His 1

1: Lancet. 2008 Jun 28;371(9631):2173-82.
Related Articles, Links
Comment in:
• Lancet. 2008 Jun 28;371(9631):2147-8.
All-cause mortality attributable to chronic kidney disease: a

prospective cohort study based on 462 293 adults in Taiwan.
Wen CP, Cheng TY, Tsai MK, Chang YC, Chan HT, Tsai SP, Chiang PH,
Hsu CC, Sung PK, Hsu YH, Wen SF.
Center for Health Policy Research and Development, National Health Research
Institutes, Zhunan, Taiwan. cwengood@nhri.org.tw
BACKGROUND: Both end-stage renal disease and chronic kidney disease are
increasing worldwide; however, the full effect of chronic kidney disease is
unknown because mortality risks for all five stages are unavailable. We assessed
prevalence and mortality risks for all stages of chronic kidney disease and
quantified its attributable mortality in Taiwan. METHODS: The cohort consisted
of 462 293 individuals aged older than 20 years who participated in a standard
medical screening programme since 1994. As of Dec 31, 2006, we identified 14
436 deaths. Chronic kidney disease was determined by glomerular filtration rate
and urinary protein. We estimated national prevalence in Taiwan from the cohort
by adjusting age and educational levels. Hazard ratios (HRs) were calculated with
Cox proportionate hazards model. We calculated mortality attributable to chronic
kidney disease for national population and for low socioeconomic status.
FINDINGS: The national prevalence of chronic kidney disease was 11.93% (95%
CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were
aware of their disorder. Prevalence was substantially higher in the group with low
socioeconomic status than in the high status group (19.87% [19.84-19.91] vs
7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney
disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-
1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort
that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-
10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were
attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the
low socioeconomic status population. 2350 (39%) deaths occurred before 65
years of age in those with chronic kidney disease. Regular users of Chinese herbal
medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing
chronic kidney disease. INTERPRETATION: The high prevalence of chronic
kidney disease and its associated all-cause mortality, especially in people with
low socioeconomic status, make reduction of this disorder a public-health priority.
Promotion of its recognition through the general public knowing their glomerular
filtration rate and testing their urine is crucial to reduce premature deaths from all
causes and to attenuate this global epidemic.
PMID: 18586172 [PubMed - indexed for MEDLINE]
2: BMC Health Serv Res. 2008 Jun 25;8:138.

Health services research in the public healthcare system in Hong

Kong: an analysis of over 1 million antihypertensive prescriptions
between 2004-2007 as an example of the potential and pitfalls of
using routinely collected electronic patient data.
Wong MC, Jiang JY, Tang JL, Lam A, Fung H, Mercer SW.
General Practice and Primary Care, Division of Community-Based Sciences,

Faculty of Medicine, University of Glasgow, 1 Horselethill Road, Glasgow G12
9LX, UK. wong_martin@cuhk.edu.hk
BACKGROUND: Increasing use is being made of routinely collected electronic

patient data in health services research. The aim of the present study was to
evaluate the potential usefulness of a comprehensive database used routinely in
the public healthcare system in Hong Kong, using antihypertensive drug
prescriptions in primary care as an example. METHODS: Data on
antihypertensive drug prescriptions were retrieved from the electronic Clinical
Management System (e-CMS) of all primary care clinics run by the Health
Authority (HA) in the New Territory East (NTE) cluster of Hong Kong between
January 2004 and June 2007. Information was also retrieved on patients'
demographic and socioeconomic characteristics, visit type (new or follow-up),
and relevant diseases (International Classification of Primary Care, ICPC codes).
RESULTS: 1,096,282 visit episodes were accessed, representing 93,450 patients.
Patients' demographic and socio-economic details were recorded in all cases.
Prescription details for anti-hypertensive drugs were missing in only 18 patients
(0.02%). However, ICPC-code was missing for 36,409 patients (39%). Significant
independent predictors of whether disease codes were applied included patient
age > or = 70 years (OR 2.18), female gender (OR 1.20), district of residence
(range of ORs in more rural districts; 0.32-0.41), type of clinic (OR in Family
Medicine Specialist Clinics; 1.45) and type of visit (OR follow-up visit; 2.39).In
the 57,041 patients with an ICPC-code, uncomplicated hypertension (ICPC K86)
was recorded in 45,859 patients (82.1%). The characteristics of these patients
were very similar to those of the non-coded group, suggesting that most non-
coded patients on antihypertensive drugs are likely to have uncomplicated
hypertension. CONCLUSION: The e-CMS database of the HA in Hong Kong
varies in quality in terms of recorded information. Potential future health services
research using demographic and prescription information is highly feasible but for
disease-specific research dependant on ICPC codes some caution is warranted. In
the case of uncomplicated hypertension, future research on pharmaco-
epidemiology (such as prescription patterns) and clinical issues (such as side-
effects of medications on metabolic parameters) seems feasible given the large
size of the data set and the comparability of coded and non-coded patients.
PMCID: PMC2453117
3: Int J Health Care Qual Assur. 2008;21(3):308-24.

Implementing QA programs in managed care health plans: factors

contributing to success.
Gross R, Ashkenazi Y, Tabenkin H, Porath A, Aviram A.
Myers-JDC-Brookdale Institute, Jerusalem, Israel. Revital@jdc.org.il
PURPOSE: The purpose of this paper is to identify the factors that contribute to
the success or failure of quality assurance programs implemented by Israeli
managed care health plans. DESIGN/METHODOLOGY/APPROACH: An in-
depth study of seven quality assurance programs was conducted, comparing
successful with unsuccessful ones using the comparative "case study" method.
Employing a semi-structured questionnaire, 42 program directors and
professionals in the field were interviewed. FINDINGS: A number of factors
associated with the programs' success emerged. Those external to the program
included: ongoing management support, resource allocation, information system
support and perceived financial benefit for the organization. Internal factors
included: leadership, perceived problem's importance, laying the groundwork in
the field, involving field staff in planning and implementation and staff
motivation. ORIGINALITY/VALUE: The study provides insights into ways to
encourage the implementation of successful quality assurance programs in the
special organizational context of managed care health plans. As the
implementation relies heavily on data, one important precondition is the
development of computerized information systems to facilitate ongoing data
collection. It is also necessary from the planning stage to take into account
organizational factors that affect success.
Publication Types:
• Research Support, Non-U.S. Gov't

Testing not-so-obvious models of healthcare quality.
Badri MA, Attia ST, Ustadi AM.
College of Business Administration, United Arab Emirates University, Al Ain,

United Arab Emirates. Masood@uaeu.ac.ae
PURPOSE: The purpose of this paper is to show that, although there has been
some research to identify the dimensions on which healthcare quality and in-
patient satisfaction should be measured, the confirmation of constructs and
indicators that constitute an overall care quality and satisfaction remains unclear.
The objective is to present several models of service quality and satisfaction in
healthcare for discharged patients; and to test those models in a sample of
discharged patients in public hospitals in the United Arab Emirates.
DESIGN/METHODOLOGY/APPROACH: A detailed in-patient survey (using
interviews) was used. Data were collected with questionnaires from adult
discharges (n = 244) in public hospitals in the UAE. Several structures are
proposed and tested. Confirmatory Factor Analysis (CFA) and LISREL SIMPLIS
using maximum likelihood estimation were used to estimate and test the
parameters of the hypothesized models derived deductively from the previous
literature. FINDINGS: Several models (with one, two, three and four constructs)
with different structures were tested using CFA. The final recommended model is
based on three constructs--quality of care, process and administration, and
information. The goodness-of-fit statistics supported the basic solution of the
healthcare quality-satisfaction model. ORIGINALITY/VALUE: The model has
been found to capture attributes that characterize healthcare quality in a
developing country such as the UAE and could represent other modern healthcare
systems. It can be used as a basis for evaluation in healthcare practices from
discharges (in-patients) point of view. The study highlights the importance of
patients' satisfaction with care as predictors of quality of care. The results also
confirm the construct validity of the previously discussed healthcare quality
scales.
Publication Types:

5: MMWR Surveill Summ. 2008 Jun 20;57(5):24-39.

Malaria surveillance--United States, 2006.
Mali S, Steele S, Slutsker L, Arguin PM; Centers for Disease Control and
Prevention (CDC).
Division of Parasitic Diseases National Center for Zoonotic, Vector-Borne, and

Enteric Diseases, CDC, Atlanta, GA 30341, USA. smali@cdc.gov
PROBLEM/CONDITION: Malaria in humans is caused by intraerythrocytic

protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, and P.
malariae). These parasites are transmitted by the bite of an infective female
Anopheles species mosquito. The majority of malaria infections in the United
States occur among persons who have traveled to areas with ongoing malaria
transmission. In the United States, cases can occur through exposure to infected
blood products, congenital transmission, or local mosquitoborne transmission.
Malaria surveillance is conducted to identify episodes of local transmission and to
guide prevention recommendations for travelers. PERIOD COVERED: This
report summarizes cases in persons with onset of illness in 2006 and summarizes
trends during previous years. DESCRIPTION OF SYSTEM: Malaria cases
confirmed by blood film or polymerase chain reaction (PCR) are mandated to be
reported to local and state health departments by health-care providers or
laboratory staff members. Case investigations are conducted by local and state
health departments, and reports are transmitted to CDC through the National
Malaria Surveillance System (NMSS), National Notifiable Diseases Surveillance
System (NNDSS), and direct CDC consultations. Data from these reporting
systems serve as the basis for this report. RESULTS: CDC received reports of
1,564 cases of malaria among persons in the United States with onset of
symptoms in 2006, six of which were fatal. This is an increase of 2.4% from the
1,528 cases reported for 2005. P. falciparum, P. vivax, P. malariae, and P. ovale
were identified in 39.2%, 17.6%, 2.9%, and 3.0% of cases, respectively. Ten
patients (0.6%) were infected by two or more species. The infecting species was
unreported or undetermined in 36.6% of cases. Compared with 2005, the largest
increases in cases were from Asia (16.0%). Based on estimated volume of travel,
the highest estimated relative case rates of malaria among travelers occurred
among those returning from West Africa. Of 602 U.S. civilians who acquired
malaria abroad and for whom chemoprophylaxis information was known, 405
(67.3%) reported that they had not followed a chemoprophylactic drug regimen
recommended by CDC for the area to which they had traveled. Seventeen cases
were reported in pregnant women, among whom only one reported taking
chemoprophylaxis precautions. Six deaths were reported; five of the persons were
infected with P. falciparum and one with P. malariae. INTERPRETATION:
Despite the 2.4% increase in cases from 2005 to 2006, the numbers of malaria
cases remained relatively stable during 2001--2006. No change was detected in
the proportion of cases by species responsible for infection. U.S. civilians
traveling to West Africa had the highest estimated relative case rates. In the
majority of reported cases, U.S. civilians who acquired infection abroad had not
adhered to a chemoprophylaxis regimen that was appropriate for the country in
which they acquired malaria. PUBLIC HEALTH ACTIONS: Additional
investigations were conducted of the six fatal cases that occurred in the United
States. Persons traveling to a malarious area should take one of the recommended
chemoprophylaxis regimens appropriate for the region of travel and use personal
protection measures to prevent mosquito bites. Any person who has been to a
malarious area and who subsequently has a fever or influenza-like symptoms
should seek medical care immediately and report their travel history to the
clinician; investigation should always include blood-film tests for malaria, with
results made available immediately. Malaria infections can be fatal if not
diagnosed and treated promptly. CDC recommendations concerning malaria
prevention are available at http://wwwn.
cdc.gov/travel/contentdiseases.aspx#malaria or by calling the CDC Malaria
Branch on weekdays (telephone: 770-488-7788; Monday--Friday, 8:00 A.M.--
4:30 P.M. EST); during evenings, weekends, and holidays, call the CDC
Director's Emergency Operations Center (telephone: 770-488-7100), and ask to
page the person on call for the Malaria Branch. Recommendations concerning
malaria treatment are available at
http://www.cdc.gov/malaria/diagnosis_treatment/treatment.htm or by calling the
CDC Malaria Hotline.
Publication Types:
• Case Reports
6: East Mediterr Health J. 2008 Mar-Apr;14(2):366-75.

Profile of paediatric emergency cases in Yemen: the need for

evidence-based guidelines.
Ishak AA, Al-Jayefy NH, Raja'a YA.
Department of Paediatrics, Faculty of Medicine and Health Sciences, Sana'a

University, Sana'a, Yemen.
This study describes the status and characteristics of children presenting to
emergency services in hospitals and health centres in Yemen in order to inform
the development of guidelines for paediatric emergency services. Information was
collected from 7 hospitals and 2 health centres in 5 governorates about 3454
cases, mostly aged < 2 years old. The majority of paediatric emergency cases
were due to respiratory system problems (28.6%) and gastrointestinal problems
(25.5%); 36.4% of children presented with a duration of complaint exceeding 4
days. One-third of cases (33.2%) were treated with 3rd generation cephalosporins
alone or in combination with other antibiotics. The mortality rate was 1.9%. The
most important causes of death were cardiac and respiratory failure.
Publication Types:
• Case Reports
7: World Hosp Health Serv. 2008;44(1):36-8.

E-health readiness assessment: promoting "hope" in the health-care

institutions of Pakistan.
Khoja S, Scott R, Gilani S.
Department of Community Health Sciences, Aga Khan University, Karachi,

Pakistan.
e-Health readiness refers to the preparedness of health-care institutions to

implement programmes that involve use of Information and Communication
Technology (ICT) in provision and management of health services. Level of
readiness depends on a number of factors that lead to success or failure of e-health
programmes, and thus increase or decrease hope of achieving the desired results.
This report presents results from in-depth interviews conducted during a larger
study and presents views of managers and health-care providers from various
institutions in Pakistan about the usefulness of e-health readiness assessment
tools. Participants emphasized the need for implementing e-health programmes in
the country, while appreciating the need for readiness assessment tools, and the
way these tools could avoid failures related to implementation of e-health
programmes. Participants also linked e-health readiness with the process of
change management, essential for sustainable implementation of e-health
programmes in the health-care institutions of developing countries.
8: J Pak Med Assoc. 2008 Mar;58(3):138-9.

Institutional and surveillance database use in epidemiologic research

in developing countries: revisiting some limitations.
Younus M, Siddiqi AE, Khan BS, Steffey AL.
Department of Epidemiology, College of Human Medicine, Michigan State

University, East Lansing, Michigan, USA.
Publication Types:
• Review
9: Qual Health Res. 2008 Jun;18(6):747-55.

Where do they go, whom do they consult, and why? Health-seeking

behaviors in the northern areas of Pakistan.
Shaikh BT, Haran D, Hatcher J.
University of Liverpool, Liverpool, United Kingdom.
This study presents an ethnographic account of health-seeking behaviors and

determinants of health service utilization of people living in the rural Northern
Areas of Pakistan. Data was gathered from 2004 to 2005 through 10 gender-
specific focus group discussions. Sociodemographic characteristics, economic
conditions, cultural forces, physical and environmental conditions, and health care
service features form the behaviors. The complex composition of health care
systems drives us to study the most intricate phenomenon of health care-seeking
behaviors. Inappropriate or delayed health care-seeking could lead to undesirable
health outcomes, high fertility, unwanted pregnancies, medical complications, and
amplified susceptibility to future illnesses. At times it results in a significant
economic burden when a simple illness becomes drawn out because of improper
health-seeking behaviors. This study is an effort to present relevant information to
the policy makers to reorient the health care services to make them more
acceptable. It is recommended that this research be used for designing behavior
change communication modules or social marketing campaigns in raising
awareness about health in the community and sensitizing health care providers to
the needs of their clients.
Publication Types:
10: Isr Med Assoc J. 2008 Mar;10(3):207-13.

Factors contributing to compliance with osteoporosis medication.
Kertes J, Dushenat M, Vesterman JL, Lemberger J, Bregman J, Friedman

N.
Maccabi HealthCare Services, Israel. dortal_j@mac.org.il
BACKGROUND: Bisphosphonates are effective in the prevention and treatment

of osteoporosis, yet their use is suboptimal. OBJECTIVES: To measure
bisphosphonate compliance among first-time users and identify factors associated
with compliance. METHODS: We conducted a prospective follow-up of all
women aged 45+ in the second largest health management organization in Israel
who were prescribed bisphosphonates for the first time. The 4448 women were
classified by drug dosage. Persistence and adherence measures of compliance
were calculated for each woman over a 1 year period. RESULTS: Mean
bisphosphonate persistence over a year was 216 days, with a mean medication
possession ratio of 66%. Women whose medication was changed, whether from
weekly to daily or daily to weekly, always had better persistence rates than those
who consistently took the original dose. Persistence rates were as follows: 264
days for women who switched back and forth between daily and weekly doses,
229 days for those who switched from daily to weekly, 222 days for those who
took the dosage weekly only, 191 days for those who switched to daily dosage,
and 167 days for those who took the dosage daily only (P < 0.001). Switchers
were also more likely to have adequate adherence rates (MPR > or = 80%):
81.3%, 76.6%, 67.5%, 61.3% and 52.2% respectively (P < 0.001). More than 20%
of women stopped taking their medication within the first month. Women with
higher supplemental insurance (offering significant discounts for weekly dose
medications) had better persistence rates: 221 vs. 208 days (P = 0.03). Younger
women and women on national pension insurance had the lowest persistence
rates: 204 and 209 days respectively. CONCLUSIONS: While weekly
bisphosphonate takers had better compliance rates, persistence and adherence
rates were inadequate for all groups. Changing medication to meet the needs of
the patient, discounting weekly medications, and providing follow-up within the
first months of prescription may promote compliance.
11: Health Serv Manage Res. 2008 May;21(2):106-16.

The effects of the global budget system on cost containment and the
quality of care: experience in Taiwan.
Chang L, Hung JH.
Department of Business Administration, Shih Hsin University, Taipei, Taiwan.
This study is an attempt to determine whether the implementation of the Global

Budget (GB) as a method of health reform has improved cost containment and
quality of care in Taiwan. Panel-data analysis is used to investigate cost
containment and quality of care in Taipei municipal hospitals before and after the
introduction of the GB. The results suggest that there is a trade-off effect. The
post-GB data indicate that cost containment comes at the expense of health-care
quality. It may, therefore, be the case that policy-makers can more effectively
balance cost containment and quality by refining the GB so that reimbursements
would be linked to standards of quality. Another way to enhance the reforms
would be a more effective monitoring and review system.
12: Pharmacoepidemiol Drug Saf. 2008 Jun;17(6):609-19.

The prescribing of Chinese herbal products in Taiwan: a cross-

sectional analysis of the national health insurance reimbursement
database.
Hsieh SC, Lai JN, Lee CF, Hu FC, Tseng WL, Wang JD.
Division of Health Technology Assessment, Center for Drug Evaluation, Taipei,

Taiwan.
PURPOSE: The consumption of Chinese herbal products (CHPs) is increasing
exponentially. However, the scientific evidence is lacking and there is an urgent
requirement for detailed pharmacoepidemiological information on CHP usage.
This study was to investigate CHP prescription patterns in Taiwan. METHODS:
We carried out a cross-sectional analysis on a cohort of 200,000 patients based on
2004 data from the National Health Insurance (NHI) reimbursement database.
Data mining techniques were applied to explore CHP co-prescription patterns.
RESULTS: A total of 46,938 patients had been prescribed CHPs on at least one
occasion in 2004. Patients using CHPs were generally female and middle-aged,
made more outpatient visits, had fewer hospitalizations and consumed more
medical resources than non-users of CHPs. A total of 1,073,030 CHPs were
contained within 220,123 prescriptions, for which acute nasopharyngitis was the
most common indication. Yan hu suo and Jia Wei Xiao Yao San were the most
frequently prescribed single herb (SH) and herbal formula (HF), respectively. The
results of the data mining showed that the best predictions were provided by co-
prescriptions of 'Mo yao and Ru xiang', 'Ye jiao teng and Suan Zao Ren Tan' and
'Dang Gui Nian Tong Tang and Shu Jing Huo Xue Tang' in the groups of SH-SH,
SH-HF and HF-HF, respectively. CONCLUSIONS: This study provides national-
level CHP prescription profiles and utilization rates, and documents, for the first
time, HF-HF prescription combinations in Chinese medicine (CM) practices in
Taiwan. We conclude that more studies are needed to validate the safety and
effectiveness of CHP prescriptions.
Publication Types:
13: Natl Med J India. 2008 Jan-Feb;21(1):14-20.

Road traffic deaths, injuries and disabilities in India: current

scenario.
Gururaj G.
Department of Epidemiology, WHO Collaborating Centre for Injury Prevention

and Safety Promotion, National Institute of Mental Health and Neuro Sciences,
Bangalore 560029, Karnataka, India. guru@nimhans.kar.nic.in
In 2005, road traffic injuries resulted in the death of an estimated 110,000

persons, 2.5 million hospitalizations, 8-9 million minor injuries and economic
losses to the tune of 3% of the gross domestic product (GDP) in India. If the
present trend continues, India will witness the deaths of 150,000 persons and
hospitalization of 3 million people annually by 2010, increasing further to
200,000 deaths and more than 3.5 million hospitalizations annually by 2015.
Nearly 10%-30% of hospital registrations are due to road traffic injuries and a
majority of these people have varying levels of disabilities. A majority of victims
of road traffic injuries are men in the age group of 15-44 years and belong to the
poorer sections of society. Also, a vast majority of those killed and injured are
pedestrians, motorcyclists and pillions riders, and bicyclists. A clearly defined
road safety policy, a central coordinating agency, allocation of adequate
resources, strict implementation of proven and effective interventions and reliable
information systems are urgently required. Greater participation from health and
other sectors based on an integrated, intersectoral and coordinated approach is
essential. Health professionals can contribute in numerous ways and should take a
lead role in reducing the burden of road traffic injuries in India.
Publication Types:
• Review
14: ScientificWorldJournal. 2008 Apr 14;8:350-6.

Referral criteria from community clinics to pediatric emergency

departments.
Urkin J, Segal I, Barak N, Press J.
Primary Care Unit, Faculty of Health Sciences, Ben-Gurion University of the

Negev, Beer-Sheva, Israel. medcad@bgu.ac.il
Referral of patients to a pediatric emergency department (PED) should be

medically justified and the need for referral well communicated. The objectives of
this paper were (1) to create a list of criteria for referral from the community to
the PED, (2) to describe how community physicians categorize their need for
referral, and (3) to determine agreement between the physician's referral letter and
the selected criteria. We present a descriptive study of referrals to the PED of
Soroka University Medical Center, Beer-Sheva, Israel, during February to April
2003. A list of 22 criteria for referral was created, using the Delphi method for
reaching consensus. One or more criteria could be selected from this list for each
referral, by the referring community physicians and, independently, based on the
physicians' referral letters, by two consultants, and compared. There were 140
referrals included in the study. A total of 262 criteria for referral were selected by
the referring community physicians. The criteria most frequently selected were:
"Need for same-day consultation/laboratory/imaging result not available in the
community" (32.1%), "Suspected life- or organ-threatening infection" (16.4%),
and "Need for hospitalization" (15.7%). Rates of agreement regarding criteria for
referral between the referring physicians and the two consultants, and a senior
community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%,
respectively. We conclude that the standard referral letter does not convey in full
the level of need for referral to the PED. A list of criteria for referral could
augment efficient utilization of emergency department services and improve
communication between community physicians and the PED.
15: J Clin Pharm Ther. 2008 Jun;33(3):243-9.

Patterns of combined prescriptions of aspirin-Ginkgo biloba in

Taiwan: a population-based study.
Chang LC, Huang N, Chou YJ, Kao FY, Hsieh PC, Huang YT.
Institute of Traditional Medicine, School of Medicine, National Yang Ming

University, and Committee on Chinese Medicine and Pharmacy, Department of
Health, Executive Yuan, Taipei, Taiwan.
BACKGROUND AND OBJECTIVES: Although interactions between aspirin

and Ginkgo biloba extract (GBE) have been documented, the extent to which
these two drugs are used in combination remains unclear. The aim of this study
was to estimate the extent and utilization patterns of combined prescriptions of
aspirin and GBE in Taiwan based on an analysis of a nationwide database.
METHODS: A representative nationwide sample of 200 000 National Health
Insurance (NHI) beneficiaries in Taiwan was used. The prescription details of
ambulatory care claims for this sample of beneficiaries for the period 1997-2003
were analysed. The prevalence of aspirin and GBE prescriptions was evaluated.
The extent of co-prescription of the two drugs was assessed together with the
associated patient characteristics. RESULTS: There was an increase in the
number of aspirin prescriptions (from 29 986 out of 2 454 879 (1.2%) in 1997, to
50 614 out of 2 499 605 (2.0%) in 2003). Aspirin was mostly prescribed to
patients over 50 years old. The percentage of prescriptions with aspirin increased
rapidly from 57% to 84%, among those over 50 years old. The number of
prescriptions with GBE also increased from 3039 to 6171 and 78-84% was
prescribed to those 50 years or older. During the study period, combined
prescriptions of aspirin and GBE dramatically increased four times. Most
prescriptions were longer than 14 days and 42.4% of combined prescriptions were
found to be at the same ambulatory care visit. CONCLUSION: The findings of
this study suggest that there is an increasing trend in co-prescription of aspirin and
GBE for Taiwan's elderly population during 1997-2003. This trend is of concern
and worthy of note.
16: Yakugaku Zasshi. 2008 May;128(5):709-16.

[Elucidation of structures and functions through Peyer's patches of

responsible carbohydrate chains in intestinal immune system
modulating polysaccharides from Japanese medicinal herbs]
[Article in Japanese]
Kiyohara H, Matsuzaki T, Matsumoto T, Nagai T, Yamada H.
Graduate School of Infectious Control, Kitasato University, Tokyo, Japan.
Carbohydrate chains in glycoconjugates play important roles in various life

phenomena, and there are numerous types of recognition system for carbohydrate
chains due to carbohydrate-lectin interactions/carbohydrate-carbohydrate
interactions in all higher life forms. It has been proposed that macromolecular
polysaccharides isolated from plants, marine organisms, or fungi cross-interact
with known and unknown recognition systems in mammals to express their
pharmacological activities. Therefore the elucidation of carbohydrate structures
related to the activities and functions of these polysaccharide molecules will lead
us to utilize the related information in the development of novel carbohydrate-
based drugs and functional foods for human health care. Peyer's patches present in
the upper intestinal tract play important roles as inductive sites for both protective
IgA production and immune tolerance induction in mucosal and systemic immune
systems. Dysfunction of the immunocompetent cells of Peyer's patches is thought
to induce allergic/autoimmune diseases and down-regulation of the protective
system against infectious agents on mucosal sites. We have isolated several
Peyer's patch cell-modulating polysaccharides from medicinal herbs used in
traditional Japanese herbal remedies, and they have been assumed to comprise the
responsible carbohydrate chains with oligosaccharide sizes for expression of
modulating activity. Accumulation of knowledge on the structures and functions
of these responsible carbohydrate chains in polysaccharide molecules is believed
to be important for the development of methodology for logically factitious
regulation of functions of immunocompetent cells in Peyer's patches. This review
deals with recent results of our study on the structural clarification of responsible
carbohydrate chains in modulating polysaccharides against functions of
immunocompetent cells in Peyer's patches.
Publication Types:
• English Abstract
• Review
17: Health Care Women Int. 2008 May;29(5):527-38.

Jordanian women's experiences with the use of traditional family

planning.
Khalaf IA, Abu-Moghli F, Callister LC, Rasheed R.
University of Jordan Faculty of Nursing, Amman, Jordan.
The United Nations Population Fund (UNFPA) and the Hashemite Kingdom of
Jordan Ministry of Health (MOH) have identified the importance of strengthening
national capacity through the integration of reproductive health (RH) services into
the primary health care system. It is reported that a high percentage of Jordanian
women use traditional family planning (TFP) methods, frequently using them
incorrectly. Our purpose in this qualitative descriptive study was to explore the
issues and challenges related to the use of TFP among Jordanian women. Six
focus groups with women of childbearing age (18-44 years of age; n = 51) were
held in the northern, central, and southern regions of Jordan. Study participants
used traditional methods such as withdrawal, periodic abstinence, and
breastfeeding. Often TFP methods were used incorrectly, resulting in a high
failure rate with unplanned pregnancies occurring within short inter pregnancy
intervals. Women preferred using TFP because of side effects experienced while
using modern family planning (MFP) methods, misconceptions, and lack of
correct information about MFP methods. Husbands often declined to use condoms
but supported the use of TFP methods. Women indicated that they have unmet
needs for family planning and that they would consider using MFP methods if
accurate information was available at health centers. They emphasized the
importance of competent and knowledgeable health care providers (HCPs) who
contribute to decision making regarding use of family planning.
Publication Types:

18: Pharmacoepidemiol Drug Saf. 2008 Jun;17(6):593-600.

A comparison of measures of disproportionality for signal detection

on adverse drug reaction spontaneous reporting database of
Guangdong province in China.
Li C, Xia J, Deng J, Jiang J.
Department of Health Statistics, Fourth Military Medical University, Xi'an,

China.
PURPOSE: To examine the concordance of various measures to Bayesian

Confidence Propagation Neural Network (BCPNN) measure used by the WHO
Collaborating Centre for International Drug Monitoring based on the database of
Guangdong province in China. METHODS: The Reporting Odds Ratio (ROR)--
1.96 standard errors (SE), Proportional Reporting Ratio (PRR)--21.96 SE,
combination chi (2)-PRR measure used by the Medicines and Healthcare Products
Regulatory Agency (MHRA) were compared with the IC--2 standard deviations
(SDs) with the tested database collected from 1 January 2002 to 30 June 2007 in
Guangdong. Additionally, the concordance of the various measures, in respect to
the number of reports per combination, was examined. RESULTS: Sensitivity,
specificity, positive predictive value and negative predictive value were high in
respect to the BCPNN measure when a combination of point and interval estimate
was used based on four types of signal detection for the ROR and PRR measures,
and the four evaluation indexes increased when A (the number of reports per
combination) increased. However the MHRA measure had decreasing sensitivity
and increasing specificity with A increasing. CONCLUSIONS: The ROR, PRR
and BCPNN measures used are broadly comparable when three or more cases per
combination have been collected. The MHRA measure is comparable to the
BCPNN when seven or less case per combination have been collected for 'drug-
ADR', 'drug category-ADR', 'drug-ADR category' combinations based on the
Guangdong database, and the MHRA is unsuitable for detecting signals from
'drug category-ADR category' combinations based on the Guangdong database
because of its low sensitivity.
Publication Types:
• Comparative Study

19: J Med Assoc Thai. 2007 Oct;90 Suppl 1:21-31.
Costs of payment in Thai acute coronary syndrome patients.
Moleerergpoom W, Kanjanavanit R, Jintapakorn W, Sritara P.
Cardiology Unit, Department of Medicine, Police General Hospital, Pratumwan,

Bangkok 10330, Thailand. drworachat@hotmail.com
BACKGROUND: Acute coronary syndrome (ACS) is a major health care

syndrome that can financially burden patients throughout the world, including
Thailand. Few studies purposed estimating the costs of treatment. The data from
the ACS registry database represented the costs of hospital charges paid by ACS
patients. Although these were not the actual treatment costs, the authors can
approximately estimate the total expenditure for the first admission.
OBJECTIVES: First, calculate the cost of ACS to the patients, including
diagnostic, demographic data, treatment modalities, type of payers, hospital
profile, and outcomes. Second, find the appropriate model to identify the
independent factors for predicting the treatment costs. MATERIAL AND
METHOD: The present study collected data from the second and third phase of a
national multicenter prospective registry of ACS in Thailand, Thai ACS registry
(TACSR). 3,552 patients with new onset of ACS were analyzed. RESULTS:
Median age was 67 years (range 26.5-105.5) with predominately male and median
length of stay (LOS) was 7 days (range, 1-184). 42% referred from other
hospitals. The median cost of the total population was 47,908 baht (range, 633-
1,279,679). When classified into those of STEMI, NSTEMI, and UA, the costs
were 82,848.5, 40,531 and 26,116 baht respectively, p < 0.0001. Patients in the
government hospital had to pay the total cost with PCI and CABG, 152,081-
161,374 baht and 203,139-223,747 baht respectively, while the private hospital
charged almost twice as much. For the types of payers, private insurance
including private employee security fund paid significantly more than others.
Costs in patients paid by "30 baht na tional health scheme and social security
fund" were significantly less than those of others. For modality of treatment in
STEMI, primary PCI was significantly more costly than thrombolytics and no
reperfusion therapy, 161,096.5 vs. 60,043.0 and 33,335.0 baht respectively p <
0.0001. Early invasive groups in NSTEMI/UA had much higher median costs
145,794.0 baht when compared to those of the conservative group, 47,908 baht, p
< 0.0001. Two multiple linear regression models according to the diagnostic
group identified the independent factors for predicting cost. PCI, LOS, CABG,
admission in a private hospital, Death, GPIIb/IlIa inhibitors use, major bleeding,
coronary angiogram, thrombolytics use, age and diabetes were independent
predictors for the cost in STEMI patients, R2 = 0.58. For those of NSTEMI/UA,
the independent predictors for the cost were PCI, LOS, CABG, admission in a
private hospital, death, GP IIb/IIIa inhibitors use, major bleeding, coronary
angiogram, age, ventricular arrhythmia, CHF and referred patients, R2 =0.62.
CONCLUSION: Costs in ACS patients were markedly different among
diagnostic groups. The clinical risk factors were hospital type, type of payers,
referred system, treatment procedures, drugs used and complications including
outcome. Some of these factors could independently predict the costs.
Publication Types:
• Multicenter Study
20: Ment Health Today. 2008 Mar:16-7.

Partnerships work. Interview by Harriet Pearce-Willis.
Wilson M, Hackett R.
Publication Types:
• Interview
21: BMC Health Serv Res. 2008 Apr 17;8:87.

An assessment of technology-based service encounters & network

security on the e-health care systems of medical centers in Taiwan.
Chang HH, Chang CS.
Dept. of Business Administration, National Cheng Kung University, 1 University

Rd,, Tainan City 701, Taiwan. easyhhc@mail.ncku.edu.tw
BACKGROUND: Enhancing service efficiency and quality has always been one
of the most important factors to heighten competitiveness in the health care
service industry. Thus, how to utilize information technology to reduce work load
for staff and expeditiously improve work efficiency and healthcare service quality
is presently the top priority for every healthcare institution. In this fast changing
modern society, e-health care systems are currently the best possible way to
achieve enhanced service efficiency and quality under the restraint of healthcare
cost control. The electronic medical record system and the online appointment
system are the core features in employing e-health care systems in the technology-
based service encounters. METHODS: This study implemented the Service
Encounters Evaluation Model, the European Customer Satisfaction Index, the
Attribute Model and the Overall Affect Model for model inference. A total of 700
copies of questionnaires from two authoritative southern Taiwan medical centers
providing the electronic medical record system and the online appointment system
service were distributed, among which 590 valid copies were retrieved with a
response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural
Relationship Model (LISREL 8.54) to analyze and evaluate the data. RESULTS:
The findings are as follows: (1) Technology-based service encounters have a
positive impact on service quality, but not patient satisfaction; (2) After
experiencing technology-based service encounters, the cognition of the service
quality has a positive effect on patient satisfaction; and (3) Network security
contributes a positive moderating effect on service quality and patient satisfaction.
CONCLUSION: It revealed that the impact of electronic workflow (online
appointment system service) on service quality was greater than electronic
facilities (electronic medical record systems) in technology-based service
encounters. Convenience and credibility are the most important factors of service
quality in technology-based service encounters that patients demand. Due to the
openness of networks, patients worry that transaction information could be
intercepted; also, the credibility of the hospital involved is even a bigger concern,
as patients have a strong sense of distrust. Therefore, in the operation of
technology-based service encounters, along with providing network security, it is
essential to build an atmosphere of psychological trust.
PMCID: PMC2364621
22: Value Health. 2008 Mar;11 Suppl 1:S52-60.

A difficult balancing act: policy actors' perspectives on using

economic evaluation to inform health-care coverage decisions under
the Universal Health Insurance Coverage scheme in Thailand.
Teerawattananon Y, Russell S.
Health Intervention and Technology Assessment Program (HITAP), Ministry of

Public Health, Thailand. yot@ihpp.thaigov.net
OBJECTIVES: In Thailand, policymakers have come under increasing pressure to

use economic evaluation to inform health-care resource allocation decisions,
especially after the introduction of the Universal Health Insurance Coverage (UC)
scheme. This article presents qualitative findings from research that assessed a
range of policymakers' perspectives on the acceptability of using economic
evaluation for the development of health-care benefit packages in Thailand. The
policy analysis examined their opinions about existing decision-making processes
for including health interventions in the UC benefit package, their understanding
of health economic evaluation, and their attitudes, acceptance, and values relating
to the use of the method. METHODS: Semistructured interviews were conducted
with 36 policy actors who play a major role or have some input into health
resource allocation decisions within the Thai health-care system. These included
14 senior policymakers at the national level, 5 hospital directors, 10 health
professionals, and 7 academics. RESULTS AND CONCLUSIONS: Policy actors
thought that economic evaluation information was relevant for decision-making
because of the increasing need for rationing and more transparent criteria for
making UC coverage decisions. Nevertheless, they raised several difficulties with
using economic evaluation that would pose barriers to its introduction, including
distrust in the method, conflicting philosophical positions and priorities compared
to that of "health maximization," organizational allegiances, existing decision-
making procedures that would be hard to change, and concerns about political
pressure and acceptability.
Publication Types:
23: Jpn J Clin Oncol. 2008 May;38(5):327-33. Epub 2008 Apr 11.
Cancer control activities in the Republic of Korea.
Yoo KY.
National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-

do 410-769, Republic of Korea. kyyoo@ncc.re.kr
South Korea has a population of 47.3 million. The whole population is covered by
a mandatory social insurance system (the National Health Insurance Program) that
is financed through the contributions paid by the insured and their employers.
Cancer has been the leading cause of death in Korea since 1983. About 130 000
people develop cancer annually with 66 000 deaths in 2006. Cancer patients' 5-
year survival rates between 1998 and 2002 were 37.8 and 57.0% for men and
women, respectively. The five leading primary cancer sites were stomach, lung,
liver, colon and rectum, and bladder among males, whereas the most common
cancers were stomach, breast, colon and rectum, uterine cervix and lung among
females. With the rapidly aging population, reducing cancer burden at the national
level has become one of the major political issues in Korea. The government
formulated its first 10-year plan for cancer control in 1996. In 2000, the National
Cancer Center was created and the Cancer Control Division was set up within the
Ministry of Health and Welfare. The Cancer Control Act was legislated in 2003.
Korea's major national cancer control programs are anti-smoking campaigns,
hepatitis B virus vaccination, cancer registration and networking, promotion of
R&D activities for cancer control, education and training for cancer control and
prevention, operation of the national cancer information center, operation of the
mass screening program for five common cancers, management of cancer patients
at home, financial support for cancer patients and designation of regional cancer
centers.
24: BMC Public Health. 2008 Apr 12;8:118.

The influences of Taiwan's generic grouping price policy on drug

prices and expenditures: evidence from analysing the consumption
of the three most-used classes of cardiovascular drugs.
Chen CL, Chen L, Yang WC.
The Department of Accounting, The College of Business, Chung Yuan Christian

University, Chung-Li City, Taoyuan County 320, Taiwan.
d90722002@ntu.edu.tw
BACKGROUND: Controlling the growth of pharmaceutical expenditures is a

major global challenge. Promotion of generic drug prescriptions or use is gaining
increased support. There are substantial contextual differences in international
experiences of implementing pharmaceutical policies related to generic drugs.
Reporting these experiences from varied perspectives can inform future policy
making. This study describes an experience of Taiwan, where patients with
chronic (long-term) conditions are usually managed in hospitals and drugs are
provided in this setting with costs reimbursed through the National Health
Insurance (NHI). It investigates the effects of Taiwan's reimbursement rate
adjustment based on chemical generic grouping in 2001. This research also
demonstrates the use of micro-level longitudinal data to generate policy-relevant
information. The research can be used to improve efficiency of health care
resource use. METHODS: We chose the three most-used classes of
cardiovascular drugs for this investigation: beta blocking agents, calcium channel
blockers mainly with vascular effects, and plain ACE inhibitors. For each drug
class, we investigated changes in daily expense, consumption volume, and total
expenditures from a pre-action period to a corresponding post-action period. We
compared an exposure or "intervention" group of patients targeted by the action
with a comparisonor "control" group of patients not targeted by the action. The
data sources are a longitudinal database for 200,000 NHI enrolees, corresponding
NHI registration data of health care facilities, and an archive recording all
historical data on the reimbursement rates of drugs covered by the NHI. We
adopted a fixed effects linear regression model to control for unobserved
heterogeneity among patient-hospital groups. Additional descriptive statistics
were applied to examine whether any inappropriate consumption of drugs in the
three classes existed. RESULTS: The daily drug expense significantly decreased
from the pre-action period to the post-action period for the exposure group. The
average magnitudes of the decreases for the three classes of drugs mentioned
above were 14.8%, 5.8% and 5.8%, respectively. In contrast, there was no
reduction for the comparison group. The number of days of the prescription
increased significantly from the pre- to the post-action period for both exposure
and comparison groups. The total expense also significantly increased for both
patient groups. For the exposure group, the average magnitudes of the growth in
the total expenditure for the three classes of drugs were 47.7%, 60.0% and 55.3%,
respectively. For the comparison group, they were 91.6%, 91.6% and 63.2%,
respectively. After the action, approximately 50% of patients obtained more than
180 days of prescription drugs for a six-month period. CONCLUSION: The 2001
price adjustment action, based on generic grouping, significantly reduced the
daily expense of each of the three classes of cardiovascular drugs. However, in
response to this policy change, hospitals in Taiwan tended to greatly expand the
volume of drugs prescribed for their regular patients. Consequently, the total
expenditures for the three classes of drugs grew substantially after the action.
These knock-on effects weakened the capability of the price adjustment action to
control total pharmaceutical expenditures. This means that no saved resources
were available for other health care uses. Such expansion of pharmaceutical
consumption might also lead to inefficient use of the three drug classes: a large
proportion of patients obtained more than one day of drugs per day in the post-
action period, suggesting manipulation to increase reimbursement and offset price
controls. We recommend that Taiwan's government use the NHI data to establish
a monitoring system to detect inappropriate prescription patterns before
implementing future policy changes. Such a monitoring system could then be
used to deter hospitals from abusing their prescription volumes, making it
possible to more effectively save health care resources by reducing drug
reimbursement rates.
Publication Types:
PMCID: PMC2377257
25: Fukuoka Igaku Zasshi. 2008 Jan;99(1):13-23.

Cell phone e-mail as a means to collect information on pregnancy

and delivery: a pilot study in Japan.
Hirano YO, Hirata N.
Department of Health Sciences, Faculty of Medical Sciences, Kyushu University,

Fukuoka, Japan. hirano@shs.kyushu-u.ac.jp
BACKGROUND: The diffusion of cell phones is 91.9% in Japan. Especially, cell

phone e-mail is now widely used as a media source in Japan. The authors of this
research have been engaged in collecting basic data to establish a system for
providing improved health information on pregnancy and delivery through cell
phones for pregnant women and their family members. OBJECTIVE: In this
study, we classified the trends of health information of pregnancy and delivery in
which people desire to obtain through cell phone based on the characteristics of
the information and, of each classification we revealed the generic characteristic
(age, gender, gestational weeks and any other children), any social support, the
types of cell phones or/and computers and their related use. METHODS:
Anonymous questionnaires were distributed to the participants of delivery
preparation workshops held at two places in the northern parts of Kyushu Area to
collect data. The cell phone e-mail usage trends were measured by four-rated
scales. To classify the characteristics of the information, a Principal Factor
Analysis was conducted. To find out correlation between the information
classified and the generic characteristics, Mann-Whitney's U-test was conducted.
RESULTS: Out of two hundred and fifteen (215) respondents including 117
pregnant women and 98 husbands, 208 respondents possessed cell phones.
Regarding the health information of pregnancy and delivery desired to obtain
through cell phone e-mail, two factors, namely "medical information" and "non-
medical information" have derived. Those who did not possess computers tended
to use their cell phone e-mail to obtain both "medical information" (P = .002) and
"non-medical information" (P = .02). While those who use cell phone e-mail
almost everyday tended to use cell phone e-mail for obtaining "non-medical
information" (P = .02). CONCLUSION: This study indicated that providing
medical information and non-medical information through cell phone e-mail is an
essential service, especially in Japan, where the diffusion of cell phones is far
higher than that of computers.
Publication Types:
26: J Occup Health. 2008 Mar;50(2):103-13.

Patterns of outpatient visits by Japanese male expatriates in

Thailand.
Sakai R, Wongkhomthong SA, Marui E, Laobhripatr S.
Department of Public Health, Juntendo University School of Medicine, Japan.

riesakai@med.juntendo.ac.jp
Objective of this study is to clarify the health-related conditions of Japanese male

expatriates in Thailand. Records of Japanese male expatriates in their 30s to 50s
who consulted outpatient clinics at Bangkok Hospital in 2005 were analyzed for
number and type of outpatient visits then compared with data from the "Patient
Survey" 2005 for age-matched males in Japan. "Diseases of the respiratory
system" and "Certain infectious and parasitic diseases" had a higher rate of
diagnosis among Japanese men living in Thailand than those living in Japan.
"Endocrine, nutritional and metabolic diseases," and "Mental and behavioral
disorders" had a lower rate of diagnosis among Japanese men living in Thailand
than those in Japan. "Acute upper respiratory infections" accounted for 87.4% of
"Diseases of the respiratory system" and "intestinal infections" accounted for
59.9% of "Certain infectious and parasitic diseases" among expatriates. Japanese
male expatriates have a tendency of not visiting hospital when they have no
subjective or objective symptoms. To support a healthy expatriate life, health
information should be propagated widely and available support services, such as
counseling via e-mail or fax, should be actively promoted. Expatriates should be
informed of the availability of these services before they go abroad and during
their stay.
Publication Types:
27: J Health Popul Nutr. 2007 Dec;25(4):436-47.

Development and management of a geographic information system

for health research in a developing-country setting: a case study
from Bangladesh.
Sugimoto JD, Labrique AB, Ahmad S, Rashid M, Klemm RD, Christian P,

West KP Jr.
Center for Human Nutrition, Department of International Health, Johns Hopkins

Bloomberg School of Public Health, Baltimore, MD 21205, USA.
In the last decade, geographic information systems (GIS) have become accessible
to researchers in developing countries, yet guidance remains sparse for
developing a GIS. Drawing on experience in developing a GIS for a large
community trial in rural Bangladesh, six stages for constructing, maintaining, and
using a GIS for health research purposes were outlined. The system contains 0.25
million landmarks, including 150,000 houses, in an area of 435 sq km with over
650,000 people. Assuming access to reasonably accurate paper boundary maps of
the intended working area and the absence of pre-existing digital local-area maps,
the six stages are: to (a) digitize and update existing paper maps, (b) join the
digitized maps into a large-area map, (c) reference this large-area map to a
geographic coordinate system, (d) insert location landmarks of interest, (e)
maintain the GIS, and (f) link it to other research databases. These basic steps can
produce a household-level, updated, scaleable GIS that can both enhance field
efficiency and support epidemiologic analyses of demographic patterns, diseases,
and health outcomes.
Publication Types:

• Research Support, U.S. Gov't, Non-P.H.S.
28: Int J Technol Assess Health Care. 2008 Spring;24(2):235-40.

Analysis of strengths, weaknesses, opportunities, and threats in the
development of a health technology assessment program in Turkey.
Kahveci R, Meads C.
Ministry of Health, Ankara, Turkey. drrabiakahveci@yahoo.com
OBJECTIVES: The Turkish healthcare system is currently undergoing reform,

and efficient use of resources has become a key factor in determining the
allocation of resources. The objective of this study was to analyze strengths,
weaknesses, opportunities, and threats (SWOT) in the development of a health
technology assessment (HTA) program in Turkey. METHODS: A SWOT
analysis was performed using a literature review and interviews with key people
in the Turkish Ministry of Health and Ministry of Labor and Social Security.
RESULTS: Regarding recent reforms in health care, investments for information
network and databank are the strengths, but the traditional "expert-based" decision
making, poor availability of data, and poor quality of data could be seen as some
of the weaknesses. Another major weakness is lack of general awareness of HTA.
Increasing demand for transparency in decision making, demand for evidence,
and demand for credibility by decision makers are some of the opportunities, and
current healthcare reforms, i.e., restructuring of healthcare and general health
insurance, could also be seen as major opportunities. These opportunities
unfortunately could be threatened by lack of funding, and resources are
challenged by large, recent national investments. CONCLUSIONS: There is a
good opportunity for Turkey to use the skills in HTA currently being developed
through activities in Europe and the Americas to assist in the development of a
much more cost-effective and transparent healthcare system in Turkey.
29: Hong Kong Med J. 2008 Apr;14(2):97-102.

Clinical profile of young children with mental retardation and

developmental delay in Hong Kong.
Tang KM, Chen TY, Lau VW, Wu MM.
Child Assessment Service, Department of Health, Hong Kong.

kitty_tang@dh.gov.hk
OBJECTIVE: To report the clinical profile of children with mental retardation

and developmental delay diagnosed by the Child Assessment Service. DESIGN:
Retrospective study. SETTING: Child Assessment Service, Department of
Health, Hong Kong. PARTICIPANTS: Data pertaining to the children with
mental retardation and developmental delay were drawn from an in-house clinical
information system in the year 2004. MAIN OUTCOME MEASURES: Clinical
profiles including: sources, reasons and age of referral, diagnosis, gender ratio,
co-morbidities, and socio-economic background. RESULTS: In 2004, 23% (1463
of 6439) of Child Assessment Service referrals were diagnosed to have mental
retardation or developmental delay. The Family Health Service was the major
source of referral (64%). The majority (93%) of children were referred before the
age of 6 years. The most common reason for referral was language delay (39%).
More boys were affected (3 boys: 1 girl). The two most common co-morbidities
were autistic spectrum disorders (33% in mental retardation and 19% in
developmental delay) and discrepant language delay (17% in mental retardation
and 47% in developmental delay). The socio-economic status of these families
was higher than those in the general population. CONCLUSION: The data
presented here provide information on the descriptive epidemiology of mental
retardation and developmental delay among Hong Kong children. Since mental
retardation and developmental delay are common developmental disabilities in
Hong Kong, public health education to promote and ensure early screening and
identification of cases is an important prelude to early training and guidance for
families with children having these conditions.
30: J Eval Clin Pract. 2008 Jun;14(3):368-77. Epub 2008 Mar 24.
Using quality report cards for reshaping dentist practice patterns: a

pre-play communication approach.
Lin C, Lin CM.
Department of Industrial Management Science and Institute of Information

Management, National Cheng Kung University, Tainan, Taiwan.
linn@mail.ncku.edu.tw
Rationale, aims and objectives Understanding how information disclosure

influences dentists' patterns of practice change is important in developing quality-
improvement policies and cost containment. Thus, using quality report cards is a
promising strategy for investigating whether dentists will reshape their patterns of
practice because of the influence of peer comparison. Methods Based on the
coordination game, a data warehouse decision support system (DWDSS) was
used as a pre-play communication instrument, along with the disclosure of quality
report cards, which allow dentists to search their own service rates of dental
restoration and restoration replacement as well as compare those results with
others. Results and conclusions The group using the DWDSS had a greater
decrease in two indicators (i.e. service rates of dental restoration and restoration
replacement) than the dentists who did not use it, which implies that the DWDSS
is a useful facility for helping dentists filter and evaluate information for
establishing the maximum utility in their practice management. The disclosure of
information makes significant contributions to solving managerial problems
associated with dentists' deviation of practice patterns.
Publication Types:
31: Health Serv Res. 2008 Apr;43(2):675-92.

Risks and causes of hospitalizations among physicians in Taiwan.
Lin CM, Yang CH, Sung FC, Li CY.
Department of Health Care Management, National Taipei College of Nursing,

#89, Neichiang St., Taipei 10842, Taiwan.
OBJECTIVES: To assess the causes and cause-specific risks of hospitalization

among physicians in Taiwan. DATA SOURCE: The data used in this study were
retrieved from filed claims and registries of the National Health Insurance
Research Database. A cohort of 33,380 physicians contracted with the national
insurance program between 1997 and 2002 were linked to the information on the
inpatient claim data for hospitalization. STUDY DESIGN: The physicians'
incidence density of hospitalization was compared with that of the general
population, other health personnel, and nurses to compute the calendar year-, age-
, and gender-standardized hospitalization ratios (SHRs). A multivariate log-linear
model was also used to assess the effects of gender, age, type of contract, and
specialty on the risks of hospitalization. PRINCIPAL FINDINGS: Compared with
the general population, physicians experienced significantly reduced risks of all
causes (SHR=54.5, 95 percent confidence interval [CI] 53.4-55.5) and all major
cause-specific hospitalizations, especially mental disorders (SHR=6.9, 95 percent
CI 5.8-8.4). On the other hand, compared with other health personnel, physicians
had a small but significantly higher risk of all causes of hospitalization
(SHR=107.8, 95 percent CI 105.1-110.6). Higher risks of hospitalization were
also noted for neoplasms (SHR=108.9, 95 percent CI 102.0-116.3) and diseases of
the respiratory system (SHR=114.2, 95 percent CI 107.3-121.5). In addition to the
above diagnoses, physicians also had significantly higher risks for genitourinary
and musculoskeletal system and connective tissue problems than nurses.
Compared with their physician colleagues, female physicians, young (<30 years)
and older (> or =60 years) physicians, and those working with the health
institutions and programs were at elevated risks of hospitalization for all causes as
well as for certain specific diseases. CONCLUSIONS: Physicians in Taiwan are
at higher risks of developing specific diseases compared with their allied health
colleagues. As the health of physicians is vital to the quality of care, Taiwanese
health policy analysts should recognize that increased patient volume and
satisfaction with public health care should not be achieved at the expense of
physicians' health.
Publication Types:
PMCID: PMC2442372 [Available on 04/01/10]
32: Pharmacogenomics. 2008 Feb;9(2):235-46.

Taiwan Biobank: a project aiming to aid Taiwan's transition into a

biomedical island.
Fan CT, Lin JC, Lee CH.
National Tsing Hua University, Institute of Law for Science and Technology,
Bioethics and Law Center, Hsinchu City, Taiwan. fanct@ms31.hinet.net
Essentially, the term 'biobank' can be defined in different ways. Taking the UK
Biobank's experience as the main example, the Taiwan Biobank aims to collect
the DNA of a large group of people on the population base and track their health
and lifestyle for at least 10 years. It is hoped that the information collected,
regarding the mechanisms underlying how genes and environmental factors
interact with each other to make us ill, will benefit the society in various ways,
including the exploration of a new generation of treatments, support to preventive
medicine discovery and also the possible benefits for the promotion of evolving
public health-related industries in Taiwan. However, the involvement of large-
scale population base gene data collection also triggered serious ethical, legal and
social issues. In Taiwan, the challenge is even more serious than for any other
biobanking experiences that have occurred previously. Among all the ethical,
legal and social issues, the convergence of aboriginal people protection provided
under Taiwan's Constitution imposes on the research team an obligation to create
an innovative Ethical & Legal Governance Framework adaptable to the unique
social background of Taiwan, including a workable public
consultation/communication mechanism. In early 2005, the creation of the
'Taiwan Biobank' has been included as a part of Taiwan's strategic development in
promoting the country as an island of biomedicine. In this report, the ideology, the
goals and special features, government strategy, visions and, in particular, the
ethical, legal and social issue planning of the Taiwan Biobank will be briefly
introduced and reviewed.
Publication Types:
• Review
33: Bull World Health Organ. 2008 Mar;86(3):221-8.

Cost and effectiveness analysis of immunization service delivery

support in Andhra Pradesh, India.
Suraratdecha C, Ramana CV, Kaipilyawar S, Krishnamurthy , Sivalenka S,

Ambatipudi N, Gandhi S, Umashankar K, Cheyne J.
PATH, 1455 NW Leary Way, Seattle, WA 98107, USA. csuraratdecha@path.org
The immunization service delivery support (ISDS) model was initiated in Andhra
Pradesh, India, in November 2003 with the aim of strengthening immunization
services through supportive supervision. The ISDS model involves a well-
established supervision system built upon the existing health infrastructure. The
objectives of this approach are to: (1) identify areas of high performance and
those that need improvement, (2) assist staff in identifying and correcting wrong
practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective
actions at appropriate levels through information sharing. An evaluation of cost
and effectiveness of ISDS in 16 districts that participated in the programme found
that the incremental cost associated with three rounds of supportive supervision
visits was approximately US$ 110,630 (US$ 36,877 per round). The performance
of health centre and immunization sessions was evaluated using 43- and 28-point
checklists, respectively, and demonstrated significant improvement during and
following the two-year implementation of ISDS. The average percentage change
in health centre performance scores from baseline to the fourth round of
evaluation was approximately 36%, and immunization session performance
scores increased by an average of 9%. The incremental costs per additional per
cent increase in average health centre performance score and per additional per
cent increase in average immunization session performance score over the
evaluation period were estimated to be US$ 3091 and US$ 12,760, respectively.
The incremental cost-effectiveness ratios are relatively sensitive to personnel and
travel costs. Integration of ISDS into the Andhra Pradesh immunization system is
projected to result in a 39% potential cost savings per round of supervision visit.
34: Int J Environ Health Res. 2008 Apr;18(2):117-27.

The weather watch/warning system for stroke and asthma in South

Korea.
Kim J, Ha JS, Jun S, Park TS, Kim H.
Korean Health Insurance Review Agency, Seoul, Korea.
Weather watch/warning systems have been established for human health

outcomes. Our study aims to develop and demonstrate a weather watch/warning
system for asthma and stroke within the whole of South Korea, using a stratified
regression approach. We converted claim-based health insurance data covering
almost all medical claims for the only health insurance system in Korea for
asthma and stroke from 1996-2003 into personalized disease episode data, and
combined them with meteorological data. We utilized a step-wise regression
method using factors extracted from the meteorological data to develop stratified
models for six (stroke) and nine (asthma) regional and day-of-week strata.
Validation studies showed that the actual number of hospitalizations in 2003
increased according to the three-leveled predictions (levels I, II, and III) from the
model based on the 1996-2002 data. This system is accessible via the internet
(http://industry.kma.go.kr/APP/sub_APP15_H01.htm) at the Korean
Meteorological Administration website.
Publication Types:

• Validation Studies
35: J Infect Dis. 2008 Feb 15;197 Suppl 1:S7-13.

China's heath care system and avian influenza preparedness.
Kaufman JA.
AIDS Public Policy Project, John F Kennedy School of Government, Harvard

University, Cambridge, MA 02138, USA. joan_kaufman@harvard.edu
The severe acute respiratory syndrome crisis exposed serious deficiencies in

China's public health system and willingness to report outbreaks of threats to
public health. Consequently, China may be one of the weak links in global
preparedness for avian influenza. China's rural health care system has been
weakened by 20 years of privatization and fiscal decentralization. China plays a
huge role in the global poultry industry, with a poultry population of 14 billion
birds, 70%-80% of which are reared in backyard conditions. Although
surveillance has been strengthened, obstacles to the timely reporting of disease
outbreaks still exist. The weakened health care system prevents many sick people
from seeking care at a health care facility, where reporting would originate.
Inadequate compensation to farmers for culled birds leads to nonreporting, and
local officials may be complicit if they suspect that reporting might lead to
economic losses for their communities. At the local level, China's crisis-
management ability and multisectoral coordination are weak. The poor quality of
infection control in many rural facilities is a serious and well-documented
problem. However, traditions of community political mobilization suggest that the
potential for providing rural citizens with public health information is possible
when mandated from the central government. Addressing these issues now and
working on capacity issues, authority structures, accountability, and local
reporting and control structures will benefit the control of a potential avian
influenza outbreak, as well as inevitable outbreaks of other emerging infectious
diseases in China's Pearl River Delta or in other densely populated locations of
animal husbandry in China.
Publication Types:

• Review
36: J Nurs Care Qual. 2008 Apr-Jun;23(2):177-83.

A crisis: fear toward a possible H5N1 pandemic.
Tzeng HM, Yin CY.
School of Nursing, Division of Nursing Business and Health Systems, University

of Michigan, Ann Arbor, MI 48109, USA. tzenghueyming@yahoo.com
This survey investigated individuals' fear when faced with a possible H5N1
human-to-human pandemic. It was conducted in Taiwan toward the end of 2005
with 452 participants, including physicians, nurses, and university students. The
results showed that for physicians and nurses, the perceived possibility of an
avian flu outbreak and the belief that hospitals lacked sufficient infection control
measures contributed to their personal fear of an avian flu epidemic. For students,
the perceived possibility of avian flu being a threat to humans contributed to their
personal fear. With sufficient, up-to-date information, unnecessary fear, and/or
panic can be avoided.
37: Natl Med J India. 2007 Nov-Dec;20(6):307-10.

Health information management: an introduction to disease

classification and coding.
Mony PK, Nagaraj C.
Institute of Population Health and Clinical Research (IPHCR), St John's National

Academy of Health Sciences, Koramangala, Bangalore 560034, Karnataka, India.
prem_mony@iphcr.res.in
Morbidity and mortality data constitute an important component of a health

information system and their coding enables uniform data collation and analysis
as well as meaningful comparisons between regions or countries. Strengthening
the recording and reporting systems for health monitoring is a basic requirement
for an efficient health information management system. Increased advocacy for
and awareness of a uniform coding system together with adequate capacity
building of physicians, coders and other allied health and information technology
personnel would pave the way for a valid and reliable health information
management system in India. The core requirements for the implementation of
disease coding are: (i) support from national/institutional health administrators,
(ii) widespread availability of the ICD-10 material for morbidity and mortality
coding; (iii) enhanced human and financial resources; and (iv) optimal use of
informatics. We describe the methodology of a disease classification and
codification system as also its applications for developing and maintaining an
effective health information management system for India.
Publication Types:
• Review
38: Natl Med J India. 2007 Nov-Dec;20(6):294-6.

Are we really making motherhood safe? A study of provision of iron

supplements and emergency obstetric care in rural Maharashtra.
Chaturvedi S, Ranadive B.
Foundation for Research in Community Health, At/p Relegan Siddhi, Taluka

Parner, Ahmednagar, Maharashtra, India. sarika_bharat@rediffmail.com
BACKGROUND: The Government of India launched the National Rural Health

Mission (NRHM) in 2005 to improve healthcare delivery and strengthen the
public health system. Prevention and management of anaemia during pregnancy
and access to quality emergency obstetric care services are important factors in
reducing maternal mortality, which is a priority goal in the NRHM. We studied
the ground realities specific to the availability of maternity services in the public
health system of Maharashtra. METHODS: The study was done in the rural areas
of Ahmednagar district in Maharashtra in 2006. Data regarding the number and
place of deliveries, and details regarding iron supplements received and used were
collected from 14 primary health centres selected by a stratified random method.
Data regarding the number of caesarean section operations conducted in 3
selected rural hospitals and the availability of iron supplements at the district
headquarters were also obtained. Three questionnaires were used in the format
prescribed under the Right to Information Act of the Government of India, 2005.
RESULTS: No iron supplement was available during the entire year in 21% of
primary health centres. Iron supplements were available for 1-4 months, 5-8
months and 9-11 months, in 4, 3 and 4 primary health centres, respectively. The
district headquarters did not receive supplies of iron supplements during the year
from higher authorities. No caesarean sections were done in any of the selected
rural hospitals during 2006. The proportion of deliveries that took place in
primary health centres and subcentres, at home, and at private healthcare facilities
was 1:1.5:5. CONCLUSION: Essential supplies such as iron supplements are in
short supply and emergency obstetric care services are nonexistent in the public
health system in our study area. The NRHM needs to address the ground realities
to make motherhood safe.
39: Community Dent Oral Epidemiol. 2008 Apr;36(2):149-56.

Contributions of social context to inequality in dental caries: a

multilevel analysis of Japanese 3-year-old children.
Aida J, Ando Y, Oosaka M, Niimi K, Morita M.
Department of Preventive Dentistry, Division of Oral Health Science, Hokkaido

University Graduate School of Dental Medicine, Sapporo, Japan.
BACKGROUND: Community context as well as individual health behavior

affects oral health status. However, the contribution of social context to dental
caries among people in various regions remains unclear when individual health
behavior is taken into account. OBJECTIVES: To determine the influence of
community context on dmft among 3-year-old children. METHODS: After all
Japanese municipalities (n = 2522) had been stratified into nine regions with three
caries levels, 44 municipalities were randomly selected. Community health
service workers were asked to collect information on sociodemographic
characteristics, oral health-related behavior, and dental condition for 3-year-old
children during community dental health check-ups. Community-related
variables, including socioeconomic status, social support, and social cohesion,
were obtained from census data. Multilevel analysis was used to determine the
effects of social context and individual behavior on dental caries. RESULTS: A
total of 3301 parents (79.9%) of 3-year-old children from 39 municipalities
participated in our survey, and complete information was obtained from 3086 of
them. Results of the analysis showed that 90.8% (P < 0.001) of variance in dmft
occurred at the individual level and that 9.2% (P < 0.001) of the variance occurred
at the community level. Individual-level variables explained only 6.6% of the
individual level variance in dmft. Community-level variables explained 47.2% of
the community level variance. CONCLUSIONS: There are statistically significant
effects of social context on dmft in municipalities in Japan.
40: Mil Med. 2008 Feb;173(2):155-8.

Characteristics of deployed Operation Iraqi Freedom military

personnel who seek mental health care.
Felker B, Hawkins E, Dobie D, Gutierrez J, McFall M.
Department of Veterans Affairs Puget Sound Health Care System, Mental Illness
Education and Clinical Center, Seattle, WA 98108-1597, USA.
INTRODUCTION: This study reports on the feasibility of using validated mental

health screening instruments for deployed Operation Iraqi Freedom military
personnel. METHODS: For a 3-month period in 2005, all service members
(N=296) who initially presented to the U.S. Military Hospital Kuwait mental
health clinic completed an intake questionnaire that gathered demographic
information and contained validated instruments to screen for mental disorders
and functional impairment. RESULTS: A total of 19% of the sample subjects
screened positive for post-traumatic stress disorder-related symptoms, 35% for a
major depressive disorder, and 11% for severe misuse of alcohol. Significant
levels of distress and functional impairment were reported by 58% of the sample.
Women represented a disproportionately high percentage of those presenting for
care (27%). CONCLUSIONS: Screening instruments were well accepted and
useful in detecting psychopathological conditions and functional impairment.
Female service members might represent a high-risk group. These results are
useful for those caring for service members during or after deployment.
41: Mil Med. 2008 Feb;173(2):119-28.

The Joint Medical Workstation (JMeWS) database in 2003:

intradeployment health encounters of military personnel supporting
Operations Enduring Freedom and Iraqi Freedom.
Hooper TI, DeBakey SF, Bellis KS, Cox KL, Gackstetter GD.
Department of Preventive Medicine and Biometrics, Room A1040G, Uniformed

Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda,
MD 20814-4712, USA.
The Joint Medical Work Station (JMeWS) is a theater medical surveillance

system that integrates information from three separate health data collection
systems for the Army, Navy, Air Force, and Marines. Our objective was to
characterize JMeWS data during its first year of implementation in 2003. We
conducted a descriptive analysis of health events documented in JMeWS among
military personnel deployed to Operations Enduring Freedom and Iraqi Freedom.
Among the 38,498 individuals (7.8%) with a JMeWS record, women, college-
educated, older individuals, and Reserve/Guard personnel were over-represented.
There was wide variability by service (Air Force, 25%; Army, 5.5%; Marine
Corps, 1.2%; and Navy, 0.6%). The most common diagnoses were in the
categories of injury and poisoning, respiratory conditions, and musculoskeletal
disorders. Differences in distribution of the various patient encounter modules in
theater likely resulted in variable data capture across services. System
enhancements should improve future applications.
Publication Types:
42: J Med Syst. 2008 Feb;32(1):37-41.

A co-payment for consultant services: primary care physicians'

referral actualization.
Vardy DA, Freud T, Sherf M, Spilberg O, Goldfarb D, Cohen AD, Mor-

Yosef S, Shvartzman P.
Clalit Health Services, Southern district, POB 616, Beer-Sheva 84105, Israel.
dvardy@bgu.ac.il
Prospective evaluation of the effect of a new copayment for specialists

consultations on actualization of referrals (2,432 patient), was examined.
Actualization of the appointment, reasons for not actualizing, and
sociodemographic characteristics were recorded. Actualization was 85.1% in
community consultation clinics and 91.7% in hospital outpatient clinics. The main
reasons for non actualization were: inability to reach the clinic (53.4%), the
problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that
they did not actualize a past consultant visit due to co-payment. Referring
physicians noted that co-payment had some effect on their decision, especially
with the elderly or lower income patients. A relatively small compulsory co-
payment was not found to have a long term effect on utilization of specialists'
services.
Publication Types:

43: J Med Syst. 2008 Feb;32(1):31-5.

A decision support system for telemedicine through the mobile

telecommunications platform.
Eren A, Subasi A, Coskun O.
Faculty of Engineering, Electronics Engineering Department, Biomedical

Engineering Division, Erciyes University, Kayseri, Turkey.
In this paper we have discussed the application of artificial intelligence in

telemedicine using mobile device. The main goal of our research is to develop
methods and systems to collect, analyze, distribute and use medical diagnostics
information from multiple knowledge sources and areas of expertise. Physicians
may collect and analyze information obtained from experts worldwide with the
help of a medical decision support system. In this information retrieval system,
modern communication tools such as computers and mobile phones can be used
efficiently. In this work we propose a medical decision support system using the
general packet radio service (GPRS). GPRS, a data extension of the mobile
telephony standard Global system for mobile communications (GSM) is emerging
as the first true packet-switched architecture to allow mobile subscribers to
benefit from high-speed transmission rates and run JAVA based applications from
their mobile terminals. An academic prototype of a medical decision support
system using mobile device was implemented. The results reveal that the system
could find acceptance from the medical community and it could be an effective
means of providing quality health care in developing countries.
44: J Health Popul Nutr. 2007 Sep;25(3):302-11.

Causes of death among women aged 10-50 years in Bangladesh,

1996-1997.
Yusuf HR, Akhter HH, Chowdhury ME, Rochat RW.
Department of Global Health, Rollins School of Public Health, Emory University,

Atlanta, Georgia, USA.
Limited information is available at the national and district levels on causes of
death among women of reproductive age in Bangladesh. During 1996-1997,
health-service functionaries in facilities providing obstetric and maternal and
child-heath services were interviewed on their knowledge of deaths of women
aged 10-50 years in the past 12 months. In addition, case reports were abstracted
from medical records in facilities with in-patient services. The study covered
4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%)
occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes,
6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and
medical causes during pregnancy respectively. Cardiac problems (11.7%),
infectious diseases (11.3%), and system disorders (9.1%) were the major medical
causes of deaths. Pregnancy-associated causes included direct maternal deaths
(20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest
proportion of deaths among women aged 10-19 years was due to injuries (39.3%)
with suicides accounting for 21.7%. The largest proportion of direct obstetric
deaths occurred among women aged 20-29 years (30.5%). At least one quarter
(24.3%) of women (n = 28,998) did not receive any treatment prior to death, and
47.8% received treatment either from a registered physician or in a facility. More
focus is needed on all causes of deaths among women of reproductive age in
Bangladesh.
Publication Types:
45: Ann Acad Med Singapore. 2008 Feb;37(2):118-27.

Bridging the gap between primary and specialist care--an

integrative model for stroke.
Venketasubramanian N, Ang YH, Chan BP, Chan P, Heng BH, Kong KH,
Kumari N, Lim LL, Phang JS, Toh MP, Widjaja S, Wong LM, Yin A, Cheah
J.
Department of Neurology, National Neuroscience Institute, Jalan Tan Tock Seng,

Singapore. ramani_nv@nni.com.sg
Stroke is a major cause of death and disability in Singapore and many parts of the
world. Chronic disease management programmes allow seamless care provision
across a spectrum of healthcare facilities and allow appropriate services to be
brought to the stroke patient and the family. Randomised controlled trials have
provided evidence for efficacious interventions. After the management of acute
stroke in a stroke unit, most stable stroke patients can be sent to their family
physician for continued treatment and rehabilitation supervision. Disabled stroke
survivors may need added home-based services. Suitable community resources
will need to be harnessed. Clinic-based stroke nurses may enhance service
provision and coordination. Close collaboration between the specialist and family
physician would be needed to right-site patients and also allow referrals in either
direction where necessary. Barriers to integration can be surmounted by trust and
improved communication. Audits would allow monitoring of care provision and
quality care enhancement. The Wagner model of chronic care delivery involves
self-management support, shared clinical information systems, delivery system
redesign, decision support, healthcare organisation and community resources. The
key and critical feature is the need for an informed, activated (or motivated)
patient, working in collaboration with the specialist and family physician, and a
team of nursing and allied healthcare professionals across the continuum of care.
The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded
by the Ministry of Health will test such an integrative system.
46: Acta Med Okayama. 2008 Feb;62(1):15-20.

A prototype model using clinical document architecture (CDA) with

a Japanese local standard : designing and implementing a referral
letter system.
Yong H, Jinqiu G, Ohta Y.
Department of Medical Informatics, Okayama University Graduate School of

Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
hvangy@md.okayama-u.ac.jp
Since clinical document architecture (CDA) became an American National

Standards Institute (ANSI)-approved health level seven (HL7) Standard, many
countries have begun making an effort to make local standards conform to CDA.
In order to make CDA compatible with the many different local standards existing
in different countries, we designed a prototype model using HL7 CDA R2 with
medical markup language (MML), a Japanese medical data exchange standard.
Furthermore, a referral letter system based on this model was developed.
Archetypes were used to express medical concepts in a formal manner and to
make 2 different standards work collaboratively. We share herein the experience
gathered in designing and implementing a referral letter system based on HL7
CDA, Release 2 (CDA R2). We also outline the challenges encountered in our
project and the opportunities to widen the scope of this approach to other clinical
documents.
47: Postgrad Med J. 2008 Feb;84(988):87-92.

Recent epidemiological changes in meningococcal disease may be

due to the displacement of serogroup A by serogroup C in Hefei
City, China.
Ni JD, Jin YH, Dai B, Wang XP, Liu DQ, Chen X, Zheng Y, Ye DQ.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui

Medical University, 81 Meishan Road, Hefei, Anhui 230032, PR China.
OBJECTIVES: To determine the change in epidemiological characteristics of

meningococcal disease in the Hefei City area and to provide valuable information
for developing timely and appropriate public health interventions. METHODS:
Meningococcal disease was identified according to the National Disease
Surveillance System. Data were collected using standardised questionnaires.
Serological and bacteria culture testing was performed on cerebrospinal fluid and
serum specimens from suspected cases for evidence of Neisseria meningitidis
infection. RESULTS: From July 2003 to June 2007, meningococcal disease was
confirmed in 386 cases in the total population. This worked out at an annual
incidence of 1.19-2.86 per 100,000 population, which was significantly higher
than that in 2002-3 (0.27 cases per 100,000 population). The increase in incidence
was accompanied by a shift in age distribution, more cases being reported in
adolescents and young adults: the median age increased to 15 years (range 2
months to 78 years). When assessed by age group, middle-school students (aged
12-17) had the highest incidence (6.57 per 100 000 population) and the highest
proportion (31.4%). The N meningitidis serogroup was identified in 135 (35.0%)
of the cases of meningococcal disease; all were serogroup C. No cases due to
serogroup A or other strains were found during the study period. The mean case-
fatality rate was 7.3%, with a peak of 16.9% in children younger than 6. Since
winter 2003, a vaccination campaign has been partially implemented, but the
effectiveness has been limited. CONCLUSIONS: The incidence of
meningococcal disease has substantially increased in Hefei City, which may be
due to the replacement of serogroup A by serogroup C. A shift in age distribution
of cases to adolescents and young adults was found.

48: Int J Drug Policy. 2008 Feb;19(1):90-3. Epub 2006 Dec 11.
The use of rapid assessment methodology to compliment existing

national assessment and surveillance data: a study among injecting
drug users in Penang, Malaysia.
Vicknasingam B, Navaratnam V.
National Centre for Drug Research, University Sains Malaysia, 11800 Penang,
Malaysia. vickna@usm.my
The study explores how data collated from rapid assessment can enhance those
produced by national level surveillance systems, in this case the national drug
information (NADI) system in Malaysia. Qualitative data were collected in
keeping with internationally accepted guidance on rapid assessment methods in
the field of substance use. An inductive research strategy was employed. The
rapid assessment produced multiple data on local drug use practices and how
these were influenced by the contexts of use. The assessment points to the
importance of collecting data not only on patterns of drug use but also on the
health and social consequences of drug use. We suggest that the current national
drug information system places greater emphasis on behavioural and health-
related variables in order to better understand the potential relationships between
drug use and health-related risk, including HIV/AIDS.
Publication Types:
49: Trop Med Int Health. 2008 Apr;13(4):532-40. Epub 2008 Feb 27.
Typhoid fever in children in Africa.
Mweu E, English M.
Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine

Research, Nairobi, Kenya, and College of Health Sciences, University of Nairobi,
Nairobi, Kenya.
Estimates for the year 2000 suggested that there were approximately 21.5 million
infections and 200,000 deaths from typhoid fever globally each year, making the
disease one of the most serious infectious disease threats to public health on a
global scale. However, these estimates were based on little data, especially from
Africa. Global prominence and high-profile outbreaks have created the perception
in Kenya that typhoid is a common cause of febrile illness. The Widal test is used
widely in diagnosis. We have reviewed recent literature, taking the perspective of
a healthcare provider, to collate information on the prevalence of typhoid in
children particularly, and to explore the role of clinical diagnosis and diagnosis
based on a crude, but common, interpretation of the Widal test. Data suggest that
typhoid in children in rural Africa is uncommon, perhaps 100 times or 250 times
less common than invasive disease because of Haemophilus influenzae or
Streptococcus pneumoniae, respectively. Frequent use of the Widal test may
result in many hundreds of over-treatment episodes for every true case treated and
may perpetuate the perception that typhoid is common. Countries such as Kenya
need better bacterial disease surveillance systems allied to better information for
healthcare providers to promote appropriate decision-making on prevention and
treatment strategies.
Publication Types:

• Review
50: Seishin Shinkeigaku Zasshi. 2007;109(10):935-9.

[Interpretation of information from psychiatric hospitals--

innovation of the health care system and selection of psychiatric
service facilities]
Nakatani S.
51: BMC Pregnancy Childbirth. 2008 Feb 28;8:6.

A prospective key informant surveillance system to measure
maternal mortality - findings from indigenous populations in
Jharkhand and Orissa, India.
Barnett S, Nair N, Tripathy P, Borghi J, Rath S, Costello A.
UCL Centre for International Health and Development, Institute of Child Health,
University College London, 30 Guilford Street, London, WC1N 1EH, UK.
sarahalbarnett@googlemail.com
BACKGROUND: In places with poor vital registration, measurement of maternal

mortality and monitoring the impact of interventions on maternal mortality is
difficult and seldom undertaken. Mortality ratios are often estimated and policy
decisions made without robust evidence. This paper presents a prospective key
informant system to measure maternal mortality and the initial findings from the
system. METHODS: In a population of 228 186, key informants identified all
births and deaths to women of reproductive age, prospectively, over a period of
110 weeks. After birth verification, interviewers visited households six to eight
weeks after delivery to collect information on the ante-partum, intra-partum and
post-partum periods, as well as birth outcomes. For all deaths to women of
reproductive age they ascertained whether they could be classified as maternal,
pregnancy related or late maternal and if so, verbal autopsies were conducted.
RESULTS: 13 602 births were identified, with a crude birth rate of 28.2 per 1000
population (C.I. 27.7-28.6) and a maternal mortality ratio of 722 per 100 000 live
births (C.I. 591-882) recorded. Maternal deaths comprised 29% of all deaths to
women aged 15-49. Approximately a quarter of maternal deaths occurred ante-
partum, a half intra-partum and a quarter post-partum. Haemorrhage was the
commonest cause of all maternal deaths (25%), but causation varied between the
ante-partum, intra-partum and post-partum periods. The cost of operating the
surveillance system was US$386 a month, or US$0.02 per capita per year.
CONCLUSION: This low cost key informant surveillance system produced high,
but plausible birth and death rates in this remote population in India. This method
could be used to monitor trends in maternal mortality and to test the impact of
interventions in large populations with poor vital registration and thus assist
policy makers in making evidence-based decisions.
Publication Types:
PMCID: PMC2268911
52: Obes Rev. 2008 Mar;9 Suppl 1:74-7.
The cost of obesity in Hong Kong.
Ko GT.
Department of Medicine and Therapeutics, The Chinese University of Hong

Kong, Hong Kong, China. garyko@cuhk.edu.hk
Obesity is now being considered a rapid growing economic burden on the

healthcare system of many countries. These costs should include expenditure on
prevention, as well as the investigation and treatment of obesity and its related
problems. Accurate information on the cost of obesity in Hong Kong is lacking so
we analysed the annual hospital discharges in a representative district hospital in
Hong Kong. The estimated hospitalization costs in Hong Kong' public hospitals
were HK$ 2.29 billion (US$ 0.29 billion) in 1998 and HK$ 3.36 billion (US$ 0.43
billion) in 2002 accounting for 8.2-9.8% of total public expenditure on health in
Hong Kong. Based on the likelihood ratio of diabetes, hypertension and
dylsipidaemia related to obesity in Hong Kong Chinese (defined as body mass
index > or = 25 kg m(-2)) the estimated proportion of these conditions attributable
to obesity are 10-20%. In addition, significant amounts of money are being spent
by the public on obesity self management schemes of no proven benefit. In 2005,
5.5% of Hong Kong's total population was consuming proprietary drugs for
obesity or its related conditions. To properly assess the overall costs of obesity,
other indirect costs should also be considered such as economic losses on sick
leave because of obesity and its related conditions.
53: Trop Med Int Health. 2008 Feb;13(2):140-3.

Bridging community-based health insurance and social protection

for health care--a step in the direction of universal coverage?
Jacobs B, Bigdeli M, van Pelt M, Ir P, Salze C, Criel B.
Publication Types:
• Editorial
54: J Intellect Dev Disabil. 2008 Mar;33(1):12-21.

Respite care as a community care service: factors associated with the

effects on family carers of adults with intellectual disability in
Taiwan.
Chou YC, Tzou PY, Pu CY, Kröger T, Lee WP.
Institute of Health and Welfare Policy, National Yang-Ming University, Taipei,

Taiwan. choucyc@ym.edu.tw
BACKGROUND: This study examines the effects and associated factors of

respite care, which was legislated as a community service for adults with an
intellectual disability (ID) in Taiwan in 1997. METHOD: A total of 116 family
carers who live with an adult with ID and have utilised the respite care program
were surveyed using standardised measures. RESULTS: The results suggest that
the most notable effects of respite care include improvement in the carers' social
support and life satisfaction, and relief of psychological stress and overall burden
of care. The factors associated with these effects include the way the participants
have used the respite care and the users' individual characteristics.
CONCLUSIONS: How families used the respite care, whether the carers
practised a religion, and where the families resided, were the most significant
factors in determining the effectiveness of the respite. Suggestions are made for
making access to information about the program more widely available, and for
extending the availability and duration of the service.
55: Acta Paediatr. 2008 Mar;97(3):267-75.

The burden of unintentional injuries among the under-five

population in South Asia.
Hyder AA, Wali S, Fishman S, Schenk E.
Department of International Health, Center for Injury Research and Policy, Johns
Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
ahyder@jhsph.edu
BACKGROUND: Childhood injuries are a growing global concern, one that falls
disproportionately on developing countries where public health systems are least
prepared to address this problem. AIM: This study assesses the impact of
childhood injuries in the developing region of South Asia in order to set forth an
agenda for improving child health in that region. METHODS: A systematic
review was conducted for literature with quantitative data on unintentional
injuries in children 0-4 years of age published between 1980 and 2007. The
information was collated to estimate the mean, weighted mean and mortality rate
for each type of injury. The rates were then applied to the 2000 UN projected
population to estimate the number of childhood deaths due to unintentional
injuries. RESULTS: Unintentional injuries are estimated to cause 389,000 annual
child deaths in South Asia. This premature mortality results in the annual loss of
74 healthy life years (HeaLYs) per 1000 population. CONCLUSION: The current
burden of childhood injuries in South Asia is unacceptably high and calls for
efforts from all sectors involved in research, policy and funding to not only assess
the impact of childhood injuries but to strengthen the health systems to stem this
preventable loss of healthy life.
Publication Types:

• Review
56: Surgery. 2008 Mar;143(3):343-51. Epub 2007 Dec 21.

Effects of surgeon and hospital volume on 5-year survival rates

following oral cancer resections: the experience of an Asian country.
Lin CC, Lin HC.
Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei,

Taiwan.
BACKGROUND: Although the relationship between provider volume and

treatment outcome has been established for many types of operations, such a
relationship has yet to be determined for resection of oral cancers. The purpose of
this report is to assess the effects of surgeon and hospital volume on 5-year
survival for oral cancer. METHODS: A total of 6,666 patients who underwent
resections of oral cancer between 1997 and 1999 were identified from the Taiwan
National Health Insurance Research Database. These data were linked to the
"cause of death" data file from the Department of Health in Taiwan and traced for
5 years to obtain the survival times for individual patients. Survival analysis and
proportional hazard regressions were conducted to assess the association between
5-year survival rates and surgeon and hospital volumes after adjusting for patient
and provider variables. Volume relationships were based on the following criteria:
low-, medium-, and high-volume surgeons were defined by <52, 52 to 142, and
>142 resections, respectively, during the 3-year period. Similarly, low-, medium-,
and high-volume hospitals were defined by <343, 343 to 531, and >531
resections, respectively, during the 3-year period. RESULTS: With an increase in
individual surgeon volume, there were increases in the unadjusted 5-year survival
rates (45.5%, 49%, and 51.8% for low-, medium-, and high-volume groups,
respectively; P < .001); no such association, however, was observed with hospital
volumes (47.5%, 51.3%, and 49% for low-, medium-, and high-volume hospitals,
respectively; P = .074). Compared with treatment by low-volume surgeons,
operations by high-volume surgeons were associated with an adjusted hazard ratio
of 0.810 (95% confidence interval = 0.735-0.893). CONCLUSIONS: We
conclude that, for patients who underwent oral cancer resections, after adjusting
for differences in the case mix, high-volume surgeons had better 5-year survival
rates. This association, however, was not discernible for high-volume hospitals.
57: J Chin Med Assoc. 2008 Feb;71(2):62-5.

Cancer incidence in the districts of Dir (North West Frontier

Province), Pakistan: a preliminary study.
Zeb A, Rasool A, Nasreen S.
Department of Biotechnology, University of Malakand, Chakdara, Pakistan.

alamzeb01@yahoo.com
BACKGROUND: Pakistan has a high incidence of cancer. The most severely

affected province is the North West Frontier Province, which has districts of low
socioeconomic status such as those in Dir. The purpose of this study was to
analyze the cancer registry record of patients from the districts in Dir in order to
obtain a net cancer incidence for use in proposing future health plans.
METHODS: The medical records of 1,105 patients registered at the Institute of
Radiotherapy and Nuclear Medicine in Peshawar were traced. Information
regarding age, gender and affected sites were obtained. RESULTS: The incidence
of cancer increased, with a mean incidence of 15.04 per 100,000 in 2000-2004. Of
the 1,105 patients, 62% were male and 38% were female. The most affected
female age groups were 41-50 and 51-60; while males in the age groups of 51-60
and 61-70 had the highest risk. The leading cancers were lymph/blood, and
cancers of the digestive system, skin and breast. CONCLUSION: The increasing
trend of cancer in Dir is alarming. Since this study was a preliminary
investigation, it could provide a leading role in prevention, treatment and future
planning regarding cancer in Pakistan.
58: Stud Fam Plann. 2007 Dec;38(4):309-21.

Confidentiality concerns with mapping survey data in reproductive

health research.
Sherman JE, Fetters TL.
Department of Geography, University of North Carolina at Chapel Hill,

CB#3220, Chapel Hill, NC 27599-3220, USA. jes@email.unc.edu
The increasing availability of georeferenced datasets creates new opportunities to

perform spatial analysis of social science and public health survey data, but also
raises ethical issues regarding the potential for unintended violation of the
confidentiality of respondents. This article examines these ethical challenges by
reflecting on the experience of a study mapping the facilities that provide
abortion-related services in Cambodia. The technique of masking is examined as a
potential method for preventing reidentification of respondents in georeferenced
surveys. Broader solutions are offered for ways to balance the potentially
conflicting goals of spatial analysis and protection of confidentiality.
59: Int J Drug Policy. 2008 Apr;19 Suppl 1:S74-9. Epub 2008 Feb 20.
Managing information: using systematic data collection to estimate

process and impact indicators related to harm reduction services in
Myanmar.
Baldwin S, Boisen N, Power R.
Burnet Institute, Centre for Harm Reduction, Melbourne, Australia.

simonb@burnet.edu.au
BACKGROUND: Discussion about coverage has primarily focused on answering

the question: what level of coverage is required to reduce the spread of HIV
among people who inject drugs? This paper documents the process involved in
designing a Monitoring Information System (MIS) that provides a tool to estimate
coverage, frequency of contacts as well as provides a mechanism for correlating
these data with changes in risk behaviour among the surveyed population.
METHODS: The system uses paper and pencil data collection forms to record
information about the type and location of a contact. Information about the
content of the contact such as the services, equipment or education that is
delivered is also collected. This data is then entered into a computer program that
manages the information and allows for simple standardised reports to be
generated. The reports provide a simple mechanism for analysing process
indicators such as the number and frequency of contacts, where the contact
occurred as well as what the contact consisted of (i.e. education content or
distribution of equipment). The system also allows correlations to be made
between exposure to services and changes in behaviour thus providing a
mechanism for assessing impact indicators. CONCLUSION AND DISCUSSION:
We present a brief description of the Monitoring Information System, its structure
and functions and encourage practitioners to consider the importance of adopting
standardised monitoring systems to measure coverage. We also explore some
potential ethical limitations around using the system.
Publication Types:
60: Mil Med. 2008 Jan;173(1 Suppl):11-3.

Dental support for U.S. Marines in Iraq.
Christopher S.
2nd Dental Battalion, Camp Lejeune, NC, USA.
This article describes the experiences of the author while assigned to a dental
detachment in Iraq. The mission of the dental detachment was to provide
emergency care and, when the situation allowed, essential nonemergency care as
far forward as required to reduce the effect of dental disease and degradation of
mission. The challenges of deploying a system of dental care presented several
logistical problems. This article discusses some of the challenges and offers
comments concerning the capture of dental emergency data in the deployed
setting.

61: Asia Pac J Public Health. 2007;19 Spec No:13-7.
Long-term capacity-building in public health emergency

preparedness in Thailand--short report.
Limpakarnjanarat K, Linkins RW, Emerson E, Aldis WL, Jiraphongsa C,

Ungchusak K.
Thailand Ministry of Public Health-U.S. CDC Collaboration, Thailand.
Thailand's long-term commitment to public health workforce capacity-building

and its health infrastructure were key components in its successful response to the
December 26, 2004 tsunami disaster. Surveillance and Rapid Response Teams,
comprising fellows and staff from the Field Epidemiology Training Programme of
Thailand, in collaboration with staff from the Thailand Ministry of Public Health-
--U.S Centers for Disease Control and Prevention and the World Health
Organization, enabled a rapid and an effective public health response. Active
surveillance, outbreak response and control, rapid health assessments, and mental
health surveys provided critical information on the public health priorities and
medical needs of the impacted populations. Environmental assessments of
temporary morgues led to health safety and infection-control recommendations,
and computerised surveillance systems assisted in victim tracking and
identification. Thailand's experience demonstrates the importance of a prepared
public health sector in mitigating the impact of disasters, and supports the
recommendation of the Fifty-Eighth World Health Assembly for Member States
to develop preparedness plans that include building capacity to respond to health-
related crises.
62: Asia Pac J Public Health. 2007;19 Spec No:7-12.

Politics and the management of public health disasters: reflections

on the SARS epidemic in greater China.
Hui DL, Ng MK.
The University of Hong Kong, Hong Kong.
This paper examines the problems of coordination between and within six
jurisdictional players, namely the Hong Kong SAR Government, the Guangdong
Province, the Central Authority (PRC), the Taiwanese Government, the Taipei
Government and the World Health Organization during the SARS episode from
November 2002 until August 2003. We found that the diverging political interests
and entrenched administrative practices accounted for the poor coordination
between and within these players. The obsession with "political correctness" has
severely hampered "rational" decision making among the jurisdictional players.
The highly fragmented and compartmentalised intra-jurisdictional public health
system means that marshalling resources from health and non-health sectors is
difficult.
63: Int Nurs Rev. 2008 Mar;55(1):13-9.

Individual testimonies to nursing care after the atomic bombing of

Hiroshima in 1945.
Yuko M, Sachie N, Kayo S, Yoshiko O, Keiko T, Yukiko H, Mutsumi U,

Ryoko O, Toshio K, Noriyuki K, Kazumi M.
Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan.

matunari@health.nop.kagoshima-u.ac.jp
AIM: The aim of the present research is to clarify the nursing care conducted just
before and after the atomic bombing of Hiroshima in 1945. METHODS: Five
surviving nurses, who were registered nursing staff at that time in Hiroshima,
offered to participate in this research. Individual interviews were conducted in
order to obtain the information concerning the nursing activities in the disaster-
stricken areas. The collected information was collated with the documents with
regard to the atomic bombing in Hiroshima, and compared with the current
studies concerning nursing in disaster. FINDINGS: The five nurses who
participated in the study made it clear that, from the day of the bombing, nursing
care activities changed moment by moment according to the condition of the
radiation victims, the stricken areas and the relief systems. Under these
circumstances, the nurses tried to help the victims of the bombing by devising
anything useful for nursing care. CONCLUSION: The research participants left
their messages, pointing out that nurses' mental attitude to those in front of them
as patients is one of the most important things to keep in mind following any
major disaster.
Publication Types:

64: Mil Med. 2007 Dec;172(12):1245-9.

The mental health screening of conscripts for the Singapore Armed

Forces: rationale, objectives, and design.
Chong SA, Wong J, Verma S, Subramaniam M, Pek E, Chan YH, Lee IM,
Cheok C.
Institute of Mental Health and Woodbridge Hospital, 10 Buangkok View,

Singapore 539747.
Identification of mentally ill military conscripts is crucial, since these individuals

may experience an exacerbation of their illness during training with dire
consequences for them and the organization. This article describes the design of a
study to validate a screening instrument for psychiatric disorders as well as to
establish their prevalence among male army conscripts in Singapore. It involved a
two-stage process: the conscripts were screened with a new instrument which we
termed the Mental Wellness Screening Questionnaire; those who screened
positive, and a random sample of those who did not, were administered the
computerized Composite International Diagnostic Interview which was the gold
standard in making the diagnosis. This study is unusual in that it involved almost
the entire male population in 1 year but its relevance is the development of a
screening instrument that can be used with ease in a large population of
conscripts.
Publication Types:

65: Cytometry B Clin Cytom. 2008;74 Suppl 1:S117-22.

Affordable diagnostics--changing the paradigm in India.
Manian BS.
ReaMetrix India Pvt. Ltd., Bangalore 560058, India. bala@reametrix.com
A successful strategy for developing affordable diagnostics begins with a shift in

viewpoint. Diagnostics is a tool for generating clinical information. Amassed
experience in different parts of the globe has shown that this process of generating
and utilizing clinical information is not only different among various countries but
also different in microenvironments within the same country. The development of
affordable diagnostics requires consideration not only of the component costs
such as hardware and consumables but also other related costs that contribute to
the generation and delivery of that information. It is important to recognize that
these costs associated with public health in resource-poor settings cannot remain
at the mercy of charitable contributions from western nations. Therefore, the
challenge of technological innovation is to create solutions that are locally
affordable and sustainable in the long run within the local macroeconomic
constraints. The solutions should permit generation of local economic activity that
will reinforce long-term economic sustainability. For this reason it is essential not
only to analyze the diagnostic process but also to define a pathway by which local
healthcare systems in recipient nations can be endowed with elements that
empower them to acquire and practice up-to-date modern diagnostic skills. The
objective of this paper is to provide a wider view of diagnostic cost components
and to show how solutions developed and delivered locally have resulted in
economically affordable as well as sustainable products. Copyright 2008 Clinical
Cytometry Society.
66: World Health Popul. 2007 Jan;9(1):14-23.

Reasons for not reporting deaths: a qualitative study in rural

Vietnam.
Huy TQ, Johansson A, Long NH.
Huy, Vietnam-Sweden Uong Bi General Hospital, Uong Bi, Vietnam.
This qualitative study explores socio-cultural and health systems factors that may
impact on death reporting by lay people to registry systems at the commune level.
Information on local perceptions of death and factors influencing death reporting
were gathered through nine focus group discussions with people of different
religions and ethnic affiliations in a rural district of northern Vietnam. Participants
classified deaths as "elderly deaths," "young deaths," and "child deaths." Child
deaths, including newborn deaths, used to be considered punishment for sins
committed by ancestors, but this is no longer the case. Concepts of the human
soul and afterlife differ between the Catholic and Buddhist groups, influencing
funeral rituals and reporting, especially of infant deaths. Participants regarded
elderly deaths as "natural" and "deserved," while young deaths were seen as either
"good deaths" or "bad deaths." "Bad deaths" were defined as deaths of
"dishonourable" persons who had led a "bad life" involving activities such as
gambling, drinking or stealing. The causes of "bad deaths" and deaths due to
stigmatized diseases (e.g., HIV/AIDS, tuberculosis and leprosy) were often
concealed by the family. The study suggests that the risk of under-reporting
deaths seems to be largest for deaths of infants and "bad deaths." Little awareness
of regulations and lack of incentives for reporting or lack of sanctions for not
reporting deaths also result in under-reporting of deaths. Therefore, education
programs and enforcement of legal regulations on death notification should be
emphasized. The risk of misreporting the real causes of "bad deaths" and deaths
due to stigmatized diseases should be considered in verbal autopsy interviews.
Using different sources of information (triangulation) is useful in order to
minimize both under-registration and misreporting causes of death.
Publication Types:
67: Health Policy Plan. 2008 Mar;23(2):101-17. Epub 2008 Feb 11.
Saving newborn lives in Asia and Africa: cost and impact of phased
scale-up of interventions within the continuum of care.
Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, Cousens S.
Department of International Health, E8153, Bloomberg School of Public Health,

Johns Hopkins University, Baltimore, MD 21205, USA. gdarmsta@jhsph.edu
BACKGROUND: Policy makers and programme managers require more detailed

information on the cost and impact of packages of evidenced-based interventions
to save newborn lives, particularly in South Asia and sub-Saharan Africa, where
most of the world's 4 million newborn deaths occur. METHODS: We estimated
the newborn deaths that could be averted by scaling up 16 interventions in 60
countries. We bundled the interventions in a variety of existing maternal and child
health packages according to time period of delivery and service delivery mode,
and calculated the additional running costs of implementing these interventions at
scale (90% coverage) in sub-Saharan Africa and South Asia. The phased
introduction and expansion of interventions was modelled to represent
incremental strategies for scaling up neonatal care in developing country health
systems. RESULTS: Increasing coverage of 16 interventions to 90% could save
0.59-1.08 million lives in South Asia annually at an additional cost of US dollars
0.90-1.76 billion. In sub-Saharan Africa, 0.45-0.80 million lives saved would cost
US dollars 0.68-1.32 billion. Additional costs for increased antenatal interventions
are low, but given relatively high baseline coverage and lower impact, fewer
additional newborn lives can be saved through this package (5-10%). Intrapartum
care has higher impact (19-34% of deaths averted) but is costly (US dollars 1.66-
3.25 billion). Postnatal family-community care, with potential for high impact at
low cost (10-27%, US dollars 0.38-0.75 billion), has been neglected. A first phase
of scaling up care in 36 high (NMR 30-45) and 15 very high (NMR >45)
mortality countries would cost approximately US dollars 0.56-1.10 and US dolars
0.09-0.17 billion annually, respectively, and would avert 15-32% and 13-29% of
neonatal deaths, respectively, in these countries. Full coverage with all
interventions in the 51 high and very high mortality countries would cost US
dollars 2.23-4.37 billion, and avert 38-68% of neonatal deaths (1.13-2.05 million),
at an extra cost per death averted of US dollars 1100-3900. CONCLUSIONS:
Low-cost, effective newborn health interventions can save millions of lives,
primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of
intervention packages scaled up incrementally as health systems capacity
increases can assist programme planning and help policy makers and donors
identify stepwise targets for investments in newborn health.
Publication Types:

68: Am J Ophthalmol. 2008 Apr;145(4):722-728. Epub 2008 Feb 11.

Seasonal variations in the occurrence of retinal vein occlusion: a

five-year nationwide population-based study from Taiwan.
Ho JD, Tsai CY, Liou SW, Tsai RJ, Lin HC.
Department of Ophthalmology, Taipei Medical University Hospital, Taipei,

Taiwan.
PURPOSE: To determine whether seasonal variation exists in the incidence of

retinal vein occlusion. DESIGN: Retrospective, nationwide population-based
administrative database study. METHODS: We collected data on outpatient and
emergency visits for the period from January 1999 through December 2003 from
the Taiwan National Health Insurance Research Database, a source that covers
more than 96% of Taiwan's 23 million citizens. In total, 20,792 patients with a
first-time diagnosis of either central retinal vein occlusion or branch retinal vein
occlusion (The International Classification of Disease, Ninth Revision, Clinical
Modification [ICD-9-CM] code 362.35 or 362.36, respectively) were identified.
Monthly incidence of retinal vein occlusion was obtained for each age group,
each gender group, and for the entire sample. The autoregressive integrated
moving average method of analysis was adopted to examine seasonality in the
monthly incidence of retinal vein occlusion. RESULTS: The monthly incidence
rates of retinal vein occlusion revealed significant seasonality, with a clear peak in
January for each age group and each gender group, as well as for the total sample.
CONCLUSIONS: Our study demonstrates significant seasonal variations in the
retinal vein occlusion incidence, with the peak occurrence in the winter month of
January.
69: Int Dent J. 2007 Dec;57(6):429-32.

Dental education in Malaysia.
Komabayashi T, Razak AA, Bird WF.
Department of Oral Health and Diagnostic Sciences, School of Dental Medicine,

University of Connecticut, Farmington 06030-1715, USA.
Tkomabayashi@gde.uchc.edu
There was only one dental school in Malaysia until 1997 but five new schools
have been established since 1998. This review provides information about dental
education in Malaysia including; the history of dental education, the current
dental school system and curriculum, and dental licensure. There are four public
and two private dental schools in Malaysia. High school graduates are required to
take the nationwide matriculation entrance examination or the Higher School
Certificate (HSC) to apply for a dental degree programme. A five-year dental
programme leads to the BDS or the DDS degree. National or state examinations
are not required to practise dentistry. Currently, there are approximately 2,500
dentists, with a ratio of 1 dentist for every 10,000 people.
Publication Types:

• Review

70: Int J Drug Policy. 2008 Apr;19 Suppl 1:S15-24. Epub 2008 Feb 7.
Tracking coverage on the silk road: time to turn theory into

practice.
Gray R, Hoffman L.
Regional Representative, Population Services International, Asia Office,

Bangkok, Thailand. robgray@laopdr.com
Scaling up coverage of programs that effectively reduce the spread of HIV among
vulnerable populations, including injecting drug users (IDUs), sex workers (SWs),
and men who have sex with men (MSM), is a critically important issue for many
countries today. However, in addition to the lack of a commonly accepted
definition of coverage, there are currently no universally accepted standards,
methodologies, or tools to track coverage among these groups. Globally, most
programs working to prevent HIV among vulnerable populations are not using
monitoring & evaluation (M&E) systems that accurately track numbers of clients
and frequency of contact with those clients. Nor do most programs have targets on
the frequency of contact needed to effectively promote healthy behaviours. This
article presents a narrative of how one program in Central Asia developed a
simple M&E system to track the extent and frequency of contacts among clients.
The system uses a simple and anonymous "Unique Identifier Code" (UIC) that is
assigned to each client and recorded into a simple database to track the client's
interaction with the program. The system allows program managers to track
numbers of clients served and at what frequency and to better monitor progress
towards goals. The data produced by the UIC system, when compared against
HIV and sexually transmitted infection (STI) sentinel surveillance data by site,
allows programs to test theorized definitions of the quantity of coverage needed to
reduce the risk behaviours that spread HIV among vulnerable populations. Such
systems can then provide urgently needed data to help national HIV/AIDS
programs understand current coverage levels and gaps in coverage that need to be
filled in order to reduce the spread of HIV. Such a system provides valuable data
to enable decision makers to make evidence-based decisions on how to allocate
resources to reach sufficient coverage to reduce the spread of HIV among
populations most at risk of HIV.
Publication Types:

71: Ther Apher Dial. 2008 Feb;12(1):49-54.
Effects of serum calcium, phosphorous, and intact parathyroid

hormone levels on survival in chronic hemodialysis patients in
Japan.
Nakai S, Akiba T, Kazama J, Yokoyama K, Fukagawa M, Tominaga Y, Iseki

K, Tsubakihara Y; Patient Registration Committee of the Japanese Society
for Dialysis Therapy, Tokyo, Japan.Collaborators (24)
Odaka M, Sawanishi K, Maeda K, Akiba T, Tsubakihara Y, Iseki K, Nakai

S, Watanabe Y, Itami Y, Yamagata K, Shoji T, Morozumi K, Matubayashi S,
Shigematsu T, Shoji T, Shinoda T, Morita O, Masakane I, Suzuki K,
Tsuchida K, Nakamoto H, Kimata N, Hamano T, Akiba T.
Fujita Health University School of Medicine, Dengakugakubo 1-98, Kutsukake,

Toyoake, Aichi 470-1192, Japan. s-nakai@mta.biglobe.ne.jp
Disturbances in bone mineral metabolism are common in chronic hemodialysis

(HD) patients and often underlie morbid conditions and mortality; however, no
large epidemiological study for Asian dialysis patients has been performed. We
analyzed the database of the Japanese Society for Dialysis Therapy registry. In
this study, data from patients who were on HD at the end of 2000 was compiled.
The Cox's proportional hazard analysis was carried out to evaluate the
significance of the impact of variables related to bone mineral metabolism on
survival after adjusting for possible confounding variables. The study period was
three years, and a cohort of 27 404 HD patients was studied. The hazard ratios
were 1.098 (P = 0.0129) for serum calcium levels ranging 10.0-10.9 mg/dL, and
1.243 (P = 0.0001) for serum calcium levels >11.0 mg/dL when the reference
serum calcium level range was 9.0-9.9 mg/dL. Similarly, the hazard ratios were
significantly higher in a serum phosphorous level of 5.0 mg/dL than for the
reference serum phosphorous level range of 4.0-4.9 mg/dL. For intact parathyroid
hormone (iPTH), the hazard ratios were significantly small (<119 pg/mL) when
the reference iPTH level range was 180-359 pg/mL. However, the hazard ratio did
not increase when the iPTH level increased to >360 pg/mL. Results showed that
disturbances in bone mineral metabolism, such as those involving serum calcium,
phosphorous, and iPTH, have a significant impact on survival in Japanese dialysis
patients.
72: Natl Med J India. 2007 Sep-Oct;20(5):250-5.

International activity in the Cochrane Collaboration with particular
reference to India.
Allen C, Clarke M, Tharyan P.
The Cochrane Collaboration Secretariat, Oxford, United Kingdom.
The Cochrane Collaboration is the world's largest organization dedicated to

preparing, maintaining and promoting the accessibility of systematic reviews of
the effects of healthcare interventions. It is an international organization with
participants in more than 100 countries. Since the year 2000, a periodic audit has
been done to count the number of active members in Cochrane Review Groups,
categorized by the countries in which these people are based. At the beginning of
2007, there were more than 15 800 people involved, an increase from about 5500
in 2000. The South Asian Cochrane Network was formed in 2005 to raise
awareness about the Cochrane Collaboration and evidence-based practice in
South Asia, support review authors and contributors from countries within the
region, promote access to The Cochrane Library and advocate high quality
research in South Asia. The growth of activity in India has been dramatic,
particularly authors of Cochrane reviews and protocols--from just 19 (with 11
authors) in 2000 to 126 (with 78 authors) in 2007. Increasing the uptake of
relevant and reliable evidence in healthcare decisions in India and the South Asian
region forms the core of the network's strategic plan. The continued growth of
contributors from India and South Asia will help ensure that decisions regarding
healthcare in the region are informed by reliable and relevant evidence.
73: Emerg Infect Dis. 2007 Sep;13(9):1301-6.

Landscape elements and Hantaan virus-related hemorrhagic fever

with renal syndrome, People's Republic of China.
Yan L, Fang LQ, Huang HG, Zhang LQ, Feng D, Zhao WJ, Zhang WY, Li
XW, Cao WC.
State Key Laboratory of Remote Sensing Science, IRSA/CAS, Beijing, People's

Republic of China.
Hemorrhagic fever with renal syndrome (HFRS) is an important public health

problem in the People's Republic of China, accounting for 90% of human cases
reported globally. In this study, a landscape epidemiologic approach, combined
with geographic information system and remote sensing techniques, was applied
to increase our understanding of HFRS due to Hantaan virus and its relationship
with landscape elements in China. The landscape elements considered were
elevation, normalized difference vegetation index (NDVI), precipitation, annual
cumulative air temperature, land surface temperature, soil type, and land use.
Multivariate logistic regression analysis showed that HFRS incidence was
remarkably associated with elevation, NDVI, precipitation, annual cumulative air
temperature, semihydromorphic soils, timber forests, and orchards. These findings
have important applications for targeting HFRS interventions in mainland China.
Publication Types:
74: Mil Med. 2008 Jan;173(1):79-84.

Developing a brucellosis public health information and awareness

campaign in Iraq.
Maxwell JR, Bill DE.
Department of Health, College of Health Sciences, West Chester University of

Pennsylvania, West Chester, PA 19383, USA.
U.S. Army civil affairs public health professionals are deployed worldwide in
support of current contingency operations to promote and to preserve the public
health of the citizens of the occupied territory or host nation. In Iraq, they face the
challenge of assisting a health care system plagued by years of neglect and
inefficient bureaucracy. Iraqi efforts to track and to control infectious diseases,
especially zoonotic diseases, are in their infancy. Brucellosis, a worldwide
zoonotic disease of ruminants, is of particular concern in Iraq because of the close
proximity of animals to humans and the cultural habits that favor disease
dissemination among the population. A public health education and awareness
campaign was recently developed in Ninewa Province, Iraq, to educate Iraqi
citizens about brucellosis and ways to prevent it. The public health campaign used
a two-pronged approach to effect change, i.e., (1) development of a social
marketing campaign (public health education) about brucellosis and its
prevention, with billboards, flyers, and public service announcements, and (2)
mobilization of key veterinary institutions to participate in educating and training
the public and farmers about brucellosis. The campaign used culturally relevant
messages and was targeted to address local cultural practices, to lower disease
transmission. Efforts were made to state messages using local terms and
references. This approach may have utility in other public health efforts in Iraq
and other postconflict stabilization operations.
75: J Prev Med Pub Health. 2008 Jan;41(1):1-9.

[Co-author and keyword networks and their clustering appearance

in preventive medicine fields in Korea: analysis of papers in the
Journal of Preventive Medicine and Public Health, 1991~2006]
[Article in Korean]
Jung M, Chung D.
Department of Medical Sociology, Graduate School of Public Health, Seoul

National University, Korea.
OBJECTIVES: This study evaluated knowledge structure and its effect factor by
analysis of co-author and keyword networks in Korea's preventive medicine
sector. METHODS: The data was extracted from 873 papers listed in the Journal
of Preventive Medicine and Public Health, and was transformed into a co-author
and keyword matrix where the existence of a 'link' was judged by impact factors
calculated by the weight value of the role and rate of author participation.
Research achievement was dependent upon the author's status and networking
index, as analyzed by neighborhood degree, multidimensional scaling,
correspondence analysis, and multiple regression. RESULTS: Co-author networks
developed as randomness network in the center of a few high-productivity
researchers. In particular, closeness centrality was more developed than degree
centrality. Also, power law distribution was discovered in impact factor and
research productivity by college affiliation. In multiple regression, the effect of
the author's role was significant in both the impact factor calculated by the
participatory rate and the number of listed articles. However, the number of listed
articles varied by sex. CONCLUSIONS: This study shows that the small world
phenomenon exists in co-author and keyword networks in a journal, as in citation
networks. However, the differentiation of knowledge structure in the field of
preventive medicine was relatively restricted by specialization.
Publication Types:

76: Saudi Med J. 2008 Feb;29(2):171-8.
Electronic-health in Saudi Arabia. Just around the corner?
Altuwaijri MM.
College of Public Health and Health Informatics, King Saud bin Abdul-Aziz
University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
majidt@ngha.med.sa
The Saudi health sector has witnessed significant progress in recent decades with
some local hospitals receiving international recognition. However, this has not
been accompanied by advancement of the electronic-health e-health field, whose
applications have become a necessity for hospitals to achieve certain objectives
such as enhancing the quality of healthcare, and reducing the time and cost for
healthcare delivery. In this paper we investigate the advancement of e-health in
the world and in Saudi Arabia. A new model for e-health diffusion in Saudi
Arabia is also proposed.
Publication Types:
• Review
77: HIM J. 2004;33(4):140-2.

Related Articles
IT in health: two reports on the conference Streamlining IT

Strategies in Healthcare, Kuala Lumpur, Malaysia, 9-10 March
2004.
Ah Yick N, Tindal RE.
NorthWestern Medical Health, Melbourne Health, The Royal Melbourne

Hospital, Parkville Vic 3050, Australia.
Publication Types:
• Congresses
78: Int J Health Geogr. 2008 Jan 30;7:5.

Measuring the geographic coverage of methadone maintenance

programme in Hong Kong by using geographic information system
(GIS).
Pang TT, Lee SS.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of

Hong Kong, Shatin, Hong Kong, China. ppang@cuhk.edu.hk
OBJECTIVE: While access and utilization form core components in assessing the
effectiveness of a health service, the concept of coverage is often neglected. In
this study we propose to develop a GIS-based methodological framework for the
measurement of district-based geographic coverage to examine the service
effectiveness of methadone treatment programme (MTP) in Hong Kong on a
regular basis. METHODS: To overcome the incompatibility of spatial units,
population data and data of heroin addiction of the year 2001 are interpolated by
population-weighted and area-weighted algorithms. Standard overlay and
proximity analytical functions are used to delineate altogether 20 accessible zones
around each methadone clinic at a fixed 1.5 km Euclidean distance. Geographic
coverage here is defined as the percentage of heroin addicts covered by a
methadone clinic within the accessible zone by district. RESULTS: A total of
6413 out of 11000 reported heroin addicts are found geographically covered. The
average geographic coverage in Hong Kong is 44.6%, with the figure varying
from 0% to 96% by district. One district having no clinic results in 0% coverage
whereas another without a clinic yields 15.3% coverage from the clinic in
adjacent district. Maps illustrating district-based geographic coverage are
generated. CONCLUSION: As continuous data collection is required for a
monitoring system, the simplified approach facilitates the handling of large
volume data and relevant data analysis. It is concluded that the number of
methadone clinics is as important as their locations. Geographic coverage could
become an important consideration for monitoring harm reduction.
Publication Types:

PMCID: PMC2268919
79: Demography. 2007 Nov;44(4):771-84.

The impact of childhood mortality on fertility in six rural thanas of

Bangladesh.
Hossain MB, Phillips JF, Legrand TK.
School of Public Health and Policy, Morgan State University, 1700 E. Cold
Spring Lane, Baltimore, MD 21251, USA. mbhossain@moac.morgan.edu
In this article, we examine the relationship between child mortality and

subsequent fertility using prospective longitudinal data on births and childhood
deaths occurring to nearly 8000 Bangladeshi mothers observed over the 1982-
1993 period, a time of rapid fertility decline. Generalized hazard-regression
analyses are employed to assess the effect of infant and child mortality on the
hazard of conception, with controls for birth order and maternal age and
educational attainment. Results show that childhood mortality reduces the time to
subsequent conception if the death occurs within a given interval, representing the
combined effect of biological and volitional replacement. The time to conception
is also reduced if a childhood death occurs during a prior birth interval, a finding
that signifies an effect of volitional replacement of the child that died. Moreover,
mortality effects in prior birth intervals are consistent with hypothesized insurance
(or hoarding) effects. Interaction of replacement with elapsed time suggests that
the volitional impact of child mortality increases as the demographic transition
progresses. This volitional effect interacts with sex of index child. Investigation of
higher-order interactions suggests that this gender-replacement effect has not
changed over time.
Publication Types:

80: Demography. 2007 Nov;44(4):747-70.

The spread of health services and fertility transition.

Brauner-Otto SR, Axinn WG, Ghimire DJ.
Carolina Population Center, University of North Carolina at Chapel Hill, CB#

8120, University Square, 123 West Franklin Street, Chapel Hill, NC 27516-2524,
USA. sbotto@email.unc.edu
We use detailed measures of social change over time, increased availability of

various health services, and couples' fertility behaviors to document the
independent effects of health services on fertility limitation. Our investigation
focuses on a setting in rural Nepal that experienced a transition from virtually no
use of birth control in 1945 to the widespread use of birth control by 1995 to limit
fertility. Changes in the availability of many different dimensions of health
services provide the means to evaluate their independent influences on
contraceptive use to limit childbearing. Findings show that family planning as
well as maternal and child health services have independent effects on the rate of
ending childbearing. For example, the provision of child immunization services
increases the rate of contraceptive use to limit fertility independently of family
planning services. Additionally, new Geographic Information System (GIS)-based
measures also allow us to test many alternative models of the spatial distribution
of services. These tests reveal that complex, geographically defined measures of
all health service providers outperform more simple measures. These results
provide new information about the consequences of maternal and child health
services and the importance of these services in shaping fertility transitions.
Publication Types:
• Research Support, N.I.H., Extramural
81: Indian J Public Health. 2007 Jan-Mar;51(1):64-5.

Conceptual framework of a geographical information system for

environment--public health surveillance in Goa.
Vaz FS, Ferreira AM, Motghare DD, Kulkarni MS.
Department of Preventive and Social Medicine, Goa Medical College, Goa.

frederickvaz@rediffmail.com
This paper proposes a conceptual framework for establishing a multidiscipline

Geographical Information System for environment public health surveillance in
the state of Goa. Sectors networking for the Geographical Information System
encompass Directorate of Health Services including peripheral health setup,
Public Works Department, State Pollution Control Board, Irrigation Department,
Inspectorate of Factories and Boilers, Town and Control Planning Department,
Meteorological Department etc. the applications of which would predict potential
outbreaks / epidemics of water borne diseases, malaria, diseases linked to
pollution and would support disease control activities. In addition to health
applications, the data generated would be used by the respective sectors for their
other planning and programming needs.
82: Indian J Public Health. 2007 Jul-Sep;51(3):139-41.

Networking for public health education and training--the need of the

hour.
Nandan D, Dobe M.
Publication Types:
• Editorial
83: BMC Public Health. 2008 Jan 28;8:37.

A hidden HIV epidemic among women in Vietnam.
Nguyen TA, Oosterhoff P, Hardon A, Tran HN, Coutinho RA, Wright P.
Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam.

anhstat@yahoo.com
BACKGROUND: The HIV epidemic in Vietnam is still concentrated among high

risk populations, including IDU and FSW. The response of the government has
focused on the recognized high risk populations, mainly young male drug users.
This concentration on one high risk population may leave other populations
under-protected or unprepared for the risk and the consequences of HIV infection.
In particular, attention to women's risks of exposure and needs for care may not
receive sufficient attention as long as the perception persists that the epidemic is
predominantly among young males. Without more knowledge of the epidemic
among women, policy makers and planners cannot ensure that programs will also
serve women's needs. METHODS: More than 300 documents appearing in the
period 1990 to 2005 were gathered and reviewed to build an understanding of
HIV infection and related risk behaviors among women and of the changes over
time that may suggest needed policy changes. RESULTS: It appears that the risk
of HIV transmission among women in Vietnam has been underestimated; the
reported data may represent as little as 16% of the real number. Although
modeling predicted that there would be 98,500 cases of HIV-infected women in
2005, only 15,633 were accounted for in reports from the health system. That
could mean that in 2005, up to 83,000 women infected with HIV have not been
detected by the health care system, for a number of possible reasons. For both
detection and prevention, these women can be divided into sub-groups with
different risk characteristics. They can be infected by sharing needles and syringes
with IDU partners, or by having unsafe sex with clients, husbands or lovers.
However, most new infections among women can be traced to sexual relations
with young male injecting drug users engaged in extramarital sex. Each of these
groups may need different interventions to increase the detection rate and thus
ensure that the women receive the care they need. CONCLUSION: Women in
Vietnam are increasingly at risk of HIV transmission but that risk is under-
reported and under-recognized. The reasons are that women are not getting tested,
are not aware of risks, do not protect themselves and are not being protected by
men. Based on this information, policy-makers and planners can develop better
prevention and care programs that not only address women's needs but also
reduce further spread of the infection among the general population.
Publication Types:

• Review
PMCID: PMC2248180

Pattern of medical waste management: existing scenario in Dhaka

City, Bangladesh.
Hassan MM, Ahmed SA, Rahman KA, Biswas TK.
Department of Geography and Environment, Jahangirnagar University, Savar,

Dhaka, Bangladesh. manzurulh@yahoo.com
BACKGROUND: Medical waste is infectious and hazardous. It poses serious
threats to environmental health and requires specific treatment and management
prior to its final disposal. The problem is growing with an ever-increasing number
of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh.
However, research on this critical issue has been very limited, and there is a
serious dearth of information for planning. This paper seeks to document the
handling practice of waste (e.g. collection, storage, transportation and disposal)
along with the types and amount of wastes generated by Health Care
Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas
provided us with relevant information. METHODS: The methodology for this
paper includes empirical field observation and field-level data collection through
inventory, questionnaire survey and formal and informal interviews. A structured
questionnaire was designed to collect information addressing the generation of
different medical wastes according to amount and sources from different HCE. A
number of in-depth interviews were arranged to enhance our understanding of
previous and existing management practice of medical wastes. A number of
specific questions were asked of nurses, hospital managers, doctors, and cleaners
to elicit their knowledge. The collected data with the questionnaire survey were
analysed, mainly with simple descriptive statistics; while the qualitative mode of
analysis is mainly in narrative form. RESULTS: The paper shows that the
surveyed HCE generate a total of 5,562 kg/day of wastes, of which about 77.4 per
cent are non-hazardous and about 22.6 per cent are hazardous. The average waste
generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The
study reveals that there is no proper, systematic management of medical waste
except in a few private HCE that segregate their infectious wastes. Some cleaners
were found to salvage used sharps, saline bags, blood bags and test tubes for
resale or reuse. CONCLUSION: The paper reveals that lack of awareness,
appropriate policy and laws, and willingness are responsible for the improper
management of medical waste in Dhaka City. The paper also shows that a newly
designed medical waste management system currently serves a limited number of
HCE. New facilities should be established for the complete management of
medical waste in Dhaka City.
PMCID: PMC2254398
85: HIM J. 2006;34(4):120-9.

Factors influencing diffusion of electronic medical records: a case

study in three healthcare institutions in Japan.
Ochieng OG, Hosoi R.

Health and Welfare Information System, Health Services Management, Graduate
School, International University of Health and Welfare, Tochigi, Japan.
gotiochiengs@yahoo.co.uk
This study examines the effect of three factors: information technology (IT) skills
of healthcare workers, present status of computerisation in their organisations, and
workers' attitudes on the diffusion of electronic medical records (EMRs) in the
healthcare environment. Data were obtained from a self-questionnaire distributed
to 390 healthcare workers. The study finds that respondents need an expanded
EMR capability to include decision support systems and reminder systems, and
that diffusion of EMR is heavily influenced by attitudes of healthcare workers.
However, targeted training of healthcare workers is needed to foster positive
attitudes about EMR, and build confidence in the benefits of these systems.
86: Accid Anal Prev. 2008 Jan;40(1):334-40. Epub 2007 Jul 31.
Distribution and characteristics of road traffic crashes in the

Chaoyang District of Beijing, China.
Wang Y, Hasselberg M, Wu Z, Laflamme L.
Karolinska Institutet, Department of Public Health Sciences, Division of

International Health, SE 171 77 Stockholm, Sweden.
In many developing urban settings, economic growth and motorization are

coupled with increasing rates of road traffic injuries (RTIs). By highlighting
typical sites and circumstances at/in which car crashes occur, more specific
targets for prevention can be identified. The study is based on police data for a 1-
year period and covers the Chaoyang District, the biggest district of Beijing City.
Focus is placed on crash patterns and their distribution by types of road and areas.
Both fatal and non-fatal crashes are considered (n=754). In the main, the crashes
occurred in relatively favorable driving circumstances (e.g., sunny weather, flat
and straight roads, asphalted roads, and good traffic signals and road markings).
They were also quite evenly distributed over time of day, day of week and season.
Five crash patterns were highlighted, of which three were strongly associated with
specific areas and four with specific types of road. The study supports the idea
that type of road and RTI severity or pattern are closely related. It contributes to
the development of context-relevant prevention measures aimed at reducing road
crashes and minimizing their consequences and also supports safe planning of the
road traffic environment.
Publication Types:
87: J Toxicol Environ Health A. 2008;71(5):301-3.

Combined effects of cigarette smoking and sulfur dioxide on lung

function in Koreans.
Min JY, Min KB, Cho SI, Paek D.
School of Public Health and Institute of Health and Environment, Seoul National
University, Seoul, Republic of Korea.
Both smoking and air pollution impair lung function, but little information is
available regarding the combined effects on the pulmonary system. The potential
effects of smoking and sulfur dioxide (SO2) were examined on lung function.
Data were collected from family health examinations of 867 subjects, aged 20-86
yr, in a Korean community. The subjects responded to a questionnaire interview
and completed lung function tests. Data on SO2 exposure were obtained from the
Environmental Management Corporation. Studies showed that exposure to SO2
induced a short, marked decrease in forced vital capacity (FVC) and forced
expiratory volume in 1 s (FEV1) in smokers compared with nonsmokers. The
effect lasted up to 30 h after exposure. Consequently, preventive efforts are
necessary to reduce the risks that air pollution and smoking pose to the respiratory
system.
Publication Types:
88: J Eval Clin Pract. 2008 Feb;14(1):116-20.

Measuring the process of quality of care for ST-segment elevation

acute myocardial infarction through data-mining of the electronic
discharge notes.
Chang SN, Lin JW, Liu SC, Hwang JJ.
Cardiovascular Division, Department of Internal Medicine, NTUH, Taipei City,

Taiwan.
BACKGROUND: Measuring parameters in the management of acute myocardial

infarction (AMI) has been used as the standard for evaluating quality of care
(QC). The purpose of this study was to elucidate the completeness of information
retrieval from electronic discharge notes (EDN) as well as to measure QC for
AMI in Taiwan. METHODS: All the narrative reports in EDN in the clinical
information systems (CIS) of National Taiwan University Hospital from 2002 to
2004 were retrieved, and the patients who presented to the emergency room (ER)
with AMI were identified. Ten parameters related to QC for AMI were measured
through data-mining of EDN alone as well as through an extensive search of the
CIS and paper medical records. RESULTS: Information retrieval from EDN alone
could obtain some parameters with a high recall, such as the use and timing of
reperfusion therapy and the prescription of medication at discharge. Other
parameters, such as the early management at ER and lipid profile after discharge,
could not be retrieved from EDN. The use of medication and early reperfusion
therapy was comparable to the US standards, while lipid control at and after
discharge were suboptimal. CONCLUSIONS: This study has demonstrated that
information retrieval from EDN alone could faithfully extract sufficient measures
of QC for AMI in some aspects, as well as could quantify the current process of
QC for AMI in Taiwan.
89: BMC Med Educ. 2008 Jan 20;8:5.

Perceptions of graduating students from eight medical schools in

Vietnam on acquisition of key skills identified by teachers.
Hoat LN, Son NM, Wright EP.
Biostatistics and Medical Informatics Department, Faculty of Public Health,

Hanoi Medical University, Dong Da, Hanoi, Vietnam. luungochoat@hn.vnn.vn
BACKGROUND: The eight main Vietnamese medical schools recently

cooperated to produce a book listing the knowledge, attitudes and skills expected
of a graduate, including specification of the required level for each skill. The
teaching program should ensure that students can reach that level. The objective
of this study was to determine the perception of graduating students on whether
they had achieved the level set for a selection of clinical and public health skills
as a guide for the schools to adjust either the levels or the teaching. METHODS:
From all eight schools, 1136 of the 1528 final year students completed
questionnaires just before completed all the requirements for graduation, a
response rate of 87% overall (ranging from 74-99% per school). They rated their
own competence on a scale of 0-5 for 129 skills selected from the 557 skills listed
in the book, and reported where they thought they had learned them. The scores
that the students gave themselves were then compared to the levels proposed by
the teachers for each skill. The proportions of the self-assessed achievement to the
levels expected by the teachers, means self-assessed scores and the coefficients of
variation were calculated to make comparisons among disciplines, among schools
and among learning sites. RESULTS: Most students felt they had learned most of
the skills for key clinical departments to the required level; this varied little
among the schools. Self-assessed skill acquisition in public health and minor
clinical disciplines was lower and varied more. Sites outside the classroom were
especially important for learning skills. The results revealed key similarities and
differences between the teachers and the students in their perception about what
could be learned and where CONCLUSION: Revising a curriculum for medical
schools demands inputs from all stakeholders. Graduating class students can
provide valuable feedback on what they have learned in the existing system.
Learning objectives should always be checked with students who have followed
their study under existing teaching conditions. The information from the
graduates helped to identify potential problem areas where either the objectives or
the teaching need adjustment.
Publication Types:
PMCID: PMC2248186

Establishing a nationwide emergency department-based syndromic

surveillance system for better public health responses in Taiwan.
Wu TS, Shih FY, Yen MY, Wu JS, Lu SW, Chang KC, Hsiung C, Chou JH,
Chu YT, Chang H, Chiu CH, Tsui FC, Wagner MM, Su IJ, King CC.
Institute of Epidemiology, College of Public Health, National Taiwan University,

Taipei City, Taiwan. wcsg@msn.com
BACKGROUND: With international concern over emerging infectious diseases

(EID) and bioterrorist attacks, public health is being required to have early
outbreak detection systems. A disease surveillance team was organized to
establish a hospital emergency department-based syndromic surveillance system
(ED-SSS) capable of automatically transmitting patient data electronically from
the hospitals responsible for emergency care throughout the country to the
Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This
report describes the challenges and steps involved in developing ED-SSS and the
timely information it provides to improve in public health decision-making.
METHODS: Between June 2003 and March 2004, after comparing various
surveillance systems used around the world and consulting with ED physicians,
pediatricians and internal medicine physicians involved in infectious disease
control, the Syndromic Surveillance Research Team in Taiwan worked with the
Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the
University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by
analyzing daily electronic ED data received in real-time from the 189 hospitals
participating in this system between April 1, 2004 and March 31, 2005.
RESULTS: Taiwan's ED-SSS identified winter and summer spikes in two
syndrome groups: influenza-like illnesses and respiratory syndrome illnesses,
while total numbers of ED visits were significantly higher on weekends, national
holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It
also identified increases in the upper, lower, and total gastrointestinal (GI)
syndrome groups starting in November 2004 and two clear spikes in enterovirus-
like infections coinciding with the two school semesters. Using ED-SSS for
surveillance of influenza-like illnesses and enteroviruses-related infections has
improved Taiwan's pandemic flu preparedness and disease control capabilities.
CONCLUSION: Taiwan's ED-SSS represents the first nationwide real-time
syndromic surveillance system ever established in Asia. The experiences reported
herein can encourage other countries to develop their own surveillance systems.
The system can be adapted to other cultural and language environments for better
global surveillance of infectious diseases and international collaboration.
Publication Types:
• Evaluation Studies
PMCID: PMC2249581
91: Res Nurs Health. 2008 Apr;31(2):172-9.

National incidence of percutaneous injury in Taiwan healthcare

workers.
Shiao JS, Lin MS, Shih TS, Jagger J, Chen CJ.
Department of Nursing, College of Medicine, National Taiwan University, Taipei,

Taiwan.
We established a standardized surveillance system using the Chinese Exposure

Prevention Information Network to estimate the frequency of percutaneous
injuries (PCIs) in Taiwanese healthcare workers (HCWs). Fourteen hospitals
employing 8,132 HCWs participated and a total of 583 PCIs were reported. The
annual number was estimated to be 8,058 PCIs per hospital size, 8,100 per
HCWs, and 8,286 per inpatient-day; indicating similar estimates using different
denominators. The estimated annual frequency of pathogen-specific PCIs was
1,168 for hepatitis B, 1,263 for hepatitis C, and 59 for HIV. This study documents
the annual incidence of PCI among HCWs showing important potential exposure
to viral hepatitis and HIV in Taiwan.
Publication Types:
92: HIM J. 2007;36(1):36-41.

Developing a model for an Iranian Classification of Diseases (IRCD)

compatible with other adaptations of the International Classification
of Diseases.
Safdari R, Meidani Z.
Department of Medical Records, School of Medicine, Tehran University of

Medical Sciences, P.O. Box 14155-6447, Tehran, Iran. rsafdari@sina.tums.ac.ir
The introduction of the electronic health record in Iran has necessitated the
development of a model for an Iranian Classification of Diseases (IRCD) which is
compatible with classifications used in other countries. T his article reports on a
comparative study of the adaptations of the International Classification of
Diseases (ICD) currently in use in the USA, France, Germany, China and Egypt
which was carried out in order to inform development of the IRCD. Data
concerning the history, evolutionary processes and general structures of tabular
lists, alphabetic lists and manuals of World Health Organization (WHO)
classifications were collected during the period 2003-2004 from a variety of
sources including written texts, periodicals, the Internet and electronic mail.
Based on this information,and following assessment by 17 Iranian national
experts by means of a questionnaire, a model of IRCDcompatible with versions of
the ICD used in other countries, in particular with that of USA, was proposed.
Publication Types:
93: HIM J. 2007;36(1):13-22.

Determining the most important evaluation indicators of health care

information systems (HCIS) in Iran.
Shahmoradi L, Ahmadi M, Haghani H.
School of Management and Medical Information Sciences, Iran University of

Medical Sciences, Tehran, Iran. L2000shahmoradi@yahoo.com
Accurate evaluation of healthcare information systems (HCIS) relies upon the

choice of appropriate indicators. Iranian healthcare and health industry
professionals were surveyed, by means of a descriptive cross sectional study, in
order to identify the indicators they considered most relevant to the evaluation of
healthcare information systems currently in use in Iran. It was concluded that
effective evaluation of HCIS should encompass a variety of perspectives and
methodologies (including qualitative methodologies), focus upon technical,
economic and organisational concerns, and involve diversely constituted research
teams.
94: Oncol Nurs Forum. 2008 Jan;35(1):131-5.

Social, marital, and sexual adjustment of Israeli men whose wives

were diagnosed with breast cancer.
Kadmon I, Ganz FD, Rom M, Woloski-Wruble AC.
Henrietta Szold Hadassah Medical Organization in Jerusalem, Israel.

ikadmon@hadassah.org.il
PURPOSE/OBJECTIVES: To explore the psychosocial adjustment of Israeli men

whose wives were diagnosed with breast cancer. DESIGN: Descriptive study.
SETTING: An urban tertiary medical center. SAMPLE: A convenience sample of
50 Israeli men whose wives had been diagnosed with breast cancer. The average
age was 53.8 years. All of the men spoke and wrote Hebrew. METHODS:
Husbands completed a demographic and wives' health-related questionnaire, the
Social Support Questionnaire to measure social support from their wives, the
Psychosocial Adjustment to Illness Scale to measure adjustment to a serious
disease of the wives, and the Locke Wallace Marital Adjustment Scale to measure
marital and sexual adjustment. MAIN RESEARCH VARIABLES: Psychosocial
adjustment, social support, relationships with their partners, and relationships with
the healthcare system. FINDINGS: A fifth of the men reported various levels of
stress and concern. Half described financial difficulties. Three-quarters of the men
noted changes in their relationships. More than a third of the husbands
experienced a reduction in communication with their families. All of the men
expressed satisfaction with the healthcare system, although some of them
expressed a need to receive more information. CONCLUSIONS: Husbands of
women with breast cancer grapple with multiple issues on several fronts. They
need support and information from the healthcare team even if they do not request
it in a timely or direct manner. IMPLICATIONS FOR NURSING: Response to
the unspoken needs of men whose wives have breast cancer necessitates
education and ongoing staff education to develop strategic support and
communication.
Publication Types:
95: Nippon Koshu Eisei Zasshi. 2007 Nov;54(11):782-91.

[The current situation of older hospitalized patients in a cadre ward

in Jilin, China]
Sun J, Kanagawa K, Ooki S.

Ishikawa Prefectural Nursing University, The First Hospital of Jilin University in
China.
OBJECTIVE: The proportion of elderly people and the nation's medical

expenditures are rapidly increasing in China. The existence of cadre wards, where
retired members of the cadre of the Communist Party of China are hospitalized
and receive careful treatment, helps in providing care for the elderly. Elderly
retired cadre patients are thought to be more frequently hospitalized and to stay in
the hospital longer than elderly non-cadre patients on general hospital wards, and
therefore might be expected make an important contribution to the increase in the
nation's medical expenditures. However the current situation is not well
characterized. The aim of this study was to provide a basis for possible solutions
related to the cadre patient burden by determining the circumstances and
background of these patients with long hospital stays and investigating their
needs. METHODS: We analyzed the medical records of hospital discharges from
a cadre ward from 2000 to 2004, and from general wards in 2004 at a large
university-affiliated hospital in Jilin, China. Additionally, a questionnaire survey
including an interview concerning needs was carried out in August 2005 for 100
elderly patients on the cadre ward (91% of the total patients on this ward) of the
same hospital at that time. RESULTS: The mean length of hospital stays of
patients on the cadre ward decreased by half during the study period, but
remained longer than that of patients on general hospital wards. Regression
analysis showed that of all the variables measured, the type of ward (cadre vs.
general) was the most influential on the mean length of hospital stay. Moreover,
patients who were hospitalized more often, males and older individuals showed
longer hospital stays. The questionnaire survey showed that there are many
patients who could be discharged from the hospital based on their health condition
but are not discharged because outside care or welfare services are insufficient, or
because there is little information available on social resources. CONCLUSIONS:
Although medical policy, by which elderly retired cadre patients receive careful
treatment, may contribute to the longer length of the hospital stay of the patients
on the cadre ward, it was thought to be important to construct appropriate
discharge plans and a support system after discharge to the community. The
results provide important information for solution of medical problems related to
elderly retired cadre patients in China.
Publication Types:
96: J Med Assoc Thai. 2007 Nov;90(11):2359-65.

Risk factors of intraoperative oxygen desaturation: a case-control
study of 152,314 anesthetics.
Charuluxananan S, Suraseranivongse S, Punjasawadwong Y,

Somboonviboon W, Sriswasdi S, Pranootnarabhal T, Chanchayanon T,
Chau-in W, Intarut N.
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University,

Bangkok, Thailand. somratcu@hotmail.com
BACKGROUND: The present study was part of the Thai Anesthesia Incidents
Study (THAI Study) of anesthetic adverse outcomes. OBJECTIVE: To determine
factors related to intraoperative oxygen desaturation (SpO2 < or =85% or < 90%
for more than 3 min). MATERIAL AND METHOD: During a 12-month period
(February 1, 2003 - January 31, 2004), a prospective multicentered registry of
patients receiving anesthesia was conducted in 20 hospitals across Thailand
Anesthesia personnel filled up patient-related, surgical-related, and anesthesia
related variables and adverse outcomes including intraoperative oxygen
desaturation. A case-control (1:4) study of patients with and without
intraoperative oxygen desaturation in the THAI Study database was done.
Univariate and multivariate analysis were used to identify factors related to
intraoperative oxygen desaturation. A p-value < 0.05 was considered as
significant. RESULTS: Among 152,314 patients without preanesthetic
desaturation in the database, 328 cases of intraoperative oxygen desaturation were
matched with 1312 control patients without desaturation. Variables that predict
desaturation by multiple logistic regression were age less than 5 years old [OR 9.3
(95% CI 5.4-16.0)], ASA physical status 3, 4, 5 [OR 3.1 (95% CI 2.2-4.3)],
history of upper respiratory tract infection [OR 10 (95% CI 1.9-51.6)], history of
asthma [OR 2.9 (95% CI 1.0-9.5)], general anesthesia [OR 4.0 (95% CI 2.4-6.7)]
duration of anesthesia 31-90 min [OR 1.9 (95% CI 1.2-3.0)], duration of
anesthesia 91-150 min (OR 2.2 (95% CI 1.3-3.6)], and duration of anesthesia
>150 min [OR 2.0 (95% CI 1.2-3.4)]. CONCLUSION: Knowing the risk factors
of intraoperative oxygen desaturation helps improving personnel to improve
preanesthetic conditions and facilitate early detection as well as prompt treatment
of intraoperative oxygen desaturation.
Publication Types:
• Multicenter Study
97: AIDS. 2007 Dec;21 Suppl 8:S149-55.

Factors associated with adherence to antiretroviral therapy among

HIV/AIDS patients in rural China.
Wang X, Wu Z.
Office of International Cooperation, Chinese Center for Disease Control and

Prevention (China CDC), Beijing, China.
OBJECTIVE: To assess the levels of adherence to antiretroviral therapy in a

sample of HIV-infected patients from rural areas in China and to determine the
factors associated with suboptimal adherence. DESIGN: A cross-sectional study
was conducted on HIV-infected adults receiving free antiretroviral therapy (ART)
in two project sites of China's Comprehensive AIDS Response program (China
CARES). METHODS: Data on socio-demographic characteristics, ART
regimens, HIV/AIDS knowledge, side effects, reasons for missing doses,
substance abuse, self-efficacy, doctor-patient relations and health services
information was collected through face-to-face interview. The adherence rate was
calculated as the number of doses taken divided by the number prescribed over
the past three days. RESULTS: A total of 181 patients participated in the study
and 81.8% of them reported > or = 95% adherence on the previous three days.
The most frequently reported reasons for missing doses were forgetfulness, being
busy and antiretroviral drug side effects. In the multivariate analysis, patients'
knowledge about side effects [odds ratio (OR) = 8.08, 95% confidence interval
(CI) 2.63-24.81], belief towards ART (OR = 3.20, 95% CI: 1.24-8.26), having
developed reminder tools of taking medication (OR = 3.49, 95% CI: 1.36-8.96)
and patient' trust and confidence in his/her doctor (OR = 7.79, 95% CI: 1.26-
48.95) were independently associated with adherence. CONCLUSION: Regular
ART adherence education and counseling, improved training on medication self-
management skills, improved adherence monitoring and health care services
should be priority strategies for improving adherence to ART among HIV/AIDS
patients who receive free ART in rural China.
Publication Types:

98: AIDS. 2007 Dec;21 Suppl 8:S143-8.

The Chinese free antiretroviral treatment program: challenges and
responses.
Zhang F, Haberer JE, Wang Y, Zhao Y, Ma Y, Zhao D, Yu L, Goosby EP.
National Center for AIDS/STD Control and Prevention/ Chinese Center for
Disease Control and Prevention, Beijing, China. treatment@chinaaids.cn
To respond to the HIV/AIDS epidemic in China, the National Center for

AIDS/STD Control and Prevention established the Division of Treatment and
Care in late 2001. The pilot for the National Free ART Program began in Henan
Province in 2002, and the program fully began in 2003. Treatment efforts initially
focused on patients infected through illicit blood and plasma donation in the mid-
1990s and subsequently expanded to include HIV-infected injection drug users,
commercial sex workers, pregnant women, and children. The National Free ART
Database was established in late 2004, and includes data on current patients and
those treated before 2004. Over 31 000 adult and pediatric patients have been
treated thus far. Challenges for the program include integration of drug treatment
services with ART, an under-resourced health care system, co-infections, stigma,
discrimination, drug resistance, and procurement of second-line ART. The
merging of national treatment and care, epidemiologic, and drug resistance
databases will be critical for a better understanding of the epidemic, for earlier
identification of patients requiring ART, and for improved patient follow-up. The
Free ART Program has made considerable progress in providing the necessary
care and treatment for HIV-infected people in China and has strong government
support for continued improvement and expansion.
99: J Vet Med Sci. 2007 Dec;69(12):1255-8.

Epidemiologic indicators associated with within-farm spread of

Johne's disease in dairy farms in Japan.
Kobayashi S, Tsutsui T, Yamamoto T, Nishiguchi A.
Epidemiological Research Team, National Institute of Animal Health, Kannondai,

Ibaraki-ken, Japan. sotaco@affrc.go.jp
Epidemiologic indicators associated with within-farm infection of Johne's disease

in dairy farms in Japan were determined through a nationwide investigation of
infected farms. We assumed that subsequent detection of the disease within one
year after the first detection could represent the occurrence of within-farm spread
occurring before the first detection. Of 594 infected farms, 158 farms (27%) had
at least one additional detection. Logistic regression analysis using epidemiologic
information obtained from infected farms at the time of the first detection
revealed three epidemiologic indicators associated with subsequent detection.
Farms at which the first cases included cattle with clinical signs were 3.8 (95%
confidence interval: 2.2, 6.8) times more likely to have additional detections than
those with cattle without clinical signs. Similarly, farms where two or more cattle
were detected at the time of first detection and where cattle were held in a loose
housing system were 2.8 (95% CI: 1.8, 4.5) and 2.0 (95% CI: 1.1, 3.6) times more
likely to have additional detections than those where only one animal was
detected and a tied-up housing system was used, respectively. These
epidemiologic indicators are likely important determinants in the selection of
farms requiring more intensive on-farm control measures.
100: Nippon Ishigaku Zasshi. 2007 Jun;53(2):229-48.

[Acute infectious diseases in occupied Japan]
Tanaka S, Sugita S, Moriyama T, Marui E.
Japan's health statistics system, considered among the best in the world today,
continually complies and organizes information about various infectious diseases.
However, systematic surveillance was not conducted by the Ministry of Health
and Welfare between World War II and the postwar period, creating a gap in
health data. In contrast, the GHQ/SCAP/PHW. which was closely involved in
health and medical reform during the Occupation, thoroughly investigated the
health conditions of the Japanese people during this period. This article describes
the trends in acute infectious diseases in Occupied Japan by using statistical
records listed in the appendices of the "Weekly Bulletin", an official document of
the GHQ/SCAP that is currently kept in the National Diet Library Modern
Japanese Political History Materials Room.
Publication Types:
• Historical Article

101: J UOEH. 2007 Dec 1;29(4):457-67.
[Clinical trial work at Hospital of UOEH]
Mizuyama N, Takahashi K, Tamari K, Koya A, Takeuchi A, Nakamura T.
Department of Pharmacy, Hospital of University of Occupational and

Environmental Health, Japan.
A clinical trial management room was established in the pharmacy at UOEH

hospital in June, 2001, and we support the clinical trials in our hospital.
Meanwhile, the number of clinical trials and CRC have increased as a result of
this. Moreover, there have been changes in the work contents due to the
introduction of the electronic clinical record system. At this time, we will report
on the various current activities, and discuss the future problems.
Publication Types:
102: Pharmacoepidemiol Drug Saf. 2008 Mar;17(3):306-11.

Antibiotic use in five children's hospitals during 2002-2006: the

impact of antibiotic guidelines issued by the Chinese Ministry of
Health.
Zhang W, Shen X, Wang Y, Chen Y, Huang M, Zeng Q, Wei J, Lu Q, Wang

G, Deng L, Wang X, Yao K, Yu S, Yang Y.
Beijing Children's Hospital, Capital Medical University, Beijing, China.
PURPOSE: To investigate the pattern of antibiotic use in five Chinese children's

hospitals from 2002 to 2006. To see if the Guidelines to encourage rational use of
antibiotics issued by the Ministry of Health in October 2004 have any impact on
the use. METHODS: The Anatomical Therapeutic Chemical
Classification/Defined Daily Doses (ATC/DDD) methodology was used.
Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of
DDD/100 bed-days for inpatients. RESULTS: Total 56 different substances of
systemic antibiotics were used. The overall consumption of antibiotic drugs was
68.2, 58.4, 65.8, 65.6 and 49.9 DDD/100 bed-days for the years 2002-2006,
respectively. The top antibiotics used were third-generation cephalosporins. There
was considerable variation in both type and amount of antibiotics used in the five
hospitals. In 2002, some hospitals had twice the antibiotic use compared to others.
While the overall antibiotic use in 2005 was largely unchanged compared with
previous years, by 2006 antibiotic use had decreased by 22.6% and the variation
in use between hospitals was also reduced. CONCLUSIONS: The ATC/DDD
methodology proved useful for studying overall antibiotic usage in children's
hospitals. The decline in antibiotic usage found in 2006 (and the reduced variation
between hospitals) may be attributed to the impact of the Ministry of Health
guidelines which took some time to be promulgated to individual staff members.
Further research will focus on compliance of antibiotic use in these five hospitals
with particular guideline recommendations for specific clinical problems such as
bacterial resistance and surgical antibiotic prophylaxis. Copyright 2007 John
Wiley & Sons, Ltd.
Publication Types:
103: Am J Trop Med Hyg. 2007 Dec;77(6):1146-9.

Endemic Japanese encephalitis in the Kathmandu valley, Nepal.
Partridge J, Ghimire P, Sedai T, Bista MB, Banerjee M.
World Health Organization, Immunization Preventable Diseases Unit,

Kathmandu, Nepal. partridgej@searo.who.int <partridgej@searo.who.int>
Japanese encephalitis (JE) is endemic in the Terai region of Nepal. There is little
information on the occurrence of JE outside the Terai and particularly in the
densely populated Kathmandu valley. Acute encephalitis syndrome (AES) cases
were detected using a sentinel surveillance system that has been functioning since
2004. JE was confirmed using anti-JE IgM ELISA. All laboratory-confirmed JE
cases that occurred in the Kathmandu valley during 2006 were followed up for
verification of residence and travel history. JE was confirmed in 40 residents of
the Kathmandu valley, including 30 cases that had no history of travel outside the
valley during the incubation period. Incidence was 2.1/100,000 and the case
fatality was 20% (8/40). Currently, JE prevention is focused on the Terai region in
Nepal; given the evidence, this should be reviewed for the possible inclusion of
the Kathmandu valley in the national JE prevention and control program.
104: Asian Pac J Cancer Prev. 2007 Jul-Sep;8(3):353-6.

Can an appointment-letter intervention increase pap smear

screening in Samliem, Khon Kaen, Thailand?
Chumworathayi B, Yuenyao P, Luanratanakorn S, Pattamadilok J,

Chalapati W, Na-Nhongkai C.
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen

University, Khon Kaen, 40002, Thailand bchumworathayi@gmail.com
Our objective was to assess the efficiency of an appointment-letter intervention

aimed to increase uptake of cervical cancer screening in women between 35 and
65 years of age. From January, 2007, we randomly recruited 320 women, not
screened for at least 5 years, from the Samliem inner-city community, Khon
Kaen, Northeast Thailand. A total of 150 women 35, 40, 45, 50, 55, 60 and 65
years of age were assigned to the intervention group according to Thai National
Cancer Institute's ( TNCI) strategy. A further 170 women between 36-39, 41-44,
46-49, 51-54, 56-59 and 61-64 years of age were assigned to the control group.
Baseline interviews were conducted for all women in both groups by one of the
researchers in January, who also provided culturally-sensitive health education
emphasizing the need for screening. Then appointment letters were sent only to
women in the intervention group in February, with the last date for an
appointment being March 31st. In April of 2007, immediately post-intervention,
screening-coverage interviews were performed in both groups for comparison.
There was a significant increase in the Pap smear screening-coverage rate in the
intervention group compared with the control group (44.67% vs. 25.88%,
p=0.001). Therefore, the appointment-letter intervention produced a significant
effect on increasing Pap smear coverage in this group of women.
Publication Types:
• Randomized Controlled Trial


105: Med Teach. 2007 Nov;29(9):984-6.
An innovative web-based peer support system for medical students

in Hong Kong.
Lau KS, Siong KH, Tang HY, Cheng PW, Cheung KS, Chan SW, Lee PW,
Wong JG.
University of Hong Kong, Hong Kong.
BACKGROUND: Psychological morbidity is commonly found in medical

students. AIMS: The Mental Health Support Group (MSG), a student-initiated
and student-run web-based peer support service aims to provide mental health
information, e mail counseling and an online forum for medical students.
METHODS: The development process of MSG is described in the paper with
presentation of preliminary evaluation results. Results: Preliminary evaluation
shows promising results. Student members of MSG acquired valuable skills in
counseling, communication, webpage design and maintenance of an online forum.
CONCLUSIONS: Future challenges include succession issues, strategies to keep
up the momentum, enhancement of publicity and further diversification of service
to meet the needs of our students.
Publication Types:
106: Health Policy. 2008 May;86(2-3):288-94. Epub 2008 Feb 21.

The soaring mechanic ventilator utilization under a universal health

insurance in Taiwan.
Cheng SH, Jan IS, Liu PC.
Institute of Health Policy & Management and Center for Health Insurance
Research, College of Public Health, National Taiwan University, 17 Hsu-Chow
Road, Room 618, Taipei 100, Taiwan. shcheng@ntu.edu.tw
OBJECTIVES: The use of mechanic ventilators (MVs) is increasing in many

countries. Taiwan's Bureau of National Health Insurance (NHI) launched a new
payment program in 2000 to encourage integrated care for mechanically
ventilated patients and to reduce the heavy utilization of high-cost intensive care
unit. This study examines the trend in MV usage in Taiwan. METHODS: This
study used nationally representative NHI claim data from 1997 to 2004 to
examine the MV usage. Total inpatient days and MV usage days were analyzed
by piece-wise regression model. We also analyzed the major diagnoses related to
MV dependence. RESULTS: While the total hospital inpatient days increased
only 49.41%, MV usage rose 181.75% over the 8-year study period. The increase
in number of MV patient-days in ICUs has not been curbed, besides there was an
increase in respiratory care center/wards. Acute respiratory failure (ARF),
pneumonia and diabetes mellitus were the leading diagnoses for mechanically
ventilated patients. CONCLUSIONS: The new NHI insurance payment program
may have helped spark the increased trend in MV usage in Taiwan. The
significant impact of insurance incentive on healthcare utilization is a critical
issue for policymakers in developing healthcare programs.
Publication Types:
107: Perspect Sex Reprod Health. 2007 Dec;39(4):216-25.

Republished from:
• Int Fam Plan Perspect. 2007 Sep;33(3):106-16.
Legal abortion worldwide: incidence and recent trends.
Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J.
Guttmacher Institute, New York, USA. gsedgh@guttmacher.org
CONTEXT: Information on abortion levels and trends can inform research and
policies affecting maternal and reproductive health, but the incidence of legal
abortion has not been assessed in nearly a decade. METHODS: Statistics on legal
abortions in 2003 were compiled for 60 countries in which the procedure is
broadly legal, and trends were assessed where possible. Data sources included
published and unpublished reports from official national reporting systems,
questionnaires sent to government agencies and nationally representative
population surveys. The completeness of country estimates was assessed by
officials involved in data collection and by in-country and regional experts.
RESULTS: In recent years, more countries experienced a decline in legal abortion
rates than an increase, among those for which statistics are complete and trend
data are available. The most dramatic declines were in Eastern Europe and
Central Asia, where rates remained among the highest in the world. The highest
estimated levels were in Armenia, Azerbaijan and Georgia, where surveys
indicate that women will have close to three abortions each, on average, in their
lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but
remained higher than rates in many Northern and Western European countries.
Rates increased in the Netherlands and New Zealand. The official abortion rate
declined by 21% over seven years in China, which accounted for a third of the
world's legal abortions in 1996. Trends in the abortion rate differed across age-
groups in some countries. CONCLUSIONS: The abortion rate varies widely
across the countries in which legal abortion is generally available and has
declined in many countries since the mid-1990s.
PMID: 18093038 [PubMed]
108: J Clin Nurs. 2008 Jan;17(1):99-108.

Service needs of residents in community-based long-term care

facilities in northern Taiwan.
Huang JJ, Lin KC, Li IC.
Chung-Huwa University of Medical Technology, Taipan, Taiwan.
AIM: The purpose of this study was to quantify the service needs of residents in
community-based long-term care (LTC) facilities and to determine their
predictors. BACKGROUND: Disabled older family members in Taiwan are often
eventually sent to community-based LTC facilities. Many service needs of these
residents are likely to go unmet. METHODS: A cross-sectional survey was used.
This involved purposive sampling of 132 residents from 10 LTC facilities in
Taipei City. A previously developed LTC service need assessment scale was used
to collect information about the residents' needs in terms of five kinds of LTC
services, namely health education, skilled nursing services, referral services,
activities of daily living (ADL) assistance and instrumental activities of daily
living assistance. RESULTS: The mean age of residents was 75.2 years. The
average period of institutionalization was 21.93 months. Overall, 70% of the
residents had either complete or partial ADL function dependency. Among the
specific ADL function dependencies of the residents, inability to take a bath was
the most common. The most significant predictors of service needs were health
status, age, number of children, number of medical diagnoses and whether the
stay is self-choice. These combined variables explained between 25.5% and
41.6% of the variance of the need for LTC services. CONCLUSION: The
findings of this study show that age, health status, number of children, number of
medical diagnoses and whether the stay is self-choice are significant determinants
of residents' needs in terms of LTC. Assessment of the extent to which facilities
meet the residents' needs is the first step in providing the most cost-effective
allocation of scarce resources. RELEVANCE TO CLINICAL PRACTICE: It is
suggested that, if reimbursement by the National Health Insurance system of
physician visits, including psychiatric visits, to LTC facilities were allowed, this
would improve quality of care.
109: Isr Med Assoc J. 2007 Nov;9(11):782-6.

Comment in:
• Isr Med Assoc J. 2007 Nov;9(11):813.
Primary care screening for childhood obesity: a population-based

analysis.
Meyerovitch J, Goldman RD, Avner-Cohen H, Antebi F, Sherf M.
Institute for Endocrinology and Diabetes, National Center for Childhood

Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
josephm@clalit.org.il
BACKGROUND: The prevalence of obesity among children and adolescents in

the western world has increased dramatically. OBJECTIVES: To assess the
efficacy of routine childhood obesity screening by primary physicians in the
pediatric population in Israel and the utilization of health services by overweight
children. METHODS: The electronic medical records of children aged 60-83
months registered in 39 pediatric primary care centers between January 2001 and
October 2004 (n=21,799) were reviewed. Those in whom height and weight were
documented during a clinic visit (index visit) were classified as overweight, at
risk of overweight, or normal weight according to body mass index percentiles.
The number of visits to the pediatrician, laboratory tests and health care costs 12
months after the index visit were calculated. RESULTS: Anthropomorphic
measurements were performed in 1556 of the 15,364 children (10.1%) who
visited the clinic during the study period. Of these, 398 (25.6%) were overweight,
185 (11.9%) were at risk of overweight, and 973 (62.5%) were normal weight.
Children in the first two groups visited the clinic slightly more often than the third
group, but the differences were not statistically significant (P = 0.12), and they
had significantly more laboratory tests than the rest of the children visiting the
clinics (P = 0.053). Health care costs were 6.6% higher for the overweight than
the normal-weight children. CONCLUSIONS: Electronic medical records are a
useful tool for population-based health care assessments. Current screening for
obesity in children during routine care in Israel is insufficient and additional
education of community pediatricians in diagnosis and intervention is urgently
needed.
110: J Urol. 2008 Feb;179(2):564-9. Epub 2007 Dec 21.

Seasonal variations in urinary calculi attacks and their association

with climate: a population based study.
Chen YK, Lin HC, Chen CS, Yeh SD.
School of Health Care Administration, Taipei Medical University, Taipei,

Taiwan.
PURPOSE: In this nationwide population based study we used 5-year data on

urinary calculi patient visits to emergency departments in Taiwan to investigate
the seasonal variation in urinary calculi attacks and the association with 5 climatic
parameters. MATERIALS AND METHODS: Comprehensive details on total
admissions to emergency departments were obtained from the Taiwan National
Health Insurance Research Database (1999 to 2003), providing monthly urinary
calculi attack rates per 100,000 of the population. Subgroups of urinary calculi
incidences were created based on gender and 3 age groups (18 to 44, 45 to 64 and
65 years old or older). Following adjustment for time trend effects, evaluation of
the monthly urinary calculi attack rates and the effects of climatic factors was
performed using auto-regressive integrated moving average regression
methodology. RESULTS: The seasonal trends in the monthly urinary calculi
attack rates revealed a peak in July to September, followed by a sharp decline in
October, with the auto-regressive integrated moving average tests for seasonality
demonstrating significance for each gender group, for each age group and for the
whole sample (all p <0.001). Although significant associations were found
between ambient temperature, atmospheric pressure and hours of sunshine vis-à-
vis monthly urinary calculi attack rates for the total population, after adjustment
for trends and seasonality, ambient temperature was found to be the sole major
factor having any positive association with the monthly attack rates.
CONCLUSIONS: We conclude that seasonal variations do exist in the monthly
urinary calculi attack rates for all age and gender populations, and that following
time series statistical adjustment, only ambient temperature had any consistent
association with monthly attack rates.
111: Educ Health (Abingdon). 2007 Nov;20(3):118. Epub 2007 Oct 19.
Gender sensitization among health providers and communities

through transformative learning tools: experiences from Karachi,
Pakistan.
Shaikh BT, Reza S, Afzal M, Rabbani F.
Health Systems Division, Department of Community Health Sciences, Aga Khan

University, Pakistan. babar.shaikh@aku.edu
CONTEXT: Pakistan lags far behind most developing countries in women's

health and gender equity. Appropriateness of health care services vis-a-vis the
gender specific cultural norms that influence clients' needs are not very visible
and are more difficult to monitor. Programs and services need to be sensitively
designed to facilitate women's access to physical and social needs. This paper
narrates the experience of working with health providers from public and private
sectors, community, local government representatives and community-based
organizations. Through transformative learning, this endeavour focused on
initiating a process of sensitization on gender related health issues for women.
APPROACH: The initiative was primarily based on the use of the following two
standardized tools: 'Health Workers for Change' for working with health providers
and 'Initiating Women Empowerment for Health' for interacting with the
community. Both tools focus primarily on women's health and social issues
affecting their health status. The research methodology used was predominantly
qualitative, using focus group discussions, participatory rural appraisal and
interactive workshops. IMPLICATIONS: This approach endeavours to sensitize
the health service providers to the health needs of female clients and encourages
behavioural changes. Simultaneously, it creates an opportunity to raise awareness
among women and the community in general regarding appropriate health-
seeking behaviour and the timely use of health services. The information collected
is evidence for policy makers regarding the gender-based problems faced by
women who are seeking health care and it suggests how to overcome these
problems.
112: Rheumatology (Oxford). 2008 Jan;47(1):88-91.

The epidemiology of total knee replacement in South Korea:
national registry data.
Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y.
Hallym University Sacred Heart Hospital, Anyang, South Korea.

kimha@hallym.ac.kr
OBJECTIVE: Knee osteoarthritis (OA) is prevalent among the elderly in Asian

countries; however, the utilization of total knee replacement (TKR) is unknown.
Using data from a national registry, we sought to estimate the incidence of TKR
by age and sex, and the trend for TKR utilization from 2002 to 2005 in South
Korea. METHODS: Reimbursement records from all hospitals in South Korea
were extracted from the Health Insurance Review Agency (HIRA) database.
Records with both the procedure code corresponding to a TKR and the diagnosis
code of knee OA were selected. We estimated the age- and sex-specific rates of
TKR. To compare the rate of TKR between men and women, we calculated age-
standardized risk ratios. A TKR registry from a single centre containing more
clinical information was analysed, and the differences in the clinical features
between men and women were compared. RESULTS: From 2002 to 2005, 47 961
TKRs were performed in subjects over the age of 40 yrs due to OA. The rate of
TKR has increased over the 4 yrs and was much higher in women than in men.
Compared with men, the age-standardized rate ratios for TKR in women ranged
from 7.4 to 8.0. The single-centre registry data revealed that there was no
difference in age, disease duration and the Kellgren-Lawrence grade at the time of
surgery between men and women. CONCLUSION: Using a national database, we
found that the rate of TKR increased steadily from 2002 to 2005 in South Korea.
The TKR rate in women was much higher than that in men. Risk factors that
account for such disparity in TKR utilization need to be further investigated.
Publication Types:
113: Ambio. 2007 Nov;36(7):593-9.

Developing a predictive understanding of landscape importance to

the Punan-Pelancau of East Kalimantan, Borneo.
Cunliffe RN, Lynam TJ, Sheil D, Wan M, Salim A, Basuki I, Priyadi H.
rcunliffe@mango.zw
In order for local community views to be incorporated into new development

initiatives, their perceptions need to be clearly understood and documented in a
format that is readily accessible to planners and developers. The current study
sought to develop a predictive understanding of how the Punan Pelancau
community, living in a forested landscape in East Kalimantan, assigns importance
to its surrounding landscapes and to present these perceptions in the form of
maps. The approach entailed the iterative use of a combination of participatory
community evaluation methods and more formal modeling and geographic
information system techniques. Results suggest that landscape importance is
largely dictated by potential benefits, such as inputs to production, health, and
houses. Neither land types nor distance were good predictors of landscape
importance. The grid-cell method, developed as part of the study, appears to offer
a simple technique to capture and present the knowledge of local communities,
even where their relationship to the land is highly complex, as was the case for
this particular community.
Publication Types:
114: Nippon Rinsho. 2007 Oct 28;65 Suppl 8:67-72.

[Reporting system for adverse drug reactions and infections]
Hashiguchi M, Mochizuki M.
Division for Evaluation and Analysis of Drug Information, Center for Clinical
Pharmacy and Clinical Sciences, School of Pharmacy, Kitasato University.
Publication Types:
• Review

115: Folia Biol (Praha). 2007;53(6):194-201.
A new mutation within the porphobilinogen deaminase gene leading

to a truncated protein as a cause of acute intermittent porphyria in
an extended Indian family.
Flachsová E, Verma IC, Ulbrichová D, Saxena R, Zeman J, Saudek V,

Raman CS, Martásek P.
Department of Pediatrics and Center for Integrated Genomics, Charles University

in Prague, 1st Faculty of Medicine, Prague, Czech Republic.
Based on Internet search, we were contacted by a 50-year-old man suffering from

severe abdominal pain. Acute hepatic porphyria was considered from positive
Watson-Schwartz test. He, not being a health professional, searched for centres
with ability to do molecular diagnosis and for information about therapeutic
possibilities. He asked his physician for haem-arginate (Normosang, Orphan
Europe, Paris) treatment, arranged sending his blood to our laboratory and
mediated genetic counselling for him and his family. Molecular analyses of the
PBGD gene revealed a novel mutation in exon 15, the 973insG. Subsequently,
genetic analysis was performed in 18 members of the proband's extensive family.
In 12 members of the family, the same mutation was found. The mutation, which
consisted of one nucleotide insertion, resulted in addition of four different amino
acids leading to a protein that is prematurely truncated by the stop codon. The
effect of this mutation was investigated by expression of the wildtype and mutated
PBGD in a prokaryotic expression system. The mutation resulted in instability of
the protein and loss of enzymatic function. The increasing access to a number of
disease- and symptom-oriented web pages presents a new and unusual venue for
gaining knowledge and enabling self-diagnosis and self-help. It is, therefore,
important that diseaseoriented Internet pages for public use should be designed
with clarity and accurate current knowledge based background.
Publication Types:
116: J Eval Clin Pract. 2007 Dec;13(6):867-81.

Estimation and prediction system for multi-state disease process:
application to analysis of organized screening regime.
Chang CM, Lin WC, Kuo HS, Yen MF, Chen TH.
Information Management Office, Center for Disease Control, Department of

Health, Taipei, Taiwan.
RATIONALE, AIMS AND OBJECTIVES: The disease progression of cancer

and non-malignant chronic disease often involve a multi-state transition.
However, estimation of parameters and prediction regarding the multi-state
disease process are complex. This study aimed to develop an estimation and
prediction system with a computer-assisted software using SAS/SCL as a
platform to predict the risk of any outcome arising from the underlying multi-state
process with or without the incorporation of individual characteristics. METHOD:
The computer-aided system is first constructed following the theoretical
framework of stochastic process. The functions provided in this software include
model specification, formulation of likelihood function, parameter estimation,
model validation and model prediction. An example of breast cancer screening for
a high-risk group in Taiwan was used to demonstrate the usefulness of this
software. RESULTS: The natural history of breast cancer of a three-state disease
process has been demonstrated. Two suspected risk factors, late age at first full-
term pregnancy and obesity, were considered by the form of the proportional
hazard model. Formulation of intensity matrix, likelihood function, assignment of
initial values, and parameter constraint and estimation were successfully
demonstrated in model specification. Model validation suggested a good fit of the
constructed model. The application of model prediction enables one to project the
effectiveness of organized screening by different inter-screening intervals from a
policy level or from an individual basis. CONCLUSIONS: A computer-aided
estimation and prediction system for multi-state disease process was developed
and demonstrated. This system can be applied to data with the property of multi-
state transitions in association with events or disease.
117: Methods Inf Med. 2007;46(6):686-93.

Risk management and measuring productivity with POAS--Point of

Act System--a medical information system as ERP (Enterprise
Resource Planning) for hospital management.
Akiyama M.
Sloan School of Management, Massachusetts Institute of Technology, Cambridge,
MA, USA. makiyama-kkr@umin.ac.jp
OBJECTIVES: The concept of our system is not only to manage material flows,
but also to provide an integrated management resource, a means of correcting
errors in medical treatment, and applications to EBM (evidence-based medicine)
through the data mining of medical records. METHODS: Prior to the
development of this system, electronic processing systems in hospitals did a poor
job of accurately grasping medical practice and medical material flows. With
POAS (Point of Act System), hospital managers can solve the so-called, "man,
money, material, and information" issues inherent in the costs of healthcare.
RESULTS: The POAS system synchronizes with each department system, from
finance and accounting, to pharmacy, to imaging, and allows information
exchange. We can manage Man (Business Process), Material (Medical Materials
and Medicine), Money (Expenditure for purchase and Receipt), and Information
(Medical Records) completely by this system. CONCLUSIONS: Our analysis has
shown that this system has a remarkable investment effect - saving over four
million dollars per year - through cost savings in logistics and business process
efficiencies. In addition, the quality of care has been improved dramatically while
error rates have been reduced - nearly to zero in some cases.
118: Methods Inf Med. 2007;46(6):679-85.

Development of hospital data warehouse for cost analysis of DPC

based on medical costs.
Muranaga F, Kumamoto I, Uto Y.
Department of Medical Informatics, Kagoshima University Hospital,

Sakuragaoka 8-35-1, Kagoshima City 890-8520, Japan. f-
mura@m.kufm.kagoshima-u.ac.jp
OBJECTIVES: To develop a data warehouse system for cost analysis, based on

the categories of the diagnosis procedure combination (DPC) system, in which
medical costs were estimated by DPC category and factors influencing the
balance between costs and fees. METHODS: We developed a data warehouse
system for cost analysis using data from the hospital central data warehouse
system. The balance data of patients who were discharged from Kagoshima
University Hospital from April 2003 to March 2005 were determined in terms of
medical procedure, cost per day and patient admission in order to conduct a drill-
down analysis. To evaluate this system, we analyzed cash flow by DPC category
of patients who were categorized as having malignant tumors and whose DPC
category was reevaluated in 2004. RESULTS: The percentages of medical
expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma,
and particularly in patients with malignant tumors of the liver and intrahepatic
bile duct. Imaging tests degraded the percentages of medical expenses in
Kagoshima University Hospital. CONCLUSIONS: These results suggested that
cost analysis by patient is important for hospital administration in the inclusive
evaluation system using a case-mix index such as DPC.
119: J Prev Med Pub Health. 2007 Nov;40(6):487-94.

[Physician factors associated with the blood pressure control among

hypertensive patients]
[Article in Korean]
Kim SY, Cho IS, Lee JH, Kim JH, Lee EJ, Park JH, Lee JS, Kim Y.
Department of Health Policy and Management, Seoul National University,

College of Medicine.
OBJECTIVES: Little is known about the physician-related factors that are

associated with the management of hypertension. The purpose of this study was to
determine the physician-related factors associated with blood pressure control in
hypertensive patients. METHODS: We surveyed 154 physicians at 117 public
health (subhealth) centers in Gyeonggi-do. Forty-one physicians completed the
survey (response rates: 26.6%) and 31 physicians were finally included as the
study subjects. Using the information obtained from the self-reported survey, we
measured the physician-related factors associated with hypertension control,
including their perception of hypertension, prescription patterns (combination
prescription rates, specific antihypertensives prescription rates among patients
with diabetes mellitus), and sociodemographic factors. We then collected data on
blood pressure and medication use in patients seen by these physicians from the
health center's information system. We compared the physicians' perceived
hypertension control rates with the actual rates, and then evaluated the rate of high
overestimation (overestimation by more than 25% of the median degree of
hypertension control rate overestimation) among the physicians. The physicians'
antihypertensive prescription patterns were also evaluated. Multiple logistic
regression analysis was used to evaluate the independent association between
hypertension control and physician-related factors. RESULTS: The physicians
tended to overestimate the proportion of their patients with controlled blood
pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with
high overestimation was 35.5% (11 physicians). The physicians with lower
control rates were more likely to highly overestimate their patients' control rates.
Physicians with below-median actual control rates tended to prescribe fewer
combination treatments for patients with uncontrolled blood pressure and
angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers
for patients with diabetes mellitus. The rate of high overestimation by physicians
was 1.31 times higher in patients with uncontrolled blood pressure than in patients
with other conditions (OR=1.31, 95% CI: 1.17-1.48). CONCLUSIONS:
Physicians have a tendency to overestimate the rates of hypertension control in
their patients. Because physicians have a direct role in treatment outcomes,
physicians' overestimation about hypertension management contributes to
inadequate blood pressure control. Thus, interventions for improving physician'
awareness regarding the management of patients with hypertension are needed.
Publication Types:
120: J Health Organ Manag. 2007;21(6):495-505.

Progress towards health reform in Tajikistan.
Mirzoev TN, Green AT, Newell JN.
University of Leeds, Leeds, UK. t.mirzoev@leeds.ac.uk
PURPOSE: The purpose of this paper is to provide an up-to-date overview of

Tajikistan's health system, focusing on the main factors affecting health systems
development. The wider contextual environment is to be explored, focusing on
political, social and economic issues. Different elements of the health system
including health policy, governance, service delivery, human resources and health
financing are reviewed in the light of their development over the past decade.
DESIGN/METHODOLOGY/APPROACH: The paper shows that the Republic of
Tajikistan is in transition. Formerly one of the most neglected republics within the
USSR, the country became independent in 1990 and faced the civil conflict
shortly thereafter. In the last few years there have been major public sector
reforms with health reforms formally launched in the late 1990s. Little
information about current Tajikistan is widely available. FINDINGS: The paper
finds that the progress of health reforms in Tajikistan has been relatively slow
compared with neighbouring Kazakhstan and Kyrgyzstan. This is largely due to
the effects of civil war in the mid-1990s and significant out-migration of qualified
experts, but it can also be attributed to an inability of central government to
adequately adapt to the requirements of transition. ORIGINALITY/VALUE: The
paper shows that many problems are still to be overcome by the health system,
ranging from operational issues related to service delivery to strategic issues such
as formulating an explicit privatisation policy, reducing fragmentation of, and
aligning, external aid. However, some recent developments, such as adoption of a
country health reform conception, a health financing strategy, and willingness of
central government to improve coordination, suggest that improvements are
possible.
121: Mil Med. 2007 Nov;172(11):1186-9.

Managing health and finance: challenges, outcome, and control in

the Israel Defense Forces.
Hosiosky I, Weiss Y, Magnezi R.
Medical Services and Supply Center, Medical Corps, Israel, Tel Hashomer, Israel.
BACKGROUND: The Ministry of Defense budget constitutes 16% of the state

budget. The budget for the Ministry of Health and for civilian health care is
derived from the state budget. The health care funds receive their budgets from
several sources. The capitation formula, which is determined by law, is the main
factor that affects the size of the budget each fund receives. OBJECTIVE: The
objective of this study is to describe the manner of planning, managing,
monitoring, and controlling the budget allocated to medical services, which is a
public budget for soldiers. METHODS: Several parameters are suggested for
comparison, including the interface with the civilian health system, the method
for budgeting a health care system, possible results of managing a medically
centered budget, and the possibilities for monitoring the provided services. We
also examine the potential for decentralization of authority. CONCLUSIONS:
Managing the budget and locating appropriate alternatives, as well as the
availability and accessibility of medical services, are important for procurement
and for forming contracts with both military and civilian systems. Turnover based
on updated information might serve to improve future health services.
122: J Clin Nurs. 2007 Nov;16(11C):341-9.

Experience of Hong Kong patients awaiting kidney transplantation

in mainland China.
Leung SS, Shiu AT.
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
AIM: This paper describes the experience of Hong Kong Chinese patients
awaiting kidney transplantation in mainland China. BACKGROUND: While
travelling to mainland China for kidney transplantation is a controversial issue,
there is an increasing trend of Hong Kong Chinese patients with chronic kidney
disease seeking this treatment choice, which outnumbers that performed in Hong
Kong. Although these patients seek pre- and post-transplantation care from Hong
Kong public healthcare system, little is known about their experience during the
waiting period. METHODS: This experience is examined in an exploratory
qualitative study. In-depth interviews were used to collect data from a purposive
sample of 12 kidney recipients. RESULTS: Three major findings are identified:
(i) transplant waiting patients may travel to mainland China for transplantation in
search of normal life, (ii) they need informational support from their continuing
healthcare providers in Hong Kong to make the informed decision and (iii) they
perceive a variation of attitudes of nurses and doctors in Hong Kong towards
transplantation in mainland China. CONCLUSIONS: This study contributes to the
literature by researching patients' perspective. The findings highlight the
importance and controversy of addressing these patients' informational needs.
While the authors have no inclination for or against travelling to mainland China
for transplantation, the findings reveal a tenacious clinical dilemma, which
deserves debate in international transplant community and further research to
inform the debate. Nurse and doctors in Hong Kong may contribute to the debate
by articulating their experience of caring for these patients. RELEVANCE TO
CLINICAL PRACTICE: Health information that is readily available for patients
scheduled for kidney transplantation in Hong Kong should be made accessible to
the whole community of patients with chronic kidney disease. To address the
complexity of patients travelling to elsewhere for transplantation and the needs of
these patients, provider reticence may be counterproductive.
Publication Types:
123: J Korean Med Sci. 2007 Sep;22 Suppl:S5-S10.

Cancer survival in Korea 1993-2002: a population-based study.

Jung KW, Yim SH, Kong HJ, Hwang SY, Won YJ, Lee JK, Shin HR.
Cancer Registration and Biostatistics Branch, National Cancer Control Research

Institute, National Cancer Center, Goyang, Korea.
Population-based survival reflect the average prognosis of unselected patients

with a variety of natural histories as well as treatment patterns and are also useful
for evaluating effectiveness and efficiency of cancer-directed health services in a
given region. Although survival data have been reported based on hospital data,
the survival data from population-based registry have been rarely reported in
Korea. Based on the Korea National Cancer Incidence Database, we report the
results from survival analysis for cancer patients diagnosed during 1993-2002 and
followed up until 31 December 2005 at primary cancer sites. The five-year
relative survival rates (RSR) were calculated using the Ederer II method. The
Kaplan-Meier method was used to estimate median survival and the 95%
confidence intervals. In males, the five-year RSR for all cancers was 32.5%
during 1993-1997 and was 37.8% during 1998-2002. In females, the five-year
RSR for all cancers was 53.7% during 1993-1997 and was 57.0% during 1998-
2002. The largest improvement in survival was shown in prostate cancer in males
and breast and stomach cancer in females. The median survival durations were
16.3 months in males and 81.6 months in females. This result will be useful for
evaluation of cancer treatment outcomes in Korea.
Publication Types:
124: Sex Transm Dis. 2007 Nov;34(11):908-16.

Comparing prevalence of condom use among 15,379 female sex

workers injecting or not injecting drugs in China.
Lau JT, Zhang J, Zhang L, Wang N, Cheng F, Zhang Y, Gu J, Tsui HY, Lan
Y.
Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of

Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
jlau@cuhk.edu.hk
OBJECTIVES: To compare the prevalence of condom use with clients and

regular sex partners between female sex workers (FSWs) who were or were not
injecting drug users (IDUs). METHODS: Behavioral surveillance data (2002-
2004) conducted in Sichuan, China were analyzed. Mapping exercises were done.
About 250 to 400 FSWs were anonymously interviewed from selected
establishments in 19 surveillance sites. RESULTS: Of all 15,379 FSWs studied,
3.2% were IDUs. This group, when compared with the non-IDU group, was less
likely to have used condoms with clients (last episode: 71.1% vs. 81.2%, OR =
0.6, P < 0.01; consistent use in the last month: 26.7% vs. 40.4%, OR = 0.5, P <
0.01) or to possess a condom (68.7% vs. 77.8%, OR = 0.6, P < 0.01). The
between-group difference in last month's consistent condom use with clients
remained significant in the multivariate analyses, after adjusting for other
significant factors [age, education level, age at first sex, having a regular sex
partner, HIV-related knowledge and perceptions, HIV antibody testing (OR = 1.1-
2.9, P < 0.05); STD symptoms, type of sex workers, longer duration of sex work,
larger number of clients per week, and not having received HIV-related
information (OR = 0.4-0.9)]. Comparable results were obtained for condom use
with the last client. Such between-group differences were, however, not observed
for condom use with regular sex partners (P > 0.05). Exposure to HIV-related
services was associated with condom use with clients (OR = 1.3-2.8, P < 0.05).
CONCLUSIONS: Higher sexual risk behaviors were found among FSWs who
were also IDUs, when compared with those who were non-IUDs. A double-risk
bridging population for HIV transmission thereby exists.
Publication Types:
125: Int J Electron Healthc. 2007;3(4):417-32.

The Internet and healthcare in Taiwan: value-added applications on

the medical network in the National Health Insurance smart card
system.
Tsai WH, Kuo HC.
Department of Business Administration, National Central University, Jhongli,

Taoyuan 320, Taiwan. whtsai@mgt.ncu.edu.tw
The introduction of smart card technology has ushered in a new era of electronic
medical information systems. Taiwan's Bureau of National Health Insurance
(BNHI) implemented the National Health Insurance (NHI) smart card project in
2004. The purpose of the project was to replace all paper cards with one smart
card. The NHI medical network now provides three kinds of services. In this
paper, we illustrate the status of the NHI smart card system in Taiwan and
propose three kinds of value-added applications for the medical network, which
are electronic exchange of medical information, retrieval of personal medical
records and medical e-learning for future development of health information
systems.

Remote patient monitoring and information system.
Al-Rousan M, Al-Ali AR, Eberlein A.
Department of Computer Engineering, IT College Jordan University of Science

and Technology, Irbid, Jordan. alrousan@just.edu.jo
This paper presents a remote healthcare patient monitoring system, called the
Virtual Eye (VI), that utilises the World Wide Web infrastructure to monitor,
collect, analyse and record patients' health status. The data is stored in the hospital
database and can be accessed from anywhere through the internet. When a patient
is in an alarming situation, the VI sends SMS messages to the mobile of the
designated health personnel via the public GSM network. The novelty of the
system lies in its security and its ability to use both the internet and the GSM
network as communication media. Doctors can access the database server to
compare the patient's current status with his/her medical history. It can be used by
one physician to monitor a group of patients simultaneously, or by a group of
physicians who all monitor the same patient. It allows plug-and-play of
multivendor off-the-shelf hardware devices, thus avoiding proprietary standards.

A HL7 transformer application for vaccination data report.
Lin IC, Hsu HM, Liu CT.
Department of Information Management, National Chung Cheng University, Min-

Hsiung Chia-Yi, Taiwan, ROC. caviar_lin@mis.ccu.edu.tw
In this paper, we design a data transformer to transform Comma Separated Value
(CSV) format into Health Level Seven (HL7) messages without losing syntax and
semantics. The algorithm of the data transformer is similar to a generic parser for
solving scheme-level mapping problems. It can be extended to transform non-
uniform formats for exchanges among different hospital information systems. To
show the flexibility and scalability of the algorithm, we use it for the
transformation of reported data in the Vaccination Reporting System (VRS).
Through the data transformer, different formats of vaccination data can be
reported directly to the Taiwan's Center for Disease Control.
Publication Types:

Revolution or evolution? An analysis of E-health innovation and

impact using a hypercube model.
Wu JH, Huang AS, Hisa TL, Tsai HT.
Department of Information Management and Institute of Healthcare Management,

National Sun Yat-Sen University, 70 Lien-hai Rd, Kaohsiung 804, Taiwan.
jhwu@mis.nsysu.edu.tw
This study utilises a hypercube innovation model to analyse the changes in both
healthcare informatics and medical related delivery models based on the
innovations from Tele-healthcare, electronic healthcare (E-healthcare), to mobile
healthcare (M-healthcare). Further, the critical impacts of these E-health
innovations on the stakeholders: healthcare customers, hospitals, healthcare
complementary providers and healthcare regulators are identified. Thereafter, the
critical capabilities for adopting each innovation are discussed.
Publication Types:
129: Phys Ther. 2008 Feb;88(2):270-85. Epub 2007 Nov 27.

Implementing an integrated electronic outcomes and electronic

health record process to create a foundation for clinical practice
improvement.
Deutscher D, Hart DL, Dickstein R, Horn SD, Gutvirtz M.
Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel.

Deutsch_d@mac.org.il
BACKGROUND AND PURPOSE: Improving clinical outcomes requires

continuous measurement and interpretation in conjunction with treatment process
and patient characteristics. The purposes of this study were: (1) to describe
implementation and integration of electronic functional status outcomes into an
electronic health record (EHR) for the promotion of clinical practice improvement
processes and (2) to examine the effect of ongoing outcomes data collection in a
large physical therapy service in relation to patient and clinic burden. SUBJECTS:
Data were examined from 21,523 adult patients (mean age=50.6 years, SD=16.3,
range=18-99; 58.9% women, 41.1% men) referred for physical therapist
management of neuromusculoskeletal disorders. METHODS: Process and patient
characteristic data were entered into the EHR. OUTCOMES: data collected using
computerized adaptive testing technology in 11 outpatient clinics were integrated
into the EHR. The effect of data collection was assessed by measuring the
participation rate, completion rate, and data entry time. Qualitative assessment of
the implementation process was conducted. RESULTS: After 1 year, the average
participation rate per clinic was 79.8% (range=52.7%-100%), the average
completion rate per clinic was 45.1% (range=19.3%-64.7%), and the average data
entry time per patient (minutes:seconds) was 03:37 (SD=02:19). Maximum
estimate of average administrative time per patient was 9.6% of overall episode
time. Barriers to and facilitators of the implementation process were identified.
DISCUSSION AND CONCLUSION: The results indicate that routine collection
of outcome data is realistic in a large public physical therapy service and can be
successfully integrated with EHR data to produce a valuable clinical practice
improvement platform for service evaluation and outcomes research. Participation
and completion rate goals of 90% and 65%, respectively, appear to be feasible.
Publication Types:
130: Clin Ther. 2007 Oct;29(10):2256-67.

Cost-effectiveness analysis of bevacizumab combined with

chemotherapy for the treatment of metastatic colorectal cancer in
Japan.
Shiroiwa T, Fukuda T, Tsutani K.
Department of Drug Policy and Management, Graduate School of Pharmaceutical

Sciences, University of Tokyo, Tokyo, Japan. t.shiroiwa@gmail.com
BACKGROUND: Rapid progress has been made in the treatment of metastatic

colorectal cancer (mCRC). New treatment regimens for mCRC include not only
cytotoxic chemotherapy but also targeted monoclonal antibodies, including
bevacizumab. However, bevacizumab is an expensive medication, which costs
from 300,000 yen to 400,000 yen (US $2500-$3300) per month. OBJECTIVE:
The purpose of this cost-effectiveness analysis was to examine the economic
efficiency of treating mCRC with bevacizumab plus chemotherapy versus
chemotherapy alone in Japan. METHODS: We searched an electronic database
(MEDLINE, UpToDate, and American Society of Clinical Oncology [ASCO]
Virtual Meeting; key terms: bevacizumab limited to randomized controlled trial;
years: 2000 to present [June 29, 2007]) to detect randomized controlled trials
(RCTs) that compared chemotherapy alone with chemotherapy plus bevacizumab.
To analyze the cost-effectiveness of bevacizumab, we used the Weibull regression
model and determined an expected treatment duration at each state using reported
survival curves of RCTs. We included only the direct medical costs (2006) of
these medications to estimate the expected values of incremental costs; thus, the
analysis was conducted from the perspective of the health care payer. The
incremental cost-effectiveness ratios (ICERs) were calculated from these expected
values of incremental life-years and incremental costs. RESULTS: We identified
5 articles using MEDLINE and 1 trial found on UpToDate and ASCO Virtual
Meeting; these data composed the final analysis group. First-line chemotherapy
regimens included in this analysis were bevacizumab + 5-fluorouracil/leucovorin
(FU/LV), irinotecan/FU/LV (IFL), infusional FU/LV/ oxaliplatin (FOLFOX6),
bolus FU/LV/oxaliplatin (bFOL), and capecitabine/oxaliplatin (CAPOX). The
only second-line chemotherapy regimen included was FOLFOX4. The ICERs of
additional bevacizumab when combined with FU/LV,IFL,FOLFOX6, bFOL, and
CAPOX were 17.4 million yen (US $145,000), 11.9 million yen ($99,000), 13.5
million yen ($113,000), 16.9 million yen ($141,000), and 8.5 million yen
($71,000), respectively, per life-year gained; the ICER was 14.1 million yen
($118,000) with second-line FOLFOX4. CONCLUSIONS: In this cost-
effectiveness analysis in Japan, the ICERs of bevacizumab + FU/LV combination
treatment, IFL, and second-line FOLFOX4 were high compared with other
chemotherapies for mCRC. It remains difficult to assess first-line therapies
comprising bevacizumab with oxaliplatin-based regimens, especially CAPOX.
Further information is needed to assess cost-effectiveness.
Publication Types:
131: BMC Med Genet. 2007 Nov 26;8:70.

Single nucleotide polymorphisms in bone turnover-related genes in

Koreans: ethnic differences in linkage disequilibrium and haplotype.
Kim KS, Kim GS, Hwang JY, Lee HJ, Park MH, Kim KJ, Jung J, Cha HS,
Shin HD, Kang JH, Park EK, Kim TH, Hong JM, Koh JM, Oh B, Kimm K,
Kim SY, Lee JY.
Center for Genome Science, National Institute of Health, 5 Nokbun-dong,

Eunpyung-gu, Seoul 122-701, Republic of Korea. kskim1997@empal.com
BACKGROUND: Osteoporosis is defined as the loss of bone mineral density that

leads to bone fragility with aging. Population-based case-control studies have
identified polymorphisms in many candidate genes that have been associated with
bone mass maintenance or osteoporotic fracture. To investigate single nucleotide
polymorphisms (SNPs) that are associated with osteoporosis, we examined the
genetic variation among Koreans by analyzing 81 genes according to their
function in bone formation and resorption during bone remodeling. METHODS:
We resequenced all the exons, splice junctions and promoter regions of candidate
osteoporosis genes using 24 unrelated Korean individuals. Using the common
SNPs from our study and the HapMap database, a statistical analysis of deviation
in heterozygosity depicted. RESULTS: We identified 942 variants, including 888
SNPs, 43 insertion/deletion polymorphisms, and 11 microsatellite markers. Of the
SNPs, 557 (63%) had been previously identified and 331 (37%) were newly
discovered in the Korean population. When compared SNPs in the Korean
population with those in HapMap database, 1% (or less) of SNPs in the Japanese
and Chinese subpopulations and 20% of those in Caucasian and African
subpopulations were significantly differentiated from the Hardy-Weinberg
expectations. In addition, an analysis of the genetic diversity showed that there
were no significant differences among Korean, Han Chinese and Japanese
populations, but African and Caucasian populations were significantly
differentiated in selected genes. Nevertheless, in the detailed analysis of genetic
properties, the LD and Haplotype block patterns among the five sub-populations
were substantially different from one another. CONCLUSION: Through the
resequencing of 81 osteoporosis candidate genes, 118 unknown SNPs with a
minor allele frequency (MAF) > 0.05 were discovered in the Korean population.
In addition, using the common SNPs between our study and HapMap, an analysis
of genetic diversity and deviation in heterozygosity was performed and the
polymorphisms of the above genes among the five populations were substantially
differentiated from one another. Further studies of osteoporosis could utilize the
polymorphisms identified in our data since they may have important implications
for the selection of highly informative SNPs for future association studies.
Publication Types:
PMCID: PMC2222243

An e-health trend plan for the Jordanian health care system: a

review.
Rawabdeh AA.
Department of Hospital Management, Faculty of Administrative and Financial

Sciences, Philadelphia University, Amman, Jordan. alirawabdeh12@yahoo.com
PURPOSE: The purpose of this research is to examine the potential of e-health by

focusing explicitly on the delivery of health care products and services. The
examination of e-health activity is guided by one broad research question, "What
is the potential for constructing e-health strategy as an innovative health
technology?". A great amount of attention has been given to e-health activity in
the present day. However important this form of e-health is, this type of service
simply does not face the same constraints that must be addressed by those actually
delivering health care services. DESIGN/METHODOLOGY/APPROACH: The
researchers employed a qualitative data collection technique to formulate more
examples and cases to derive lessons for Jordan. Phone interviews in a random
sample were conducted with corporate officers in Jordan in order to reveal the
internal organizational structure and business trends, interface issues, marketing
strategies, as well as comparing and contrasting the online health world to the
traditional health care realm. FINDINGS: Internet-related projects is a top priority
for health care information technology executives in the present day, with a
cautious approach toward "e-health", as many products have yet to mature, and
that the "click and mortar" model may perhaps be the optimal strategy for e-health
in Jordan. RESEARCH LIMITATIONS/IMPLICATIONS: This paper reviews
the e-health trends to demonstrate the tremendous potential for health-related
commercial activity on the internet. However, the researcher examining the
barriers facing e-health to the Jordanian health system also pointed out almost
insurmountable challenges. PRACTICAL IMPLICATIONS: Despite the apparent
promise of e-health, its instability is measured by its failure so far to
systematically penetrate the organization of health care. Beyond the pragmatic
negotiation of e-health in the immediate context of clinical practice, there are
wider issues about how the development/implementation of e-health is funded,
about its organization and management at the policy level; and about its potential
medico-legal risks. ORIGINALITY/VALUE: It is hoped that the handful of
ventures into cyber medicine appears to be coming from a few enterprising
physicians who have set up medical practices on the Web.
Publication Types:
• Review

Development of a framework towards successful implementation of

e-governance initiatives in health sector in India.
Ray S, Mukherjee A.
ICFAI Business School, Salt Lake, Kolkata, India. subhasisr@ibsindia.org
PURPOSE: The purpose of this paper is to explore the route map for employing
efficient e-governance so that at least existing resource and infrastructure are
better utilized and deficiencies are tracked for future planning. National health is
one of the most important factors in a country's economic growth. India seems to
be a victim of the vicious cycle around poor economy and poor health conditions.
DESIGN/METHODOLOGY/APPROACH: A detailed study was carried out to
find out India's healthcare infrastructure and its standing in e-governance
initiatives. After consolidating the fact that effective e-governance can enhance
the quality of healthcare service even within limited resources, authors explored
success and failure factors of many e-governance initiatives in India and abroad.
Finally, an e-governance framework is suggested based on the above factors
together with the authors' own experience of implementing e-governance projects
in India and abroad. FINDINGS: The suggested framework is based on a phased
implementation approach. The first phase "Information Dissemination" is more
geared towards breaking the "digital divide" across three dimensions:
G2Business; G2Citizen; and G2Agent. The most advanced stage is aimed towards
joining up healthcare information across the above three dimensions and drawing
meaningful analytics out of it. The recommendations also include management of
Policies, Scope, Process Reform, Infrastructure, Technology, Finance, Partnership
and People for efficient implementation of such e-governance initiatives.
RESEARCH LIMITATIONS/IMPLICATIONS: The paper provides measures for
continuous evaluation of systems as one passes through various stages of
implementation. However, the framework can be tested on real or simulated
environment to prove its worthiness. PRACTICAL IMPLICATIONS: This paper
can be a potential frame of reference for nation-wide e-healthcare projects not
only in India but also in other developing countries. The paper also describes
challenges that are most likely to be faced during implementation.
ORIGINALITY/VALUE: Since the paper is practical in nature, the real appeal
will be to practitioners who are responsible for implementation of large e-
governance initiatives for improving healthcare services.
134: Lancet. 2007 Oct 26. [Epub ahead of print]

A scandal of invisibility: making everyone count by counting

everyone.
Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Jha P, Stout S, Abouzahr

C; on behalf of the Monitoring of Vital Events (MoVE) writing group.
MEASURE Evaluation, Carolina Population Center and Departments of

Epidemiology and Anthropology, University of North Carolina at Chapel Hill,
Chapel Hill NC USA.
Most people in Africa and Asia are born and die without leaving a trace in any
legal record or official statistic. Absence of reliable data for births, deaths, and
causes of death are at the root of this scandal of invisibility, which renders most of
the world's poor as unseen, uncountable, and hence uncounted. This situation has
arisen because, in some countries, civil registration systems that log crucial
statistics have stagnated over the past 30 years. Net of debt relief, official
development assistance reached US$80 billion in 2004. Yet because of the
weakness in recording vital statistics, we have little authoritative evidence that
these funds have their desired effects on either mortality or poverty reduction.
Sound recording of vital statistics and cause of death data are public goods that
enable progress towards Millennium Development Goals and other development
objectives that need to be measured, not only modelled. Vital statistics are most
effectively generated by comprehensive civil registration. Civil registration has a
dual function, both statistical and legal; it also helps with economic development.
30 years of stagnation will not be overcome quickly, although new efforts to
develop national statistical capacities offer a unique opportunity to refocus
attention on civil registration. Now is the time to make the long-term goal of
comprehensive civil registration in developing countries the expectation rather
than the exception. The international health community can assist by sharing
information and methods to ensure both the quality of vital statistics and cause of
death data, and the appropriate use of complementary and interim registration
systems and sources of such data. The continued cost of ignorance borne by
countries without civil registration far outweighs the affordable necessity of
action.
PMID: 18029007 [PubMed - as supplied by publisher]
135: Acta Otolaryngol Suppl. 2007 Oct;(558):54-60.

A standardized database management of middle ear surgery in

Korea.
Kim HJ.
Department of Otolaryngology, Hallym University College of Medicine,

Chuncheon, Korea. hjk1000@hallym.ac.kr
CONCLUSION: The classification and hearing result reporting system of middle

ear surgery provide a set of standard that otologic surgeons should comply with
when they investigate the efficacy of procedures or report the post-operative
results of middle ear surgery. Keeping up with this system will, in turn, facilitate
and activate the evidence-based clinical research they would ask for.
OBJECTIVES: The aims of the project were to establish the standardized
classification nomenclature, to propose a guideline for the post-operative result
reporting system, and to develop a database management program for middle ear
surgery. METHODS: Nine otologic surgeons from seven university hospitals in
Korea carried out a field survey on the nation-wide status of middle ear surgery
and its records, and also collected the information regarding international
classification and result reporting system from 2001 through 2004. To make a
consensus, it also underwent a process of public audit and, a questionnaire
investigation, as well. RESULTS: The classification of surgery consisted of four
kinds of procedures of mastoidectomy, tympanoplasty, extraneous procedures,
and concurrent procedures. Post-operative hearing result reporting consisted of
basic requirement and reporting guidelines of hearing success. The basic
requirements stated minimum follow up duration, and computing formulae of
pure tone average (PTA) and post-operative air bone gap (ABG). The reporting
guidelines included criteria of hearing success (Post-operative ABG <or= 20 dB,
hearing gain >or=15 dB, or hearing level <or=30 dB), post-operative ABG
grading of excellent, good, no or poor improvement, and comparisons of hearing
improvement among the groups. Next, a database management program was
developed using the standardized classification and result reporting system.
Structure of database is composed of 144 fields including patient
information/preoperative findings (45 fields), operative findings (36 fields),
operative procedures (29 fields), and post-operative follow up (23 fields).
Publication Types:
136: J Nucl Med Technol. 2007 Dec;35(4):259-71. Epub 2007 Nov 15.
Considerations for setting up an order entry system for nuclear

medicine tests.
Hara N, Onoguchi M, Nishida T, Honda M, Houjou O, Yuhi M, Takayama

T, Ueda J.
Department of Radiological Technology, Sumitomo Hospital, 5-3-20

Nakanoshima, Kita-ku, Osaka 530-0005, Japan. hara-narihiro@sumitomo-hp.or.jp
Integrating the Healthcare Enterprise-Japan (IHE-J) was established in Japan in

2001 and has been working to standardize health information and make it
accessible on the basis of the fundamental Integrating Healthcare Enterprise (IHE)
specifications. However, because specialized operations are used in nuclear
medicine tests, online sharing of patient information and test order information
from the order entry system as shown by the scheduled workflow (SWF) is
difficult, making information inconsistent throughout the facility and uniform
management of patient information impossible. Therefore, we examined the basic
design (subsystem design) for order entry systems, which are considered an
important aspect of information management for nuclear medicine tests and needs
to be consistent with the system used throughout the rest of the facility.
METHODS: There are many items that are required by the subsystem when
setting up an order entry system for nuclear medicine tests. Among these items,
those that are the most important in the order entry system are constructed using
exclusion settings, because of differences in the conditions for using
radiopharmaceuticals and contrast agents and appointment frame settings for
differences in the imaging method and test items. CONCLUSION: To establish
uniform management of patient information for nuclear medicine tests throughout
the facility, it is necessary to develop an order entry system with exclusion
settings and appointment frames as standard features. Thereby, integration of
health information with the Radiology Information System (RIS) or Picture
Archiving Communication System (PACS) based on Digital Imaging
Communications in Medicine (DICOM) standards and real-time health care
assistance can be attained, achieving the IHE agenda of improving health care
service and efficiently sharing information.
Publication Types:
• Guideline
137: BMC Public Health. 2007 Nov 15;7:330.

Avian influenza outbreak in Turkey through health personnel's

views: a qualitative study.
Sarikaya O, Erbaydar T.
Department of Medical Education School of Medicine University of Marmara,

Istanbul Turkey. osarikaya@gmail.com
BACKGROUND: Avian influenza threatens public health worldwide because it is

usually associated with severe illness and, consequently, a higher risk of death.
During the first months of 2006, Turkey experienced its first human avian
influenza epidemic. A total of 21 human cases were identified, 12 of which were
confirmed by the National Institute for Medical Research. Nine of the cases,
including the four fatal ones, were from the Dogubeyazit-Van region. This study
aims to evaluate the efforts at the avian influenza outbreak control in the Van-
Dogubeyazit region in 2006 through the experiences of health personnel.
METHODS: We conducted in-depth interviews with seventeen key informants
who took active roles during the avian influenza outbreak in East Turkey during
the first months of 2006. We gathered information about the initial responses, the
progress and management of the outbreak control, and the reactions of the health
professionals and the public. The findings of the study are reported according to
the topics that appeared through thematic analysis of the interview transcripts.
RESULTS: Following the first suspected avian influenza cases, a Van Crisis
Coordination Committee was formed as the coordinating and decision-making
body and played an important role in the appropriate timing of decisions. The
health and agriculture services could not be well coordinated owing to the lack of
integrated planning in preparation for outbreak and of integrated surveillance
programs. Traditional poultry practice together with the low socio-economic
status of the people and the lack of health care access in the region seemed to be a
major risk for animal to animal and animal to human transmission. The strengths
and weaknesses of the present health system - primary health care services,
national surveillance and notification systems, human resource and management -
affected the inter organizational coordination during the outbreak. Open
communication between the government and the public played an important part
in overcoming difficulties. CONCLUSION: Although there were problems during
the avian influenza outbreak in Turkey, the rapid responses of the central and
regional health authorities and the performance of the health workers were the key
points in controlling the epidemic. The lessons from this outbreak should provide
an opportunity for integrating the preparation plans of the health and agricultural
organizations, and for revising the surveillance system and enhancing the role of
the primary health care services in controlling epidemic disease. Developing
successful strategies based on knowledge and experience may play a valuable role
in delaying an avian influenza pandemic.
Publication Types:
PMCID: PMC2211309
138: Conf Proc IEEE Eng Med Biol Soc. 2007;2007:6155.

Some perspectives on affordable healthcare systems in China.
Zhang YT, Yan YS, Poon CC.
Joint Research Center for Biomedical Engineering, Department of Electronic

Engineering, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong.
ytzhang@ee.cuhk.edu.hk
Consistent with the global population trend, China is becoming an aging society.
Over one-fifth of the world's elderly population (aged 65 and over) lives in China.
Statistics show that the elderly populace in China constitutes 8% of the total
population in 2006 and the percentage will be tripled to become 24% in 2050. As
a result, there is inevitably an increase in the prevalence of chronic disease that
accounted for almost 80% of all deaths in China in 2005. On the other hand, from
1978 to 2003, the total expenditure on healthcare in China increased from 11.02
billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase
from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare
investment is therefore even higher than the annual rate of GDP increase (9.38%)
during the last two decades. Meeting the long-term healthcare needs of this
growing elderly population and escalating healthcare expenditure pose a grim
challenge to the current Chinese healthcare system and the solvency of state
budgets. In fact, the healthcare services in China have become less accessible
since the early 1980s when its costs soared up. The rising costs have prevented
many Chinese people from seeking early medical care. The phenomenon has
created a wide disparity in seeking healthcare between urban and rural areas.
These trends are of particular concern to the elderly, who have higher healthcare
needs yet lesser means to afford the services. Furthermore, according to the 3rd
National Health Service Survey, 79.1% of rural residents and 44.8% of urban
citizens did not have any form of medical insurance. Such a low percentage of
coverage of medical insurance indicates that many people may not be able to
afford medical services when they suffer from severe diseases. Therefore, there is
a great need of a more effective and low-cost healthcare system. A new system
that can allow multi-level, multi-dimensional and standardized healthcare services
for urban and rural citizens is proposed based on the development of miniaturized,
integrated, networked, digitalized, and smart (MINDS) medical devices. Different
from the traditional healthcare systems, the new one should bridge individuals and
hospitals through a four-layer (PHCH) system structure: wearable intelligent
sensors and devices for p-Healthcare system (PHS), home healthcare system
(HHS), community healthcare system (CHS), and hospital health information
system (H2IS). This four-layer structure should ensure people be monitored by
the new system as closely as it can, resulting in the novel transformation of the
function of healthcare systems from symptoms treatment to early risk detection
and prevention. The new system is of particular importance to the cost reduction
of healthcare services. It can reduce the chance of individual providers taking
advantage of the provider-patient information asymmetry to prescribe
unnecessary or inappropriate (but profitable) care. It also allows people to self-
monitor their health conditions at their convenience in an attempt to lighten the
workload of doctors and nurses. Moreover, more people can benefit from the new
system with much lower medical insurance fees due to the reduced risk of
developing severe diseases through regular, long-term and effective monitoring of
citizens' health conditions nation-wide.
Publication Types:
139: Conf Proc IEEE Eng Med Biol Soc. 2007;2007:3673-6.

A conceptual persistent healthcare quality improvement process for
software development management.
Lin JC, Su MJ, Cheng PH, Weng YC, Chen SJ, Lai JS, Lai F.
Department of Electrical Engineering, National Taiwan University, Taipei,

Taiwan.
This paper illustrates a sustained conceptual service quality improvement process

for the management of software development within a healthcare enterprise. Our
proposed process is revised from Niland's healthcare quality information system
(HQIS). This process includes functions to survey the satisfaction of system
functions, describe the operation bylaws on-line, and provide on-demand training.
To achieve these goals, we integrate five information systems in National Taiwan
University Hospital, including healthcare information systems, health quality
information system, requirement management system, executive information
system, and digital learning system, to form a full Deming cycle. A preliminary
user satisfaction survey showed that our outpatient information system scored an
average of 71.31 in 2006.
140: Telemed J E Health. 2007 Oct;13(5):545-55.

Realizing telemedicine advantages at the national level: cases from

the United Arab Emirates.
Al-Qirim N.
College of Information Technology, United Arab Emirates University, Al Ain,

United Arab Emirates. nalqirim@ueau.ac.ae
This research was initiated to explore telemedicine adoption and diffusion in

healthcare organizations in the United Arab Emirates (UAE). Research on
telemedicine applications in the UAE focused on two main areas. First, it was
revealed that the telemedicine application was not extensively employed in the
UAE. There are no self-initiated telemedicine networks or specialty telemedicine
centers in the UAE. A study was conducted on the perceptions of UAE healthcare
professional concerning their attitudes and behavior toward adopting the
telemedicine technology in their organizations, using a theoretical construct
extended from the technological innovation literature. Second, existing
telemedicine activities were initiated in cooperation with the Mayo Clinic. These
consist of multimedia telemedicine systems for second opinion tele-consultations.
The effectiveness of this approach has also been examined. The research
discusses the findings in the light of the overall literature, highlighting further
implications and suggesting ways where telemedicine could be applied in the
UAE. There is still much growth and opportunity for self-governed specialty
telemedicine systems and networks in the UAE.
141: Nephrology (Carlton). 2007 Dec;12 Suppl 3:S27.

Glomerulonephritis network in Korea.
Chae DW.
Department of Internal Medicine, Seoul National University Bundang Hospital,

Seongnam, Korea.
Publication Types:
• Review
142: Int J Hematol. 2007 Oct;86(3):269-74.

Unification of hematopoietic stem cell transplantation registries in

Japan and establishment of the TRUMP System.
Atsuta Y, Suzuki R, Yoshimi A, Gondo H, Tanaka J, Hiraoka A, Kato K,

Tabuchi K, Tsuchida M, Morishima Y, Mitamura M, Kawa K, Kato S,
Nagamura T, Takanashi M, Kodera Y.
Department of HSCT Data Management, Nagoya University, School of Medicine,

Nagoya, Japan.
There are 4 registries of hematopoietic cell transplantation in Japan; the Japan

Society for Hematopoietic Cell Transplantation (JSHCT), Japanese Society of
Pediatric Hematology, Japan Marrow Donor Program, and Japan Cord Blood
Bank Network; each play an important role in society by reporting the number
and outcomes of transplantations and contributing new findings obtained from
studies on individual topics. However, there have been a number of issues with
the difficulty of analyzing data in overlapping registries and multiple databases at
centers affiliated with each of the 4 registry organizations. JSHCT was pivotal in
orchestrating the computerization and unification of hematopoietic stem cell
transplantation registries for the purpose of resolving these issues and providing a
more accurate awareness of hematopoietic stem cell transplantations being
performed in Japan. JSHCT played a central role in developing the "Transplant
Registry Unified Management Program (TRUMP)" to enable transplantation
institutes to manage patient information with emphases on convenience to
institutes, safety of patient information, and quality of data management. While
enhancing domestic registries, the program seeks to coordinate with other
hematopoietic cell transplantation registries around the world to contribute to the
development of registries throughout Asia.
143: Mil Med. 2007 Oct;172(10):1071-6.

Gaining experience with military medical situational awareness and

geographic information systems in a simulated influenza epidemic.
DeFraites RF, Chambers WC.
Medical Situational Awareness in the Theater Advanced Concept Technology

Demonstration (MSAT ACTD), Headquarters, U.S. Army Medical Research and
Materiel Command, Attn: MCMR-ZB-AMS, 504 Scott Street, Fort Detrick, MD
21702, USA.
The purpose of medical situational awareness is to provide useful and actionable

information for preparing and employing medical assets in support of a wide
variety of operational missions around the world, and monitoring and protecting
the health of the force in the face of rapidly changing health threats. Since 2005,
the Medical Situational Awareness in the Theater Advanced Concept Technology
Demonstration has exploited advances in information technology, geographic
information systems, and open systems architecture to produce a functioning
prototype of a medical situational enhancement capability. In May 2006, this
prototype supported the medical staff of a combined/joint task force in a realistic
command postexercise featuring a simulated outbreak of influenza during
Exercise COBRA GOLD in Thailand. The proliferation and maturation of
geographic information systems present many opportunities for the military
medical community to improve the health of the populations for which it is
responsible.

144: Int J Immunopathol Pharmacol. 2007 Apr-Jun;20(2 Suppl 2):51-3.
A proposal for guideline for prevention of allergic occupational

asthma in conformity with the globally harmonized system of
classification and labelling of chemicals (GHS).
Sato K, Kusaka Y; Japanese Society of Occupational and Environmental

Allergy.
Special committee of Japanese Society of Occupational and Environmental

Allergy, Department of Environmental Health, School of Medicine, University of
Fukui, Matsuoka-cho, Japan. satokazu@fmsrsa.fukui-med.ac.jp
The use of chemical products to enhance and improve life is a widespread

worldwide practice. Alongside the benefits of these products, there is also the
potential of chemicals for adverse effects to people or the environment. As a
result, a number of countries or organizations have developed laws or regulations
over the years that require information to be prepared and transmitted to those
using chemicals, through labels or Safety Data Sheets (SDS). Their differences
are significant enough to result in different labels or SDS for the same product in
different countries. In July 2003, United Nations (UN) recommended the globally
harmonized system of classification and labelling of chemicals (GHS). We,
special committee of Japanese Society of Occupational and Environmental
Allergy proposed a guideline for prevention of allergic occupational asthma and
sensitizers (n=60) causing occupational asthma or contact dermatitis in
conformity with respiratory and skin sensitization criteria of GHS. We should
propose these 60 sensitizers to the chemical industry association and governments
to control, regulate and label them in each country.
Publication Types:
• Guideline
145: Resuscitation. 2008 Mar;76(3):388-96. Epub 2007 Oct 31.

An observational study describing the geographic-time distribution

of cardiac arrests in Singapore: what is the utility of geographic
information systems for planning public access defibrillation?
(PADS Phase I).
Ong ME, Tan EH, Yan X, Anushia P, Lim SH, Leong BS, Ong VY, Tiah L,
Yap S, Overton J, Anantharaman V.
Department of Emergency Medicine, Singapore General Hospital, Outram Road,

Singapore. marcus.ong.e.h@sgh.com.sg
INTRODUCTION: Public access defibrillation (PAD) has shown potential to

increase cardiac arrest survival rates. OBJECTIVES: To describe the geographic
epidemiology of prehospital cardiac arrest in Singapore using geographic
information systems (GIS) technology and assess the potential for deployment of
a PAD program. METHODS: We conducted an observational prospective study
looking at the geographic location of pre-hospital cardiac arrests in Singapore.
Included were all patients with out-of-hospital cardiac arrest (OHCA) presented to
emergency departments. Patient characteristics, cardiac arrest circumstances,
emergency medical service (EMS) response and outcomes were recorded
according to the Utstein style. Location of cardiac arrests was spot-mapped using
GIS. RESULTS: From 1 October 2001 to 14 October 2004, 2428 patients were
enrolled into the study. Mean age for arrests was 60.6 years with 68.0% male.
67.8% of arrests occurred in residences, with 54.5% bystander witnessed and
another 10.5% EMS witnessed. Mean EMS response time was 9.6 min with
21.7% receiving prehospital defibrillation. Cardiac arrest occurrence was highest
in the suburban town centers in the Eastern and Southern part of the country. We
also identified communities with the highest arrest rates. About twice as many
arrests occurred during the day (07:00-18:59 h) compared to night (19:00-06:59
h). The categories with the highest frequencies of occurrence included residential
areas, in vehicles, healthcare facilities, along roads, shopping areas and
offices/industrial areas. CONCLUSION: We found a definite geographical
distribution pattern of cardiac arrest. This study demonstrates the utility of GIS
with a national cardiac arrest database and has implications for implementing a
PAD program, targeted CPR training, AED placement and ambulance
deployment.
Publication Types:
146: BMC Public Health. 2007 Nov 2;7(147):313.

Cigarette smoking and tooth loss experience among young adults: a

national record linkage study.
Ojima M, Hanioka T, Tanaka K, Aoyama H.
Department of Preventive Dentistry, Graduate School of Dentistry, Osaka

University, Osaka, Japan. ojima@dent.osaka-u.ac.jp
BACKGROUND: Various factors affect tooth loss in older age including

cigarette smoking; however, evidence regarding the association between smoking
and tooth loss during young adulthood is limited. The present study examined the
association between cigarette smoking and tooth loss experience among adults
aged 20-39 years using linked data from two national databases in Japan.
METHODS: Two databases of the National Nutrition Survey (NNS) and the
Survey of Dental Diseases (SDD), which were conducted in 1999, were obtained
from the Ministry of Health, Labor and Welfare with permission for analytical
use. In the NNS, participants received physical examinations and were
interviewed regarding dietary intake and health practices including cigarette
smoking, whereas in the SDD, participants were asked about their frequency of
daily brushing, and received oral examinations by certified dentists. Among 6,805
records electronically linked via household identification code, 1314 records of
individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss
was compared among non-, former, and current smokers. Multiple logistic
regression models were constructed including confounders: frequency of tooth
brushing, body mass index, alcohol consumption, and intake of vitamins C and E.
RESULTS: Smoking rates differed greatly in men (53.3%) and women (15.5%).
The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women).
Tooth loss occurred more frequently among current smokers (40.6%) than former
(23.1%) and non-smokers (27.9%). Current smoking showed a significant
association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40-3.50], P =
0.0007) and women (1.70 [1.13-2.55], P = 0.0111). A significant positive
exposure-related relationship between cigarette smoking status and tooth loss was
observed (P for trend < 0.0001 and 0.0004 in men and women, respectively).
Current smoking was also associated with the prevalence of decayed teeth (1.67
[1.28-2.20], P = 0.0002). CONCLUSION: An association between cigarette
smoking and tooth loss was evident among young adults throughout Japan. Due to
limitations of the available variables in the present databases, further studies
including caries experience and its confounders should be conducted to examine
whether smoking is a true risk of premature tooth loss in young adults.
Publication Types:
PMCID: PMC2186324
147: Nippon Koshu Eisei Zasshi. 2007 Sep;54(9):644-52.
[A nationwide survey on the implementation of health education

programs using information technology and public health nurses'
awareness of its importance in Japanese municipalities]
Kai Y, Yamaguchi Y.
Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and
Welfare, Tokyo, Japan.
PURPOSE: This study investigated the actual situation surrounding

implementation of health education programs using information technology (IT-
program) and assessed the related environmental factors, including public health
nurses' awareness of the importance and barriers to IT-program adoption in local
Japanese municipalities. METHODS: All municipalities of 50,000 people or more
(Big-town) and randomly selected municipalities of less than 50,000 people
(Small-town) were surveyed. In February 2005, questionnaires about IT-programs
were mailed to a total of 1,267 municipalities. Public health nurses in charge of
health education responded to the questionnaire. An IT-program was defined as a
non face-to-face program using information technology, such as e-mail or the
internet (excluding telephone counseling), for disease prevention and lifestyle
modification. RESULTS: The response rate to the questionnaire was 70.11% in
this survey. A personal computer and internet access had been installed in over
95% of municipalities. The rate of IT-program implementation was 3.9% in Big-
towns and 1.10% in Small-towns. The rate of respondents who were aware of
existence of IT-programs was 74.2% in Big-towns and 63.7%o in Small-towns.
Respondents who felt a need for an IT-program comprised 42.5% in Big-towns
and 25.0% in Small-towns, whereas about half of respondents answered,
"Neither". It was expected that merits of IT-program were diversification of
populations participating in health education, efficiency of data management, and
individualization of programs. The barriers to IT-program adoption were lack of
budget, labor power constraints and availability of an IT system. CONCLUSION:
At the time of the investigation, health education programs using information
technology had been implemented by only few local municipalities in Japan.
However, the existence of IT-programs was well known, and public health nurses
had great expectations of the merits of IT for health education. To promote the
implementation of health education programs using IT, it is necessary to develop
an IT program that addresses public needs, then provide evidence of its utility and
increase its availability.
Publication Types:
• Randomized Controlled Trial
148: J Med Libr Assoc. 2007 Oct;95(4):454-8.

Barriers and enablers to the acceptance of bioinformatics tools: a

qualitative study.
Shachak A, Shuval K, Fine S.
Bar-Ilan University, Department of Information Science, Ramat-Gan, 52900,

Israel. ashachak@tx.technion.ac.il
Publication Types:
PMCID: PMC2000792
149: Nihon Hotetsu Shika Gakkai Zasshi. 2007 Oct;51(4):691-8.

[Construction and promotion of prosthodontics based on health

sciences: for the achievement of a long life and good health
cultivated by occlusion and mastication]
Hirai T.
Department of Occlusion and Removable Prosthodontics, Health Sciences

University of Hokkaido School of Dentistry, Japan. hirai@hoku-iryo-u.ac.jp
Prosthodontics is a practical science based on life sciences and health sciences,
and takes a role to contribute to the improvement of people's health and welfare. It
is true the main field of prosthodontics and/or prosthodontic treatments is oral
rehabilitation including recoveries of morphological defects and the functional
disability caused by teeth loss. From this point of view, I am sure that the ultimate
target of prosthodontics and/or prosthodontic treatments is maintenance and
improvement of patient's QOL. To achieve this purpose, I think research,
education, and clinical practice to be inseparable and integral in prosthodontics.
This ensures that prosthodontics become more academic which can contribute to
the society more greatly. Advertisement disclosure of "Prosthodontic Specialist
certified by Japan Prosthodontic Society" is our earnest wish. The specialist
system is regarded to be effective for the improvement of the medical treatment
level, the information provision to the patient, and the promotion of cooperation
hospital and clinic. On the other hand, the high quality treatments are severely
requested and the specialists are strictly evaluated by the many people more than
before. We have to be aware of our responsibility as Prosthodontic Specialists. In
addition, Japan Prosthodontic Society is a corporate judicial person, and there is
obligation and a responsibility that transmit necessary information to the society
certainly and promptly, and present various proposals based on EBM as the
opinion leader. Concretely, it is necessary to promote basic researches as well as
clinical researches on prosthodontic treatments, and to examine the improvement
of educational methods of prosthodontics. Let's reconfirm the purpose of our
Society written in the article of incorporation and make an effort to achieve this
purpose!
Publication Types:
150: Suicide Life Threat Behav. 2007 Oct;37(5):593-9.

A decrease in suicide rates in Japanese rural towns after

community-based intervention by the health promotion approach.
Motohashi Y, Kaneko Y, Sasaki H, Yamaji M.
Department of Public Health, Akita University School of Medicine, Akita City,

Japan. motohasi@med.akita-u.ac.jp
A community-based intervention study for suicide prevention was conducted in

six towns (total population 43,964) in Akita Prefecture of Japan according to a
quasi-experimental design to reduce suicide rates in rural towns. Public awareness
raising activities using a health promotion approach emphasizing the
empowerment of residents and civic participation were conducted. The welfare
measures of promoting a sense of purpose among senior citizens and creating a
community network were also taken. As a result, the suicide rate per 100,000 in
the intervention towns decreased from 70.8 before intervention (1999) to 34.1
after intervention (2004). The suicide rate per 100,000 in the control towns was
47.8 before intervention and 49.1 after intervention.
Publication Types:
151: Circ J. 2007 Nov;71(11):1791-3.

Effect of revision of Japanese diagnostic criterion for fever in

Kawasaki disease on treatment and cardiovascular outcome.
Muta H, Ishii M, Iemura M, Suda K, Nakamura Y, Matsuishi T.
Department of Pediatrics, Kurume University School of Medicine, Kurume,

Japan. qze05346@nifty.com
BACKGROUND: The aim of this study was to investigate the effect of a revision
of the fever criterion for initial intravenous immunoglobulin (IVIG) treatment,
and cardiovascular sequelae, in the new Japanese diagnostic criteria for Kawasaki
disease. METHODS AND RESULTS: Patients who were reported in the 16th and
18th nationwide surveys in Japan were analyzed. New criteria group comprised
patients who received the diagnosis of Kawasaki disease in the 18th nationwide
survey (n=18,789). Old criteria group was comprised patients who received their
diagnosis in the 16(th) nationwide survey (n=15,017). The difference between the
new and old criteria for complete cases was only 1%. The proportion of patients
who were treated with IVIG within 4 days of illness onset in the new criteria
group was significantly lower than in the old criteria group (27.7% vs 30.7%).
Multivariate logistic regression analysis identified criteria sex, age, recurrence,
diagnosis, last day of initial IVIG and additional IVIG treatment as significant
independent factors for cardiovascular sequelae. CONCLUSIONS: The guideline
revision improves diagnostic sensitivity somewhat, but reflects the clinical reality
of the disease that approximately 30% of patients are treated with IVIG within 4
days of illness onset.
Publication Types:
152: Health Policy Plan. 2008 Jan;23(1):76-82. Epub 2007 Oct 27.
Implementation of a new birth record in three hospitals in Jordan: a

study of health system improvement.
Khresheh R, Barclay L.
Faculty of Nursing, Muttah University, PO Box 7, Karak, Jordan.
This study tested the introduction of a new integrated clinical record in Jordan
where currently no clinical report links antenatal, birth and postnatal care for
women. As a result, no continuity of information is provided to clinicians nor are
there national statistics on trends, or performance of hospitals around birth. Our
study was conducted in the Jordanian Ministry of Health, the maternity wards and
registration departments of three hospitals in Jordan and in the Maternal and Child
Health Centres located near these hospitals. We used an exploratory, descriptive
design and practice-research engagement to investigate and report on the process
of change to improve and implement the new birth record. Through engaging
practitioners in research, care improved, the quality of reporting changed,
managers developed more effective measures of hospital performance and policy
makers were provided with information that could form the basis of a national
maternity data monitoring system. Quantitative and qualitative audit data
demonstrated improved clinical reporting, organizational development and
sustained commitment to the new record from clinicians, managers and policy
leaders.
153: Int J Public Health. 2007;52(3):166-72.

2nd-generation HIV surveillance and injecting drug use: uncovering

the epidemiological ice-berg.
Reintjes R, Wiessing L.
Department of Public Health, Faculty Life Sciences, Hamburg University of
Applied Sciences, Hamburg, Germany. Ralf.Reintjes@rzbd.haw-hamburg.de
OBJECTIVES: HIV/AIDS surveillance methods are under revision as the

diversity of HIV epidemics is becoming more apparent. The so called "2nd
generation surveillance (SGS) systems" aim to enhance surveillance by
broadening the range of indicators to prevalence, behaviors and correlates, for a
better understanding and a more complete and timely awareness of evolving
epidemics. METHODS: Concepts of HIV SGS are reviewed with a special focus
on injecting drug users, a major at-risk and hard to reach group in Europe, a
region with mainly low or concentrated epidemics. RESULTS: The scope of
HIV/AIDS surveillance needs to be broadened following principles of SGS.
Specifically for IDUs we propose including hepatitis C data as indicator for
injecting risk in routine systems like those monitoring sexually transmitted
infections and information on knowledge and attitudes as potential major
determinants of risk behavior. CONCLUSIONS: The suggested approach should
lead to more complete and timely information for public health interventions,
however there is a clear need for comparative validation studies to assess the
validity, reliability and cost-effectiveness of traditional and enhanced HIV/AIDS
surveillance systems.
Publication Types:
154: Ned Tijdschr Geneeskd. 2007 Sep 29;151(39):2166-9.

[Adverse events following influenza vaccination: reaction to specific

reports and the necessity of a central registration system]
[Article in Dutch]
Swaan CM, van der Sande MA, Speelman P, Conyn-van Spaendonck MA,
Straus SM, Coutinho RA.
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Interne

Geneeskunde, Amsterdam. corien.swaan@rivm.nl
The influenza vaccine is considered safe, but information on vaccine-related

adverse events is limited and a nationwide overview of adverse events is lacking.
In 2006, after deaths occurred in Israel and the Netherlands following influenza
vaccination, the Dutch Ministry of Health, Welfare and Sport (VWS) asked the
National Institute for Public Health and the Environment (RIVM) twice for a
recommendation regarding the continuation of the national vaccination campaign.
After 4 deaths were reported in Israel in October 2006 following administration of
Vaxigrip, the Dutch vaccination campaign was suspended for one week. One
month later, 4 additional deaths were reported after influenza vaccination in the
Netherlands. The newly appointed outbreak management team concluded that a
causal relationship between vaccination and the deaths was highly unlikely, based
on data regarding the individual cases, background mortality rates and prior
reports of adverse events. Further suspension of the vaccination campaign was
deemed unnecessary this time. A centralised nationwide registry of adverse events
has since been established to provide further insight into the incidence of adverse
events following influenza vaccination. Physicians are advised to report potential
adverse events following influenza vaccination to the Netherlands
Pharmacovigilance Centre Lareb (www.lareb.nl).
Publication Types:
155: J Environ Sci Health A Tox Hazard Subst Environ Eng. 2007 Oct;42(12):1719-
28.
Arsenic risk mapping in Bangladesh: a simulation technique of

cokriging estimation from regional count data.
Hassan MM, Atkins PJ.
Department of Geography and Environment, Jahangirnagar University, Savar,

Dhaka 1342, Bangladesh. manzurulh@yahoo.com
Risk analysis with spatial interpolation methods from a regional database on to a

continuous surface is of contemporary interest. Groundwater arsenic poisoning in
Bangladesh and its impact on human health has been one of the "biggest
environmental health disasters" in current years. It is ironic that so many
tubewells have been installed in recent times for pathogen-free drinking water but
the water pumped is often contaminated with toxic levels of arsenic. This paper
seeks to analyse the spatial pattern of arsenic risk by mapping composite
"problem regions" in southwest Bangladesh. It also examines the cokriging
interpolation method in analysing the suitability of isopleth maps for different risk
areas. GIS-based data processing and spatial analysis were used for this research,
along with state-of-the-art decision-making techniques. Apart from the GIS-based
buffering and overlay mapping operations, a cokriging interpolation method was
adopted because of its exact interpolation capacity. The paper presents an
interpolation of regional estimates of arsenic data for spatial risk mapping that
overcomes the areal bias problem for administrative boundaries. Moreover, the
functionality of the cokriging method demonstrates the suitability of isopleth
maps that are easy to read.
Publication Types:
156: Saudi J Kidney Dis Transpl. 2007 Nov;18(4):556-64.

Prevalence and clinical findings of biopsy-proven

glomerulonephritidis in Iran.
Naini AE, Harandi AA, Ossareh S, Ghods A, Bastani B.
Division of Nephrology, Isfahan University of Medical Sciences and Health

Services, Isfahan, Iran. emaminaini_afsoon@yahoo.com
Epidemiological data of renal diseases is population-based and have great

geographic variability. Due to the lack of a national renal data registry system,
there is no information on the prevalence rate, and clinical and laboratory features
of various glomerulo-nephritidis (GNs) in Iran. In a retrospective cross sectional
study, we analyzed 462 adult renal biopsies in Tehran, Iran. We determined the
prevalence rate and the frequency of different clinical and laboratory findings in
patients with different GNs. We also compared our results with the reports from
other countries. There were 267 (57.8%) males and 195 (42.2%) females. The
mean (+/- SD) age was 33.6 +/- 15.7 (range, 13-75) years. A total of 55 biopsies,
which had revealed pathologies other than GNs, were excluded. Among the
remaining 407 biopsies, membranous glomerulopathy (MGN) was the most
common GN (23.6%), followed by IgAN (13.5%), membranoproliferative GN
(MPGN) (11.5%), systemic lupus nephritis (SLE-GN) (10.6%), focal and
segmental glomerulosclerosis (FSGS) (10.3%), and minimal change disease
(MCD) (9.8%). Our study shows that MGN is the most common form of GN,
followed by IgAN, MPGN, SLE-GN, FSGS and MCD in adult patients in Iran. A
multi-center study with a larger sample size is needed for more comprehensive
data in Iranian population.
Publication Types:

Distributed personal health information management system for

dermatology at the homes for senior citizens.
Lavanya J, Goh KW, Leow YH, Chio MT, Prabaharan K, Kim E, Kim Y,
Soh CB.
Biomed. Eng. Res. Centre, Nanyang Technol. Univ.,Singapore.
A distributed personal health information management system (D-PHIMS) has

been tested at a nursing home for the senior citizens (NHSC) in Singapore. The
personal health information management system (PHIMS) from the University of
Washington was customized to Singapore's context for teledermatology. A
clinical trial commenced in October 2005 is ongoing and the survey results
obtained indicate that the participants are satisfied with the D-PHIMS system. The
diagnosis and treatment recommendations made by the dermatologists using the
D-PHIMS diagnosis module were effective in most cases based on feedback from
the nursing staff at the elderly nursing home. The results suggest that a
teledermatology system could become a useful tool for the nursing homes and to
control increasing healthcare costs for elderly care.

Use of hand held devices in a Western Australian health sector.
Patel KJ, Gururajan R.
Centre for Computer Technology and Super Cisco Academy Training Centre
(Asia-Pacific), Box Hill Institute of TAFE, Victoria, Australia.
k.patel@bhtafe.edu.au
This paper outlines the results of wireless development for a private healthcare
provider in Western Australia. The case study is presented here discusses the
software methodology used, problems encountered in developing the software
application and then delivering it. Furthermore, the important issues associated
with integration of new software with existing modules, human factors that
impeded some aspects of development and issues associated with rigorous testing
to ensure user requirements are also discussed.
159: Isr Med Assoc J. 2007 Sep;9(9):652-5.

Cardiovascular risk factors in the Bedouin population: management

and compliance.
Tamir O, Peleg R, Dreiher J, Abu-Hammad T, Rabia YA, Rashid MA,

Eisenberg A, Sibersky D, Kazanovich A, Khalil E, Vardy D, Shvartzman P.
Siaal Research Center for Family Medicine and Primary Care, Department of
Family Medicine, Division of Community Health, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Beer Sheva, Israel.
BACKGROUND: Until three decades ago coronary heart disease and stroke were
considered rare in the Israeli Bedouin population. Today, this population shows
increasing high prevalence compared to the Jewish population. OBJECTIVES: To
evaluate the prevalence of diagnosed cardiovascular risk factors among Bedouins
(hypertension, diabetes mellitus, dyslipidemia), and to assess compliance with
follow-up tests and drug treatment. METHODS: The study included all listed
patients aged 20 years and older in eight clinics in major Bedouin towns, and in
two large teaching clinics in Beer Sheva (Jewish population). Risk factor data
were extracted from the clinics' computerized databases. For those diagnosed with
hypertension, diabetes or dyslipidemia, drug purchasing data were collected from
the pharmacy database to determine compliance with treatment, and from the
central laboratory mainframe (HbAlc and low density lipoprotein-cholesterol) to
evaluate follow-up and control. RESULTS: A significantly higher prevalence of
diabetes in all age groups was found in the Bedouin population compared to the
Jewish population; age-adjusted results show a prevalence of 12% vs. 8%
respectively (P < 0.001). The prevalence of dyslipidemia and age-adjusted
hypertension was lower among Bedouins (5.8% vs. 18.2%, P < 0.01 and 17% vs.
21%, P < 0.001 respectively). Two-thirds of hypertensive Bedouin patients and
72.9% of diabetic Bedouin patients were not compliant with treatment. For
dyslipidemia only 10.4% of the Bedouins were compliant compared with 28.2%
in the Jewish population (P < 0.001). CONCLUSIONS: Compliance with drug
therapy and follow-up tests was found to be a major problem in the Bedouin
population.
160: Int Fam Plan Perspect. 2007 Sep;33(3):106-16.

Republished in:
• Perspect Sex Reprod Health. 2007 Dec;39(4):216-25.
Legal abortion worldwide: incidence and recent trends.
Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J.
Guttmacher Institute, New York, NY, USA. gsedgh@guttmacher.org
CONTEXT: Information on abortion levels and trends can inform research and
policies affecting maternal and reproductive health, but the incidence of legal
abortion has not been assessed in nearly a decade. METHODS: Statistics on legal
abortions in 2003 were compiled for 60 countries in which the procedure is
broadly legal, and trends were assessed where possible. Data sources included
published and unpublished reports from official national reporting systems,
questionnaires sent to government agencies and nationally representative
population surveys. The completeness of country estimates was assessed by
officials involved in data collection and by in-country and regional experts.
RESULTS: In recent years, more countries experienced a decline in legal abortion
rates than an increase, among those for which statistics are complete and trend
data are available. The most dramatic declines were in Eastern Europe and
Central Asia, where rates remained among the highest in the world. The highest
estimated levels were in Armenia, Azerbaijan and Georgia, where surveys
indicate that women will have close to three abortions each on average in their
lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but
remained higher than rates in many Northern and Western European countries.
Rates increased in the Netherlands and New Zealand. The official abortion rate
declined by 21% over seven years in China, which accounted for a third of the
world's legal abortions in 1996. Trends in the abortion rate differed across age-
groups in some countries. CONCLUSIONS: The abortion rate varies widely
across the countries in which legal abortion is generally available and has
declined in many countries since the mid-1990s.
Publication Types:
161: Reprod Health Matters. 2007 Nov;15(30):91-102.

Persistence of high maternal mortality in Koppal district,

Karnataka, India: observed service delivery constraints.
George A.
Indian Institute of Management Bangalore, India. ashasara@gmail.com
Rural women with obstetric complications access many health providers in

Koppal, the poorest district in the state of Karnataka, south India. Yet they die.
Based on insights derived from case studies of women seeking emergency
obstetric care and participant-observation of government health services, this
article highlights service delivery constraints that underlie the persistence of high
levels of maternal mortality in Koppal. Weak information systems, discontinuity
in care, unsupported health workers, haphazard referral systems and distorted
accountability mechanisms are identified as critical service delivery problems. For
example, maternal deaths are under-reported and not reviewed, antenatal care and
institutional delivery are not linked to post-partum or emergency obstetric care,
and health workers use inappropriate injections but don't treat anaemia or sepsis.
Families waste valuable time and resources accessing many providers but fail to
get effective care, and blame is laid on lower-level health workers and women for
not accessing institutional delivery. Lastly, the role of administrators and
politicians in ensuring functioning health services is obscured. While important
supply and demand-side reforms are being implemented, these do not
constructively engage with informal providers nor address systemic service
delivery constraints. Critical managerial change is required, without which new
budgetary allocations will be squandered with little impact on saving women's
lives.
Publication Types:
• Case Reports
162: Reprod Health Matters. 2007 Nov;15(30):72-80.

Improving emergency obstetric care in a context of very high

maternal mortality: the Nepal Safer Motherhood Project 1997-2004.
Rath AD, Basnett I, Cole M, Subedi HN, Thomas D, Murray SF.
Nepal Safer Motherhood Project, Kathmandu, Nepal. d.demborath@options.co.uk
The Nepal Safer Motherhood Project (1997-2004) was one of the first large-scale
projects to focus on access to emergency obstetric care, covering 15% of Nepal.
Six factors for success in reducing maternal mortality are applied to assess the
project. There was an average annual increase of 1.3% per year in met need for
emergency obstetric care, reaching 14% in public sector facilities in project
districts in 2004. Infrastructure and equipment to achieve comprehensive-level
care were improved, but sustained functioning, availability of a skilled doctor,
blood and anaesthesia, were greater challenges. In three districts, 70% of
emergency procedures were managed by nurses, with additional training.
However, major shortages of skilled professionals remain. Enhancement of the
weak referral system was beyond the project's scope. Instead, it worked to
increase information in the community about danger signs in pregnancy and
delivery and taking prompt action. A key initiative was establishing community
emergency funds for obstetric complications. Efforts were also made to develop a
positive shift in attitudes towards patient-centred care. Supply-side interventions
are insufficient for reducing the high level of maternal deaths. In Nepal, this
situation is complicated by social norms that leave women undervalued and
disempowered, especially those from lower castes and certain ethnic groups, a
pattern reflected in use of maternity services. Programming also needs to address
the social environment.
163: Comput Methods Programs Biomed. 2007 Nov;88(2):102-11.

Building a portable data and information interoperability

infrastructure-framework for a standard Taiwan Electronic Medical
Record Template.
Jian WS, Hsu CY, Hao TH, Wen HC, Hsu MH, Lee YL, Li YC, Chang P.
Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Traditional electronic health record (EHR) data are produced from various
hospital information systems. They could not have existed independently without
an information system until the incarnation of XML technology. The
interoperability of a healthcare system can be divided into two dimensions:
functional interoperability and semantic interoperability. Currently, no single
EHR standard exists that provides complete EHR interoperability. In order to
establish a national EHR standard, we developed a set of local EHR templates.
The Taiwan Electronic Medical Record Template (TMT) is a standard that aims
to achieve semantic interoperability in EHR exchanges nationally. The TMT
architecture is basically composed of forms, components, sections, and elements.
Data stored in the elements which can be referenced by the code set, data type,
and narrative block. The TMT was established with the following requirements in
mind: (1) transformable to international standards; (2) having a minimal impact
on the existing healthcare system; (3) easy to implement and deploy, and (4)
compliant with Taiwan's current laws and regulations. The TMT provides a basis
for building a portable, interoperable information infrastructure for EHR
exchange in Taiwan.
Publication Types:
164: Int J Med Inform. 2008 Jul;77(7):461-9. Epub 2007 Nov 1.

A pervasive health monitoring service system based on ubiquitous

network technology.
Lin CC, Lee RG, Hsiao CC.
Department of Computer Science and Information Engineering, Center for

Healthy Aging Research, Chang Gung University, Taoyuan 333, Taiwan, ROC.
OBJECTIVES: The phenomenon of aging society has derived problems such as

shortage of medical resources and reduction of quality in healthcare services.
METHOD: This paper presents a system infrastructure for pervasive and long-
term healthcare applications, i.e. a ubiquitous network composed of wireless local
area network (WLAN) and cable television (CATV) network serving as a
platform for monitoring physiological signals. Users can record vital signs
including heart rate, blood pressure, and body temperature anytime either at home
or at frequently visited public places in order to create a personal health file.
RESULTS: The whole system was formally implemented in December 2004.
Analysis of 2000 questionnaires indicates that 85% of users were satisfied with
the provided community-wide healthcare services. Among the services provided
by our system, health consultation services offered by family doctors was rated
the most important service by 17.9% of respondents, and was followed by control
of one's own health condition (16.4% of respondents). Convenience of data access
was rated most important by roughly 14.3% of respondents.
DISCUSSION/CONCLUSION: We proposed and implemented a long-term
healthcare system integrating WLAN and CATV networks in the form of a
ubiquitous network providing a service platform for physiological monitoring.
This system can classify the health levels of the resident according to the variation
tendency of his or her physiological signal for important reference of health
management.
165: BMC Public Health. 2007 Oct 12;7(147):289.

Comparisons of predictors for typhoid and paratyphoid fever in

Kolkata, India.
Sur D, Ali M, von Seidlein L, Manna B, Deen JL, Acosta CJ, Clemens JD,
Bhattacharya SK.
1National Institute of Cholera and Enteric Diseases, Kolkata, India.

dipikasur@hotmail.com
BACKGROUND: Exposure of the individual to contaminated food or water

correlates closely with the risk for enteric fever. Since public health interventions
such as water improvement or vaccination campaigns are implemented for groups
of individuals we were interested whether risk factors not only for the individual
but for households, neighbourhoods and larger areas can be recognised?
METHODS: We conducted a large enteric fever surveillance study and analyzed
factors which correlate with enteric fever on an individual level and factors
associated with high and low risk areas with enteric fever incidence. Individual
level data were linked to a population based geographic information systems.
Individual and household level variables were fitted in Generalized Estimating
Equations (GEE) with the logit link function to take into account the likelihood
that household factors correlated within household members. RESULTS: Over a
12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were
detected among 56,946 residents in two bustees (slums) of Kolkata, India. The
incidence of paratyphoid fever was lower (0.8/1000/year), and the mean age of
paratyphoid patients was older (17.1 years) than for typhoid fever (incidence
1.4/1000/year, mean age 14.7 years). Residents in areas with a high risk for
typhoid fever had lower literacy rates and economic status, bigger household size,
and resided closer to waterbodies and study treatment centers than residents in
low risk areas. CONCLUSION: There was a close correlation between the
characteristics detected based on individual cases and characteristics associated
with high incidence areas. Because the comparison of risk factors of populations
living in high versus low risk areas is statistically very powerful this methodology
holds promise to detect risk factors associated with diseases using geographic
information systems.
Publication Types:
PMCID: PMC2099435
166: J Environ Biol. 2007 Apr;28(2 Suppl):503-15.

Mesofaunal biodiversity and its importance in Thar desert.
Tripathi G, Kumari R, Sharma BM.
Department of Zoology, J.N.V. University, Jodhpur-342 001, India.

drgst@rediffmail.com
Soil animals are considered as important contributors to soil fertility However,

there is paucity of such information for harsh climatic conditions. Therefore, the
below ground faunal density and frequency have been studied in relation to
physicochemical properties of soil in Thar desert. The selected soil systems were
Vigna radiata--Cuminum cyminum, grassland, flower garden and Zizyphus
mauritiana. Acari and other soil arthropods exhibited seasonal variation in their
populations. There were two population peaks, one in February/March and other
in August/September. The highest population was in flower garden, whereas
lowest was in Z. mauritiana field. It clearly indicates that the soil fauna population
develops in different degrees. The relative density showed that the acarines were
more prevalent in comparison to other soil arthropods. The prostigmatids
exhibited maximum relative density in comparison to cryptostigmatids and
mesostigmatids in all fields. Pauropus showed higher relative density among all
other soil arthropods. Acari had higher frequency of occurrence, while the other
soil arthropods indicated lower frequency of occurrence in all systems. The
highest frequency of occurrence was recorded in July/August and the lowest in
May/June. The soil temperature, moisture, organic carbon, total nitrogen and
carbon/nitrogen ratio varied significantly throughout the year The fluctuations in
physicochemical characteristics of soil greatly influenced below ground faunal
density in different fields. A highly significant and positive correlation was
obtained among different soil fauna groups. Faunal population showed a
significant positive correlation with soil moisture, organic carbon and total
nitrogen. The abiotic factors such as temperature, pH and C/N ratio showed
negative correlation with moisture, organic carbon and total nitrogen. However,
moisture, organic carbon and total nitrogen had positive correlation among
themselves. The present study suggests that the plantation may be done for
improvement of physicochemical and biological health of soil on a sustainable
basis in desert.
167: Pharmacoepidemiol Drug Saf. 2008 Jan;17(1):62-9.

Trends in the use of lipid-lowering drugs by outpatients with

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

Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
PURPOSE: To analyze recent trends in LLD use by outpatients with diabetes in

Taiwan over a 7-year period and to see whether the trends are consistent with
clinical trial outcomes and published guidelines. METHODS: A cross-sectional
survey was implemented using the National Health Insurance Research Database
between January 1997 and December 2003. Adult outpatients who had diagnoses
of diabetes and dyslipidemia and who had concurrent antidiabetic drug and LLD
claim were identified. The prescribing trends were described in terms of the
prescribing rates and patterns of LLDs in each study year. RESULTS: Between
1997 and 2000, fibrates were the most widely prescribed major class of LLDs,
while the rates showed a significant decline over time. The proportions of statin
use increased 3.3-fold from 20.8% of all LLDs in 1997 to 69.0% in 2003. With
the continuous increase in the use of statins, by 2001, they replaced fibrates as the
most heavily used LLDs. Monotherapy was the most prominent prescribing
pattern comprising 98.1% and 98.3% of all LLD prescriptions in 1997 and 2003,
respectively. Among patients with diabetic dyslipidemia plus CHD, the use of
statins increased almost threefold instead of a large reduction in the percentage
with non-statin class. CONCLUSIONS: The prescribing rates of LLDs shifted
from the fibrates to statins, especially in newer statin. The majority of patients
were maintained on monotherapy. These findings may imply that management of
hyperlipidemia in patients with diabetes had a positive trend towards recent
clinical trial outcomes and guideline's recommendation.
168: Soc Sci Med. 2008 Jan;66(2):467-78. Epub 2007 Oct 24.
Implementing community interventions for HIV prevention: insights

from project ethnography.
Evans C, Lambert H.
University of Nottingham, School of Nursing, Queens Medical Centre,

Nottingham, UK. catrin.evans@nottingham.ac.uk
Global policy on HIV prevention among marginalised populations recommends a

community-based approach with participation and mobilisation as central
features. The overall aim is to empower individuals and groups to reduce their
vulnerability to HIV. Community empowerment initiatives have had mixed
results, however, in spite of utilising very similar peer-education based
intervention strategies. This is particularly true of community-based interventions
in sex work settings. Drawing upon an ethnographic study conducted in the early
years of a well-known sex worker initiative-the Sonagachi STD/HIV Intervention
Project (SHIP) in Kolkata, India-this paper argues that ethnographic research can
illuminate the complex and inter-dependent dynamics of context, practice, agency
and power that are specific to a project and shape the course of intervention
implementation in ways that may be 'hidden' in conventional techniques of project
reporting. Two detailed excerpts of what we refer to as 'private contexts of
practice' are presented-focusing upon the complex processes underlying
community mobilisation and peer education. We show that the gathering of
ethnographic forms of evidence in conjunction with more conventional evaluation
measures has two distinct benefits. First, an ethnographic approach is able to
capture the play of power through observation of real-time events that involve
multiple actors with widely different perspectives, as compared with retrospective
accounts from carefully selected project representatives (the usual practice in
project evaluations). Second, observation of actual intervention practices can
reveal insights that may be hard for project staff to articulate or difficult to
pinpoint, and can highlight important points of divergence and convergence from
intervention theory or planning documents.
Publication Types:

169: Am J Cardiol. 2007 Oct 15;100(8):1282-5. Epub 2007 Aug 9.
Epidemiologic features of infective endocarditis in Taiwanese adults

involving native valves.
Lee CH, Tsai WC, Liu PY, Tsai LM, Ho MT, Chen JH, Lin LJ.
Department of Internal Medicine, National Cheng Kung University Hospital,

Tainan, Taiwan.
Little is known about the incidence and clinical outcomes of infective

endocarditis (IE) involving native valves in Asian countries. This nationwide
study investigated epidemiologic features and in-hospital mortality associated
with IE in adults (age > or =18 years) based on Taiwan's National Health
Insurance database from 1997 through 2002. Of 7,240 enrolled patients with IE
involving native valves, the mean age was 53 +/- 19 years and 70% were men.
The mean annual crude incidence was 7.6 per 100,000 inhabitants. The incidence
was significantly higher in men than in women (10.4 vs 4.6 per 100,000; p
<0.001). The incidence of IE increased steadily with age, ranging from 3.8 per
100,000 persons in patients <30 years of age to 33 per 100,000 persons in patients
> or =80 years of age (p <0.001). Staphylococcal (32%) and streptococcal species
(61%) were the most common causative pathogens. The mean in-hospital
mortality rate was 18%. Multivariate analysis showed that male gender, older age
(> or =50 years), diabetes mellitus, heart failure, neurologic complications, renal
insufficiency, respiratory failure, shock, and Staphylococcus species as the
causative microorganism were independent predictors of in-hospital mortality. In
conclusion, this Taiwanese study revealed a high incidence of IE in men and
elderly subjects. The in-hospital mortality rate remained high. Patients with IE
who also developed shock and respiratory failure were the most likely to have a
poor outcome.
170: J Prev Med Pub Health. 2007 Sep;40(5):363-70.

[Environmental health surveillance of low birth weight in Seoul

using air monitoring and birth data]
[Article in Korean]
Seo JH, Ha EH, Kim OJ, Kim BM, Park HS, Leem JH, Hong YC, Kim YJ.
Department of Preventive Medicine, College of Medicine, Ewha Medical
Research Center, Ewha Womans University.
OBJECTIVES: The principal objective of this study was to determine the

relationship between maternal exposure to air pollution and low birth weight and
to propose a possible environmental health surveillance system for low birth
weight. METHODS: We acquired air monitoring data for Seoul from the Ministry
of Environment, the meteorological data from the Korean Meteorological
Administration, the exposure assessments from the National Institute of
Environmental Research, and the birth data from the Korean National Statistical
Office between January 1, 2002 and December 31, 2003. The final birth data were
limited to singletons within 37-44 weeks of gestational age. We defined the Low
Birth Weight (LBW) group as infants with birth weights of less than 2500g and
calculated the annual LBW rate by district. The air monitoring data were
measured for CO, SO(2), NO(2), and PM(10) concentrations at 27 monitoring
stations in Seoul. We utilized two models to evaluate the effects of air pollution
on low birth weight: the first was the relationship between the annual
concentration of air pollution and low birth weight (LBW) by individual and
district, and the second involved a GIS exposure model constructed by Arc View
3.1. RESULTS: LBW risk (by Gu, or district) was significantly increased to
1.113(95% CI=1.111-1.116) for CO, 1.004 (95% CI=1.003-1.005) for NO(2),
1.202(95% CI=1.199-1.206) for SO(2), and 1.077(95% CI=1.075-1.078) for
PM(10) with each interquartile range change. Personal LBW risk was
significantly increased to 1.081(95% CI=1.002-1.166) for CO, 1.145(95%
CI=1.036-1.267) for SO(2), and 1.053(95% CI=1.002-1.108) for PM(10) with
each interquartile range change. Personal LBW risk was increased to 1.003(95%
CI=0.954-1.055) for NO(2), but this was not statistically significant. The air
pollution concentrations predicted by GIS positively correlated with the numbers
of low birth weights, particularly in highly polluted regions. CONCLUSIONS:
Environmental health surveillance is a systemic, ongoing collection effort
including the analysis of data correlated with environmentally-associated diseases
and exposures. In addition, environmental health surveillance allows for a timely
dissemination of information to those who require that information in order to
take effective action. GIS modeling is crucially important for this purpose, and
thus we attempted to develop a GIS-based environmental surveillance system for
low birth weight.
Publication Types:
171: Int J Occup Environ Health. 2007 Jul-Sep;13(3):290-4.

Occupational accidents and injuries in Thailand.
Thepaksorn P, Daniell WE, Padungtod C, Keifer MC.
International Scholars in Occupational and Environmental Health, Department of

Environmental and Occupational Health Sciences, School of Public Health and
Community Medicine, University of Washington, Seattle 98195-7234, USA.
The Workers' Compensation Fund (WCF) represents only a limited fraction of

work-related injuries in the Thai workforce. This cross-sectional study examined
258,986 records from the Thai National Injury Surveillance (NIS) system
collected during 2001-2004, focusing on 17,538 injuries coded as work-related.
NIS records provided information generally not represented in WCF statistics,
such as construction and agriculture. The reported mechanisms in 129 work-
related fatalities were particularly informative, including electrical current (27%),
transport accidents (20%), and falls (15%). Mortality in transport accidents was
dramatically higher when seat belts or motorcycle helmets were not used, whether
work-related or not. The findings emphasize the need to use multiple sources of
information for a complete picture of work-related injuries in Thailand, and
possibly in other countries. The mechanisms of fatal injury indicate areas where
focused efforts are warranted.
Publication Types:

• Research Support, U.S. Gov't, P.H.S.
172: IEEE Trans Inf Technol Biomed. 2007 Sep;11(5):507-17.

A mobile care system with alert mechanism.
Lee RG, Chen KC, Hsiao CC, Tseng CL.
Department of Electronic Engineering, National Taipei University of Technology,

Taipei 10643, Taiwan, R.O.C. evans@ntut.edu.tw
Hypertension and arrhythmia are chronic diseases, which can be effectively

prevented and controlled only if the physiological parameters of the patient are
constantly monitored, along with the full support of the health education and
professional medical care. In this paper, a role-based intelligent mobile care
system with alert mechanism in chronic care environment is proposed and
implemented. The roles in our system include patients, physicians, nurses, and
healthcare providers. Each of the roles represents a person that uses a mobile
device such as a mobile phone to communicate with the server setup in the care
center such that he or she can go around without restrictions. For commercial
mobile phones with Bluetooth communication capability attached to chronic
patients, we have developed physiological signal recognition algorithms that were
implemented and built-in in the mobile phone without affecting its original
communication functions. It is thus possible to integrate several front-end mobile
care devices with Bluetooth communication capability to extract patients' various
physiological parameters [such as blood pressure, pulse, saturation of
haemoglobin (SpO2), and electrocardiogram (ECG)], to monitor multiple
physiological signals without space limit, and to upload important or abnormal
physiological information to healthcare center for storage and analysis or transmit
the information to physicians and healthcare providers for further processing.
Thus, the physiological signal extraction devices only have to deal with signal
extraction and wireless transmission. Since they do not have to do signal
processing, their form factor can be further reduced to reach the goal of
microminiaturization and power saving. An alert management mechanism has
been included in back-end healthcare center to initiate various strategies for
automatic emergency alerts after receiving emergency messages or after
automatically recognizing emergency messages. Within the time intervals in
system setting, according to the medical history of a specific patient, our
prototype system can inform various healthcare providers in sequence to provide
healthcare service with their reply to ensure the accuracy of alert information and
the completeness of early warning notification to further improve the healthcare
quality. In the end, with the testing results and performance evaluation of our
implemented system prototype, we conclude that it is possible to set up a
complete intelligent healt care chain with mobile monitoring and healthcare
service via the assistance of our system.
Publication Types:
173: Stud Health Technol Inform. 2007;129(Pt 2):1442-6.

Conceptual model of health information ethics as a basis for

computer-based instructions for electronic patient record systems.
Okada M, Yamamoto K, Watanabe K.
Department of Health Informatics, Kawasaki University of Medical Welfare,

Japan.
A computer-based learning system called Electronic Patient Record (EPR)

Laboratory has been developed for students to acquire knowledge and practical
skills of EPR systems. The Laboratory is basically for self-learning. Among the
subjects dealt with in the system is health information ethics. We consider this to
be of the utmost importance for personnel involved in patient information
handling. The variety of material on the subject has led to a problem in dealing
with it in a methodical manner. In this paper, we present a conceptual model of
health information ethics developed using UML to represent the semantics and
the knowledge of the domain. Based on the model, we could represent the scope
of health information ethics, give structure to the learning materials, and build a
control mechanism for a test, fail and review cycle. We consider that the approach
is applicable to other domains.

Penetration and adoption of health information technology (IT) in

Thailand's community health centers (CHCs): a national survey.
Kijsanayotin B, Pannarunothai S, Speedie S.
Health Informatics Graduate Program, Medical School, University of Minnesota,

Minneapolis, Minnesota 55455, USA. kijs0001@umn.edu
A universal healthcare coverage program has been implemented in Thailand since

2001 and the Thailand Ministry of Public Health (MOPH) is restructuring its
health information systems to support the management of this reform. The MOPH
believes that health information technology (IT) is fundamental to the
development of an effective health information system, and that users' adoption of
health IT is one of the most important factors to the success of health IT
implementation projects. However, there is no national data available regarding
the penetration and adoption of health IT in Thai community health centers
(CHCs). This cross sectional survey was designed to study the penetration and
adoption of health IT in the country's community health centers. A random
sample of 1,607 regionally stratified CHC's from a total of 9,806 CHCs was
selected. With an 82% response rate, the data showed that people who worked in
CHCs were currently heavy users of health IT. They exhibited high IT acceptance
and positive attitudes toward using health IT. CHCs' staff was less resistant to
adopt health IT than previously anticipated. These results are similar in all of the
country's geographic regions. Health IT is pervasive in CHCs across the country
and penetrates all regions.
Publication Types:

Building a womb-to-tomb health record in Hong Kong--an

application of information architecture.
Fung V, Cheung NT, Ho E, Cheung C, Chan H, Tsang K, Cheung J, Ho W,

Lau M, Hung V, Wong A, Tong A, Wong WN, Sek A.
Health Informatics Section, Hospital Authority, Hong Kong Special

Administration Region, Kowloon. funghv@ha.org.hk
The Hospital Authority developed the Information Architecture (IA) model in

2002 to support a fast, robust, flexible and accurate electronic patient record
(ePR) to meet the high-tempo health care environment in Hong Kong. With
several successful applications in sharing data that were created for the same
patients in various systems, the IA model was further developed to extend the
longitudinal ePR to include one's fetal data as entered in the mother's record. This
paper describes how various IA elements: Section, View, Form, Group, Entity,
Content, Document supports the building of a true womb-to-tomb ePR for the HA
patients. The future focus of Information Architecture in the HA will include
building a Information Architecture Management System and linking the ePR
with other patient records in the community.

A survey of the effects of the full computerized nursing records

system on sharing nursing records among health professionals.
Kurihara Y, Asai N, Ishimoto E, Kawamata S, Nakamura S.

Department of Nursing Science, Kochi Medical School, Japan. kurihary@kochi-
u.ac.jp
In the last decade computerized nursing records systems (CNRSs) have been
implemented at many hospitals around the world. Several effects of the CNRS
were expected; the improvement of the quality of medicine and nursing care, the
increased efficiency and the reduction of the cost. This study focused on the
effects of the CNRS on access and sharing of nursing records among various
health professionals. Timely access and availability of nursing records should
improve the quality of medicine and nursing care. In 2003, we conducted a survey
of the effectiveness of the CNRS on access and availability of nursing records
among health professionals. We found that the CNRS contributed to the
multidisciplinary sharing of nursing records without increasing the overall time
spent on nursing documentation at most hospitals. However, effective sharing of
nursing records even among nurses through the use of the CNRS did not occur at
many nursing divisions.

Principles-based medical informatics for success--how Hong Kong

built one of the world's largest integrated longitudinal electronic
patient records.
Cheung NT, Fung V, Wong WN, Tong A, Sek A, Greyling A, Tse N, Fung H.
Health Informatics Section, Hospital Authority, Kowloon, Hong Kong SAR.

cheungnt@ha.org.hk
Since 1994, the Hospital Authority has been developing and deploying clinical
applications at its constituent 41 hospitals and 121 clinics. The Clinical
Management System (CMS) is now used by over 4000 doctors and 20000 other
clinicians on a daily basis to order, document and review care. The territory-wide
Electronic Patient Record (ePR) has given clinicians an integrated, longitudinal,
lifelong view of a patient's record. Today the CMS and ePR form an essential
clinical and management tool to the Hospital Authority. The CMS handles two
million clinical transactions per day, and the ePR has over 6TB of data covering
57 million episodes for 7.9 million patients. This paper describes how the HA has
taken a principles-based approach to Medical Informatics to achieve its success in
the enterprise-wide deployment and deep utilization of a comprehensive clinical
information system.

A territory-wide electronic health record--from concept to

practicality: the Hong Kong experience.
Sek AC, Cheung NT, Choy KM, Wong WN, Tong AY, Fung VH, Fung M,
Ho E.
Department of Health Informatics, Hospital Authority, Kowloon, Hong Kong

SAR, China. sekch@ha.org.hk
In Hong Kong, a pilot project is being undertaken to implement a web-based

electronic patient record system to allow integrated, real time patient based
information to be shared in clinics, private and public hospitals. Such sharing
aims to ensure that complete and accurate healthcare information is available to
citizens' multiple points of care through a stable IT system. A challenge is to share
this electronic information whilst ensuring privacy and security. Hong Kong has
achieved its initial goals and pioneered in building a territory-wide electronic
health record (EHR). This paper will outline the tasks involved, approach, method
used and initial review of the pilot project. Barriers to implementation are
discussed and critical success factors are identified.
179: Pediatrics. 2007 Oct;120(4):e788-94.

Postdischarge infant mortality among very low birth weight infants:

a population-based study.
Kugelman A, Reichman B, Chistyakov I, Boyko V, Levitski O, Lerner-Geva

L, Riskin A, Bader D; Israel Neonatal Network.
Department of Neonatology, Bnai Zion Medical Center, Bruce Rappaport Faculty

of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
dramir@netvision.net.il
OBJECTIVE: The objective of this study was to identify factors that were
associated with death after discharge from the NICU of very low birth weight
infants in a population-based study. METHODS: From a national cohort of
13,430 very low birth weight infants who were born in Israel from 1995 to 2003,
10,602 infants were discharged from the hospital and composed the study
population. Demographic and clinical data regarding the pregnancy, delivery, and
neonatal course were obtained from the Israel national very low birth weight
infant database. Data on each case of death during the postdischarge period until 1
year of age were provided by the Ministry of Health from national linked birth
and death certificates. Univariate analyses and a multivariable logistic regression
analyses were performed to examine the perinatal and neonatal risk factors for
postdischarge death. RESULTS: The postdischarge mortality rate was 7.5 per
1000 (80 of 10,602 infants discharged from the hospital). The death rate was
significantly higher in non-Jewish infants, infants who were born to young
mothers, and infants who were born to low-educated mothers. After adjustment
for demographic characteristics and perinatal and neonatal variables,
postdischarge mortality was independently associated with congenital
malformations, neonatal seizures, necrotizing enterocolitis, and
bronchopulmonary dysplasia. CONCLUSION: Although the postdischarge death
rate was relatively low in our cohort of very low birth weight infants, attention
should be focused on the subgroups of infants who are at higher risk to decrease
their mortality further.
Publication Types:
180: J Assoc Physicians India. 2007 Jul;55:491-5.

Identifying the need for pre-hospital and emergency care in the

developing world: a case study in Chennai, India.
Ramanujam P, Aschkenasy M.
Department of Emergency Medicine, University of California - San Diego, CA

92103-8676, USA.
OBJECTIVES: Increasing industrialization in the developing world has

contributed to an epidemiological transition in disease pattern from infectious
disease as a primary cause of morbidity and mortality, to more chronic illness
such as heart disease and trauma. This study was done in order to assess the
effectiveness of pre-hospital and emergency care as the health care needs of the
population changes and to make recommendations to meet the growing need for
organized emergency services in that community. METHODS: Sundaram
Medical Foundation Hospital in the town of Annanagar, Chennai, India was our
study site. Statistics describing the health status, demographic, and socio-ecoomic
profiles of the community were obtained from a published community survey.
Information regarding availability of resources in the hospitals for management of
trauma and cardio-vascular emergencies was obtained from unpublished survey
results of the local hospitals. Retrospective data was obtained from trauma and
ambulance registries regarding trauma related admissions, death and pre-hospital
assistance. RESULTS: Data analysis revealed increasing mortality from trauma
and cardiovascular etiologies. Hospital statistics showed that 1/3 of the annual
hospitalizations were from trauma and acute coronary syndromes. Half the trauma
victims had no formal prehospital intervention. Standard of care in the emergency
departments varied considerably with less than half of them carrying defibrillators
and only a third of them carrying defirbillators and only a third of them carrying
intubation equipment. CONCLUSION: As developing countries begin to urbanize
and grow, so do their health care needs. The current system does not meet the
needs of increased mortality from trauma and cardiovascular disease. We have
suggested necessary changes for establishment of emergency medical services to
meet the evolving health care needs.
181: J Affect Disord. 2008 May;108(1-2):43-8. Epub 2007 Sep 27.

Enhanced cancer risk among patients with bipolar disorder.
BarChana M, Levav I, Lipshitz I, Pugachova I, Kohn R, Weizman A,

Grinshpoon A.
Cancer Registry, Ministry of Health, Jerusalem, Israel.
BACKGROUND: In contrast to numerous epidemiological studies that explored

the risk for cancer among persons with schizophrenic psychoses, analogous
studies conducted on people with bipolar disorder are rarer, despite some
commonalities in biological, treatment-related variables and unhealthy lifestyles.
This study investigates the risk for cancer among psychiatric inpatients diagnosed
with bipolar disorder. METHODS: Linkage analysis was conducted based on the
psychiatric and the cancer national databases. Standardized incidence ratios (SIR)
for both aggregated sites and for breast cancer were calculated by comparing the
incidence rates among hospitalized patients with bipolar disorder with the
incidence rates in the Jewish-Israeli general population. RESULTS: An enhanced
cancer risk was found for bipolar disorder in both genders: men, SIR 1.59 (95%
CI 1.01-2.17); women, SIR 1.75 (95% CI 1.31-2.18). The risk for breast cancer
was higher, but not significantly, than in the general female population, SIR 1.70
(95% CI 0.99-2.41). LIMITATIONS: Our sample was derived from psychiatric
inpatients, thus it is likely that the bipolar disorder cases had greater severity.
Putative factors such as diet, smoking and medications were not investigated.
CONCLUSIONS: Our study showed an enhanced risk for cancer among patients
with bipolar disorder. Clinicians might note this risk for timely diagnosis and
treatment.
182: Arch Iran Med. 2007 Oct;10(4):439-45.

Erratum in:
• Arch Iran Med. 2008 Jan;11(1):135.
Comment in:
• Arch Iran Med. 2007 Oct;10(4):433-4.
Determinants of seeking needed outpatient care in Iran: results from

a national health services utilization survey.
Hosseinpoor AR, Naghavi M, Alavian SM, Speybroeck N, Jamshidi H, Vega

J.
Department of Equity, Poverty and Social Determinants of Health, Evidence and

Information for Policy, World Health Organization, 20 Avenue Appia, CH 1211
Geneva 27, Switzerland. hosseinpoora@who.int
BACKGROUND: To assess the inequity in seeking needed outpatient services in

Iran and to investigate its influential factors. METHOD: The data were taken
from a nation-wide Iranian health survey conducted in 2003. This study is based
on individuals aged 15 years and over who had mentioned their need to seek
outpatient care within two weeks prior to the day of the interview. The outcome
was seeking needed outpatient care. The independent variables included
respondents' age, gender, marital status, education, occupation, index of
household economic status, health insurance status and residential place (urban
vs. rural).RESULTS: Sixty-nine point five percent of those in need sought
outpatient care. The rich (OR: 2.38, 95% CI: 1.64 - 3.43) and the health insured
(OR: 1.62, 95% CI: 1.25 - 2.08), the pensioners and the retired (OR: 2.26, 95%
CI: 1.22 - 4.20), the housewives (OR: 1.77, 95% CI: 1.07 - 2.95) were more likely
to seek outpatient care than other occupations. On the other hand, people living in
remote rural areas (OR: 0.40, 95% CI: 0.28 - 0.57) were less likely to seek their
needed outpatient care than those living in main rural areas and urban areas.
CONCLUSIONS: As in different parts of the world, differences in seeking
needed healthcare still exist across different groups in Iran. Indeed, seeking
outpatient care in Iran is related not only to health system functions--like health
insurance and health facilities--but also on factors beyond the scope of health
authorities such as economic status and occupation. This study can be
instrumental for the recent five-year Economic, Social and Cultural Development
Plan of Iran which identified the reduction of inequalities in social determinants
of health [corrected]
183: South Med J. 2007 Sep;100(9):948-9.

Therefore choose life: the Jewish perspective on coping with

catastrophe.
Pollock DM.
Jewish Community Relations Council of New York, 70 West 36th Street, Suite
700, New York, NY 10018, USA. pollockd@jcrcny.org
184: South Med J. 2007 Sep;100(9):929-31.

A decade of disasters: lessons from the Indian experience.
Kasi S, Bhadra S, Dyer AR.
Department of Psychiatric Social Work, National Institute of Mental Health and

Neuro Sciences (NIMHANS), Bangalore, India.
185: Stud Health Technol Inform. 2007;127:91-7.

The value of information for decision-making in the healthcare

environment.
Shabtai I, Leshno M, Blondheim O, Kornbluth J.

College of Management Academic Studies, Tel Aviv University, Israel.
With their ever-growing importance and usability, the healthcare sector has been
investing heavily in medical information systems in recent years, as part of the
effort to improve medical decision-making and increase its efficiency through
improved medical processes, reduced costs, integration of patients' data, etc. In
light of these developments, this research aims to evaluate the contribution of
information technology (IT) to improving the medical decision-making processes
at the point of care of internal medicine and surgical departments and to evaluate
the degree to which IT investments are worthwhile.This has been done by
assessing the value of information to decision-makers (physicians) at the point of
care by investigating whether the information systems improved the medical
outcomes. The research included three steps (after a pilot study)--the assessment
of the subjective value of information, the assessment of the realistic value of
information, and the assessment of the normative value of information, the results
of each step being used as the starting assumptions for the following steps.
Following a discussion and integration of the results from the various steps, the
results of the three assessment stages were summarized in a cost-effectiveness
analysis and an overall return on investment (ROI) analysis. In addition, we tried
to suggest IT strategies for decision-makers in the healthcare sector on the
advisability of implementing such systems as well as the implications for
managing them.This research is uniquely pioneering in the manner in which it
combines an assessment of the three kinds of measures of value of information in
the healthcare environment. Our aim in performing it was to contribute to
researchers (by providing additional insight into the fields of decision theory,
value of information and medical informatics, amongst others), practitioners (by
promoting efficiency in the design of new medical IS and improving existing IS),
physicians (by enhancing the efficient use of information resources), patients (by
improving healthcare services) and policy decision-makers in the healthcare
sector (regarding the advisability of investments in such systems and suggestions
for managing them).
186: Circ J. 2007 Oct;71(10):1617-21.

Registration and surveillance of acute myocardial infarction in

Japan: monitoring an entire community by the Takashima AMI
Registry: system and design.
Turin TC, Kita Y, Rumana N, Sugihara H, Morita Y, Tomioka N, Okayama

A, Nakamura Y, Ueshima H.
Department of Health Science, Shiga University of Medical Science, Seta
Tsukinowa-cho, Otsu 520-2192, Japan.
BACKGROUND: The purpose of this registration is to follow incidence and case

fatality trend of acute myocardial infarction (AMI) in Japan, using a whole
community population disease registry that surveys the most up-to-date
information. Since the 1970s, mortality from coronary heart disease has followed
a declining trend in Japan, which has been attributed to a decrease in the
incidence of AMI and some evidence suggests that incidence has leveled off
during the past couple of decades. These reported decreasing or stable trends in
AMI have been observed despite recent worsening of the cardiovascular risk
factor situation in Japan (Japanese paradox). Therefore, monitoring the disease
course of AMI is of immense importance. METHODS AND RESULTS: The
Takashima AMI Registry established in 1988 covers a stable population of
approximately 55,000 in Takashima County in central Japan. Registered patients
included all Takashima County residents who have been diagnosed with AMI.
The criteria of AMI are in accord with those of the World Health Organization's
Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-
MONICA) project. CONCLUSION: Comprehensive disease registry data is
especially appropriate for determining the incidence as well as the trend of
diseases such as AMI. This registration study covering an entire community will
enable researchers to follow trends in AMI incidence with a high degree of
precision.
Publication Types:
187: Lancet. 2007 Sep 22;370(9592):1040-54.

Comment in:
• Lancet. 2007 Oct 20;370(9596):1413; author reply 1413-4.
Can we achieve Millennium Development Goal 4? New analysis of

country trends and forecasts of under-5 mortality to 2015.
Murray CJ, Laakso T, Shibuya K, Hill K, Lopez AD.
Institute for Health Metrics and Evaluation at the University of Washington,

Seattle, WA 98102, USA. cjlm@u.washington.edu
BACKGROUND: Global efforts have increased the accuracy and timeliness of

estimates of under-5 mortality; however, these estimates fail to use all data
available, do not use transparent and reproducible methods, do not distinguish
predictions from measurements, and provide no indication of uncertainty around
point estimates. We aimed to develop new reproducible methods and reanalyse
existing data to elucidate detailed time trends. METHODS: We merged available
databases, added to them when possible, and then applied Loess regression to
estimate past trends and forecast to 2015 for 172 countries. We developed
uncertainty estimates based on different model specifications and estimated levels
and trends in neonatal, post-neonatal, and childhood mortality. FINDINGS:
Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72
(70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5
(13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global
under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially
less than the target of Millennium Development Goal 4 (MDG4) of a 67%
decrease. Several regions in Latin America, north Africa, the Middle East,
Europe, and southeast Asia have had consistent annual rates of decline in excess
of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions
in sub-Saharan Africa, which also has the slowest rates of decline in fertility.
INTERPRETATION: Globally, we are not doing a better job of reducing child
mortality now than we were three decades ago. Further improvements in the
quality and timeliness of child-mortality measurements should be possible by
more fully using existing datasets and applying standard analytical strategies.
Publication Types:
188: Rinsho Byori. 2007 Aug;55(8):764-72.

[Trends of utilization of information technologies in clinical

laboratory and pathology domain]
Tofukuji I.
Department of Healthcare Informatics, Faculty of Health and Welfare, Takasaki

University of Health and Welfare, Takasaki.
The life expectancy of the Japanese population is one of longest in the world.
Society is aging, with fewer children, increasing the total national medical
payment in Japan. This situation has forced the Government to reduce the
payment and to increase the efficiency of the medical system, so information
technologies are expected to contribute to these policies. Electronic patient record
systems (EPR) were expected to be used widely, but only 23% of clinical training
hospitals have implemented them. This is mainly due to the lack of incentives and
large costs to install EPR. Standardization is a good method to reduce system
construction cost and increase its quality. New global IHE activities are expected
to solve these problems with methodologies of workflow analyses, standard
applications, tests and demonstrations. Laboratory information systems (LIS)
have a long history and tradition of standard interfaces for connecting computers
with analyzers. IHE activities for LIS are providing easy and secure connections
with hospital information systems (HIS). Pathology departments also have their
own information systems. IHE activities for pathology were launched in 2005,
and we are now developing in collaboration with the international IHE pathology
working group, HL7 SIG pathology and DICOM WG-26. Pathologists and
technical experts in Japanese laboratories are encouraged to join IHE activities to
ensure good results.
Publication Types:
189: Atherosclerosis. 2008 Apr;197(2):860-7. Epub 2007 Sep 12.

Renal function and metabolic syndrome components on

cardiovascular and all-cause mortality.
Chien KL, Hsu HC, Lee YT, Chen MF.
Institute of Preventive Medicine, College of Public Health, National Taiwan

University, Taipei, Taiwan. klchien@ha.mc.ntu.edu.tw
OBJECTIVES: Impaired renal function and metabolic syndrome have been

associated with risk of cardiovascular disease (CVD). We investigated their roles
in CVD and all-cause death among ethnic Chinese population. METHODS: We
followed up a cohort of 11429 men and 7472 women aged 20 years and older for
an average 4.9 years (median: 3.5, inter-quartile range: 2.7-7.9) from the tertiary
hospital health check-up population. RESULTS: CVD death rates increased when
the quintiles of each variable progressed. Metabolic syndrome was a significant
predictor for CVD death, with relative risk of up to 4.68. In the multivariate
adjusted model that included metabolic syndrome, quintiles of serum creatinine
concentrations, estimated glomerular filtration rate (GFR), and uric acids were
significantly associated CVD death, with the highest relative risk of creatinine
concentration (11.22, 95% confidence interval [CI]: 2.43-51.7, P for trend:
<0.001). Serum creatinine concentrations and estimated GFR had the higher areas
under ROC curves of CVD death (0.76, 95% CI: 0.71-0.80 for creatinine and
0.76, 95% CI: 0.72-0.81 for estimated GFR). The two marker models showed that
metabolic syndrome and impaired renal function had the most significant roles in
predicting CVD deaths; the multivariate relative risk was 30.6 (95% CI: 3.7-254,
P: 0.002) in participants with the highest creatinine and presence of metabolic
syndrome compared with those with the lowest and absence of metabolic
syndrome. CONCLUSIONS: Impaired renal function and metabolic syndrome are
important risk factors for CVD and all-cause deaths among ethnic Chinese.
Publication Types:
190: N Z Med J. 2007 Sep 7;120(1261):U2712.

Comment in:
• N Z Med J. 2007;120(1261):U2707.
The impact of New Zealand CVD risk chart adjustments for family
history and ethnicity on eligibility for treatment (PREDICT CVD-5).
Wells S, Kerr A, Broad J, Riddell T, Kenealy T, Jackson R.
Section of Epidemiology and Biostatistics, School of Population Health,

University of Auckland, Auckland. s.wells@auckland.ac.nz
AIMS: Current New Zealand cardiovascular (CVD) risk management guidelines

advocate targeting treatment to patients with a high 5-year CVD risk assessed
using a calculator derived from the Framingham Heart Study. For some high-risk
population subgroups, a 5% upward adjustment to their calculated 5-year CVD
risk is recommended. We estimated the impact of these adjustments on eligibility
for treatment in a primary care setting. METHODS: Between 2002 and 2006,
23,709 patients visiting their primary care provider in Auckland, New Zealand
had CVD risk assessments as part of an opportunistic screening programme using
PREDICT, a web-based clinical decision support system. We calculated their
baseline CVD risk with and without the 5% upward adjustment for family history
of premature ischaemic CVD or for being of Maori, Pacific or Indian
subcontinent ethnicity. RESULTS: A baseline CVD risk could be calculated for
23,693 (99.9%) patients of whom 90% were between ages 35 and 74 years.
Unadjusted risk scores classified the majority (70%) below the 10% 5-year risk
threshold for specific individualised treatment. A further 11% were between 10 to
15% risk (recommended to receive individualised lifestyle counselling in general
practice) and 19% had a greater than 15% risk ( recommended for drug treatment
and referral to a dietician in addition to individualised lifestyle counselling). Over
a quarter of patients were recorded as having a premature family history of CVD;
21% were Maori, Pacific, or Indian subcontinent and thus met the criteria for a
single 5% upward adjustment. This increased the number of people eligible for
drug treatment, intensive lifestyle management, and dietician referral by
approximately 20% and individualised lifestyle assessment and counselling by
50%. CONCLUSIONS: The upward adjustments to the calculated CVD risk
recommended by the New Zealand CVD risk management guidelines has the
potential to substantially increase resource requirements for CVD preventive
services in primary care. Moreover the true impact is likely to be underestimated
given other adjustment factors related to diabetes risk that were not available in
this dataset. Given the impact of these relatively small changes to the CVD risk
calculator, locally developed and validated risk equations are urgently needed.
Publication Types:
191: Scand J Public Health. 2008 Jan;36(1):99-106.

Managing with maps? The development and institutionalization of a

map-based health management information system in Madhya
Pradesh, India.
De Costa A, Saraf V, Jhalani M, Mahadik VK, Diwan VK.
Division of International Health, Karolinska Institutet, Stockholm, Sweden.

Ayesha.de.costa@ki.se
AIMS: This paper presents the development of a map-based health management

information system (mHMIS) in the central Indian province of Madhya Pradesh.
Sample outputs and statistics from the system for one district are presented. The
implementation dynamics and the preliminary performance of the system are
discussed. METHODS: The development of the mHMIS was a collaborative
effort between the provincial Department of Health, the medical university and
the Danidasupported Madhya Pradesh Basic Health Services project. One of
India's most socioeconomically backward provinces, Madhya Pradesh is spread
over an area of 304,000 km(2), and has a population of 60.4 million distributed in
its 55,392 villages and 394 towns. A primary survey of all healthcare providers
(public and private) in the province was done to map these. Secondary data
sources for sociodemographic information (census of India), vital statistics and
health program indicators (health worker records) were used in developing the
system. The process of mapping from obtaining hand-drawn maps of the villages
from the commissioner, land records, to final digitizing is also described.
CONCLUSIONS: Sample outputs and statistics for one district (Chindwara) from
the system are presented. There were 20.35 trained doctors in rural areas and
72.78 in urban areas per 100,000 population. Preliminary experience after a year,
advantages, constraints (both systemic limitations and weakness in the mHMIS)
to optimal usage, and future prospects for use in this setting are discussed.
192: Clin Toxicol (Phila). 2008 Mar;46(3):206-10.

Illicit cathinone ("Hagigat") poisoning.
Bentur Y, Bloom-Krasik A, Raikhlin-Eisenkraft B.
Israel Poison Information Center, Rambam Health Care Campus, The Bruce
Rappaport Faculty of Medicine, Haifa, Israel. d_bentur@rambam.health.gov.il
INTRODUCTION: Khat leaves (mainly cathinone and cathine) have been

chewed for centuries as stimulants. Hagigat (capsules of 200 mg cathinone) have
been marketed in Israel as a natural stimulant and aphrodisiac. The consequences
of illicit exposure to cathinone are reported. METHODS: Prospective
observational study of calls to the Poison Center regarding exposure to Hagigat
during the course of 10 months. Demographic and clinical data were abstracted
from patients' records and telephone follow up was performed. RESULTS: Data
of 34 consecutive patients aged 16-54 years were analyzed. The amount
consumed was (1/2)-6 capsules (ingestion-32, sniffing-2). Main clinical
manifestations were headache, vomiting, hypertension, nausea, tachycardia,
dyspnea, chest pain, and myalgia. Main complications were myocardial ischemia
(3), pulmonary edema (2), and intracerebral hemorrhage (1), all in young subjects.
Treatment was supportive; one patient underwent neurosurgery. CONCLUSION:
Exposure to illicitly synthesized cathinone is associated with serious
cardiovascular and neurological toxicity, even in young subjects.
193: Int Dent J. 2007 Aug;57(4):274-8.

Education of dentists in Thailand.
Komabayashi T, Srisilapanan P, Korwanich N, Bird WF.
Division of Endodontology, School of Dental Medicine, University of

Conncecticut, Farmington 06030-1715, USA. Tkomabayashi@gde.uchc.edu
Thailand is geographically located in southeast Asia and its population is 63

million. Little has been published on dental education in Thailand. This paper
provides information about Thailand regarding its dental history, dental school
system including curriculum and dental licensure. There are eight public and one
private dental school in Thailand. A six-year dental education leads to the DDS
degree. On graduation from the public dental schools, dentists are required to
work in the public system for three years. Currently, there are approximately 8000
active dentists, with a dentist: population ratio of approximately 1:7000.
Publication Types:
• Historical Article
194: Comput Inform Nurs. 2007 Sep-Oct;25(5):294-300.

Nurses' experiences using a nursing information system: early stage

of technology implementation.
Lee TT.
National Taipei College of Nursing, Taipei, Taiwan. tingting@ntcn.edu.tw
Adoption of information technology in nursing practice has become a trend in

healthcare. The impact of this technology on users has been widely studied, but
little attention has been given to its influence at the beginning stage of
implementation. Knowing the barriers to adopting technology could shorten this
transition stage and minimize its negative influences. The purpose of this study
was to explore nurses' experiences in the early stage of implementing a nursing
information system. Focus groups were used to collect data at a medical center in
Taiwan. The results showed that nurses had problems with the system's content
design, had insufficient training, were concerned about data security, were
stressed by added work, and experienced poor interdisciplinary cooperation. To
smooth this beginning stage, the author recommends involving nurses early in the
system design, providing sufficient training in keyboard entry skills, redesigning
workflow, and improving interdisciplinary communication.
Publication Types:
195: J Indian Med Assoc. 2007 Feb;105(2):70.

IT buzzword--telemedicine.
Daga S.
Publication Types:
• Editorial
196: J Nurs Res. 2007 Sep;15(3):202-14.

Testing a model of stress and health using meta-analytic path

analysis.
Yu L, Chiu CH, Lin YS, Wang HH, Chen JW.
College of Health Science, Kaohsiung Medical University, Taiwan, ROC.
The goal of this study was to use meta-analytic path analysis to evaluate a
theoretical model of stress and health. A meta-analysis technique was adopted to
combine and re-analyze 477 studies that investigated stress-related topics between
January 1980 and December 2003 in Taiwan. Databases searched included
PerioPath-Index to Chinese Periodical Literature, Electronic Theses and
Dissertations System, and NSC (National Science Council) Science and
Technology Information System. Variables recorded included stress, health,
social support, coping strategies, and personality traits. A correlation matrix of
these variables was derived from meta-analytic data and then analyzed using
structural path analysis to test the fitness of the hypothesized stress-health model
to the observed aggregated data. Results showed the revised hypothesized model
to be a reasonable, good fit to aggregated data. Based on the theoretical stress-
health model developed in this study, subjective stress was found to have a
substantively important and direct effect on health, whereas objective stress
required the mediating function of subjective stress to exercise an influence on
health. Such variables as social support, coping strategies, and personality traits
had comparatively weaker influences, either direct or indirect, on the stress-health
process. This study provided a holistic view on the relationship between stress
and health in the context of stress and proposed a direction for future research and
practice.
Publication Types:
• Meta-Analysis
197: Soc Work Health Care. 2007;45(1):81-97.

Needs of family caregivers caring for stroke patients: based on the

rehabilitation treatment phase and the treatment setting.
Kim JW, Moon SS.
School of Social Work, The University of Texas at Arlington, 211 S Cooper

Street, Arlington, TX 76019, USA.
The objective of the study was to identify the needs of family members across
rehabilitation treatment phases and treatment settings. Participants were 123
family caregivers in rehabilitation settings in South Korea that replied to the
survey. The needs were measured by the Family Needs Questionnaire (FNQ) and
the t-test and one-way ANOVA were used to analyze collected data. In the
comparison of two rehabilitation phases, the family caregivers caring for their
patients in the acute rehabilitation phase perceived the need for health information
as more important than those in the postacute phase. In addition, the family
caregivers caring for patients in the acute rehabilitation phase were less satisfied
with community network support and family support than those in the postacute
phase. In the comparison of treatment settings, family caregivers caring for their
patients in outpatient clinic services showed the lowest satisfaction of their needs
in four areas (health information, emotional support, instrumental support, and
professional support) compared with those in inpatient facilities or day hospitals.
Findings are discussed within the context of the empirical and theoretical
literature and implications for social work practice are considered.
198: Lancet. 2007 Sep 22;370(9592):1061-77.

Mental health systems in countries: where are we now?
Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ,

Sreenivas V, Saxena S.
Department of Psychiatry, Christian Medical College, Vellore, India.
More than 85% of the world's population lives in 153 low-income and middle-
income countries (LAMICs). Although country-level information on mental
health systems has recently become available, it still has substantial gaps and
inconsistencies. Most of these countries allocate very scarce financial resources
and have grossly inadequate manpower and infrastructure for mental health.
Many LAMICs also lack mental health policy and legislation to direct their
mental health programmes and services, which is of particular concern in Africa
and South East Asia. Different components of mental health systems seem to vary
greatly, even in the same-income categories, with some countries having
developed their mental health system despite their low-income levels. These
examples need careful scrutiny to derive useful lessons. Furthermore, mental
health resources in countries seem to be related as much to measures of general
health as to economic and developmental indicators, arguing for improved
prioritisation for mental health even in low-resource settings. Increased emphasis
on mental health, improved resources, and enhanced monitoring of the situation in
countries is called for to advance global mental health.
Publication Types:

• Review
199: Scand J Public Health Suppl. 2007 Aug;69:21-5.

An introduction to the general temporal data model and the

structured population event history register (SPEHR).
Clark SJ.
Department of Sociology, University of Washington, USA.

samclark@u.washington.edu
There are some 37 demographic surveillance system sites active in sub-Saharan

Africa, Asia and Central America. These sites, and other longitudinal population
and health research projects, generate data over time in order to describe and
explain the event histories of individuals and the populations they constitute. This
note addresses key data management challenges presented by such complex
temporal data-gathering efforts. Ideas supporting a standard definition for
temporal population data, and a standard design for temporal databases to
improve management of longitudinal population data, are presented and briefly
discussed.
200: Bull World Health Organ. 2007 Aug;85(8):607-14.

Mortality in the Islamic Republic of Iran, 1964-2004.
Khosravi A, Taylor R, Naghavi M, Lopez AD.
School of Population Health, University of Queensland, Brisbane, QLD,

Australia.
OBJECTIVE: Reliable information on the pattern, level and trend of mortality is

essential for evidence-based policy to improve health. Various sources of
mortality data in the Islamic Republic of Iran have not been critically assessed.
This paper aims to document and evaluate the completeness of the different data
sources on mortality and to estimate the level and trends of mortality over the past
40 years according to various mortality indices such as child mortality, adult
mortality and life expectancy. METHODS: We undertook a systematic review of
all available studies on infant mortality from 1964 to 2004 and estimated the most
probable trend in child mortality. Death registration data from between 1992 and
2004 were assessed for completeness to estimate the level of adult mortality. Life
tables for 2004 were constructed for the Islamic Republic of Iran based on these
data, corrected for under-registration of death. FINDINGS: Infant mortality
decreased from an estimated 154 deaths per 1000 live births in 1964 to 26 in
2004. The risk of adult mortality in 2004 was estimated to be 0.124 and 0.175 for
females and males respectively. According to adjusted death registration data, life
expectancy at birth in 2004 was 71.2 for females and 68.7 for males. The average
completeness of death registration for ages 5 years and older across all systems
was 76% for the period 2001-2004. CONCLUSION: There has been a general
decline in child mortality in the Islamic Republic of Iran over the past three
decades. Adult mortality levels also have declined, but less substantially.
Mortality information systems have improved, yet serious concerns remain
regarding the completeness and quality of data.
Publication Types:

His 1

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

His 1

Uploaded by

Copyright:

Available Formats

1: Lancet. 2008 Jun 28;371(9631):2173-82.

Related Articles, Links

• Lancet. 2008 Jun 28;371(9631):2147-8.

All-cause mortality attributable to chronic kidney disease: a

PMID: 18586172 [PubMed - indexed for MEDLINE]

2: BMC Health Serv Res. 2008 Jun 25;8:138.

Health services research in the public healthcare system in Hong

General Practice and Primary Care, Division of Community-Based Sciences,

BACKGROUND: Increasing use is being made of routinely collected electronic

PMID: 18578878 [PubMed - indexed for MEDLINE]

3: Int J Health Care Qual Assur. 2008;21(3):308-24.

Implementing QA programs in managed care health plans: factors

Gross R, Ashkenazi Y, Tabenkin H, Porath A, Aviram A.

Myers-JDC-Brookdale Institute, Jerusalem, Israel. Revital@jdc.org.il

PMID: 18578215 [PubMed - indexed for MEDLINE]

4: Int J Health Care Qual Assur. 2008;21(2):159-74.

Testing not-so-obvious models of healthcare quality.

Badri MA, Attia ST, Ustadi AM.

College of Business Administration, United Arab Emirates University, Al Ain,

• Research Support, Non-U.S. Gov't

5: MMWR Surveill Summ. 2008 Jun 20;57(5):24-39.

Malaria surveillance--United States, 2006.

Division of Parasitic Diseases National Center for Zoonotic, Vector-Borne, and

PROBLEM/CONDITION: Malaria in humans is caused by intraerythrocytic

PMID: 18566568 [PubMed - indexed for MEDLINE]

6: East Mediterr Health J. 2008 Mar-Apr;14(2):366-75.

Profile of paediatric emergency cases in Yemen: the need for

Ishak AA, Al-Jayefy NH, Raja'a YA.

Department of Paediatrics, Faculty of Medicine and Health Sciences, Sana'a

PMID: 18561729 [PubMed - indexed for MEDLINE]

7: World Hosp Health Serv. 2008;44(1):36-8.

E-health readiness assessment: promoting "hope" in the health-care

Khoja S, Scott R, Gilani S.

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

e-Health readiness refers to the preparedness of health-care institutions to

8: J Pak Med Assoc. 2008 Mar;58(3):138-9.

Institutional and surveillance database use in epidemiologic research

Younus M, Siddiqi AE, Khan BS, Steffey AL.

Department of Epidemiology, College of Human Medicine, Michigan State

PMID: 18517119 [PubMed - indexed for MEDLINE]

9: Qual Health Res. 2008 Jun;18(6):747-55.

Where do they go, whom do they consult, and why? Health-seeking

Shaikh BT, Haran D, Hatcher J.

University of Liverpool, Liverpool, United Kingdom.

This study presents an ethnographic account of health-seeking behaviors and

• Research Support, Non-U.S. Gov't

PMID: 18503016 [PubMed - indexed for MEDLINE]

10: Isr Med Assoc J. 2008 Mar;10(3):207-13.

Factors contributing to compliance with osteoporosis medication.

Kertes J, Dushenat M, Vesterman JL, Lemberger J, Bregman J, Friedman

Maccabi HealthCare Services, Israel. dortal_j@mac.org.il

BACKGROUND: Bisphosphonates are effective in the prevention and treatment

PMID: 18494234 [PubMed - indexed for MEDLINE]

11: Health Serv Manage Res. 2008 May;21(2):106-16.

Chang L, Hung JH.

Department of Business Administration, Shih Hsin University, Taipei, Taiwan.

This study is an attempt to determine whether the implementation of the Global

PMID: 18482934 [PubMed - indexed for MEDLINE]

12: Pharmacoepidemiol Drug Saf. 2008 Jun;17(6):609-19.

The prescribing of Chinese herbal products in Taiwan: a cross-

Division of Health Technology Assessment, Center for Drug Evaluation, Taipei,

• Research Support, Non-U.S. Gov't

PMID: 18481335 [PubMed - indexed for MEDLINE]