct 2;259(1-3):31-43.

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Health assessment for mercury exposure among schoolchildren residing near a gold processing and refining plant in Apokon, Tagum, Davao del Norte, Philippines.

Akagi H, Castillo ES, Cortes-Maramba N, Francisco-Rivera AT, Timbang TD.

National Institute for Minamata Disease, Japan.

Artisanal gold-mining activities in the Philippines have proliferated since the early 1980s. Presently, environmental and health monitoring conducted by several governmental agencies is limited to the determination of total mercury only. Previous studies undertaken focused mainly on the exposure of adults and workers to mercury during mining/processing operations. However, in one area in Mindanao, mined ores are brought down and processed in the lowlands where residential communities are exposed to environmental pollutants resulting from gold processing/refining operations. The area of study is Apokon, Tagum, Davao del Norte, which has 29 gold processing and refining plants. Health complaints among schoolchildren in Apokon Elementary School were received by the Department of Health and were attributed to the mercury pollution in the environment. As part of a collaboration with the Health Department, UP-National Poisons Control and Information Service, the National Institute for Minamata Disease (NIMD), Japan, provided technical assistance in the analytical determination of mercury in biological and environmental samples. Elevated mercury concentrations were noted in some of the river systems up to 15 km from the mining areas. Environmental quality monitoring showed T-Hg sediment levels ranged from 0.553 to 66.471 microg/g dry wt. while water samples from river systems exhibited mercury levels from 72.8 to 78.4 ng/ml. Twenty-seven sediment samples from river systems near mining operations and seven water samples were also brought to the Institute for analysis. Fish samples collected showed levels ranging from 1.07 to 438.8 ng/g for total mercury and 0.71-377.18 ng/g for methylmercury. Methylmercury content in fish is predominant. All water and sediment samples collected from three sampling sites have elevated T-Hg level while three fish species have elevated T-Hg and methylmercury levels (WHO/CDC, 1994). Blood and hair samples from 162 schoolchildren aged 5-17

years were collected and analyzed at the NIMD for mercury analysis. Analytical procedures used in the NIMD for mercury testing were applied. Laboratory results showed that total mercury hair samples ranged from 0.278 to 20.393 microg/g while methylmercury hair results were from 0.191 to 18.469 microg/g. Methylmercury in hair showed levels from 45.96 to 99.81%. Total blood mercury levels ranged from 0.757 to 56.88 microg/l while Me-Hg blood levels ranged from 1.36 to 46.73 microg/l. It was determined that 10 children had elevated T-Hg blood levels while one child had high total and methylmercury levels in hair. A summary of physical examination results showed that the predominant findings include under-height, gingival discoloration, adenopathy, underweight and dermatologic abnormalities among children examined.

PMID: 11032133 [PubMed - indexed for MEDLINE]

examined. PMID: 11032133 [PubMed - indexed for MEDLINE] 1552: Seishin Shinkeigaku Zasshi. 2000;102(7):640-52.

1552: Seishin Shinkeigaku Zasshi. 2000;102(7):640-52.

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[A survey of drug utilization in psychiatric hospitals in Japan:

comparison of 1973, 1979, and 1993]

[Article in Japanese]

Yamauchi K, Baba K, Ikegami N, Ono Y, Miyaoka H, Kamijima K.

Department of Health Policy & Management, Keio University School of Medicine.

This paper investigated the trend in prescription patterns in the treatment of psychiatric inpatients using a database of our 1993 survey as well as reports of surveys conducted by Ito et al. in 1973 and 1979. To make the database of our survey comparable with surveys in 1973 and 1979, we extracted and analyzed 1,164 cases which met the criteria of Ito's survey, requiring that patients were diagnosed as having schizophrenia and were hospitalized for two years or longer. The results were as follows: 1) The most common number of different drugs per patient increased from 4 in 1973 and 1979 to 8 in 1993. That of psychotropics increased from 2 to 5. That of neuroleptics increased from 2 to 3. 2) The most commonly prescribed neuroleptics were haloperidol followed by levomepromazine and chlorpromazine. While the top three neuroleptics had not changed, the mean daily dose of haloperidol rose from 8.4 mg in 1979 to 15.3 mg in 1993.

Publication Types:

Comparative Study

English Abstract

Research Support, Non-U.S. Gov't

PMID: 11026079 [PubMed - indexed for MEDLINE]

1553: Southeast Asian J Trop Med Public Health. 2000 Mar;31(1):91-5. Southeast Asian J Trop Med Public Health. 2000 Mar;31(1):91-5.

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Factors associated with TT (tetanus toxoid) immunization among pregnant women, in Saparua, Maluku, Indonesia.

Roosihermiatie B, Nishiyama M, Nakae K.

National Institute of Health System Research and Development, Surabaya, Indonesia. betty@dokkyomed.ac.jp

A cross sectional study was conducted at Saparua Health Center to determine factors associated with the administration of tetanus toxoid. In all, 64 pregnant women were recruited. The majority of the women were housewives, aged 17 to 30 years old, and having more than one child. They were educated to high school, knew some information on tetanus toxoid, and knew at least one of the tetanus symptoms. Almost all did not know the cause of tetanus. The logistic regression of knowledge on tetanus and TT immunization: mothers who heard of TT were 1.54 more likely to have been immunized than those who did not, while mothers who knew the use of tetanus toxoid were 2.15 times more likely to have been immunized than those who did not, and those who knew at least one of the tetanus symptoms were 1.86 times more likely to have been immunized than those who did not, respectively controlling other variables constant. Furthermore, women who had antenatal care were 30 times more likely to have been immunized than those who did not. Enhancing mothers knowledge on tetanus is important to increase the coverage of tetanus toxoid. Moreover, antenatal care would cause contact with sources of tetanus toxoid and hence increase the chance of having the immunization. At the same time, this decreases tetanus neonatorum. Considering the majority of pregnant women received information on tetanus from healthworkers, the use a variety of media would be advantageous.

PMID: 11023073 [PubMed - indexed for MEDLINE]

1554: J UOEH. 2000 Sep 1;22(3):283-90. J UOEH. 2000 Sep 1;22(3):283-90.

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[A report on symposium, "protection for personal information in epidemiological research and cancer registry"]

[Article in Japanese]

Hoshuyama T, Sakurazawa H.

Department of Environmental Epidemiology, University of Occupational and Environmental Health, Kitakyushu, Japan.

A symposium on protection of personal information in epidemiological research

and the compilation of a cancer registry was held at the National Cancer Center, Japan, on March 16, 2000. Participants discussed the use of personal health

information in epidemiological research activities such as the compiling of a cancer registry to protect personal information. Legislation in Japan is pending in the near future. A total of thirteen domestic and foreign speakers and commentators shared opinions from various viewpoints and discussed the issue. It was proposed that protection regarding personal information should be legislated

as soon as possible for the development of cancer registry; patients could be

exempted from informed consent for utilization of personal health information, in particular, in public health activities such as the complication of a cancer registry

and epidemiological research with the approval of an ethics review board; ethical guidelines including these steps should be established in Japan. An appropriate system of protection of personal information should be established through constructive discussion at frequent meetings and symposia which are open to the citizenry.

Publication Types:

English Abstract

PMID: 11019394 [PubMed - indexed for MEDLINE]

Abstract PMID: 11019394 [PubMed - indexed for MEDLINE] 1555: Health Policy Plan. 2000 Sep;15(3):332-7. Related

1555: Health Policy Plan. 2000 Sep;15(3):332-7.

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Policy Plan. 2000 Sep;15(3):332-7. Related Articles , Links A participatory approach to sanitation: experience of

A participatory approach to sanitation: experience of Bangladeshi NGOs.

Hadi A.

Research and Evaluation Division, BRAC, Dhaka, Bangladesh. shirsha@bangla.net

This study assesses the role of participatory development programmes in improving sanitation in rural Bangladesh. Data for this study came from a health surveillance system of BRAC covering 70 villages in 10 regions of the country. In-depth interviews were conducted with one adult member of a total of 1556 randomly selected households that provided basic socioeconomic information on the households and their involvement with NGO-led development programmes in

the community. The findings reveal that households involved with credit programmes were more likely to use safe latrines than others who were equally poor but not involved in such programmes. The study indicates that an unmet need to build or buy safe and hygienic latrines existed among those who did not own one. Such latent need could be raised further if health education at the grassroots level along with supervised credit supports were provided to them. Unlike conventional belief, the concept of community-managed jointly owned latrines did not seem a very attractive alternative. The study argues that social and behavioural aspects of the participatory development programmes can significantly improve environmental sanitation in a traditional community.

PMID: 11012409 [PubMed - indexed for MEDLINE]

community. PMID: 11012409 [PubMed - indexed for MEDLINE] 1556: Health Policy Plan. 2000 Sep;15(3):303-11. Related

1556: Health Policy Plan. 2000 Sep;15(3):303-11.

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Plan. 2000 Sep;15(3):303-11. Related Articles , Links Financing reforms for the Thai health card scheme.

Financing reforms for the Thai health card scheme.

Pannarunothai S, Srithamrongsawat S, Kongpan M, Thumvanna P.

Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.

The Thai health card scheme originated from a pilot study on community financing and primary health care in maternal and child health in 1983. The scheme later changed to one of voluntary health insurance and finally received a matching subsidy from the government. The coverage of the scheme is described by a U-curve, i.e. it started with 5% of the total population in 1987, declined to 3% in 1992, with an upturn to 14% in 1997. The upturn has been the result of concerns about universal coverage policy, together with reforms of fund management. The provincial fund is responsible for basic health, basic medical, referral, and accident and emergency services. The central fund takes 2.5% of the total fund to manage cross-boundary services and high cost care (a reinsurance policy). On average, the utilization rate of the voluntary health card was higher than that of the compulsory (social security) scheme. And amongst three variants of health cards, the voluntary health card holders used health services twice to three times more than the community and health volunteer card holders. Cost recovery was low, especially in the provinces with low coverage. In the province with highest coverage, cost recovery was as high as 90% of the non-labour recurrent cost. Only 10% of the budgeted fund for reinsurance was disbursed, implying considerable management inefficiency. The management information system as well as the management capacity of the Health Insurance Office should be strengthened. After comparing the health card with other insurance schemes in terms of coverage, cost recovery, utilization and management cost, it is recommended that this voluntary health insurance should be modified to be a compulsory insurance, with some other means of premium collection and minimal

co-payment at the point of delivery.

Publication Types:

Evaluation Studies

Research Support, Non-U.S. Gov't

PMID: 11012405 [PubMed - indexed for MEDLINE]

Gov't PMID: 11012405 [PubMed - indexed for MEDLINE] 1557: Health Policy Plan. 2000 Sep;15(3):279-86. Related

1557: Health Policy Plan. 2000 Sep;15(3):279-86.

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Plan. 2000 Sep;15(3):279-86. Related Articles , Links Improving the monitoring of immunization services in

Improving the monitoring of immunization services in Kyrgyzstan.

Weeks RM, Svetlana F, Noorgoul S, Valentina G.

USAID/BASICS Project, Arlington, Virginia 22209, USA.

Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system

improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

PIP: Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. To reduce the burden of excessive record-keeping and reporting requirements, the working group identified four key indicators for the services delivery level: 1) diphtheria, pertussis, tetanus (DPT) immunization coverage rates for children less than 1 year of age; 2) contraindication rates for DPT; 3) usage of DPT vaccine; and 4) daily refrigerator temperature. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but also the new approach provided visible evidence that the MOH was approaching its objectives. The project demonstrated that giving health workers the basic epidemiological skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

Publication Types:

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11012402 [PubMed - indexed for MEDLINE]

Non-P.H.S. PMID: 11012402 [PubMed - indexed for MEDLINE] 1558: Ned Tijdschr Geneeskd. 2000 Sep 9;144(37):1785-9.

1558: Ned Tijdschr Geneeskd. 2000 Sep 9;144(37):1785-9.

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[Relation between ethnicity and reason for referral of new patients to the Internal Medicine outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt, 1997]

[Article in Dutch]

Manna DR, Bootsma AH, Lamberts SW, Mackenbach JP.

Erasmus Universiteit, Rotterdam. manna@bmg.eur.nl

OBJECTIVE: To inventory the ethnic composition of the patients referred to an internal medicine outpatient clinic of a Dutch academic hospital and to determine to what extent ethnic minorities differ from Dutch patients in terms of referral reasons, taking relevant background characteristics into account. DESIGN: Cross- sectional analysis. METHOD: Data were collected on all new patients referred in 1997 for the first time to the internal medicine outpatient clinic of the Academic Hospital Dijkzigt, Rotterdam, the Netherlands, using the hospital information system (n = 3205). Patients were categorised into ethnic groups based on country of birth or name. Ethnic differences in referral reasons were tested for the 4 largest ethnic groups by means of logistic regression analysis with adjustment for age, sex, mean income of the zipcode area of the patients' residence and type of health insurance. RESULTS: The percentage of ethnic minorities amongst all referred patients was 22% (696/3205). The percentage of ethnic minorities among the patients referred from the catchment area of the outpatient clinic was 48% (209/440). Compared with Dutch patients Turkish patients were referred more often with stomach ache (odds ratio (OR): 4.26) and joint problems (OR: 7.16) as reasons. Moroccans were more often referred with stomach ache (OR: 4.10) and diabetes (OR: 4.51). Ethnic minorities were referred less often with dyslipidemia (Turks: OR: 0.11; Surinamese: OR: 0.17; Moroccans: 0 patients).

Publication Types:

English Abstract

PMID: 11004953 [PubMed - indexed for MEDLINE]

Abstract PMID: 11004953 [PubMed - indexed for MEDLINE] 1559: Inj Prev. 2000 Sep;6(3):199-202. Related Articles ,

1559: Inj Prev. 2000 Sep;6(3):199-202.

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Inj Prev. 2000 Sep;6(3):199-202. Related Articles , Links Motor vehicle crashes in Pakistan: the emerging epidemic.

Motor vehicle crashes in Pakistan: the emerging epidemic.

Hyder AA, Ghaffar A, Masood TI.

Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. ahyder@jhsph.edu

SETTING: Motor vehicle injuries are increasingly being recognized as a growing public health issue in the developing world. Pakistan is a developing country in South Asia where motor vehicle use has increased since independence in 1947. OBJECTIVE: This paper explores the magnitude and impact of injuries from motor vehicle crashes in Pakistan. METHODS: An exhaustive review of

published and gray literature, together with a detailed analysis of government data from 1956. RESULTS: The data indicate a persistent increase in the numbers of motor vehicle crashes, injuries, and fatalities. Changes in the reporting of rates are important to note in evaluating the data. Commercial vehicles contribute disproportionately to these motor vehicle injuries. CONCLUSIONS: There is a need to further the recognition of injuries as a public health issue in this country. Specific exploration of the epidemiological data; intersectoral collaboration between health, law, police and transport; and the development of appropriate information systems, will contribute to an appropriate response by Pakistan.

Publication Types:

Research Support, Non-U.S. Gov't

Review

PMID: 11003185 [PubMed - indexed for MEDLINE]

PMCID: PMC1730645

11003185 [PubMed - indexed for MEDLINE] PMCID: PMC1730645 1560: Bull World Health Organ. 2000;78(7):884-90. Related

1560: Bull World Health Organ. 2000;78(7):884-90.

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Building the evidence base for global tobacco control.

Corrao MA, Guindon GE, Cokkinides V, Sharma N.

American Cancer Society, Atlanta, GA 30329-4251, USA.

The tobacco control movement needs a global information system permitting routine monitoring of the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. The Tobacco Control Country Profiles database, a data collection initiative led by the American Cancer Society in collaboration with WHO and the Centers for Disease Control and Prevention, represents the first step in the development of such a system. Baseline data on several indicators of tobacco use were obtained from 191 Member States of WHO, two Associate Members, Hong Kong Special Administrative Region of China (Hong Kong SAR), China (Province of Taiwan) and the West Bank and Gaza Strip. The methods used to compile the data are described in the present paper. Selected indicators from the database were analysed in order to demonstrate the potential utility and value of data derived from an information system devoted to tobacco control. The analyses covered gender-specific smoking prevalence by WHO Region, per capita cigarette consumption by Human Development Index (HDI) category, and average real annual percentage changes in cigarette prices between

1990 and 1999 for selected countries in each category. In 1998, men were almost four times more likely than women to be smokers. The prevalence of smoking among men was highest in the Western Pacific Region. The differential in gender- specific smoking prevalence was narrowest in the Region of the Americas and the European Region. It was wider in the South-East Asia Region and the Western Pacific Region. The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively. In the medium HDI category, China's growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption. Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries. The implications of the findings for future tobacco control efforts are discussed, as are issues surrounding the quality of available data, priorities for future data collection and the need to maintain and improve the information system in order to support such efforts.

PMID: 10994261 [PubMed - indexed for MEDLINE]

such efforts. PMID: 10994261 [PubMed - indexed for MEDLINE] 1561: Methods Inf Med. 2000 Aug;39(3):238-40. Related

1561: Methods Inf Med. 2000 Aug;39(3):238-40.

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Subjective symptoms acquisition system in a health promotion system for the elderly. Committee of System Development, Council of Japan AMHTS Institutions.

Tanaka Y, Shibata S, Ohtuka Y, Hattori M, Aoshima T, Tohyama S, Uchiyama A, Kashihara H, Tamura M, Tsuchiya A, Yoshida K, Sasamori N.

Toshiba Medical Systems Co., Tokyo, Japan. yoshifusa.tanaka@glb.toshiba.co.jp

A previous report was concerned with the evaluation of quality of life using a Health Promotion System for the Elderly. In the present report, we describe one part of that system: a subjective symptoms acquisition and reporting system. The main purpose of this system is to permit any physician or nurse to uniformly employ questionnaires to acquire accurate subjective symptoms. This system is applied in three steps. First, the subjective answers to 21 questions displayed on a personal computer are obtained. These answers correspond to the basic subjective symptoms. Second, if a basic subjective symptom is "positive", more detailed questions are automatically generated. Finally, clear sentences regarding subjective symptoms are generated and output as a "finding report". This information is helpful to physicians and nurses in their health-counseling work. An artificial intelligence (AI) program based on "XpertRule" produces detailed questions which are generated by an interactive questionnaire using branching logical rules.

PMID: 10992751 [PubMed - indexed for MEDLINE]

1562: Int J STD AIDS. 2000 Aug;11(8):536-44. Int J STD AIDS. 2000 Aug;11(8):536-44.

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J STD AIDS. 2000 Aug;11(8):536-44. Related Articles , Links Employment and contextual impact of safe and

Employment and contextual impact of safe and unsafe sexual practices for STI and HIV: the situation in China.

Wang SM, Gao MY.

National Centre in HIV Social Research, The University New South Wales, Sydney, Australia. pssw@cc.newcastle.edu.au

China's dual employment system plays a crucial role in sexually transmitted infections (STIs) and HIV-related safe and unsafe sexual practices among young Chinese people. Social and psychological determinants of safe and unsafe sexual practices for HIV infection among young people in Sichuan, China were examined. Our findings indicate that changes in China's social structure and employment system impact upon the social contextual involvement and socio- sexual practice of young Chinese people. The findings in the study suggest that the employment-related contextual involvement was a major predictor in the relationships between demography, information, and psychological risk-taking factors on one hand and the people's safe and unsafe sexual practices on the other. Self-employed people (officially called 'getihu') were more likely than the state- employed people to engage in unprotected sex with casual sexual partners. As China undergoes social restructuring and many state-employed people are laid off, the risk may also extend into the broader non-self-employed population as more state-employed people become involved not only in the self-employed getihu's socioeconomic activities but also in their unconventional socio-sexual practices. Collective vulnerability to STI and HIV, due to the current socio-sexual practices of the getihu young people, has created a new frontier for STI and HIV prevention in today's China, as well as demonstrating the importance of collective action with STI and AIDS prevention strategies within relevant social and sub- cultural contexts.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10990339 [PubMed - indexed for MEDLINE]

1563: J Med Syst. 2000 Jun;24(3):195-211. J Med Syst. 2000 Jun;24(3):195-211.

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Medical markup language (MML) for XML-based hospital

information interchange.

Araki K, Ohashi K, Yamazaki S, Hirose Y, Yamashita Y, Yamamoto R, Minagawa K, Sakamoto N, Yoshihara H.

Miyazaki Medical College Hospital, Japan.

Medical Markup Language (MML) has been developed over the last 6 years in order to create a set of standards by which medical data, within Japan and hopefully worldwide, can be stored, accessed and exchanged in any number of physical locates. The MML version 2.21 is characterized by XML as meta- language, module structure for each document and enhancement of linking function among documents. Data exchange specification has been also added for query and reply. MML instances are composed of MML header and MML body. The MML header includes information for data transmission, while MML body includes several module items. One module item contains two elements:

document information and module content. Nine MML module contents are defined at the present time: patient information, health insurance information, diagnosis information, lifestyle information, basic clinic information, particular information at the time of first visit, progress course information, surgery record information and clinical summary information.

PMID: 10984873 [PubMed - indexed for MEDLINE]

1564: QJM. 2000 Sep;93(9):617-31. QJM. 2000 Sep;93(9):617-31.

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1564: QJM. 2000 Sep;93(9):617-31. Related Articles , Links Is there evidence for exogenous risk factors in

Is there evidence for exogenous risk factors in the aetiology and spread of Creutzfeldt-Jakob disease?

Hillier CE, Salmon RL.

Welsh Combined Centres for Public Health, University of Wales College of Medicine, Cardiff, UK. charlie.hillier@cdsc.wales.nhs.uk

Publication Types:

Meta-Analysis

PMID: 10984557 [PubMed - indexed for MEDLINE]

Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect.

Kleschen MZ, Holbrook J, Rothbaum AK, Stringer RA, McInerney MJ, Helgerson SD.

Pacifi-Care Asia Pacific, Tamuning, Guam. MaryKleschen@phs.com

BACKGROUND: Pneumococcal disease kills more people in the United States than any other vaccine-preventable bacterial disease, and a national health objective for the year 2000 is that at least 60% of eligible persons be immunized with pneumococcal vaccine. METHODS: An electronic care monitoring system was used to track immunization of patients with diabetes in a managed care plan who were receiving their care through a staff-model primary care clinic in Guam. In November 1998 a letter was sent to all patients not known to be immunized. The letter invited these patients to attend immunization clinics and waived usual copayment. Standing orders were also created for the clinic nurses to administer pneumococcal vaccines. In addition, a diabetes care status report was placed on each patient's medical record. RESULTS: The immunization rate for the 1,278 actively enrolled patients with diagnosed diabetes increased from 42% in October 1998 to 62% in January 1999. Compared to November 1995, 1996, and 1997, the number of pneumococcal immunizations increased more than 15-fold in November 1998. DISCUSSION: The combined use of patient outreach letters, special immunization clinics, standing orders, and practitioner reminders on medical records resulted in a rapid, marked increase in the pneumococcal immunization rate for patients with diabetes. The electronic care monitoring system is being used to target get interventions for improvement opportunities for an array of diabetes care measures, including regular foot care and eye exams.

PMID: 10983294 [PubMed - indexed for MEDLINE]

and eye exams. PMID: 10983294 [PubMed - indexed for MEDLINE] 1566: Isr Med Assoc J. 2000

1566: Isr Med Assoc J. 2000 Jul;2(7):510-2.

Related Articles,

Links

Med Assoc J. 2000 Jul;2(7):510-2. Related Articles , Links Clinical information system based on the medical

Clinical information system based on the medical smart card.

Danon YL, Saiag E.

Kipper Institute of Immunology and Human Genetics, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. ydanon@tau.post.ac.il

BACKGROUND: Over the last 5 years Israel has implemented a nationwide health insurance plan covering the entire population of the country. We have

developed a clinical information system based on electronic-chip health care medical smart cards. Health care cards are used in several European countries and chip smart cards have been successful in many sectors. Our project involves the community use of the MSC, thereby enabling health care professionals to skillfully employ card systems in the health care sector. This system can easily arrange electronic medical charts in clinics, facilitating the confidential sharing of personal health databases among health professionals. OBJECTIVES: To develop an MSC applicable for daily use in the community and hospital system. RESULTS AND CONCLUSIONS: The MSC project, currently underway in Israel and the USA, will aid in determining the costs, benefits and feasibility of the MSC. Successful implementation of the MSC in chosen clinics will promote a nationwide willingness to adopt this promising technology.

Publication Types:

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10979323 [PubMed - indexed for MEDLINE]

Non-P.H.S. PMID: 10979323 [PubMed - indexed for MEDLINE] 1567: J Hazard Mater. 2000 Nov 3;78(1-3):19-39. Related

1567: J Hazard Mater. 2000 Nov 3;78(1-3):19-39.

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Links

Mater. 2000 Nov 3;78(1-3):19-39. Related Articles , Links Comparative risk assessment: an international comparison of

Comparative risk assessment: an international comparison of methodologies and results.

Morgenstern RD, Shih J, Sessions SL.

Resources for the Future, 1616 P Street, N.W., Washington, DC 200 36, USA. morgenst@rff.org

Comparative risk assessment (CRA) is a systematic procedure for evaluating the environmental problems affecting a geographic area. This paper looks beyond the U.S. border and examines the experience with CRAs conducted in various developing countries and economies in transition, including Bangkok, Thailand, Cairo, Egypt and Quito, Ecuador, as well as other locations in Eastern Europe, Asia and Central and South America. A recent pilot CRA conducted in Taiwan is also considered. Comparisons are made of both the methodologies and the results across the relatively diverse international literature. The most robust finding is that conventional air pollutants (e.g., particulate matter and lead) consistently rank as high health risks across all of the CRAs examined. Given the varied nature of the settings studied in the CRAs, including level of economic development, urban-rural differences, and climate, this finding is particularly significant. Problems involving drinking water are also ranked as a high or medium health

risk in almost all the countries studied. This is consistent with the results of analyses conducted by the World Bank suggesting contamination, limited coverage and erratic service by water supply systems.Beyond the major air pollutants and drinking water, the CRA results diverge significantly across countries. A number of problems involving toxic chemicals, e. g., hazardous air pollutants, rank as high health risks in the US but do not appear as consistent areas of concerns in the other countries studied. This likely reflects the so-called "risk transition" - the shift from sanitation and infection disease problems to those involving industry, vehicles and toxic substances - that often occurs with economic development. It may also reflect the greater information about sources of toxic pollutants in the U.S. For other problems, there are important differences across the developing countries and economies in transition. For example, hazardous and (industrial) non-hazardous waste issues ranked as medium or low health risks in all the countries studied, except for Taiwan where unmanaged toxic waste sites were considered to pose high risks. While the generally low ranking is consistent with the notion that few people are directly exposed to hazardous and (industrial) non-hazardous waste, it is not entirely surprising that views might be different in Taiwan, where space is so limited and population density is so high.We suggest that the wide range of findings likely reflect genuine differences among the countries studied. However, we cannot entirely rule out the possibility that some of the observed similarities (and differences) arise from the (relatively) common methodologies employed.

Publication Types:

Comparative Study

PMID: 10978559 [PubMed - indexed for MEDLINE]

Study PMID: 10978559 [PubMed - indexed for MEDLINE] 1568: Gan To Kagaku Ryoho. 2000 Aug;27(9):1347-53. Related

1568: Gan To Kagaku Ryoho. 2000 Aug;27(9):1347-53.

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[Cost-effectiveness of cancer therapy]

[Article in Japanese]

Hisashige A.

Dept. of Preventive Medicine, School of Medicine, University of Tokushima.

Under recent healthcare reforms, the urgent need for establishing evidence-based healthcare and for economic evaluation has been emphasized. Cancer not only accounts for a major burden of diseases, but also has major economic impacts on both individual patients and society. Most cancer therapies are essentially high- cost and high-technology, and provide uncertain outcomes. Concerns about the

appropriate choice and utilization of cancer therapy is increasing. However, economic evaluations for cancer therapy are lacking in a number of areas, despite recent advances. In Japan, to catch up with international trends, serious efforts to generate better evidence for economic evaluation of cancer therapy have recently been made. A league table for economic evaluation of cancer therapy in Japan has been constructed, based on results including preventive antiemetic treatment, breast conserving and post-adjuvant therapy for early breast cancer, bone marrow transplantation for leukemia, interferon treatment for hepatitis C with liver cirrhosis, and others. This information shows substantial possibilities for evaluating the value-for-money of cancer therapy. This may lead to the establishment of an effective and efficient healthcare system in Japan.

Publication Types:

English Abstract

Review

PMID: 10969588 [PubMed - indexed for MEDLINE]

• Review PMID: 10969588 [PubMed - indexed for MEDLINE] 1569: Harefuah. 1999 Jul;137(1-2):1-4, 88. Related

1569: Harefuah. 1999 Jul;137(1-2):1-4, 88.

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[The Israeli pharmaceutical market]

[Article in Hebrew]

Shani S, Shemer J.

Pharmaceutical Policy and Economics Unit, Israeli Center for Health Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer.

The pharmaceutical market in Israel has undergone many major changes over the past 2 years. We detail measures taken with regard to drug prices and utilization, from 1992 until 1995, when the National Health Insurance Law was implemented. This provides an information base for marketing and dispensing of drugs, economic planning in the public health system, and for physicians and pharmacists in clinical practice. The national expenditure on pharmaceuticals in 1994 was 9.4% of the annual national health expenditure. From this fact, and the number of registered drugs and the number of clinical trials conducted, it appears that our pharmaceutical market is quite diversified and well developed compared to other markets in the western world. This size advantage enables our sick funds to purchase drugs at much lower prices than the private sector.

Publication Types:

English Abstract

PMID: 10959264 [PubMed - indexed for MEDLINE]

1570: Comput Nurs. 2000 Jul-Aug;18(4):197-206. Comput Nurs. 2000 Jul-Aug;18(4):197-206.

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Computer knowledge, attitudes, and skills of nurses in People's Hospital of Beijing Medical University.

Liu JE, Pothiban L, Lu Z, Khamphonsiri T.

Nursing Department, People's Hospital, Beijing Medical University, China.

The first Chinese Hospital Information Systems (HIS) was used as a pilot project at People's Hospital, of Beijing Medical University (BMU). To assess the computer knowledge, attitudes, and skills of nurses working in the hospital, and to examine the relationships among these factors, 169 staff nurses working on clinical units were surveyed by proportionate stratified random sampling. Computer knowledge, attitudes, and skills were measured, by a nurses' computer knowledge questionnaire (NCKQ), nurses' computer attitude scale (NCAS), and nurses' computer skill scale (NCSS), respectively, developed by the investigators. Data analysis showed that the overall computer knowledge and skills of nurses were at moderate levels and the computer attitudes were neutral. Nurses' computer skills were significantly and positively correlated with both computer knowledge and computer attitudes; however, no significant correlation was found between computer knowledge and computer attitudes. Strategies to enhance nurses' computer knowledge, attitudes, and skills were proposed.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10939189 [PubMed - indexed for MEDLINE]

1571: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 4:i-iv, 1-101. Southeast Asian J Trop Med Public Health. 1999;30 Suppl 4:i-iv, 1-101.

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Mekong malaria. Malaria, multi-drug resistance and economic development in the greater Mekong subregion of Southeast Asia.

Singhasivanon P.

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. tmpsh@mahidol.ac.th

This monograph brings together national malaria databases for 1996, 1997 and 1998 from the 6 countries comprising the Greater Mekong Subregion of Southeast Asia: Cambodia, China (southern provinces), Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam. The objective is to create a regional perspective in what is a global epicenter of drug resistant falciparum malaria, so to enhance the information flow required to improve malaria control on a regional basis in the context of economic and social change. Geographical Information Systems technology has been applied to the regional mapping of total reported malaria cases, malaria incidence, confirmed cases, parasite species distribution. There is great diversity in disease patterns in the 6 countries and at subnational administrative unit area level in each country, so that in the region as a whole there is marked asymmetry in disease distribution, with many areas of high endemicity. Focal expansion of maps in the vicinity of international border areas delineates the differential trans-border malaria distribution that presents a challenge for disease control. The malaria pattern is also depicted in environmental context against regional elevation and forest cover profiles, which affect mosquito breeding site distribution and agricultural activity. Data on resistance of falciparum malaria to a range of anti-malarial drugs summarise the historical and recent context of resistance development and spread in terms of geography and time frame. Data on population movement across international borders identify the magnitude of a major factor in the dispersal of malaria, including resistant parasite strains. Malaria control involves consideration of microeconomic capacity and operates in the broader context of macroeconomic policy: economic and social profiles of the region are included to provide this perspective. So too are maps depicting major economic development projects in the region, projects that have and will continue to have profound, dynamic impacts on malaria epidemiology. The geographic collation of regional malaria databases is thus placed in overall geographic, health, environmental and economic perspective. This beginning can form a basis for the development of an effective regional malaria surveillance system in the context of rapidly evolving social and infrastructural change, leading eventually to a multi-disease surveillance network.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10935286 [PubMed - indexed for MEDLINE]

External quality assurance in Malaysia.

Nawawi H, Lim HH, Zakiah I.

Department of Pathology, Hospital UKM, Kuala Lumpur, Malaysia.

An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.

PMID: 10926257 [PubMed - indexed for MEDLINE]

1573: Harefuah. 1999 Mar 1;136(5):349-52, 420, 419. Harefuah. 1999 Mar 1;136(5):349-52, 420, 419.

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[Quality assurance in the mental health department of the Israel Defense Forces]

[Article in Hebrew]

Mark M, Abramowitz MZ, Intrator O, Bodner E, Shklar R, Knobler HY.

Mental Health Department, Medical Corps, Israel Defence Forces.

A review of quality assurance in the mental health department of the Israel Defence Forces allowed the examination of certain unique elements of quality control which pertain to the military. These include the psychiatric medical board, the computerized documentation of appointments and sessions with soldiers, the psychiatric hospitalization database, control systems implemented in the draft boards, peer-review boards and supervision, and a special officer in charge of handling outside consultations and queries. There were other components of quality assurance and control as well. These instruments are vital in a dynamic system constantly striving to improve clinical performance. Future plans include the continued use and expansion of quality control boards, the inclusion of quality assurance in the curriculum of mental health officers, and the use of clinical guidelines in working with soldiers. All of this is in keeping with the principle of continuous quality improvement, with the aim of viewing the soldier in need of help as a client.

Publication Types:

English Abstract

PMID: 10914235 [PubMed - indexed for MEDLINE]

1574: Harefuah. 1998 Mar 1;134(5):348-51, 423. Harefuah. 1998 Mar 1;134(5):348-51, 423.

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[What has happened to patient satisfaction with the care in general hospitals in the years from 1993-1995?]

[Article in Hebrew]

JDC-Brookdale Institute of Gerontology and Human Development, Jerusalem.

Patient satisfaction with the hospitalization process is an important element in the measurement of quality of care. Information from a survey of patients' experiences could therefore help hospitals improve their service, and provide decision-makers with relevant information. We present the findings of a study of some 4,500 patients, aged 18+, released from hospitals in the fall of 1993 and of 1995 from the wards of 9 acute care hospitals, psychiatric and geriatric wards excluded. Self-administered questionnaires were sent and returned by mail, with an overall response rate of 82%. Despite the many changes in Israel's health system in general and its hospital system in particular, and the social and demographic changes between those 2 periods, patient satisfaction remained constant. Of those discharged from medical or surgical wards, 70% were satisfied to a "great" or "ver great" extent with their hospital experience. There was improvement in most areas of hospitalization in the course of the 2 years. The greatest improvement was with regard to admission, nursing staff, hotel services, in patient satisfaction food and supplies. On the other hand there was deterioration in visiting conditions and hours. Satisfaction with physicians, nurses and hotel services had the strongest links with general satisfaction.

Publication Types:

English Abstract

PMID: 10909547 [PubMed - indexed for MEDLINE]

Abstract PMID: 10909547 [PubMed - indexed for MEDLINE] 1575: Brain Res Mol Brain Res. 2000 May

1575: Brain Res Mol Brain Res. 2000 May 31;78(1-2):146-53.

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Res. 2000 May 31;78(1-2):146-53. Related Articles , Links Point mutation associated with X-linked dominant

Point mutation associated with X-linked dominant Charcot-Marie- Tooth disease impairs the P2 promoter activity of human connexin- 32 gene.

Wang HL, Wu T, Chang WT, Li AH, Chen MS, Wu CY, Fang W.

Department of Physiology, Chang Gung University School of Medicine, Kwei- San, Tao-Yuan, Taiwan, ROC. hlwns@mail.cgu.edu.tw

Many lines of evidence suggest that connexin-32 gap junction is involved in the exchange of information and metabolites in the peripheral nervous system. It has been shown that connexin-32 protein and mRNA are expressed in Schwann cells that function as myelinating cells of the peripheral nervous system. The physiological importance of connexin-32 gap junctions in regulating the normal function of myelinating Schwann cell is indicated by recent findings that X-linked

dominant Charcot-Marie-Tooth disease, a hereditary peripheral neuropathy, is associated with the mutations of connexin-32 gene. Recently, we encountered a Taiwanese family affected with X-linked dominant Charcot-Marie-Tooth neuropathy. Therefore, we investigated the possible mutation in the coding and noncoding regions of the connexin-32 gene of affected members of this family. Our results suggest that a G-to-A transition at the position -215 (in relation to the transcription initiation site) of the nerve-specific P2 promoter region is associated with the pathogenesis of X-linked dominant Charcot-Marie-Tooth disease. Further experiments using the promoter assay indicate that G-to-A mutation at the position -215 greatly impairs the transcriptional activity of connexin-32 P2 promoter. These findings propose that a reduced expression of connexin-32 mRNA and protein in the myelin sheath could be responsible for the development of X-linked dominant Charcot-Marie-Tooth neuropathy.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10891594 [PubMed - indexed for MEDLINE]

Gov't PMID: 10891594 [PubMed - indexed for MEDLINE] 1576: Ethn Health. 1999 Feb-May;4(1-2):5-18. Related

1576: Ethn Health. 1999 Feb-May;4(1-2):5-18.

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Surveillance for the impact in the UK of HIV epidemics in South Asia.

Cliffe S, Mortimer J, McGarrigle C, Boisson E, Parry JV, Turner A, Mithal J, Goldberg D, Nicoll A.

Public Health Laboratory Service AIDS & STD Centre, Communicable Disease Surveillance Centre, London, UK.

OBJECTIVES: To determine whether, because of the extensive recent spread of HIV infection in South Asia, South Asians (those people who classify themselves as Indian, Pakistani, Bangladeshi or Sri Lankan in origin) resident in the UK were at increased risk of HIV infection and to review current surveillance systems for detecting any such increase. DESIGN: Analysis of: ethnic grouping and probable country of infection recorded on voluntary confidential reports of AIDS cases and newly diagnosed HIV infections; blood donation testing data; reports of imported gonorrhoea infections; country of birth data from the unlinked anonymous (UA) survey of Sexually Transmitted Disease (STD) clinic attenders; district of residence data from the UA survey of pregnant women; ethnic grouping of prevalent diagnosed HIV infections. RESULTS: Few reported AIDS cases or HIV infections were found in people of South Asian ethnic origin and few reported HIV or gonorrhoea infections were associated with exposure in South Asia. Data

derived from the UA programme suggested as yet no increase in HIV prevalence in either STD clinic attenders born in South Asia or in pregnant women resident in districts containing substantial numbers of ethnic South Asians. CONCLUSIONS: There was no evidence that South Asians resident in the UK are currently at greater risk of HIV infection than people of white ethnicity or, therefore, that south Asian heterosexuals are a group deserving priority in HIV prevention. However, as rapid spread of HIV infection is being recorded in the Indian subcontinent, continuous monitoring is necessary. This will be facilitated by improved collection of ethnic group information in all surveillance activities.

PMID: 10887457 [PubMed - indexed for MEDLINE]

1577: Harefuah. 2000 Mar 15;138(6):465-8. Harefuah. 2000 Mar 15;138(6):465-8.

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[The Israel Freedom of Information Law, 1998: implications with respect to the health care system]

[Article in Hebrew]

Yahalom Z, Shani S.

Publication Types:

Review

PMID: 10883161 [PubMed - indexed for MEDLINE]

1578: J Cancer Educ. 2000 Summer;15(2):82-5. J Cancer Educ. 2000 Summer;15(2):82-5.

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Promoting cancer prevention activities among Vietnamese physicians in California.

Nguyen BH, Nguyen KP, McPhee SJ, Nguyen AT, Tran DQ, Jenkins CN.

Vietnamese Community Health Promotion Project, Department of Medicine, University of California, San Francisco 94102, USA.

BACKGROUND: To promote prevention and early detection of cancer, the authors conducted a three-year intervention targeting Vietnamese physicians in solo practice in California. METHODS: Twenty subjects who had received their medical training in Vietnam were recruited into a randomized controlled trial. The intervention included computerized or manual cancer screening reminders,

continuing medical education seminars, Vietnamese-language health education materials, newsletters, and oncology data-query programs. Evaluation included chart audits for eight targeted activities pre- and post-intervention. RESULTS:

Before the intervention, annual physician performance rates were low for all eight activities: routine checkups (65.6%), Pap testing (13.8%), pelvic examinations (19.8%), clinical breast examinations (13.3%), mammography (6.4%), hepatitis B serologies (21.9%), hepatitis B immunizations (12.8%), and smoking cessation counseling (1.6%). After the intervention, performance rates increased significantly for smoking cessation counseling (p = 0.02), Pap testing (p = 0.004), and pelvic examinations (p = 0.01). CONCLUSIONS: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities.

Publication Types:

Clinical Trial

Randomized Controlled Trial

Research Support, U.S. Gov't, P.H.S.

PMID: 10879896 [PubMed - indexed for MEDLINE]

P.H.S. PMID: 10879896 [PubMed - indexed for MEDLINE] 1579: Lancet. 2000 Jun 24;355(9222):2231-6. Related

1579: Lancet. 2000 Jun 24;355(9222):2231-6.

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2000 Jun 24;355(9222):2231-6. Related Articles , Links Comment in: • Lancet. 2000 Jun 24;355(9222):2248. •

Comment in:

Lancet. 2000 Jun 24;355(9222):2248.

Lancet. 2000 Sep 16;356(9234):1034-5.

Lancet. 2000 Sep 16;356(9234):1035.

Lancet. 2000 Sep 16;356(9234):1035.

Lancet. 2000 Sep 16;356(9234):1036.

Lancet. 2000 Sep 16;356(9234):1036.

North and South: bridging the information gap.

Horton R.

The Lancet, London, UK. richard.horton@lancet.com

Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how

technical fixes--such as the internet--might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty.

PMID: 10881907 [PubMed - indexed for MEDLINE]

poverty. PMID: 10881907 [PubMed - indexed for MEDLINE] 1580: Mil Med. 2000 May;165(5):321-36. Related Articles ,

1580: Mil Med. 2000 May;165(5):321-36.

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Comment in:

Mil Med. 2000 Aug;165(8):iii, 625.

Mil Med. 2000 Sep;165(9):iv-v.

The role of the sand in chemical warfare agent exposure among Persian Gulf War veterans: Al Eskan disease and "dirty dust".

Korényi-Both AL, Svéd L, Korényi-Both GE, Juncer DJ, Korényi-Both AL, Székely A.

Hungarian Home Defense Forces, Hungary.

The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. Signs and symptoms of Al Eskan disease have been termed by the news media "Persian Gulf syndrome." The dust becomes a warfare agent when toxic chemicals are microimpregnated into inert particles. The "dirty dust" concept, that the toxicity of an agent could be enhanced by absorption into inactive particles, dates from World War I. A growing body of evidence shows that coalition forces have encountered Iraqi chemical warfare in the theater of operation/Persian Gulf War to a much greater extent than early U.S. Department of Defense information had indicated. Veterans of that war were exposed to chemical warfare agents in the form of direct (deliberate) attacks by chemical weapons, such as missiles and mines, and indirect (accidental) contamination from demolished munition production plants and storage areas, or otherwise. We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-

intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses.

Publication Types:

Review

PMID: 10826378 [PubMed - indexed for MEDLINE]

• Review PMID: 10826378 [PubMed - indexed for MEDLINE] 1581: J Clin Virol. 2000 Jun;17(1):23-30. Related

1581: J Clin Virol. 2000 Jun;17(1):23-30.

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Clin Virol. 2000 Jun;17(1):23-30. Related Articles , Links An outbreak of enterovirus 71 infection in Taiwan,

An outbreak of enterovirus 71 infection in Taiwan, 1998:

epidemiologic and clinical manifestations.

Liu CC, Tseng HW, Wang SM, Wang JR, Su IJ.

Department of Pediatrics, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, Taiwan, ROC. liucc@mail.ncku.edu.tw

BACKGROUND: An outbreak of enterovirus infections occurred throughout Taiwan in 1998. The diseases were manifectated with hand, foot, and mouth disease (HFMD), some associated with meningitis, encephalitis, or acute flaccid paralysis (AFP). OBJECTIVES: This study is aimed to characterize and analyze the epidermologic and clinical features during the outbreak. STUDY DESIGN:

The epidemiologic information was collected from the Ministry of Health on passive surveillance; clinical and virological investigations were carried out at National Cheng Kung University Medical Center. RESULTS: Between April and December 1998, 405 children were hospitalized, and 78 patients died during this outbreak in Taiwan. There were 119 cases identified to be EV71 infection in Tainan and Chiayi areas; 105 cases by virus isolation and 14 by serological assay. The outbreak had a biphasic curve with peak in June and October, especially in the southern Taiwan. Seventy-two percent of patients were below 3 years of age. The spectrum of disease included HFMD in 54, HFMD with central nerve system (CNS) involvement in 37, herpangina in 12, aseptic meningitis in three, encephalitis/ meningoencephalitis in ten, acute flaccid paralysis in three. There was nine fatal cases complicated with neurogenic pulmonary edema. Myoclonus with sleep disturbance was the most important early sign of EV71 infection with CNS involvement. CONCLUSION: Our experience demonstrated that the EV71

isolated in Taiwan had strong dermatotropic as well as neurotropic tendencies. Early detecting CNS involvement and commencing aggressive therapy may reduce the mortality.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10814935 [PubMed - indexed for MEDLINE]

1582: Methods Inf Med. 1999 Dec;38(4-5):362. Methods Inf Med. 1999 Dec;38(4-5):362.

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Patient information maintained electronically: a new regulatory action in Japan.

Matsumoto Y.

Office of Medical Technology and Information Development, Health Policy Bureau, Ministry of Health and Welfare, Tokyo, Japan. ym-ecw@mhw.go.jp

PMID: 10805029 [PubMed - indexed for MEDLINE]

1583: J Radiat Res (Tokyo). 1999 Dec;40 Suppl:155-64. J Radiat Res (Tokyo). 1999 Dec;40 Suppl:155-64.

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(Tokyo). 1999 Dec;40 Suppl:155-64. Related Articles , Links Biological dosimetry of atomic bomb survivors exposed within

Biological dosimetry of atomic bomb survivors exposed within 500 meters from the hypocenter and the health consequences.

Kamada N.

Department of Cancer Cytogenetics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan. nkamada@ipc.hiroshima-u.ac.jp

Seventy-eight atomic bomb survivors were examined for biological dosimetry using chromosome abnormality. They had been exposed within 500 meters from the hypocenter in heavily shielded conditions and were found from NHK-RIRBM joint study carried out from 1966 to 1971. Estimation of the exposure doses for these survivors was made under the following steps; 1) calculation by DS86 system (physically estimated doses) in survivors who had been exposed within 1,500 meters and had precise records of exposure conditions. RBE for the neutron was defined as 10. 2) setting of exposure dose-chromosome aberration curve, and

3) observation of chromosome aberrations in the proximally exposed survivors, for whom biological doses were estimated. Estimation of the exposure doses were possible from the aberration rate of chromosome in the peripheral lymphocytes, even 25-40 years after the exposure. Of the 78 survivors, 96% were estimated to have exposed more than one Sv. Detection of transforming gene(s) of N and K RAS genes in DNAs from non-leukemic survivors was carried out as one of the biological investigations for these heavily exposed survivors. All four survivors examined showed N or K RAS gene mutation. Three of the four healthy survivors had cancer or leukemia 7-10 years after the examination. Further continuous follow-up study of these heavily exposed people will give us more information on the late effects of A-bomb radiation, which may arise in the future.

PMID: 10805004 [PubMed - indexed for MEDLINE]

in the future. PMID: 10805004 [PubMed - indexed for MEDLINE] 1584: Rinsho Byori. 2000 Mar;48(3):269-75. Related

1584: Rinsho Byori. 2000 Mar;48(3):269-75.

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[A cost-effectiveness analysis of a pre-visit testing system for new outpatients in primary care medicine]

[Article in Japanese]

Takemura Y, Ishida H, Inoue Y, Beck JR.

Pathology/Information Technology Program, Baylor College of Medicine, Houston, Texas 77030-3498, USA.

We evaluated cost-effectiveness parameters of common diagnostic test panels advocated by the Japan Society of Clinical Pathology in order to determine the validity of pre-visit testing of these test panels for new outpatients with some defined symptoms. The "Essential Laboratory Tests(ELT) (2)" panel was universally applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in the National Defense Medical College and its affiliated hospital. A "useful result(UR)", the unit of usefulness of the ELT, was assigned by assessing the impact of its results on physician's diagnosis- or decision- making. Patients were classified into 7 major symptom groups according to their chief complaint, and clinical effectiveness(UR/patient), economic efficiency(cost/UR) and cost-effectiveness(delta cost/delta UR) were analyzed in each patient group. Clinical effectiveness ranged from 1.38(renal/urinary tract symptoms) to 0.27 UR/patient(neurological symptoms) with a cost disparity from yen 1,222 to yen 5,946/UR between these patient groups. Substantial decreases in clinical effectiveness were demonstrated in all patient groups with the ELT(1)- testing alone in a simulation study; however, cost-effectiveness parameters still remain in excellent values in the renal/urinary tract symptom and infection/inflammation-related symptom groups(1.13 and 0.77 UR/patient at a cost of yen 836 and yen 1,181/UR, respectively). The addition of some ELT(2)-

specific test items such as AST, ALT to the ELT(1) baseline panel improved clinical effectiveness of the ELT(1) in lassitude/exhaustive symptom group at a minimal cost increment. This study verified the validity of the ELT(1) as a panel for pre-visit testing in patients with renal/urinary tract symptoms and infection/inflammation-related symptoms, but not in those with other symptoms.

Publication Types:

English Abstract

Research Support, Non-U.S. Gov't

PMID: 10804836 [PubMed - indexed for MEDLINE]

Gov't PMID: 10804836 [PubMed - indexed for MEDLINE] 1585: Public Health. 2000 Mar;114(2):133-6. Related

1585: Public Health. 2000 Mar;114(2):133-6.

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Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh.

Rahman F, Andersson R, Svanström L.

Department of Epidemiology and Biostatistics, Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh.

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post- mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential

sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.

PMID: 10800153 [PubMed - indexed for MEDLINE]

countries. PMID: 10800153 [PubMed - indexed for MEDLINE] 1586: Health Policy Plan. 1999 Dec;14(4):342-53. Related

1586: Health Policy Plan. 1999 Dec;14(4):342-53.

Related Articles,

Links

Plan. 1999 Dec;14(4):342-53. Related Articles , Links National Health Accounts development: lessons from Thailand.

National Health Accounts development: lessons from Thailand.

Tangcharoensathien V, Laixuthai A, Vasavit J, Tantigate NA, Prajuabmoh- Ruffolo W, Vimolkit D, Lertiendumrong J.

Health Systems Research Institute, Thailand.

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in

1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10787650 [PubMed - indexed for MEDLINE]

Gov't PMID: 10787650 [PubMed - indexed for MEDLINE] 1587: Int J Tuberc Lung Dis. 2000 Apr;4(4):345-9.

1587: Int J Tuberc Lung Dis. 2000 Apr;4(4):345-9.

Related Articles,

Links

High rate of non-compliance with anti-tuberculosis treatment despite a retrieval system: a call for implementation of directly observed therapy in Saudi Arabia.

Al-Hajjaj MS, Al-Khatim IM.

King Saud University Medical College, Riyadh, Saudi Arabia. mshajjaj@ksu.edu.sa

SETTING: Taif Chest Hospital, Taif, Saudi Arabia. OBJECTIVES: Non- compliance with anti-tuberculosis drug therapy is recognised as a major cause of treatment failure, drug resistance and relapse. In Saudi Arabia, the problem of non-compliance is frequent and has serious implications which need urgent attention from the health-care authority. The objectives of this study were to define factors that affect compliance rate and to determine the appropriate

methods to modify these factors. DESIGN: We designed and tested a retrieval system to improve patient return for follow-up and drug collection after an initial hospital admission period in a large chest hospital in the western region of the country. RESULTS: Of 628 patients, 358 (57%) did not attend the first out-patient clinic visit. The retrieval system was successful in bringing back only 83 patients, reducing the default rate by only 13.2%. Various factors that may affect compliance were analysed in the remaining 275 (43.8%) non-compliant patients. CONCLUSION: Because many of these factors are difficult to change, we strongly support implementation of the WHO-recommended directly observed treatment (DOT) strategy in Saudi Arabia and other countries facing similar problems with tuberculosis control.

PMID: 10777084 [PubMed - indexed for MEDLINE]

control. PMID: 10777084 [PubMed - indexed for MEDLINE] 1588: Southeast Asian J Trop Med Public Health.

1588: Southeast Asian J Trop Med Public Health. 1999 Sep;30(3):427-31.

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Links

Cost-effectiveness analysis of lambdacyhalothrin-treated nets for malaria control: the patients' perspective.

Butraporn P, Kamolratanakul P, Prasittisuk M, Prasittisuk C, Indaratna K.

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. tmpbt@mahidol.ac.th

The present study was undertaken to evaluate the cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT-spraying as a method of malaria control according to the patients' perspective among migrant populations in a high-risk area along the Thai-Myanmar border in Thailand. Ten hamlets comprising 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets comprising 294 houses and 1,315 inhabitants represented the DDT-treated area and another six hamlets with 171 houses and 695 inhabitants served as controls. Information as to consumer costs was obtained by interviewing 3,214 patients seeking care at all levels of the health care system in the study area. Analysis showed that the impregnated-net program was more cost-effective than the DDT-spraying program or surveillance alone (US$ 0.59 vs US$ 0.74 vs US$ 0.79 per 1 case of prevented malaria). We conclude that in a high-risk area such as along the Thai-Myanmar border in western Thailand, integrating the use of impregnated nets with large-scale primary health care programs is likely to constitute the most cost-effective method for controlling malaria according to the patients' perspective.

Publication Types:

Comparative Study

Research Support, Non-U.S. Gov't

PMID: 10774647 [PubMed - indexed for MEDLINE]

1589: MMWR Morb Mortal Wkly Rep. 2000 Mar 31;49(12):248-53. MMWR Morb Mortal Wkly Rep. 2000 Mar 31;49(12):248-53.

Related Articles,

Links

Rep. 2000 Mar 31;49(12):248-53. Related Articles , Links Imported dengue--United States, 1997 and 1998. Centers for

Imported dengue--United States, 1997 and 1998.

Centers for Disease Control and Prevention (CDC).

Dengue is a mosquito-transmitted acute viral disease caused by one of four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). Dengue is endemic in most tropical areas of the world and has occurred in U.S. residents returning from travel to such areas. CDC maintains a laboratory-based passive surveillance system for imported dengue among U.S. residents. The system relies principally on reports by clinicians to state health departments, which forward patient specimens to CDC for diagnostic testing. This report summarizes information about imported dengue cases among U.S. residents for 1997 and 1998, which indicates that most persons with a known travel history probably acquired infection in the Caribbean islands or Asia.

PMID: 10774545 [PubMed - indexed for MEDLINE]

1590: Southeast Asian J Trop Med Public Health. 1998 Dec;29(4):669-84. Southeast Asian J Trop Med Public Health. 1998 Dec;29(4):669-84.

Related Articles,

Links

Comment in:

Southeast Asian J Trop Med Public Health. 1998 Dec;29(4):667-8.

Application of geographical information systems to co-analysis of disease and economic resources: dengue and malaria in Thailand.

Indaratna K, Hutubessy R, Chupraphawan S, Sukapurana C, Tao J, Chunsutthiwat S, Thimasarn K, Crissman L.

WHO Collaborating Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand. Kaemthong.I@chula.ac.th

Two vector-borne communicable diseases, malaria and dengue, are among a number of diseases of particular importance in relation to economic development in Southeast Asia and thus need to be assessed in relation to economic parameters in the region. Geographical Information Systems (GIS) provide one means of

comparing disease and resource data versus time and place, to facilitate rapid visualization by planners and administrators. Given that Thailand is a global epicenter of multidrug resistant falciparum malaria and of dengue hemorrhagic fever, both of which are mosquito-borne, application of GIS methods to these two diseases gives opportunity for comparison of resource needs and allocation in relation to disease epidemiologic patterns. This study examined per capita gross provincial product (GPPpc) and health care resources in relation to geographic distribution of malaria and dengue in Thailand. The two diseases vary greatly in overall seasonal patterns and in relation to provincial economic status, and present differing demands on resource utilization: planned integration of control of malaria and dengue could utilize such analyses in relation to resource sharing and consideration of allocative efficiency. The concentration of malaria (and to a lesser extent dengue) along international border areas underscores the desirability of multi-country coordination of disease management and control programs. Because socio-economic and disease data are collected by quite different means and in different time frames, there are some limitations to the dynamic interpolation of these two broad data sets, but useful inferences can be drawn from this approach for application to overall planning, at both national and multi- country levels.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10772545 [PubMed - indexed for MEDLINE]

Gov't PMID: 10772545 [PubMed - indexed for MEDLINE] 1591: Turk J Pediatr. 1999;41 Suppl:27-34. Related

1591: Turk J Pediatr. 1999;41 Suppl:27-34.

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Multimedia and children in Turkey.

Tuncer AM, Yalçin SS.

Hacettepe University Institute of Child Health, Ankara, Turkey.

Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood

obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available.

Publication Types:

Review

PMID: 10770073 [PubMed - indexed for MEDLINE]

• Review PMID: 10770073 [PubMed - indexed for MEDLINE] 1592: Turk J Pediatr. 1999;41 Suppl:7-12. Related

1592: Turk J Pediatr. 1999;41 Suppl:7-12.

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Children in Japan and multimedia.

Shimauchi Y.

Benesse Corporation, Japan.

Many parents in Japan today are very concerned and have daily problems with their children over the following kind of issues concerning video games, multimedia, and similar devices. 1) Is children's enthusiasm for video games actually harming their growth (physically or mentally)? 2) Is there any way that video games can help children in the future? For example, will playing these games help children learn to use computers or develop their power of thought? 3) Will excessive enthusiasm for TV games undermine our basic lifestyle? Is the time they spend studying at home or playing outside actually decreasing? 4) Will the methods of communication brought about by computers, pagers, and cellular phones weaken human relations among children? 5) Will being immersed in a virtual world created by computers result in a diminished sense of reality? The causes of this uneasiness may be traced to parents' own anxieties and concerns about the exceedingly rapid growth of the "information society" of today, together with the fact that their children are directly caught up in the deluge of this

information and multimedia society. The development of media has coincided with the growth of today's adults, but children are immersed in a media-filled environment from the day they are born. In Japan, there are now children who can play video games before even learning to write. No one can predict what kind of adults these children will grow to be in the future, and it is fair to say that the most parents and children in Japan are being tossed about on the waves of this information explosion. At this international symposium, we hope to hear the many views that are held around the world concerning children and multimedia.

PMID: 10770069 [PubMed - indexed for MEDLINE]

1593: J Manag Med. 1999;13(2-3):178-89. J Manag Med. 1999;13(2-3):178-89.

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Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine.

Lian PC, Marnoch G.

Department of Management Studies, University of Aberdeen, Scotland, UK.

This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelines- based medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit--less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings.

PMID: 10747449 [PubMed - indexed for MEDLINE]

1594: Top Health Inf Manage. 2000 Feb;20(3):75-9. Top Health Inf Manage. 2000 Feb;20(3):75-9.

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Automation of practice management in a Lebanese University Health Clinic.

Hamadeh G.

Department of Family Medicine, University Health Services, American University of Beirut, Lebanon.

Interest in technology and the recognition that clinical practice analysis data is crucial for planning have stimulated the development of information management solutions at all levels in developing countries. The spectrum of such endeavors remains restrained due to the limitations in human resources skills. This paper describes an inexpensive operation for automating practice analysis in a Lebanese University Health Clinic. The system was developed in piecemeal fashion to accommodate the needs of the staff and their computer expertise. It demonstrates the impact of such automation on patient care, including missing medical records, appointment scheduling, referral rates, and repeat prescriptions.

PMID: 10747437 [PubMed - indexed for MEDLINE]

prescriptions. PMID: 10747437 [PubMed - indexed for MEDLINE] 1595: Mil Med. 2000 Mar;165(3):228-36. Related Articles ,

1595: Mil Med. 2000 Mar;165(3):228-36.

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Shipboard medical admissions during peacetime and combat support deployments.

Blood CG.

Medical Information Systems and Operations Research Department, Naval Health Research Center, San Diego, CA 92186-5122, USA.

Hospitalizations aboard aircraft carriers were examined to ascertain differences in illness type attributable to theater of operations and combat deployment status. Percentage distributions and lengths-of-stay statistics of major diagnostic categories are provided and compared between Vietnam combat support and peacetime modes of operations and between Western Pacific and Mediterranean theaters of operations. Respiratory disease proportions were found to be significantly higher for Vietnam combat support deployments than during subsequent peacetime deployments. For peacetime deployments, the Western Pacific deployments had higher percentages of infective, respiratory, and skin disorders, whereas the Mediterranean theater had a larger proportion of total admissions accounted for by accidents.

Publication Types:

Comparative Study

Historical Article

Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10741089 [PubMed - indexed for MEDLINE]

1596: Sex Transm Dis. 2000 Mar;27(3):138-42. Related Articles , Links Comment in: • Sex Transm

1596: Sex Transm Dis. 2000 Mar;27(3):138-42.

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Comment in:

Sex Transm Dis. 2000 Mar;27(3):143-5.

Epidemiologic trends of sexually transmitted diseases in China.

Chen XS, Gong XD, Liang GJ, Zhang GC.

Department of Epidemiology and Surveillance, National Center for STD and Leprosy Control, Chinese Academy of Medical Sciences, Nanjing.

OBJECTIVE: To describe the current epidemiology of sexually transmitted diseases (STDs), we analyzed the time trends in distribution of reported cases of STDs in China from 1989 to 1998. STUDY DESIGN: Based on the computerized database of the National System of STD Surveillance, a retrospective study of STD cases reported from 1989 to 1998 was carried out. RESULTS: From 1989 to 1998, STD incidence increased significantly in men and women and demonstrated nonlinear growth trends, with the exception of gonorrhea incidence. Between 1990 and 1998, the incidence increased more in females (4.20 times) than that in males (3.79 times). Syphilis incidence increased approximately 20 times during this period at an average annual rate of 52.7%. Gonorrhea incidence increased 2.6 times during this period at an average annual rate of 11.4%, which reached a plateau from 1994 to 1997. Extramarital transmission as source of STD infection has significantly increased from 1995 to 1998. CONCLUSION: The incidence of STDs has continued to increase in China from 1989 to 1998. The epidemic patterns are different from rates in developed counties in which behavior interventions have been successfully implemented, suggesting the need for active behavioral-intervention programs in China.

PIP: To describe the current epidemiology of sexually transmitted diseases (STDs), the authors analyzed the time trends in distribution of reported cases of STDs in China from 1989 to 1998. Based on the computerized database of the National System of STD Surveillance, a retrospective study of STD cases reported from 1989 to 1998 was carried out. From 1989 to 1998, STD incidence increased significantly in men and women and demonstrated nonlinear growth trends, with the exception of gonorrhea incidence. Between 1990 and 1998, the incidence increased more in females (4.20 times) than that in males (3.79 times). Syphilis incidence increased approximately 20 times during this period at an average annual rate of 52.7%. Gonorrhea incidence increased 2.6 times during this period at an average annual rate of 11.4%, which reached a plateau from 1994

to 1997. Extramarital transmission as source of STD infection significantly increased from 1995 to 1998. The incidence of STDs continued to increase in China from 1989 to 1998. The epidemic patterns are different from rates in developed counties in which behavior interventions have been successfully implemented, suggesting the need for active behavioral-intervention programs in China.

Publication Types:

Research Support, Non-U.S. Gov't

PMID: 10726645 [PubMed - indexed for MEDLINE]

Gov't PMID: 10726645 [PubMed - indexed for MEDLINE] 1597: Kekkaku. 2000 Feb;75(2):79-88. Related Articles ,

1597: Kekkaku. 2000 Feb;75(2):79-88.

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[A study on tuberculosis cases among over-staying foreigners]

[Article in Japanese]

Yamamura J,