h & c management

301: Int J Health Care Finance Econ. 2007 Sep;7(2-3):217-31.

Related Articles, Links

The organization and financing of end-stage renal disease treatment in Japan. Fukuhara S, Yamazaki C, Hayashino Y, Higashi T, Eichleay MA, Akiba T, Akizawa T, Saito A, Port FK, Kurokawa K. Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan. [email protected] End-stage renal disease (ESRD) affects 230,000 Japanese, with about 36,000 cases diagnosed each year. Recent increases in ESRD incidence are attributed mainly to increases in diabetes and a rapidly aging population. Renal transplantation is rare in Japan. In private dialysis clinics, the majority of treatment costs are paid as fixed fees per session and the rest are fee for service. Payments for hospital-based dialysis are either fee-for-service or diagnosis-related. Dialysis is widely available, but reimbursement rates have recently been reduced. Clinical outcomes of dialysis are better in Japan than in other countries, but this may change given recent ESRD cost containment policies. Publication Types:

• Review

PMID: 17690980 [PubMed - indexed for MEDLINE]

302: Nurse Educ Pract. 2007 Sep;7(5):323-31. Epub 2006 Nov 22.


Learning to nurse in China--structural factors influencing professional development in practice settings: a phenomenological study. Shen J, Spouse J. School of Health, The First Affiliated Hospital of Chongqing Medical University, No. 176, Daping Region, Changjiang Road, Yuzhong District, Chongqing

400016, China. [email protected] This paper describes findings from a stratified phenomenological investigation into Chinese nursing students' experiences of learning in practice placements. The investigation was undertaken in China whilst studying at an English University for a post-graduate degree. With the transition of Chinese nursing education into higher education institutions, clinical nursing experience remains a fundamental factor in students' preparation for qualification. This small phenomenological study sought to understand the kinds of experiences students encounter, the factors that supported or inhibited their learning and the ways in which learning in practice could be enhanced. This paper concentrates on the structural factors that influenced students' learning. These structural factors included; the opportunities available for students to learn, students' participation in clinical nursing activities; the relationship that placement staff were willing to engage in with the students and the prevailing learning climate of the placement setting. PMID: 17689459 [PubMed - indexed for MEDLINE]

303: Br J Gen Pract. 2007 Aug;57(541):643-9.


Health locus of control and use of conventional and alternative care: a cohort study. Tokuda Y, Takahashi O, Ohde S, Ogata H, Yanai H, Shimbo T, Fukuhara S, Hinohara S, Fukui T. Clinical Practice Evaluation and Research Centre, St Luke's Life Science Institute, Tokyo, Japan. [email protected] BACKGROUND: Health locus of control influences health-related behaviour, but its association with healthcare use is unclear. AIM: To investigate the association between individuals' health locus of control and the use of conventional and alternative health care. DESIGN OF STUDY: Prospective cohort study. SETTING: A nationally representative random sample of community-dwelling adult households in Japan. METHOD: Health locus of control, symptom-related visits to physicians, and the use of dietary and physical complementary and alternative medicine (CAM) was measured. Dietary CAM included supplements, such as herbs and vitamins. Physical CAM included manipulations, such as acupuncture and acupressure. RESULTS: Of the 2453 adult participants studied, 2103 (86%; 95% CI [confidence interval] = 84 to 88%) developed at least one symptom during the 31-day study period. Of these symptomatic adults, 639 visited physicians (30%; 95% CI = 28 to 32%), 480 used dietary CAM (23%;

95% CI = 21 to 25%), and 156 (7%; 95% CI = 6 to 9%) used physical CAM. The likelihood of visiting a physician was not related significantly to individuals' health locus of control. Increased use of dietary CAM was weakly associated with control by spiritual powers (P = 0.028), internal control (P = 0.013), and less control by professionals (P = 0.020). Increased use of physical CAM was significantly associated with control by spiritual powers (P = 0.009) indicating a belief that supernatural forces control individuals' health status. CONCLUSION: The likelihood of visiting a physician is not affected by individuals' health locus of control. Control by spiritual powers is involved with increased CAM use. Internal control is weakly associated with greater use of dietary CAM; professional control is weakly associated with less use of dietary CAM. Publication Types:

• Multicenter Study • Research Support, Non-U.S. Gov't


PMCID: PMC2099670 [Available on 08/01/08]

304: Nurs Health Sci. 2007 Sep;9(3):228-33.


Health status, trends, and issues in Sri Lanka. Jayasekara RS, Schultz T. Discipline of Nursing, JBI Research Unit, School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, SA 5005, Australia. [email protected] It is widely recognized that better health is a prerequisite for the overall economic and social development of a nation. Sri Lanka, like many other countries experiencing the epidemiological transition, will have to make effective decisions on health-care service management and the development of education and training programs for health-care professionals. This paper provides a comprehensive review of current health service administration, health status, trends and issues, and health financing and resource allocation in Sri Lanka. The review revealed that Sri Lanka has achieved a relatively high health status given a low level of spending on its health-care services; however, Sri Lanka still experiences vital

health problems in all stages of the life cycle, mainly related to lifestyle and the epidemiological transition associated with widespread societal and economic crises. Publication Types:

• Review


305: Nurs Health Sci. 2007 Sep;9(3):221-7.


Nursing competency and organizational climate as perceived by staff nurses in a Chinese university hospital. Ying L, Kunaviktikul W, Tonmukayakal O. Faculty of Nursing, Chiang Mai University, 10 Intavaroros Sriphum, Chiang Mai 50200, Thailand. [email protected] Nursing competency is important to ensure patient safety and improve the quality of nursing care. Based on competency-based human resource management strategies, the organizational climate can positively influence nursing competency. However, a review of the literature indicated that there were no studies about the relationship between nursing competency and organizational climate in the People's Republic of China. This descriptive, correlational study examined the relationship between nursing competency and the organizational climate. The sample consisted of 243 staff nurses who completed the questionnaire worked at one university hospital in Liao Ning Province. The findings showed that there was a significantly moderate positive relationship between nursing competency and organizational climate. The study results suggested that Chinese nurse managers should maintain and provide a positive organizational climate to improve nursing competency. PMID: 17688481 [PubMed - indexed for MEDLINE]

306: Psychol Rep. 2007 Jun;100(3 Pt 1):915-23.


Disabled children in special education programs in Taiwan: use of mental health services and unmet needs. Liang HY, Chang HL. Department of Child Psychiatry Chang Gung Children's Hospital, Kweishan, Taoyuan, Taiwan. Despite national health insurance coverage in Taiwan, many health care needs remain unmet. In the current study, the behavior and emotional problems of 1,042 disabled children in special education programs were evaluated using the Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF). Using the 60th percentile on the two tests as a cutoff representing a clinical indication, students who reached this cutoff point but did not receive mental health services in the past six months were considered to have "unmet mental health needs." Of the special education students in the study 73.9% reached clinical indications, but did not receive mental health care. Publication Types:

• Research Support, Non-U.S. Gov't


307: East Mediterr Health J. 2007 May-Jun;13(3):492-504.


Quality improvement programme for diabetes care in family practice settings in Dubai. Khattab MS, Swidan AM, Farghaly MN, Swidan HM, Ashtar MS, Darwish EA, Al Mazrooei AK, Mohammad AA. Primary Health Care Sector, Department of Health and Medical Services, Dubai, United Arab Emirates. [email protected] A continuous quality improvement programme for the care of registered diabetes patients was introduced in 16 government-affiliated primary health care centres in Dubai. Quality improvement teams were formed, clinical guidelines and information systems were developed, diabetes nurse practitioners were introduced and a team approach was mobilized. Audits before and after the introduction of the scheme showed significant improvements in rates of recording key clinical

indicators and in their outcomes. For example, the proportion of patients with glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg. Publication Types:

• Evaluation Studies


308: Epidemiol Infect. 2008 Apr;136(4):436-48. Epub 2007 Aug 9.


Part I. Analysis of data gaps pertaining to Salmonella enterica serotype Typhi infections in low and medium human development index countries, 1984-2005. Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. [email protected] There are only 10 contemporary, population-based studies of typhoid fever that evaluate disease incidence using blood culture for confirmation of cases. Reported incidence ranged from 13 to 976/100 000 persons per year. These studies are likely to have been done preferentially in high- incidence sites which makes generalization of data difficult. Only five of these studies reported mortality. Of these the median (range) mortality was 0% (0-1.8%). Since study conditions usually involved enhanced clinical management of patients and the studies were not designed to evaluate mortality as an outcome, their usefulness for generalizing case-fatality rates is uncertain. No contemporary population-based studies reported rates of complications. Hospital-based typhoid fever studies reported median (range) complication rates of 2.8% (0.6-4.9%) for intestinal perforation and case-fatality rates of 2.0% (0-14.8%). Rates of complications other than intestinal perforation were not reported in contemporary hospital-based studies. Hospital-based studies capture information on the most severe illnesses among persons who have access to health-care services limiting their generalizability. Only two studies have informed the current understanding of typhoid fever age distribution curves. Extrapolation from population-based studies suggests that most typhoid fever occurs among young children in Asia. To reduce gaps in the current understanding of typhoid fever incidence, complications, and case-fatality

rate, large population-based studies using blood culture confirmation of cases are needed in representative sites, especially in low and medium human development index countries outside Asia. Publication Types:

• Research Support, N.I.H., Extramural • Research Support, Non-U.S. Gov't • Review


309: Int Nurs Rev. 2007 Sep;54(3):288-94.


Jordanian women's perceptions of post-partum health care. Khalaf IA, Abu-Moghli FA, Mahadeen AI, Callister LC, Al-Hadidi M. University of Jordan, Faculty of Nursing, Amman, Jordan. PURPOSE: This qualitative descriptive study aimed to explore Jordanian childbearing women's perceptions of their needs for health care and the post-partum healthcare services they received. METHODS: Twenty-four Jordanian childbearing women participated in the focus groups. Discussions focused on infant and maternal health concerns, access to post-partum health care, including family-planning services, the characteristics and behaviour of healthcare providers, and suggestions for the provision of quality maternal post-partum health care. FINDINGS: The majority of the women indicated that most of the services perceived and provided during the post-natal period were related to child care. They indicated that they attend post-natal visits mostly for treatment, family planning and/or child care and stated that they have not been told about the post-natal visits during pregnancy, or after giving birth. CONCLUSIONS: Study findings provided insight and understanding of women's perspectives on post-partum health care and implied a need to translate qualitative findings into clinical practice guidelines. It is suggested that the Jordanian Ministry of Health develops a comprehensive plan to improve educational offerings for post-partum women, and ensure that all healthcare facilities offer affordable and high-quality post-partum health care. Publication Types:



310: Int Nurs Rev. 2007 Sep;54(3):280-7.


Diabetes knowledge and glycemic control among Chinese people with type 2 diabetes. He X, Wharrad HJ. [email protected] BACKGROUND: Diabetes self-management education (DSME) is a key component of effective glycemic control and an important part of clinical diabetes management. The effects of DSME in China have not been investigated. OBJECTIVES: To identify factors that could enhance the quality of Chinese DSME programmes. The relationship between patients' diabetes knowledge and their glycemic control was explored. METHODS: A non-experimental cross-sectional study was undertaken in a large Shanghai hospital in China. Forty inpatients and 60 outpatients with type 2 diabetes mellitus were recruited. A Chinese version of the Diabetes Knowledge Scale was used to assess subjects' diabetes knowledge and collect demographic data and HbA1c levels. RESULTS: The mean diabetes knowledge scores among Chinese with type 2 diabetes was 22.1 +/- 3.76 out of a possible 30 marks. There was no difference in overall diabetes knowledge in people with HbA1c <7%, indicating good control and those with HbA1c >or=7%, indicating suboptimal glycemic control (t = -0.811, P = 0.419). However, there were differences in scores between the two groups for some specific questions on sick day management and food substitution. Moreover, sociodemographic characteristics such as age and occupation were significantly correlated with diabetes knowledge; age was negatively correlated with diabetes knowledge and white-collar workers had the highest mean knowledge score and housewives the lowest. CONCLUSION: Sociodemographic characteristics need to be considered when developing diabetes self-management programmes for Chinese people with type 2 diabetes. PMID: 17685912 [PubMed - indexed for MEDLINE]

311: J Med Liban. 2007 Apr-Jun;55(2):59-62.


[Recommendations on the relationship between surgeons and anesthesiologists as part of the health care team] [Article in French] Daher M. Service de Chirurgie générale, Hôpital Saint-Georges-CHU, Beyrouth, Liban. [email protected] Surgeon and anesthesiologist work as a team. Physicians of different but complementary specialties, they work jointly in the management of the patient during the pre, per and postoperative periods, with the main objective of ensuring the best quality of care and the greatest safety. However, the unprecedented development of new technologies during the last decades, deeply modified the conditions of exercise of these two specialities. Thus, the practice of anaesthesia is not only necessary for performing the surgical act, but also for diagnostic and therapeutic techniques using high technologies. So, from a traditional partner of the surgeon, the anesthetist became the privileged collaborator of a great number of specialists. Within these teams, the anesthetist must achieve his/her task in all independence, as stated in the Lebanese Code of Ethics. I will try in this message to point out the responsibilities of each of the two partners in this joint practice. The practice of a shared activity, in the same place, for the benefit of the patient, requires a preliminary definition of roles, in the mutual respect of competencies and responsibilities of each specialist, based on the respect of the rules edicted in the Code of Ethics. Publication Types:

• English Abstract


312: Sante Publique. 2007 Jan-Feb;19 Suppl 1:S97-106.


[North-South transfers and professional learning appropriateness] [Article in French] Canonne F.


313: East Mediterr Health J. 2007 Mar-Apr;13(2):408-19.


Attitudes to evidence-based medicine of primary care physicians in Asir region, Saudi Arabia. Khoja TA, Al-Ansary LA. Executive Board of the Health Ministers Council for GCC States, Riyadh, Saudi Arabia. A questionnaire survey was made of primary health care physicians in Asir region, Saudi Arabia in 1999 to explore their awareness of and attitude towards evidence-based medicine. The 272 respondents welcomed the principles of evidence-based medicine. Awareness and use of extracting journals, review publications and databases was low. Pharmaceutical company sponsored journals were the most commonly read. Bibliographic databases could only be accessed by 13% of respondents and the Internet by only 6%. There was only partial understanding of technical terms used in evidence-based medicine. Absence of a local library and increased patient workload were seen by most respondents as the main obstacles to practising evidence-based medicine. Publication Types:



314: Arch Pediatr Adolesc Med. 2007 Aug;161(8):740-3.


Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists. Shavit I, Keidan I, Hoffmann Y, Mishuk L, Rubin O, Ziv A, Steiner IP. Emergency Department, Meyer Children's Hospital, Rambam Medical Center,

Haifa, Israel. [email protected] OBJECTIVE: To evaluate the impact of simulation-based education on patient safety during pediatric procedural sedation. DESIGN: A prospective, observational, single-blind, controlled study of pediatric procedural sedation outside the operating room. SETTING: Two university teaching hospitals in Israel. PARTICIPANTS: Nonanesthesiologists, with or without training in simulation-based education on patient safety, who routinely perform procedural sedation outside the operating room. These comprise full-time pediatricians practicing emergency medicine and a cohort of pediatric gastroenterologists. INTERVENTION: The study investigators used the internally developed, 9-criteria Sedation Safety Tool to observe and evaluate nonanesthesiologists who were trained in sedation safety and compared their performance with that of colleagues who did not receive similar training. OUTCOME MEASURE: For each of the 9 criteria on the evaluation form, odds ratios and 95% confidence intervals were calculated to compare the actions of the individuals in the 2 study groups. RESULTS: Thirty-two clinicians were evaluated. Half of the physicians were graduates of the simulation-based sedation safety course. Significant differences in performance pertaining to patient safety were found between those physicians who did and those who did not complete simulation-based training. CONCLUSIONS: Pediatric procedural sedations conducted by simulator-trained nonanesthesiologists were safer. The simulation-based sedation safety course enhanced physician performance during pediatric procedural sedation. Publication Types:

• Clinical Trial


315: Harefuah. 2007 May;146(5):337-40, 407.


[Temporal trends in characteristics of diabetic subjects in Beer Sheba in two cohorts: 1988-90 and 1996-97 is immigration part of these trends?] [Article in Hebrew] Bilenko N, Biderman A, Rosen S, Weitzman S. Ministry of Health, Southern District, Beer Sheba.

BACKGROUND: Israel is a country with high immigration rates. In previous studies, immigrants were found to have a relatively higher risk for cardiovascular diseases, higher rates of hypertension, as well as overall mortality rates. In this study we examined whether patient characteristics in the diabetic population of selected clinics in Beer Sheba differed between the years 1988 and 1997, and if immigration could explain these differences. METHODS: All known diabetic patients diagnosed at age 30 and older were enrolled in the study from 3 clinics in Beer Sheba in the years 1988-90 (Cohort 1), and from one of those clinics in 1996-97 (Cohort 2). Demographic, behavioral, clinical and biochemical characteristics of the two cohorts were compared, paying special attention to recent immigrants (< 10 years in Israel). RESULTS: About 17% of Cohort 1 and 47% of Cohort 2 were recent immigrants. Patients from Cohort 1 were significantly younger and had lower BMI compared to Cohort 2. They had higher systolic (148+/-22 vs. 141+/-21, p<0.001) and diastolic (83+/-12 vs. 80+/-10, p<0.001) blood pressure. More patients from Cohort 2 were on oral hypoglycemic medications (56% vs. 75%, p<0.001). Glucose control by HbAlc was better in patients from Cohort 2. The differences between cohorts were maintained after stratification by immigration status. CONCLUSIONS: Diabetes-related characteristics of patients differed during the seven-year period and were not explained by immigration status. Improvement in care and more intensive management of patients with diabetes may explain, at least partially, the described differences. Publication Types:

• English Abstract • Multicenter Study


316: Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):647-50. Epub 2007 Jul 25.


Comment in:

• Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):650-1. • Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):651.

Venous trauma in the Lebanon War--2006. Nitecki SS, Karram T, Hoffman A, Bass A.

Department of Vascular Surgery, Rambam Medical Center, P.O. Box 9602, Haifa 36091, Israel. [email protected] OBJECTIVES: Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. METHODS: All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. RESULTS: Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. CONCLUSIONS: Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can be safely and effectively performed in young patients. Postoperative course is not compromised and late sequelae of venous interruption may be prevented. PMID: 17670724 [PubMed - indexed for MEDLINE]

317: J Wound Ostomy Continence Nurs. 2007 Jul-Aug;34(4):407-11.


Clinical and epidemiologic evaluation of pressure ulcers in patients at a university hospital in Turkey. Leblebici B, Turhan N, Adam M, Akman MN. Baskent University Faculty of Medicine, Department of Physical Medicine and

Rehabilitation, Ankara, Turkey. OBJECTIVE: We sought to measure the incidence of pressure ulcer development at a university health center in Turkey, and to determine whether the Waterlow Pressure Sore Risk (PSR) Scale score predicted pressure ulcer development, stage, or number of ulcers. DESIGN: We prospectively evaluated patients who were hospitalized at our university-based medical center. SETTING AND SUBJECTS: We analyzed data from 22,834 patients hospitalized at the Baskent University Adana Teaching and Medical Research Center in Ankara, Turkey from January 1, 2004 to December 31, 2004, including 360 patients who developed pressure ulcers. INSTRUMENTS: The Waterlow PSR Scale was used to assess pressure ulcer risk. In addition, age, sex, the ward or unit in which the patient was hospitalized, reason for hospitalization, and location and stage of ulcers were collected on a data form designed specifically for this study. METHODS: A single nurse physiotherapist assessed all patients daily during their hospitalization. When a pressure ulcer was diagnosed by the nurse physiotherapist, a physician staged the pressure ulcers based on the US National Pressure Ulcer Advisory Panel (NPUAP) staging system. RESULTS: Three hundred sixty out of 22,834 patients developed 1 or more pressure ulcers, resulting in an incidence rate of 1.6%. Most ulcers (59.2%) occurred in patients hospitalized in the intensive care unit (n = 213). A positive correlation between the Waterlow PSR Scale score and number of ulcers per patient (r: 0.178, P < .01) was identified. No significant correlation was found linking Waterlow PSR Scale score and ulcer stage or the development of a single ulcer. CONCLUSION: We found significantly lower pressure ulcer incidence rates than those commonly reported in the literature, which we believe is principally attributable to short hospital stays and a strong emphasis on preventive nursing care. While high Waterlow PSR scale Scores correlated positively with development of multiple ulcers, this did not predict ulcer stage or the presence of a single pressure ulcer. PMID: 17667087 [PubMed - indexed for MEDLINE]

318: Isr J Psychiatry Relat Sci. 2007;44(1):47-53.


Selecting and implementing evidence-based practices in psychiatric rehabilitation services in Israel: a worthy and feasible challenge. Roe D, Hasson-Ohayon I, Lachman M, Kravetz S. Rutgers University Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USA. [email protected]

Major recent conceptual and legal advancements in Israel have generated a profound shift in the services provided for people with severe mental illness. Perhaps the most influential development has been the passage of the act for the rehabilitation of persons with a psychiatric disability in the community in the year 2000. In this paper we argue that the psychiatric rehabilitation services defined by the recent legislation lack explicit standards or criteria for selection, and thus could benefit from incorporating interventions that evidence has shown to be effective in assisting clients to achieve desirable outcomes. We propose a practical five-step plan to facilitate the implementation of these evidence-based practices including creating demand, selecting the EBPs, preparing practitioners and agencies, monitoring and feedback, and ensuring sustainability. The importance of an ongoing dialogue between stakeholders to facilitate the integration of research evidence, clinical expertise and rehabilitation values to improve the quality of service is discussed. PMID: 17665811 [PubMed - indexed for MEDLINE]

319: Int J Health Serv. 2007;37(2):291-320.


Health care reform and the paradox of efficiency: "writing in" culture. Anderson JM, Tang S, Blue C. School of Nursing, University of British Columbia, Vancouver, Canada. [email protected] Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to

diverse client populations. Publication Types:



320: Bangladesh Med Res Counc Bull. 2006 Aug;32(2):43-8.


Head and neck squamous cell carcinoma (HNSCC) 5 year study at BSMMU. Siddiquee BH, Alauddin M, Choudhury AA, Akhtar N. Deptt. of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka. Head and Neck Squamous Cell Carcinoma (HNSCC) are generally similar in their clinical features, epidemiology and etiology although their natural and clinical history and treatment differ. Despite lot of improvement in diagnostic and management technique, there is little improvement in survival rate over the last few decades. This study was carried-out in a multidisciplinary tertiary level hospital (BSMMU), with a country-wide catchment area to see the burden of HNSCC existing in our country and their clinical pattern. The overall incidence rate of HNSCC in this study was (0.15%) i.e. 150 person in 1,00,000 population. Male incidence (0.19%) was higher than female (0.12%). This study revealed that carcinoma of the larynx (25.22%) and pyriform fossae (20.57%) were the main culprit, whereas buccal carcinoma was the main component (37.70%) in the female series. Highest incidence was found in the 6th decade in both sexes. As the treatment of HNSCC may be time consuming, requires multidisciplinary approach, demands lot of clinical, social and financial consideration, therefore, the best treatment can be offered through a combined board consisting of Surgical, Radiation, Medical oncologists, Histopathologist and Speech therapist as required. PMID: 17663359 [PubMed - indexed for MEDLINE]

321: BMC Clin Pharmacol. 2007 Jul 28;7:8.


Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: a prospective study. Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ. Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital Parel, Mumbai, India. [email protected] BACKGROUND: Adverse drug reactions (ADRs) are now recognized as an important cause of hospital admissions, with a proportion ranging from 0.9-7.9%. They also constitute a significant economic burden. We thus aimed at determining the prevalence and the economic burden of ADRs presenting to Medical Emergency Department (ED) of a tertiary referral center in India METHODS: A prospective, observational study of adult patients carried out over a 6 week period in 2005. The prevalence of ADRs, their economic burden from the hospital perspective, severity, and preventability were assessed using standard criteria. RESULTS: A total 6899 patients presented during the study period. Of these, 2046 were admitted for various reasons. A total of 265/6899 patients had ADRs (3.84 %). A total of 141/265 was admitted due to ADsR, and thus ADRs as a cause of admissions were 6.89% of total admissions. A majority (74.71%) were found to be of moderate severity. The most common ADRs were anti-tubercular drug induced hepatotoxicity, warfarin toxicity and chloroquine induced gastritis. The median duration of hospitalization was 5 days [95% CI 5.37, 7.11], and the average hospitalization cost incurred per patient was INR 6197/- (USD 150). Of total ADRs, 59.62% (158/265) were found to be either definitely or potentially avoidable. CONCLUSION: The study shows that ADRs leading to hospitalization are frequent and constitute a significant economic burden. Training of patients and prescribers may lead to a reduction in hospitalization due to avoidable ADRs and thus lessen their economic burden. PMID: 17662147 [PubMed - indexed for MEDLINE]

PMCID: PMC1963321

322: Rinsho Byori. 2007 Jun;55(6):540-3.


[Role of a clinical laboratory center as a correlational center for infection control]

[Article in Japanese] Hiramatsu K. Safety Management Center and Infection Control Center, Oita University Hospital, Oita. The prevention of hospital acquired infection is one of the most critical managements for the maintenance of high clinical quality. Surveillance such as the isolation rate of MRSA (methicillin resistant Staphylococcus aureus), MDRP (multidrug-resistant Pseudomonas aeruginosa) and catheter associated blood stream infection rate are useful tools for infection control. In these surveillances, the clinical laboratory center plays an important role in hospitals. Recent studies have shown that community-acquired MRSA has spread rapidly in the United States and clonal MDRP has also spread in Japan. In our studies, similar genotyped MDRP was isolated from several hospitals in the same region. These results suggested that infection control associated with regional hospitals is important to prevent the spread of antimicrobial resistant pathogens. The clinical laboratory center should also play an important role in regional infection control. Publication Types:

• English Abstract • Review


323: J Clin Nurs. 2007 Aug;16(8):1587-8.


Comment on:

• J Clin Nurs. 2007 Jan;16(1):168-78.

Commentary on Hjelm K, Bard K, Nyberg P and Apelqvist J (2007) management of gestational diabetes from the patient's perspective--a comparison of Swedish and Middle-Eastern born women. Journal of Clinical Nursing 16, 168-178. Mander R.

School of Health, University of Edinburgh, Edinburgh, UK. [email protected] Publication Types:

• Comment


324: J Clin Nurs. 2007 Aug;16(8):1571-9.


Evaluating effects of a prenatal web-based breastfeeding education programme in Taiwan. Huang MZ, Kuo SC, Avery MD, Chen W, Lin KC, Gau ML. Delivery Ward, Shin Kong Wu Ho-Su Memorial Hospital, and Graduate Institute of Nurse-Midwifery, National Taipei College of Nursing, Taiwan. AIMS: The objectives of this study were to evaluate a web-based breastfeeding education programme provided to primigravida in the third trimester of pregnancy with the aim of deepening breastfeeding knowledge and enhancing skills. The study was conducted at a hospital in Taiwan. BACKGROUND: Education is the cornerstone supporting the framework of lactation and breastfeeding. Web-based instruction is an efficient way to provide education. DESIGN: A quasi-experimental design was used. METHODS: The target population was women at 29-36 weeks gestation using the Internet on regular basis. The primigravida were assigned to either the control group (n=60) or the experimental group (n=60) according to time sequence. RESULTS: Women who received web-based breastfeeding education had a higher mean breastfeeding knowledge score and more positive attitude about breastfeeding. In addition, generalized estimating equations (GEE) model was used to examine the breastfeeding rate at different time points. After adjusting for the time trend and infant birth weight, there was a significant effect in exclusive breastfeeding for the experimental group. On the other hand, the web-based breastfeeding education programme also had a significant effect on mixed feeding rate for the experimental group. CONCLUSION: Results suggest that web-based breastfeeding education may contribute to breastfeeding knowledge and attitude and improved breastfeeding rate. RELEVANCE TO CLINICAL PRACTICE: Web-based breastfeeding education programme can achieve success in promoting breastfeeding and provide health professionals with an evidence-based intervention.

Publication Types:



325: J Clin Nurs. 2007 Aug;16(8):1550-60.


Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles. Chen CM, Kuo SF, Chou YH, Chen HC. College of Nursing, Taipei Medical University, Taipei, Taiwan. BACKGROUND: To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period. AIM: To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan. METHODS: This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale. RESULTS: The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. CONCLUSIONS: This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE: This

study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities. Publication Types:



326: J Clin Nurs. 2007 Aug;16(8):1525-33.


Conducting clinical post-conference in clinical teaching: a qualitative study. Hsu LL. Graduate Institute in Health Allied Education, National Taipei College of Nursing, Taipei, Taiwan. [email protected] AIM AND OBJECTIVE: The aim of this study was to explore nurse educators' perceptions regarding clinical postconferences. Additional aims included the exploration of interaction characteristics between students and faculty in clinical postconferences. BACKGROUND: Nursing students are challenged to think and learn in ways that will prepare them for practice in a complex health care environment. Clinical postconferences give students the opportunity to share knowledge gained through transformative learning and provide a forum for discussion and critical thinking. Faculty members must guide students as the latter participate in discussions, develop problem-solving skills and express feedings and attitudes in clinical conferences. METHODS: The study used qualitative research methods, including participant observation and an open-ended questionnaire. Participant observers watched interaction activities between teachers and students in clinical postconferences. A total of 20 clinical postconferences, two conferences per teacher, were observed. The Non-Numerical Unstructured Data Indexing Searching and Theory-building qualitative software program was used in data analysis. CONCLUSIONS: Research findings indicated that, of the six taxonomy questions, lower-level questions (knowledge and comprehensive questions) were mostly asked by faculty members' postclinical conferences. The most frequently used guideline was task orientation, which is related to practice goals and was found in discussions of assignments,

reading reports, discussions of clinical experiences, role plays, psychomotor skill practice, quizzes and student evaluations. RELEVANCE TO CLINICAL PRACTICE: It is an essential responsibility of nurse educators to employ postconferences to assist students in applying their knowledge in practical situations, in developing professional values and in enhancing their problem solving abilities. PMID: 17655541 [PubMed - indexed for MEDLINE]

327: J Clin Nurs. 2007 Aug;16(8):1506-15.


Predictors of recognition and practice of family nursing among healthcare professionals in Japan. Takemoto H, Hagihara A, Kinoshita M, Matsuoka M, Baba M, Nobutomo K. Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Higashi-ku, Fukuoka, Japan. [email protected] BACKGROUND: Although many nurses have become aware of the importance of family-centered nursing, very little is known about the advanced knowledge and intervention skills of family nursing in Japan. OBJECTIVES: We examined the characteristics of their recognition of family nursing and factors related to the practice of family nursing. METHODS: The subjects were nursing staff at a large hospital in Fukuoka, Japan (n=596). A study using self-administered questionnaires was conducted in October 2002. Factor analysis and multiple linear regression analysis were used to analyse the data. RESULTS: Of 596 nurses, 376 returned questionnaires (63.6%). The study achieved the following findings. (1) The nurse's recognition of family nursing had four subscales: skills required to interview family members to construct a trusted relationship; assessment of family structure and family functioning; interventional skills of family nursing; and skills to collect information on family members. (2) The predictors of family nursing recognition were 'gender', 'job position in hospital', 'individual experience of caring for their family members', 'length of clinical experience' and 'types of wards where they work'. (3) The predictors of practice of family nursing were 'interventional skills of family nursing', 'skills to collect information on family members' and the 'total of four skills'. CONCLUSIONS: It is implied that the acquisition of knowledge and skills of family nursing in hospital settings are invaluable to consciousness-raising and practice of family nursing. RELEVANCE TO CLINICAL PRACTICE: As the factors related to practice or recognition of family nursing have been identified, the present findings are useful for hospital administrators who want to promote family nursing in their

hospitals. PMID: 17655539 [PubMed - indexed for MEDLINE]

328: J Clin Nurs. 2007 Aug;16(8):1444-53.


Mobbing in the workplace by peers and managers: mobbing experienced by nurses working in healthcare facilities in Turkey and its effect on nurses. Yildirim A, Yildirim D. Nursing Administration Department, Florence Nightingale School of Nursing, Istanbul University, Sisli/Istanbul, Turkey. [email protected] AIM: This research was conducted as a descriptive and cross-sectional study with the purpose of determining the mobbing experienced by nurses who work in healthcare facilities in Turkey, its emotional, social and physiological effects on the nurses and the actions that the individuals take to escape from the mobbing. BACKGROUND: The term 'mobbing', which includes workplace terrorizing, pressure, frightening, belittling and psycho-terror, is defined as the presence of systematic, directed, unethical communication and antagonistic behaviour by one or more individuals. These actions that occur frequently and continue for a long time are the most serious and effective causes of workplace stress. The person who is the target of the mobbing is left without help, without protection and alone in the workplace. Individuals who are exposed to psychological abuse experience physiological, psychological and social problems that are related to high levels of stress and anxiety. DESIGN AND METHOD: The research participants were 505 nurses of whom 325 (64%) worked in public and 180 (36%) in private hospitals. All of the participants were female. A questionnaire developed by the researchers in the light of information in the literature was used for data collection and had four sections including the participants' demographic characteristics and questions asking about mobbing behaviours, reaction to mobbing incidents and actions taken to escape from the mobbing. The data were collected between October and December 2005 by giving an envelope to the participants and then collecting the responses in the closed envelope. FINDINGS: The overwhelming majority (86.5%) of the nurses participating in the research reported facing mobbing behaviour in the workplace in the last 12 months. The nurses working at private hospitals faced statistically significantly more mobbing behaviours than those at public hospitals (p<or=0.02). It was determined that the nurses who faced mobbing behaviours gave various physiological, emotional and social reactions to these incidents. The most common behaviours exhibited by the participants to

escape mobbing was 'to work harder and be more organized' and 'to work more carefully to avoid criticism'. In addition 10% of the participants stated that they 'consider committing suicide sometimes.' RELEVANCE TO CLINICAL PRACTICE: Mobbing behaviours in the workplace need to be defined and appropriate policies and procedures need to be developed and shared with all employees to prevent the development of these behaviours. In addition, managers should adopt an open managerial approach to prevent the development of these behaviours. PMID: 17655532 [PubMed - indexed for MEDLINE]

329: Acta Oncol. 2007;46(6):852-8.


Increasing trend in the incidence of cervical cancer among the elderly in Korea: a population-based study from 1993 to 2002. Jo H, Jeon YT, Hwang SY, Shin HR, Song YS, Kang SB, Lee HP, Kim JW. Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University, Seoul, Korea. Cancer is primarily a disease of older adults. However, little data is available on the clinical features of cervical cancer in elderly patients. We investigated the trends in incidence and clinical features associated with cervical cancer among the elderly in Korea during the period of 1993-2002. We obtained data from the National Cervical Cancer Incidence Database, which was constructed in collaboration with the Korea Central Cancer Registry (KCCR) and Korea Gynecologic Cancer Registry (KGCR). A total of 44 191 women with cervical cancer were diagnosed between 1993 and 2002. Patients were divided into three groups based on age: </=49 years (Group 1), 50-69 years (Group 2), and>/=70 years (Group 3). During this period, upward incidence trends were noted in Group 3 while constant and downward incidence trends were noted in Groups 1 and 2, respectively. Pooled analysis across years revealed that squamous cell carcinoma and advanced stage (IIB, III, and IV) were more common in Group 3 than in Groups 1 and 2. With regard to primary treatments in the elderly patients, surgery appeared to be performed increasingly despite the fact that advanced stage (IIB, III, and IV) was more common in Group 3 than in Groups 1 and 2. Our findings suggest that the incidence of cervical cancer in the elderly is increasing in Korea, while it is decreasing overall. The current health service must emphasize education for the elderly about cervical cancer prevention while concentrating on screening. PMID: 17653911 [PubMed - indexed for MEDLINE]

330: Emerg Med J. 2007 Aug;24(8):550-2.


Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre. Ashkenazi I, Haspel J, Alfici R, Kessel B, Khashan T, Oren M. Surgery B Department, Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel. [email protected] OBJECTIVE: To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. METHODS: Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre. RESULTS: Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully. CONCLUSIONS: Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated. Publication Types:

• Comparative Study


331: Epilepsia. 2007 Dec;48(12):2217-23. Epub 2007 Jul 25.


Convulsive status epilepticus: clinical profile in a developing country. Murthy JM, Jayalaxmi SS, Kanikannan MA. Department of Neurology, The Institute of Neurological Sciences, CARE Hospital, Hyderabad, India. [email protected] PURPOSE: In developing countries optimal care of status epilepticus (SE) is associated with major barriers, particularly transportation. METHODS: A prospective study of SE was performed between 1994 and 1996 to determine the clinical profile, response to treatment and outcome, Glasgow Outcome Scale (GOS). RESULTS: Of the 85 patients admitted, the mean age was 33 years (8-75 years), 16% <16 years of age. The mean duration of SE before admission was 18.02 h (1-72 h). Only 23 (28%) patients, all locals, presented within <3 h of onset. Etiology included acute symptomatic (54%), remote symptomatic (7%), cryptogenic (19%), and established epilepsy (20%). Central nervous system infections accounted for 24 (28%) of the etiologies. Seventy-five (88%) patients responded to first-line drugs and 10 (12%) required second-line drugs. The mean duration of SE was significantly long in nonresponders (Mean +/- SD: 32.6 +/- 20.11 vs. 15.2 +/- 18.32, p < 0.006). Duration (p < 0.01; OR 1.04, 95% CI 1.01-1.07) and acute symptomatic etiology (p < 0.038; OR 10.38, 95% CI 1.13-95.09) were the independent predictors of no-response to first-line drugs. Of the nine deaths (10.5%), eight were in acute symptomatic group. Predictors of mortality included female sex (p < 0.017, OR 13.41, 95% CI 1.59-115.38) and lack of response to first-line drugs (p < 0.0001, OR 230.27, 95% CI 8.78-6037.19). Longer duration was associated with poor GOS 1-4 (p = 0.001). Of the 37 patients with <6 h, 81% had GOC5 outcome. CONCLUSION: This study suggests that longer duration of SE and acute symptomatic etiology are independent predictors of lack of response to first-line drugs. Failure to respond to first-line drugs and duration predict the outcome. Publication Types:



332: Acta Psychiatr Scand. 2007 Aug;116(2):125-8.


Comment in:

• Acta Psychiatr Scand. 2007 Aug;116(2):155; author reply 155-6.

Can health workers diagnose dementia in the community? Jacob KS, Senthil Kumar P, Gayathri K, Abraham S, Prince MJ. Department of Psychiatry, Christian Medical College, Vellore, India. [email protected] OBJECTIVE: This study attempted to evaluate sensitivity, specificity and predictive values of the diagnosis of dementia made by trained community health workers. METHOD: A total of 1,000 subjects over the age of 65 years were recruited for the study. The community health workers identified nine subjects as having dementia. This was compared against an education adjusted diagnosis of dementia made in accordance with the 10/66 dementia research group protocol. RESULTS: The sensitivity and specificity of the community health worker diagnosis was 3.8% and 99.4% respectively. The false positive rate and positive predictive values were 55.6% and 44.4%, respectively. The false negative rate and negative predictive value were 10.3% and 89.7% respectively. Similar values were obtained against a DSM IV diagnosis. Subjects with dementia who were correctly diagnosed by the community health workers and those whose condition was missed did not differ significantly on socio-demographic and clinical variables. CONCLUSION: Informal screening by community health workers resulted in low sensitivity and positive predictive values. Screening strategies in situations of low prevalence are not effective. Publication Types:

• Evaluation Studies • Research Support, Non-U.S. Gov't


333: J Med Microbiol. 2007 Aug;56(Pt 8):1086-96.


Diarrhoeagenic Escherichia coli and other causes of childhood diarrhoea: a case-control study in children living in a wastewater-use area in Hanoi, Vietnam. Hien BT, Trang do T, Scheutz F, Cam PD, Mølbak K, Dalsgaard A. Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam. [email protected] A case-control study was conducted to identify the aetiology of diarrhoeal diseases in pre-school children in a suburban area of Hanoi where the use of untreated wastewater in agriculture and aquaculture is a common practice. Stool specimens and clinical information were collected from 111 pairs of children with diarrhoea and healthy controls. A total of 73 cases (66 %) and 41 controls (36 %) had an enteric pathogen. The pathogens most often associated with diarrhoea were rotavirus (17 % of cases) and Entamoeba histolytica (15 %), followed by Shigella (5 %). Diarrhoeagenic Escherichia coli (DEC) was found in 23 % of both patients and controls. Characterization of DEC by serotyping, antimicrobial susceptibility test and PFGE showed that DEC represented by different pathotypes belonged to various serotypes. Except for three enterotoxigenic E. coli strains, typing by PFGE revealed no correlation between pathotype and serotype of DEC strains. This suggests a high prevalence of a variety of DEC subtypes in this area. For this particular region, vaccine development strategies targeting rotavirus and Shigella are likely to be of public health benefit, whereas the role of DEC and preventive measures need to be further elaborated. Publication Types:



334: J Paediatr Child Health. 2008 Jan;44(1-2):57-61. Epub 2007 Jul 19.


Pre-admission consultation and late referral in infants with neonatal cholestasis. Lee WS.

Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia. [email protected] AIMS: To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia. METHODS: A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia. RESULTS: Thirty-one of the 65 (43%) patients studied encountered delay or had an inappropriate action taken before referral. Factors leading to delayed referral, which adversely affected the outcome of biliary atresia (BA) and neonatal acute liver failure, were repeated reassurances by medical and paramedical staff (n = 17, 26%), failure of hospital services at the referring hospital (n = 7, 11%) and parental refusal for referral (n = 5, 8%). Only three (14%) of the 22 patients who developed liver failure had liver transplantation (LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-year survival rate (native liver and LT) was 41%. CONCLUSIONS: Repeated false reassurance, failure of hospital services and parental refusal all contributed to delayed referral in neonatal cholestasis. In addition to education of medical and public health workers, and parents on the importance of early referral in neonatal cholestasis, health authorities in Malaysia should consider the feasibility of universal stool colour screening in newborn infants to improve the outcome of BA. PMID: 17640283 [PubMed - indexed for MEDLINE]

335: Nucl Med Commun. 2007 Aug;28(8):661-6.


Nuclear medicine scans in Beijing: insights from the Beijing Quality Control Centre Survey 2005-2006. Hongwei S, Jianhua G, Shengzu C. Department of Nuclear Medicine, Cancer Hospital, Beijing, China. OBJECTIVE: To survey nuclear medicine scans carried out in Beijing during 2005. METHODS: Forty-two nuclear medicine departments were surveyed by using mailed questionnaires sent during September 2006. RESULTS: By the end of January 2007, 30 out of 42 hospitals had replied to our survey. The estimated annual number of SPECT procedures was 6.72 per 1000 population during 2005. Among SPECT applications, whole-body bone scans (n=23,090) were performed with the highest frequency, followed by myocardial perfusion imaging (n=19,092), and renal function imaging (n=10,287). The estimated number of myocardial perfusion scintigraphy scans was 1530 procedures per million population. The annual number of PET procedures was 0.25 per 1000 population.

Most of these PET and SPECT examinations used relative monotonous radiotracers and most patients were in the age group of 40-70 years. However, for each cancer and each type of application, age distributions slightly varied. In addition, the analysis of gender distribution revealed that the number of male patients was higher than for female patients. CONCLUSION: The number of nuclear medicine scans carried out in Beijing during 2005 was considerable, with unbalanced clinical applications. Excluded myocardial perfusion scintigraphy, the frequencies of some applications were still lower than in western countries. Furthermore, most procedures used relatively monotonous radiotracers. Most patients were in the age group of 40-70 years and were male. PMID: 17625389 [PubMed - indexed for MEDLINE]

336: N Engl J Med. 2007 Jul 12;357(2):115-23.


Comment in:

• N Engl J Med. 2007 Jul 12;357(2):175-6. • N Engl J Med. 2007 Oct 11;357(15):1555-6; author reply 1556. • N Engl J Med. 2007 Oct 11;357(15):1555; author reply 1556.

Clinical outcomes of breast cancer in carriers of BRCA1 and BRCA2 mutations. Rennert G, Bisland-Naggan S, Barnett-Griness O, Bar-Joseph N, Zhang S, Rennert HS, Narod SA. Clalit Health Services, National Cancer Control Center and Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Haifa, Israel. [email protected] BACKGROUND: Some features of breast cancer in women with a BRCA1 mutation suggest that hereditary breast cancer has a poor outcome. We conducted a national population-based study of Israeli women to determine the influence, if any, of a BRCA1 or a BRCA2 mutation on the prognosis in breast cancer. METHODS: We obtained data on all incident cases of invasive breast cancer that were diagnosed from January 1, 1987, to December 31, 1988, and recorded in the Israel National Cancer Registry. We requested a paraffin-embedded tumor block or an unstained slide and the corresponding pathological and clinical records for all such cases. DNA extracted from the tumor specimens was analyzed for the three founder mutations in BRCA1 and BRCA2. For each subject, available

pathological and oncologic records were reviewed. RESULTS: We were able to retrieve a pathological sample from 1794 of 2514 subjects (71%). Among those women, we obtained medical records for 1545 (86%). A BRCA1 or BRCA2 mutation was identified in 10% of the women who were of Ashkenazi Jewish ancestry. The adjusted hazard ratios for death from breast cancer were not significantly different among mutation carriers and noncarriers (hazard ratio among BRCA1 carriers, 0.76; 95% confidence interval [CI], 0.45 to 1.30; P=0.31; hazard ratio among BRCA2 carriers, 1.31; 95% CI, 0.80 to 2.15; P=0.28). Among women who were treated with chemotherapy, the hazard ratio for death among BRCA1 carriers was 0.48 (95% CI, 0.19 to 1.21; P=0.12). CONCLUSIONS: Breast cancer-specific rates of death among Israeli women are similar for carriers of a BRCA founder mutation and noncarriers. Copyright 2007 Massachusetts Medical Society. Publication Types:

• Research Support, N.I.H., Extramural


337: J Med Assoc Thai. 2007 Jun;90(6):1089-96.


Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischemic stroke. Suwanwela NC, Eusattasak N, Phanthumchinda K, Piravej K, Locharoenkul C. Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Rd, Bangkok 10330, Thailand. [email protected] BACKGROUND: The stroke unit has been established as a standard care for stroke. However, it has not been widely established in developing countries due to the lack of understanding and limited resources. OBJECTIVE: To compare the complications and mortality of stroke patients admitted in the stroke unit and short-term ward with those admitted in the general medical ward. MATERIAL AND METHOD: The authors prospectively collected data of acute stroke patients who were admitted after the set up of the stroke unit and stroke short-term ward in 2003, and compared with the data of those who were admitted in a general medical ward in 2001. All acute stroke patients who presented within seven days

of the onset were admitted and those who had final diagnosis of ischemic stroke or transient ischemic attack (TIA) were studied. Patients in the stroke unit were taken care of by a multidisciplinary team approach under clinical guidelines and a care map. The short-term ward is a part of the general medical ward and stroke patients were treated by a multidisciplinary team followed by homecare treatment. The endpoints were mortality rate, neurological and medical complications during admissions, and the mean length of stay. RESULTS: Seven hundred and ninety-four patients were studied. Three hundred and eighty-seven patients were admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three hundred and one cases were treated in the acute stroke unit whereas 106 were admitted in the short-term ward. There was no difference in stroke risk factors and stroke subtypes between the two groups, except for dyslipidemia and cigarette smoking, which were more prevalent in patients admitted in 2003. Patients in the stroke unit and the short-term ward had significantly less mortality than those in the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit and the short-term ward were 16.8%, compared to 26% of those admitted into the general medical ward. Significantly less brain edema, hemorrhagic infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively. CONCLUSION: Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units. PMID: 17624201 [PubMed - indexed for MEDLINE]

338: Diabetes Care. 2007 Oct;30(10):2690-4. Epub 2007 Jul 10.


Relationship among alcohol, body weight, and cardiovascular risk factors in 27,030 Korean men. Sung KC, Kim SH, Reaven GM. Department of Medicine, Sungkyunkwan University, Kangbuk Samsung Hospital, Seoul, Korea. OBJECTIVE: Recent studies suggest a lower risk for overweight/obesity in moderate alcohol drinkers. However, the validity of this relationship and its impact on the putative benefits of alcohol consumption on cardiovascular disease (CVD) risk has not been well evaluated. RESEARCH DESIGN AND

METHODS: We assessed the impact of BMI on the relationship between alcohol consumption and CVD risk factors (blood pressure, lipid panel, and glucose and insulin concentrations) in 27,030 healthy Korean men with no major comorbidities or medication intake seen in a large urban Korean hospital. RESULTS: BMI and overweight prevalence increased linearly with alcohol intake (P < 0.001). Alcohol intake was also positively associated with blood pressure and triglyceride, HDL, and fasting glucose concentrations (P < 0.001) and negatively associated with LDL and insulin concentrations (P < 0.001). With nondrinkers as the reference group, the odds ratio for having insulin in the top quartile also declined linearly when adjusted for age, BMI, smoking, and exercise, with the heaviest drinkers (>40 g/day) having an odds ratio of 0.71 (95% CI 0.62-0.82) (P < 0.001). The relationship between alcohol and CVD risk factors was similar in normal-weight and overweight individuals. CONCLUSIONS: Alcohol intake is associated with increasing BMI and several metabolic abnormalities, including higher fasting glucose. Paradoxically, it is also associated with lower insulin concentrations. The clinical significance of these findings needs further investigation. PMID: 17623829 [PubMed - indexed for MEDLINE]

339: J Med Syst. 2007 Jun;31(3):166-72.


Efficiency measurement for hospitals owned by the Iranian social security organisation. Hajialiafzali H, Moss JR, Mahmood MA. Discipline of Public Health, Schiool of Population Health and Clinical Practice, The University of Adelaide, South Australia, 5005 Australia. [email protected] This study used Data Envelopment Analysis (DEA) to examine the relative efficiency of hospitals owned by the Iranian Social Security Organization, which is the second largest institutional source of hospital care in that country. Using data for the year 2002, 26 of the 53 hospitals were deemed to be efficient. Inefficient hospitals had an average score of 90%, implying a potential reduction in all inputs on average by about 10% with no impact on output levels. In addition to the conventional DEA measurement, efficient hospitals were ranked by calculating super-efficiency scores, by identifying weak efficient hospitals, and by determining the frequency of peers. The study provides useful information for improving hospital management, rationalizing resource allocation, and improving services provided by hospitals.

Publication Types:



340: J Travel Med. 2007 Jul-Aug;14(4):254-8.


There is need for antigen-based rapid diagnostic tests to identify common acute tropical illnesses. Wilde H, Suankratay C. Queen Saovabha Memorial Institute, and Division of Infectious Diseases, King Chulalongkorn University Hospital, Thai Red Cross Society, Bangkok 10330, Thailand. [email protected] Enteric fever, typhus, leptospirosis, dengue, melioidosis, and tuberculous meningitis present urgent diagnostic problems that require experience and clinical judgment to make early evidence-based management decisions. Basic and applied research dealing with reliable antigen-based diagnostics has been published and confirmed for several of these infections. This should have initiated commercial production but has not. Established international firms see little profit in such diagnostic kits since they would be used in poor countries with little prospects for return of investment capital. We attempt to illustrate this issue, using common causes of acute febrile illnesses in the Southeast Asian region. We believe that rapid diagnostic technology could prevent significant delay in starting appropriate therapy, reduce hospital expenses, and even save lives. Publication Types:

• Review


341: Mil Med. 2007 Jun;172(6):634-9.


The factors affecting length of stay of the patients undergoing appendectomy surgery in a military teaching hospital. Demir CC, Celik Y, Gider O, Yağci G, Sahin B, Tufan T, Akdeniz A, Sen D. Department of Health Services Management, Gulhane Military Medical Academy, 06018 Etlik, Ankara, Turkey. The principal objectives of this study were to identify the main predictors of the length of postoperative hospital stay for patients undergoing appendectomy in a military training hospital in Turkey, to examine the effects of each significant predictor, and to justify to hospital health care managers the reasons why an increase in effective use of hospital utilization resources is needed and so important. This study gives the results of a 2-year retrospective study conducted at Gulhane Military Medical Academy between January 2003 and January 2005. The medical files of 417 patients undergoing appendectomy during this 2-year period were reviewed. A number of demographic and clinical patient characteristics were examined to determine their significance in lengthening the post-operative and total hospital stay. After taking all demographic and clinical patient characteristics into account, it was determined that those patients who were temporary or short-term service members and whose medical complications were more severe were more likely to stay in the hospital for longer periods. Despite its limitations, the study reveals that factors affecting variations in resource utilization can be minimized by following very simple administrative procedures. Furthermore, the results could increase awareness among hospital managers of the significant factors involved for health care providers in modifying their behavior concerning resource utilization decisions. PMID: 17615847 [PubMed - indexed for MEDLINE]

342: Int J Dent Hyg. 2007 Aug;5(3):145-50.


Dental hygiene residential care in a 3-year dental hygiene education programme in Japan: towards dysphagia management based on the dental hygiene process of care. Nishimura T, Takahashi C, Takahashi E. Miyagi Advanced Dental Hygienist College, Sendai, Miyagi, Japan. This paper reports an evaluation of a residential care practice, which was part of a

'Dysphagia Management' course introduced into a 3-year dental hygiene curriculum in Japan. The clinical practice was performed at a care facility for the elderly people. Dental hygiene interventions, which consisted mainly of professional oral care, were implemented on a client who was bed-bound after suffering from a stroke. As the client had severe tension in muscles around oral cavity, it was difficult for the facility care workers to provide daily oral hygiene care. The goals of the dental hygiene care plan included decreasing tension of oral muscles and reducing periodontal inflammation and halitosis. The dental hygiene interventions were given once a month for 5 months. Evaluation in the fifth month demonstrated relaxation of oral muscles, decrease in plaque accumulation, and improvements in levels of gingival inflammation, indicating the partial achievements of the initial goals. Possibilities for revision of the care plan could call for more active involvement of the facility care workers and client-centered goal setting. This learning experience provided an opportunity for continuing intervention and evaluation of dental hygiene care for the same client. The positive results of our limited interventions further confirmed the importance of professional oral care in organic and functional improvements in oral health for the elderly people. Publication Types:

• Case Reports


343: Nurs Adm Q. 2007 Jul-Sep;31(3):244-53.


Nurse/physician conflict management mode choices: implications for improved collaborative practice. Hendel T, Fish M, Berger O. Department of Nursing, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. [email protected] In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care

hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction. PMID: 17607137 [PubMed - indexed for MEDLINE]

344: Clin Calcium. 2007 Jul;17(7):1022-8.


[Absolute risk for fracture and WHO guideline. Fracture risk assessments recommended by World Health Organization and Japanese guidelines for prevention and treatment of osteoporosis 2006] [Article in Japanese] Nakamura T; World Health Organization. University of Occupational and Environmental Health, Department of Orthopedic Surgery. Bone mineral density (BMD) is a strong predictor of osteoporotic fractures. However, the increase in fracture risk is not steep, rather gentle, for the decline in BMD values. Postmenopausal women with osteopenia (T scores between - 2.5 and - 1.0) may also be at risk. Case finding strategies such as the combination of BMD and appropriate clinical risk factors for fracture are shown to identify subjects at high fracture risk. World Health Organization developed a fracture risk assessment tool, recommending its exploitation in the case findings. Under these circumstances, Japan guideline 2006 provided new criteria for the pharmacological intervention to prevent fragility fracture, besides the conventional criteria for diagnosing osteoporosis. Publication Types:



345: Clin Calcium. 2007 Jul;17(7):1015-21.


[Absolute risk for fracture and WHO guideline. WHO model for assessing absolute risk of fracture] [Article in Japanese] Iki M; World Health Organization. Kinki University School of Medicine, Department of Public Health. Goal for management of osteoporosis is prevention of fractures, although the diagnosis of osteoporosis is made according to bone mineral density (BMD) which plays a great role in monitoring the effectiveness of treatment. However, there are many countries and regions where BMD measurement is not available in primary health care. Even if it is available, BMD shows limited validity in predicting fracture risk. A research group of the World Health Organization (WHO) has developed absolute risk assessment models for fracture incorporating several clinical risk factors with and without BMD. The present paper described the outline of these models and addressed several issues when applying these models to the primary medical care and preventive practice in Japan. Publication Types:



346: Rev Iberoam Micol. 2007 Jun;24(2):113-7.


Tinea unguium in the north-west of Iran (1996-2004). Kazemi A.

National Public Health Management Center, Infectious and Tropical Diseases Research Center & Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. [email protected] Tinea unguium is a common mycosis in many part of the world including Iran. The prevalence of this mycosis varied depending on time, health level and geographical location. To stabilise the etiological, epidemiological and risk factors of tinea unguium in North-west Iran, a study of patients with suspected dermatophyte infections of their nails was carried out between 1996 and 2004. During this study 590 (354 females and 236 males) patients with clinical presentation of fungal infection in fingernails, toenails or in the both sites, were investigated using direct microscopy and culture of clinical samples. Tinea unguium was documented in 41 cases (7%) and among positive cases, 16 cases (39% total positive cases) were female and 25 cases (61% total positive cases) were male. Seventeen patients (41% total positive cases) had tinea unguium in their finger nails and 24 patients (59% total positive cases) had infection in their toe nails. According to the isolated etiologic agent, 66% (19 cases) of tinea unguium infections were caused by zoophilic drematophytes, 31% (9 cases) were caused by anthropophilic drematophytes and 3% (1 case) were caused by geophilic dermatophytes. With regard of sex, tinea unguium did not show a significant difference. The highest prevalence of tinea unguium was found in patients between 11 and 40 years of age. In conclusion the current results identified the etiological agents and epidemiological aspects of tinea unguium in North-west Iran. Tinea unguium in this region is associated with animal husbandry and direct or indirect contact with their products (wool, leather). PMID: 17604428 [PubMed - indexed for MEDLINE]

347: J Midwifery Womens Health. 2007 Jul-Aug;52(4):398-405.


Midwifery education and maternal and neonatal health issues: challenges in Pakistan. Rukanuddin RJ, Ali TS, McManis B. The Aga Khan University, School of Nursing, Karachi, Pakistan. [email protected] Although numerous health care interventions have been implemented in Pakistan, the high maternal and neonatal mortality rates still remain a challenge. Developed countries have reduced maternal and neonatal mortality rates by improving the skill and knowledge levels of nurse-midwives. This paper reviews maternal and neonatal health issues, challenges in current midwifery education, and the role of

government and international agencies in Pakistan. The exact maternal and neonatal mortality rates in Pakistan are unknown; a census has not occurred since 1998, and data provided in more recent studies were presented in summary format. A number of factors that contribute to the high mortality rate could easily be controlled by using competent nurse-midwives throughout all levels of the Pakistani health care system. A reduction in the maternal mortality rate is likely to occur if the Pakistan government and international agencies work together to implement specific recommendations in maternal and neonatal health. These recommendations include: 1) holding an invitational conference; 2) strengthening the existing midwifery and Lady Health Visitor curricula; 3) pilot testing an expanded midwifery program; and 4) advocating for and obtaining political commitments and resources for midwifery education. Publication Types:

• Review


348: Telemed J E Health. 2007 Jun;13(3):257-68.


An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF. Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China. A randomized, controlled trial was conducted to assess the effectiveness of Blue Angel for Asthma Kids, an Internet-based interactive asthma educational and monitoring program, used in the management of asthmatic children. One hundred sixty-four (n = 164) pediatric patients with persistent asthma were enrolled and randomized into two study groups for a 12-week controlled trial. The intervention group had 88 participants who were taught to monitor their peak expiratory flows (PEF) and asthma symptoms daily on the Internet. They also received an interactive response consisting of a self-management plan from the Blue Angel monitoring program. The control group had 76 participants who received a traditional asthma care plan consisting of a written asthma diary supplemented with instructions for self-management. Disease control was assessed by weekly averaged PEF values, symptom scores, and asthma control tests. Adherence measures were assessed by therapeutic and diagnostic monitoring. Outcome was

assessed by examining quality of life and retention of asthma knowledge. The data were analyzed by comparing results before and after the trial. At the end of trial, the intervention group decreased nighttime (-0.08 +/- 0.33 vs. 0.00 +/- 0.20, p = 0.028) and daytime symptoms (-0.08 +/- 0.33 vs. 0.01 +/- 0.18, p =0.009); improved morning (241.9 +/- 81.4 vs. 223.1 +/- 55.5, p =0.017) and night PEF (255.6 +/- 86.7 vs. 232.5 +/- 55.3, p =0.010); increased adherence rates (p < 0.05); improved well-controlled rates (70.4% vs. 55.3%, p < 0.05); improved knowledge regarding self-management (93.2% vs. 70.3%, p < 0.05); and improved quality of life (6.5 +/- 0.5 vs. 4.3 +/- 1.2 on a 7-point scale, p < 0.05) when compared with conventional management. The Internet-based asthma telemonitoring program increases selfmanagement skills, improves asthma outcomes, and appears to be an effective and well-accepted technology for the care of children with asthma and their caregivers. Publication Types:

• Clinical Trial • Randomized Controlled Trial • Research Support, Non-U.S. Gov't


349: Intern Med. 2007;46(13):927-31. Epub 2007 Jul 2.


Prescription of nonsteroidal anti-inflammatory drugs and co-prescribed drugs for mucosal protection: analysis of the present status based on questionnaires obtained from orthopedists in Japan. Tsumura H, Tamura I, Tanaka H, Chinzei R, Ishida T, Masuda A, Shiomi H, Morita Y, Yoshida M, Kutsumi H, Inokuchi H, Doita M, Kurosaka M, Azuma T. Department of Gastroenterology, Kobe University School of Medicine. OBJECTIVE: Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events. METHODS: We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name,

pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs. RESULTS: Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%). CONCLUSION: Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics. PMID: 17603228 [PubMed - indexed for MEDLINE]

350: Clin Neurol Neurosurg. 2007 Sep;109(7):571-7. Epub 2007 Jun 27.


Prediction of functional outcome of ischemic stroke patients in northwest China. Liu X, Lv Y, Wang B, Zhao G, Yan Y, Xu D. Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. OBJECTIVES: To identify the clinical factors which predicted the outcome of ischemic stroke patients in northwest China. PATIENTS AND METHODS: We retrospectively reviewed 489 consecutive patients with ischemic stroke admitted to the Neurology Department of Xijing Hospital. Demographic, clinical and laboratory data were recorded. Follow-up assessments were performed by telephone interviews or letters. The clinical outcome was assessed by using the modified Rankin Scale (mRS) and categorized as good (score 0-2) or poor (score 3-6) outcomes. Univariate and multivariate logistic regression analyses were performed to explore predictors of ischemic stroke. RESULTS: The follow-up period was up to 47 months (mean, 28.3 months). Fifty-five patients (11.2%) were

lost. Among these 434 patients, 244 (56.2%) patients had good outcome and 190 (43.8%) had poor outcome. The poor outcome was associated with old age (OR: 3.505; CI 95%: 2.100-5.849), lower educational level (OR: 0.686; CI 95%: 0.570-0.825), having stroke history (OR: 2.481; CI 95%: 1.442-4.268), and higher NIHSS total score (OR: 2.619; CI 95%: 1.584-4.330). CONCLUSION: The results suggest that age, the educational level, stroke history, and NIHSS score are useful in the prediction of functional outcome of ischemic stroke in Chinese northwest area. PMID: 17600616 [PubMed - indexed for MEDLINE]

351: BMC Med Ethics. 2007 Jun 29;8:8.


An eight-year follow-up national study of medical school and general hospital ethics committees in Japan. Akabayashi A, Slingsby BT, Nagao N, Kai I, Sato H. Department of Biomedical Ethics, Graduate School of Medicine University of Tokyo University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. [email protected] BACKGROUND: Ethics committees and their system of research protocol peer-review are currently used worldwide. To ensure an international standard for research ethics and safety, however, data is needed on the quality and function of each nation's ethics committees. The purpose of this study was to describe the characteristics and developments of ethics committees established at medical schools and general hospitals in Japan. METHODS: This study consisted of four national surveys sent twice over a period of eight years to two separate samples. The first target was the ethics committees of all 80 medical schools and the second target was all general hospitals with over 300 beds in Japan (n = 1457 in 1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee structure, (2) frequency of annual meetings, (3) committee function, and (4) existence of a set of guidelines for the refusal of blood transfusion by Jehovah's Witnesses. RESULTS: Committee structure was overall interdisciplinary. Frequency of annual meetings increased significantly for both medical school and hospital ethics committees over the eight years. The primary activities for medical school and hospital ethics committees were research protocol reviews and policy making. Results also showed a significant increase in the use of ethical guidelines, particularly those related to the refusal of blood transfusion by Jehovah's Witnesses, among both medical school and hospital ethics committees. CONCLUSION: Overall findings indicated a greater recognized degree of

responsibilities and an increase in workload for Japanese ethics committees. Publication Types:



PMCID: PMC1925100

352: J Assoc Physicians India. 2007 Mar;55:198-202.


Spectrum of renal disorders in a tertiary care hospital in Haryana. Aggarwal HK, Yashodara BM, Nand N, Sonia , Chakrabarti D, Bharti K. Department of Nephrology and Med V, Pt BDS, Postgraduate Institute of Medical Sciences, Rohtak-124 001, Haryana, India. INTRODUCTION: There is a paucity of data pertaining to spectrum of renal diseases in various parts of India. Available literature has emphasized more on specific clinical syndromes of renal diseases rather than over all spectrum. The present study highlights specimen of symptomatic renal disorders at a tertiary care hospital in Haryana and will find place for better resource management and planning. MATERIALS AND METHODS: It included 1806 patients either presenting for the first time to nephrology outpatient department of admitted between Jan 1996 - Dec 2001 to the institute. The study was retrospective for five years (1996-2000) and prospective for one year. Records of all these patients were analyzed and patients were grouped in different renal syndromes. RESULTS: Mean age of patients was (38.79 +/- 15.15 years) with male preponderance in all renal syndromes. Chronic renal failure (CRF) was the commonest presentation (56.02%). Nephrotic syndrome accounted for 22.36% whereas acute renal failure (ARF) was seen in 12.84%. Other presentations were acute nephritic syndrome (6.75%) and asymptomatic urinary abnormality (AUA) (0.99%). Chronic glomerulonephritis (CGN) (39.32%) and diabetic nephropathy (DN) (19.16%) were leading causes of CRF. Medical ARF accounted for 2/3rd of the cases of ARF and surgical etiology was seen in 1/5th of causes whereas obstetric cause was responsible for 1/7th of the cases. Minimal change disease (MCD) (33.33%) was the commonest cause of primary nephrotic syndrome followed by membranoproliferative glomeruolonephritis (MPGN). Secondary glomerular diseases were found in 21.28%. Post-streptococcal glomerulonephritis (PSGN)

was the commonest cause of nephritic syndrome (37.70%). CONCLUSION: It is the first large study of its kind from a tertiary health care centre of Haryana. Male patients in their peak of life (3rd and 4th decade) were the major candidates requiring renal care with CRF as the commonest presentation and diabetic nephropathy as the second commonest cause of CRF after CGN. We need more Indian studies on spectrum of renal diseases for better available resource management. PMID: 17598331 [PubMed - indexed for MEDLINE]

353: Pediatr Infect Dis J. 2007 Jul;26(7):565-71.


Effectiveness of Haemophilus influenzae type B conjugate vaccine on prevention of pneumonia and meningitis in Bangladeshi children: a case-control study. Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, Moulton LH, Black RE, Santosham M. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. [email protected] BACKGROUND: Few Asian countries have introduced Haemophilus influenzae type b (Hib) conjugate vaccine because of its cost and uncertainty regarding disease burden. METHODS: To estimate the effectiveness of Hib conjugate vaccine in preventing pneumonia and meningitis in children age <2 years, an incident case-control study was conducted in a birth cohort of about 68,000 infants in Dhaka city, Bangladesh. DPT vaccine was systematically replaced by a combined Hib-DPT vaccine in selected immunization centers of the study area. Four matched community- and 2 hospital-controls were randomly selected for each confirmed case of pneumonia and meningitis from the study area. RESULTS: About 35% of the infants received each of the 3 doses of Hib-DPT vaccine. There were 2679 children who had a chest roentgenogram. For 475 children, a radiologist and a pediatrician independently identified substantial alveolar consolidation. Following at least 2 doses of Hib vaccine, the preventable fractions [95% confidence intervals (CI)] using community and hospital controls were 17% (-10% to 38%) and 35% (13% to 52%) respectively. Of these 475 cases, 2 radiologists with the World Health Organization concurred with the findings for 343 patients, yielding preventable fractions of 34% (6% to 53%) and 44% (20% to 61%). Fifteen confirmed Hib meningitis cases were identified; the preventable fractions (95% CI) using community and hospital controls, respectively, were 89% (28% to 100%) and 93% (53% to 100%). CONCLUSIONS: The study documented that significant fractions of pneumonia

and meningitis in Bangladeshi children age <2 years can be prevented by the Hib conjugate vaccine. Publication Types:

• Controlled Clinical Trial • Research Support, Non-U.S. Gov't • Research Support, U.S. Gov't, Non-P.H.S.


354: Nephron Clin Pract. 2007;106(4):c157-61. Epub 2007 Jun 26.


Natural history and prognostic factors of IgA nephropathy presented with isolated microscopic hematuria in Chinese patients. Shen P, He L, Li Y, Wang Y, Chan M. Department of Nephrology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China. BACKGROUND/AIMS: IgA nephropathy (IgAN) with isolated microscopic hematuria (IMH) is prevalent in Asian countries including China. However, the natural history of IgAN with IMH has not yet been clarified. The aim of this study was to review the natural course and prognostic factors of IgAN with IMH in Chinese patients. METHODS: We retrospectively studied 135 patients (43 males and 92 females) followed up for a mean period of 92 +/- 28 months. In order to identify factors associated with renal progression, clinical and pathological data at onset were reviewed. RESULTS: During the follow-up period, hematuria of 16 patients (12%) disappeared while persistent microscopic hematuria was seen in 119 patients (88%), and proteinuria was present in 39 patients (29%). The prevalence of hypertension was 32% (43 patients), and 20% (27 patients) developed renal insufficiency. The prevalence of proteinuria and hypertension in the microalbuminuria group was significantly higher than those in the normoalbuminuria group. Poor renal outcome is usually associated with hematuria, microalbuminuria, and tubulointerstitial lesions. CONCLUSION: IgAN with IMH may not imply favorable outcome, so early diagnosis and careful follow-up are clinically significant. Hematuria, microalbuminuria, and tubulointerstitial lesions are useful markers to identify those patients at high risk for renal progression. Copyright 2007 S. Karger AG, Basel.


355: J Am Osteopath Assoc. 2007 May;107(5):181-9.


Diagnosis and management of posttraumatic stress disorder in returning veterans. Reeves RR. Chief of Mental Health, G.V. (Sonny) Montgomery VA Medical Center (11M), 1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116, USA. [email protected] As the conflict in Iraq continues, public health authorities in the United States anticipate that many returning soldiers will suffer from posttraumatic stress disorder (PTSD). Initially, most of these veterans are likely to consult their primary care physicians about health problems. However, the diagnosis of PTSD is often missed in primary care settings. The author encourages physicians to become better prepared to recognize this disorder in their patients and initiate proper treatment or appropriate referral. Current diagnostic approaches and treatment modalities for combat-related PTSD are reviewed-with an emphasis on clinical procedures for the primary care physician. Publication Types:

• Review


356: Rev Iberoam Micol. 2007 Mar;24(1):38-40.


Sporotrichosis in Iran. Kazemi A, Razi A. National Public Health Management Center (NPMC) and Immunology and

Parasitology Department, Biotechnology Research Center (BRC), Tabriz University of Medical Sciences Tabriz, Iran. [email protected] This report describes a 23 year-old male florist gardener diagnosed with subcutaneous sporotrichosis caused by the dimorphic pathogenic soil fungus Sporothrix schenckii. The patient had several small skin lesions over the left upper arm with ascendant chains of enlarged lymph nodes.Sporothrix schenckii was detected from clinical samples by direct microscopy and culture and its ability to switch from mould to yeast form at 37 degrees C. The patient was successfully treated with long-term potassium iodide and advised to wear gloves and long sleeves when handling any kind of plant material. Publication Types:

• Case Reports


357: Arch Intern Med. 2007 Jun 25;167(12):1297-304.


Lower risk of tuberculosis in obesity. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung G, Law WS, Tam CM, Chan CK, Chang KC. Tuberculosis and Chest Service, Department of Health, The University of Hong Kong, and Tuberculosis and Chest Unit, Grantham Hospital, Wanchai Chest Clinic, 99 Kennedy Rd, Wanchai, Hong Kong, China. [email protected] BACKGROUND: Obesity is increasingly prevalent in both developed and developing areas. Although undernutrition is well associated with tuberculosis, few studies have systematically examined the association with obesity. Method A cohort of 42 116 individuals 65 years or older enrolled at 18 health centers for elderly patients in Hong Kong, China (which has a tuberculosis incidence of approximately 90 per 100,000 population), in 2000 were followed up prospectively through the territory-wide tuberculosis registry for the development of active tuberculosis from 3 months after enrollment until December 31, 2005, using the identity card number as the unique identifier. The association with body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), as categorized by the Asian standards, was assessed with the control of other baseline characteristics. RESULTS: Obese (BMI>or=30) and

overweight (BMI, 25 to <30) individuals were at significantly lower risks of developing active tuberculosis than normal-weight individuals (BMI, 18.5 to <25), with hazard ratios (95% confidence intervals) of 0.36 (0.20-0.66) and 0.55 (0.44-0.70), respectively, after adjustment for baseline demographic, social, and clinical variables. An inverse linear association was observed predominantly for pulmonary but not extrapulmonary tuberculosis. This association persisted after controlling for potential confounders or excluding individuals with known tuberculosis risk factors. CONCLUSIONS: Obesity is associated with a lower risk of active pulmonary tuberculosis in the older population of Hong Kong. The presence of such a strong but selective association across the whole spectrum of BMI could have major biological, clinical, and/or epidemiological implications. Further studies are indicated to explore the underlying mechanisms, potential clinical utilities, and possible epidemiological consequences. Publication Types:

• Multicenter Study


358: Heart. 2008 Mar;94(3):354-9. Epub 2007 Jun 25.


Ethnic differences in healthcare-seeking behaviour and management for acute chest pain: secondary analysis of the MINAP dataset 2002-2003. Ben-Shlomo Y, Naqvi H, Baker I. Department of Social Medicine, University of Bristol, Bristol, UK. [email protected] OBJECTIVE: To examine whether there are ethnic differences in the healthcare-seeking behaviour and management of patients with chest pain. DESIGN: Prospective cohort of patients attending accident and emergency departments with chest pain. SETTING: Hospitals in England and Wales from 1 January 2002 to 31 December 2003. PARTICIPANTS: Patients with chest pain. MAIN OUTCOME MEASURES: Whether patients arrived by ambulance, whether they received thrombolysis and the time it took from symptom onset to arrive at hospital and receive thrombolysis. RESULTS: South Asian patients were less likely to arrive by ambulance (age and sex adjusted odds ratio 0.64, 95% CI 0.60 to 0.69, p<0.001) regardless of admission diagnosis. Overall, they were more likely to

receive thrombolysis (adjusted multivariable odds ratio 1.19, 95% CI 1.10 to 1.30, p<0.001) and the difference was more marked if they had non-specific ECG changes for heart disease rather than definite evidence of a myocardial infarction. There was no evidence of an important clinical delay in South Asians receiving thrombolysis after arrival at hospital. CONCLUSIONS: There are ethnic differences in healthcare-seeking behaviour and the way doctors manage South Asians with chest pain. The relative underuse of ambulances by South Asians may either reflect cultural differences or geographical proximity to hospitals. Doctors may have a lower threshold for giving thrombolytic therapy to South Asian men with chest pain possibly because they are aware of the increased risk of coronary heart disease in this population. PMID: 17591647 [PubMed - indexed for MEDLINE]

359: Circ J. 2007 Jul;71(7):1128-30.


Price disparity of percutaneous coronary intervention devices in Japan and the United States in 2006. Yasunaga H, Ide H, Imamura T, Ohe K. Department of Planning, Information and Management, University of Tokyo Hospital, Tokyo, Japan. [email protected] BACKGROUND: The price disparity between Japan and foreign countries for medical devices is a controversial issue. Price differences existed between Japan and USA for various medical devices in early 2005, so in the present study, a more precise and detailed investigation of the latest market prices of medical devices between Japan and USA was conducted in 2006, focusing on coronary stents and percutaneous transluminal coronary angioplasty (PTCA) catheters, for an evaluation of the efficacy of current Japanese policies. METHODS AND RESULTS: Japanese market prices were obtained from 31 university hospitals, and US market prices were obtained from 1 hospital chain and 2 group-purchasing organizations. The price ratio (Japanese market price/US market price) was determined to be 1.2-1.4 for drug-eluting stents (DES), 1.6-2.4 for non-DES, and 4.1-5.1 for PTCA catheters. CONCLUSIONS: Results showed that the price disparity was relatively small for DES, but still significant for non-DES and PTCA catheters. Radical measures must be taken to improve the fundamental causes of price disparity and might include reviewing the implementation of the Japanese Pharmaceutical Affairs Law, abolishing the reimbursement price system for medical devices, and establishing centers of clinical excellence.

Publication Types:



360: Circ J. 2007 Jul;71(7):1004-12.


Characterization of outpatients with systolic dysfunction in a Japanese community by total enumeration. Okura Y, Ohno Y, Suzuki K, Taneda K, Ramadan MM, Mitsuma W, Tanaka K, Kashimura T, Ito M, Ishizuka O, Kato K, Hanawa H, Honda Y, Kodama M, Aizawa Y. Division of Cardiology, First Department of Internal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan. [email protected] BACKGROUND: The prevalence of congestive heart failure (CHF) is increasing with the aging of the community. Management of patients with systolic dysfunction (SD) is important for prevention of CHF, but there is little information regarding the burden of SD on Japanese communities. METHODS AND RESULTS: In order to delineate the epidemiological and clinical characteristics of SD patients, the medical records of patients from Sado Island were collected and summarized in 2003. From the 5 years prior to 2003, data for 497 patients were extracted. The mortality rate was significantly higher compared with the general population; and the total number of survivors had decreased to 410 by 2003. The proportion of SD patients in the general population increased sharply after the age of 65 years in males and 70 years in females, reaching 3.3% and 1.7% for men and women, respectively, in their 80 s. In 49% of the patients, the Charlson comorbidity index was > or = 2, whereas 24% of females led a solitary life. CONCLUSIONS: The total count of outpatients with SD is progressively increasing with age. These patients have multiple comorbidities, making the outcome of SD a poor one. The gender difference in disease characteristics and living conditions should be taken into consideration when establishing preventive strategies for CHF in Japanese communities. Publication Types:



361: Circ J. 2007 Jul;71(7):995-1003.


Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan. Yamazaki T, Goto S, Shigematsu H, Shimada K, Uchiyama S, Nagai R, Yamada N, Matsumoto M, Origasa H, Bhatt DL, Steg PG, Ikeda Y; REACH Registry Investigators. Department of Clinical Epidemiology and Systems, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. [email protected] BACKGROUND: The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international observational study of patients with, or at risk of, atherothrombotic disease. Japanese patients were analyzed to clarify national prevalence and treatment. METHODS AND RESULTS: Almost 68,000 outpatients were recruited worldwide with 5,193 in Japan. Among the Japanese patients, 83.7% had established vascular disease (symptomatic) and 16.3% had risk factors only (asymptomatic). Of the symptomatic patients, 14.0% had atherothrombotic lesions in more than 1 vascular bed, with 0.8% having lesions in 3 areas: brain, heart, and peripheral arteries. The prevalence of additional atherothrombotic risk factors among symptomatic patients was independent of the vascular lesion. Obesity was recorded in 10.6% and 42.1% of patients according to the National Cholesterol Education Program and Japanese guidelines, respectively. Pharmacologic intervention for risk factors was inadequate: only 37.7% of diabetic patients received antidiabetic medication, 79.6% of hypertensive patients used antihypertensives, and 74.0% received antiplatelet agents. The use of statins (44.1%) and aspirin (54.7%) was less common than seen in REACH globally. CONCLUSIONS: Japanese patients enrolled in REACH share many similarities with the global population, but with some important differences. Long-term follow-up will determine the impact of these factors on the development of atherothrombotic events. Publication Types:



362: J Clin Nurs. 2007 Jul;16(7B):234-42.


Nurses' perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis. Chan MF, Zang YL. School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China. [email protected] AIMS: Nurses' perceived and actual diabetes knowledge was explored by identifying profiles of nurses working in two hospitals in Hong Kong. Relationships between nurses' perceived and actual diabetes knowledge are explored. BACKGROUND: In non-specialist clinical settings in Hong Kong, nurses provide diabetes self-management education to patients, therefore, nurse's knowledge and skill in giving diabetes care is very important. Though patients' perceptions are important, if patients solely select and set their own priorities for learning about and managing diabetes, their care could be compromised by knowledge deficits. METHOD: A descriptive correlational survey was conducted during the period September 2004 to July 2005 in two local hospitals in Hong Kong. 245 nurses completed a structured questionnaire. Nurses' demographic data, competence, perceived and actual diabetes mellitus knowledge were collected. RESULTS: Two-step cluster analysis yielded three clusters: Cluster 1 nurses were characterized by relatively good competence and high diabetes knowledge than nurses in Clusters 2 and 3. Cluster 3 nurses reported low competence and diabetes knowledge than nurses in Clusters 1 and 2. Cluster 2 was a large group of nurses holding both positive and moderate competence and diabetes knowledge. Statistically significant differences were found between clusters. Overall, nurses' perceived diabetes knowledge was statistically significant correlated with actual knowledge (r(s) = 0.32). CONCLUSIONS: Nurses have the responsibility to educate patients with correct and updated information, therefore, knowledge should be provided and maintained to a certain standard. RELEVANCE TO CLINICAL PRACTICE: Lack of knowledge among nursing staff has contributed to diabetes patients receiving inadequate health care instruction. As indicated by the results of this study, 'tailor-made' educational programmes should be designed to meet the learning needs of each subgroup. Expertise and nurse education should be recognized when such educational programmes are designed.

Publication Types:



363: J Clin Nurs. 2007 Jul;16(7):1367-73.


Effect of the diabetes outpatient intensive management programme on glycaemic control for type 2 diabetic patients. Song MS, Kim HS. Department of Nursing, Dongham Health College, Suwon, Korea. AIM: The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme (DOIMP) on glycaemic control over a 12 week follow-up period for type 2 diabetic patients in Korea. BACKGROUND: Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range. Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range. METHODS: DOIMP was composed of multidisciplinary education, complication monitoring and telephone counselling. Twenty-five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses. RESULTS: Patients in the intervention group had a mean decrease of 2.3%, which those in the control group having a mean decrease 0.4% in glycosylated haemoglobin (HbA(1)c). There was no difference between the two groups in the change in fasting blood glucose (FBG) and two-hour postprandial blood glucose (2-h PBG). The proportion of the patients with HbA(1)c <7% was higher in the intervention group than in the control group at the post-test compare with the pretest. CONCLUSION: DOIMP can reduce HbA(1)c in type 2 diabetes patients. RELEVANCE TO CLINICAL PRACTICE: These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients. Publication Types:

• Controlled Clinical Trial


364: J Clin Nurs. 2007 Jul;16(7):1353-60.


Effects of the diabetic patients' perceived social support on their quality-of-life. Göz F, Karaoz S, Goz M, Ekiz S, Cetin I. Dicle Universitesi, Diyarbakir Atatürk Sağlik Yüksek Okulu, Diyarbakir, Turkey. [email protected] AIM: The aim of this descriptive study was to determine effects of the diabetic patients' perceived social support on theirs life qualities. BACKGROUND: Type 2 diabetes and its treatment effects patients' quality of life. Quality-of-life is important for people with diabetes and their health care providers. Social support for diabetic adults has been shown to benefit disease management and adjustment. RESEARCH DESIGN: This research was conducted with 66 type 2 diabetic patients who came for control to the diabetes policlinic between May and June 2003 at diabetes polyclinic in Kocaeli State Hospital of Marmara Region in Turkey. Informed consent was obtained from patients. Data were collected by using the quality-of-life scale (SF-36), perceptional social support scale and the questionnaire prepared by the researchers. METHOD: For the analysis of data, Mann-Whitney U-test, Kruskal-Wallis test, Pearson and Spearman correlation analysis have been employed. RESULTS: Perceived social support and quality-of-life were increased together. Male patients' and retired patients' quality life score and perceived social support were high. Meanwhile when educational level was increased, perceived social support and quality-of-life were increased. The quality life scores and perceived social support scores were high in patients who living alone and used oral antidiabetic drugs. CONCLUSIONS: If perceived social support and quality-of-life were increased together, it means social support increases quality-of-life. That is why nurses must try to plan some strategies for increase social support of patients. RELEVANCE TO CLINICAL PRACTICE: Assessment of social support of type 2 diabetic patients may assist in determining individualized goals and strategies. Enhanced social support in diabetes self-management may subsequently improve metabolic control, self-management and psychosocial adjustment to diabetes. PMID: 17584354 [PubMed - indexed for MEDLINE]

365: J Clin Nurs. 2007 Jul;16(7):1302-12.


Comment in:

• J Clin Nurs. 2008 Jun;17(11):1530-1.

An RCT of adherence therapy for people with schizophrenia in Chiang Mai, Thailand. Maneesakorn S, Robson D, Gournay K, Gray R. Institute of Psychiatry, King's College London, London, UK. AIM: The aim of this paper was to evaluate the effectiveness of adherence therapy-a brief intervention based on compliance therapy and motivational interviewing techniques-in a sample of people with schizophrenia in Thailand. BACKGROUND: Poor adherence is problematic, but knowledge about how to improve medication adherence is limited. Studies focusing on the effects of interventions used to improve adherence have produced inconsistent outcomes and have been mainly conducted in western countries. METHODS: An exploratory single blind randomized controlled trial was conducted in Chiang Mai, Thailand. Thirty-two patients with schizophrenia were randomly allocated to receive eight weekly sessions of adherence therapy or continue with their treatment as usual. Patients were assessed at baseline and after nine weeks. The primary outcome was overall psychotic symptoms. Secondary outcomes were general functioning, attitude towards and satisfaction with antipsychotic medication and medication side effects. RESULTS: The findings of this study indicated that patients who received adherence therapy significantly improved in overall psychotic symptoms, attitude towards and satisfaction with medication compared with treatment as usual but no significant difference was found in general functioning or side effects compared with treatment as usual. RELEVANCE TO CLINICAL PRACTICE: Adherence therapy has a positive impact on patients' psychiatric symptoms, attitude towards and satisfaction with medication. Nurses can effectively deliver adherence therapy following intensive training. Publication Types:

• Randomized Controlled Trial


366: J UOEH. 2007 Jun 1;29(2):169-81.


[An investigation of factors affecting job satisfaction among psychiatric nurses--focussed on stress-coping and a character tendency] [Article in Japanese] Kubo Y, Nagamatsu Y, Takeyama Y, Anan A, Kawamoto R, Kanayama M, Murase C. Department of Clinical Nursing II, School of Health Sciences, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan. The relation between stress, stress coping behavior and job satisfaction was investigated for psychiatric nurses who work in the northern part of Kyushu and the Chugoku district of Japan. As a result, the people with high job satisfaction had a tendency for the stress coping ability to be high, the daily stress of the people with low job satisfaction was high, and a relation with the character which is the individual characteristic was also seen. In the relation between stress management factor and job satisfaction, those who can have change of action by a hobby, amusement, etc., those with a strong tolerance to stress and the people with social support showed a tendency for job satisfaction to be high. The people especially with a high degree of satisfaction with their professional status showed the tendency for the stress management factor to be high. On the contrary, the people with a high stressor of daily hassles showed the tendency for job satisfaction to be low. Moreover, anger, nervousness and the people with a tendency to take a Type A action pattern showed the tendency for job satisfaction to be low. From these findings, it is suggested that a stressor or not only coping behavior but character tendency is related to job satisfaction. Publication Types:



367: Biomed Instrum Technol. 2007 May-Jun;41(3):208-10.


Educating clinical personnel--it begins with the BMET. Shah AV, Hamid A. Commission for the Advancement of Healthcare Technology Management in Asia. PMID: 17582953 [PubMed - indexed for MEDLINE]

368: Clin Infect Dis. 2007 Jul 15;45(2):241-9. Epub 2007 Jun 4.


Comment in:

• Clin Infect Dis. 2007 Jul 15;45(2):250-3.

Postpartum tuberculosis incidence and mortality among HIV-infected women and their infants in Pune, India, 2002-2005. Gupta A, Nayak U, Ram M, Bhosale R, Patil S, Basavraj A, Kakrani A, Philip S, Desai D, Sastry J, Bollinger RC; Byramjee Jeejeebhoy Medical College-Johns Hopkins University Study Group. Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. [email protected] BACKGROUND: In contrast with many other countries, isoniazid preventative therapy is not recommended in clinical care guidelines for human immunodeficiency virus (HIV)-infected persons with latent tuberculosis (TB) in India. METHODS: Seven hundred fifteen HIV-infected mothers and their infants were prospectively followed up for 1 year after delivery at a public hospital in Pune, India. Women were evaluated for active TB during regular clinic visits, and tuberculin skin tests were performed. World Health Organization definitions for confirmed, probable, and presumed TB were used. Poisson regression was performed to determine correlates of incident TB, and adjusted probabilities of mortality were calculated. RESULTS: Twenty-four of 715 HIV-infected women who were followed up for 480 postpartum person-years developed TB, yielding a TB incidence of 5.0 cases per 100 person-years (95% confidence interval [CI], 3.2-7.4 cases per 100 person-years). Predictors of incident TB included a baseline CD4 cell count <200 cells/mm(3) (adjusted incident rate ratio [IRR], 7.58; 95% CI, 3.07-18.71), an HIV load >50,000 copies/mL (adjusted IRR, 3.92; 95% CI,

1.69-9.11), and a positive tuberculin skin test result (adjusted IRR, 3.08; 95% CI, 1.27-7.47). Three (12.5%) of 24 women with TB died, compared with 7 (1.0%) of 691 women without TB (IRR, 12.2; 95% CI, 2.03-53.33). Among 23 viable infants with mothers with TB, 2 received a diagnosis of TB. Four infants with mothers with TB died, compared with 28 infants with mothers without TB (IRR, 4.71; 95% CI, 1.19-13.57). Women with incident TB and their infants had a 2.2- and 3.4-fold increased probability of death, respectively, compared with women without active TB and their infants, controlling for factors independently associated with mortality (adjusted IRR, 2.2 [95% CI, 0.6-3.8] and 3.4 [95% CI, 1.22-10.59], respectively). CONCLUSIONS: Among Indian HIV-infected women, we found a high incidence of postpartum TB and associated postpartum maternal and infant death. Active screening and targeted use of isoniazid preventative therapy among HIV-infected women in India should be considered to prevent postpartum maternal TB and associated mother-to-child morbidity and mortality. Publication Types:

• Clinical Trial, Phase III • Randomized Controlled Trial • Research Support, N.I.H., Extramural


369: Disabil Rehabil. 2007 Jun 15-30;29(11-12):935-48.


Evaluation of CIR-whirlwind wheelchair and service provision in Afghanistan. Armstrong W, Reisinger KD, Smith WK. Center for International Rehabilitation, Chicago, Illinois 60611, USA. [email protected] PURPOSE: The Center for International Rehabilitation (CIR) developed a wheelchair provision strategy that combines central fabrication with regional distribution and local service provision by trained practitioners. A field study was initiated in Kabul, Afghanistan to evaluate this plan. METHOD: The CIR-Whirlwind Wheelchair (study wheelchair) is an adult size, manual wheelchair designed to be adjustable to accommodate the individual user and durable to withstand rugged terrain. Manufactured in India, the study wheelchairs, with seat cushions, were packaged as kits and shipped to Afghanistan. Local practitioners

in Kabul were trained on user assessment, fitting and training, and wheelchair assembly, maintenance and repair. One hundred subjects with previous experience of independently propelling a manual wheelchair participated in the study. This 4-month study entailed three subject visits for initial wheelchair fitting and training and then follow-up at 3 and 10 weeks. Subject training included wheelchair use and maintenance, and wheelchair skill activities. RESULTS: The study wheelchair was rated favorably by the subjects in all of five categories. Adjustments made to the wheelchairs during the study were typical for maintaining or improving the fit or function of a manual wheelchair. With the exception of brake handles, the need to repair or replace components on the wheelchairs was minimal. The subjects' proficiency at wheelchair skill activities increased throughout the study. CONCLUSIONS: Data collected indicates that the study wheelchair performed very well. The data also served to identify those aspects of the wheelchair that may require additional development and testing prior to further production. To gain additional information on long term wheelchair use and performance, the CIR plans to extend this study by interviewing the same subjects at nine and fifteen months from the date they originally received the study wheelchair. Publication Types:

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


370: BMC Health Serv Res. 2007 Jun 19;7:90.


Integration in primary community care networks (PCCNs): examination of governance, clinical, marketing, financial, and information infrastructures in a national demonstration project in Taiwan. Lin BY. Institute of Health Service Administration, China Medical University, Taiwan. [email protected] BACKGROUND: Taiwan's primary community care network (PCCN) demonstration project, funded by the Bureau of National Health Insurance on March 2003, was established to discourage hospital shopping behavior of people

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



PMCID: PMC1931593

371: J Prev Med Pub Health. 2007 May;40(3):249-58.


[Antihypertensive drug medication adherence of people with disabilities and its affecting factors in Korea]

[Article in Korean] Park JH, Shin Y, Lee SY, Park JH. National Cancer Center, Department of Health Policy and Management, Seoul National University College of Medicine, Korea. OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA>80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA>or=80%) rate was 54.5% and 20.5% of patients had a CMA<50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea. Publication Types:



372: J Contin Educ Health Prof. 2007 Spring;27(2):105-10.


Integrating hospital-acquired lessons into community health practice: optimizing antimicrobial use in Bangalore. Biswas R, Dineshan V, Narasimhamurthy NS, Kasthuri AS.

Department of Medicine, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, India. [email protected] INTRODUCTION: Even as antimicrobial resistance is a serious public health concern worldwide, the uncertainties of diagnosis and treatment of fever strongly influence community practitioners toward prescribing antibiotics. To help community practitioners resolve their diagnostic questions and reduce the unnecessary use of antibiotics for viral fevers, thus helping to contain antibiotic resistance, we suggest fever-charting and monitoring fever patterns for two days. METHODS: This was a qualitative study, with relevant quantitative descriptions. Patients presenting with recent onset fever to the Vydehi Institute of Medical Sciences (VIMS) and Research Centre, Bangalore, India, were monitored with simple fever charting and managed based on their fever patterns for two days. Initially only antipyretics were given in optimal doses; if the fever showed a continuous pattern suggestive of septicemia, antibiotics were instituted for typhoid, the commonest organism to cause sepsis in a community setting short of pointers to other causes. The different clinical profiles of these patients of viral and enteric fevers were circulated among the community practitioners, and an assessment of their approach was made. Finally, it was revealed to the practitioners how successful management of the patient was possible without antibiotics. RESULTS: During the study period, 4289 patients presented to VIMS. The antibiotic prescribing rate when given the clinical profiles of true patients with viral fevers was high among community practitioners. Community practitioners agreed that in a controlled hospital setting, the results could be spectacular, but the challenges were different in community practice. There was an initial reluctance to use fever charting due to fear of patient noncompliance. DISCUSSION: Fever charting can be an invaluable means to help differentiate viral and enteric fevers and thus help reduce unnecessary antibiotic prescriptions for viral fevers. PMID: 17576636 [PubMed - indexed for MEDLINE]

373: J R Army Med Corps. 2007 Mar;153(1):44-51.


Reflections on medical aspects of ISAF IX in Afghanistan. Bricknell MC. Headquarters Allied Rapid Reaction Corps, BFPO 40. [email protected] This paper is a personal review of my experience as the Medical Adviser in the NATO Headquarters of International Assistance Force (ISAF) in Afghanistan

from August 2006 to February 2007. It is in 5 sections, medical plans and operations, clinical issues, supporting the Afghan Security Forces Medical Services, supporting Health Sector Reconstruction and Development and preventive medicine. It concludes with a short summary of personal lessons. PMID: 17575877 [PubMed - indexed for MEDLINE]

374: PLoS Med. 2007 Jun;4(6):e191.


Comment in:

• PLoS Med. 2007 Jun;4(6):e216.

Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study. Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A. Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust, London, United Kingdom. [email protected] BACKGROUND: Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. METHODS AND FINDINGS: We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81) relative to the white British patient group. Variations in prescribing and

achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. CONCLUSIONS: Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes. Publication Types:

• Comparative Study • Research Support, Non-U.S. Gov't


PMCID: PMC1891316

375: J Nurs Care Qual. 2007 Jul-Sep;22(3):266-71.


Inpatient satisfaction with nursing care and factors influencing satisfaction in a teaching hospital in China. Liu Y, Wang G. Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [email protected] This study examined inpatient satisfaction with nursing care in a teaching hospital in China. Patient satisfaction with nursing care was assessed by a self-designed questionnaire administered to 320 inpatients selected by a convenience sampling method. The patients had a relatively high level of satisfaction with nursing care. Patients' age, educational background, occupation, methods of payment, and hospital wards were main factors influencing their satisfaction with nursing care. The study provides a new tool for measuring patient satisfaction with nursing care in China. Publication Types:



376: Pharm World Sci. 2008 Jan;30(1):24-30. Epub 2007 Jun 12.


Self-medication patterns in Amman, Jordan. Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M. Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman 11942, Jordan. [email protected] OBJECTIVE: The classification of medicine as Prescription-Only-Medicine (POM) and Over-The-Counter (OTC) drugs in Jordan is present but not yet enforced on community pharmacies, the fact that allows access of the public to a wider range of medications that otherwise are provided only on prescription. This, of course, has its implications on safety and effectiveness of the pharmacotherapy in question. This research aims to establish a baseline data concerning the extent of self-medication among Jordanians, and to assess possible factors associated with self-medication, so that future interventions can be documented and planned. SETTING: A total of 155 out of Amman's 900 community pharmacies. METHODS: A cross-sectional observational study using a pre-piloted questionnaire was conducted. Over 800 customers who visited the pharmacies over a period of 4 months were interviewed and their non-prescription drug requests patterns were recorded to assess the prevalence of self-medication and offered justification. RESULTS: Self-medication was a common practice among Jordanians (42.5%). The variable that was associated with extent of self-medication was respondents' age, where patients younger than 16 years and those older than 60 years were less likely to self-treat. The most common reasons for self-medication were that the ailments were too minor to see a doctor (46.4%), the long waiting time to be seen by doctors (37.7%) and avoiding the cost of doctors' visits (31.4%). People tended to select medication based on advice received from pharmacy staff (14.2%), friends/neighbors (17.6%) or informal advice from other health professionals like dentists and nurses (21.9%). Alternatively, patients selected products based on their previous experiences with similar symptoms (27%) or similar diseases (33.5%). CONCLUSIONS: Self-medication is a common health care practice in Jordan, where people are becoming increasingly familiar with drugs and their brand names. Self-medication behavior varied significantly with a number of socio-economic factors. Unfortunately, only a small percentage of patients engaged pharmacy personnel in therapeutic consultations beyond briefly mentioning a symptom. Publication Types:



377: Indian J Dermatol Venereol Leprol. 2007 May-Jun;73(3):176-8.


Chromoblastomycosis in Nepal: a study of 13 cases. Pradhan SV, Talwar OP, Ghosh A, Swami RM, Shiva Raj KC, Gupta S. Department of Pathology, Manipal College of Medical Science and Manipal Teaching Hospital, Pokhara, Nepal. [email protected] BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by several pigmented fungi commonly seen in tropical and subtropical climates. AIM: To evaluate the epidemiologic, clinical and pathological characteristics of chromoblastomycosis in our patients. METHODS: This retrospective and prospective study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal. Clinical features and histopathology of all the cases diagnosed as chromoblastomycosis during the last eight years were studied. RESULTS: A total of 13 cases of chromoblastomycosis were diagnosed during the period of 1999-2006. The disease was seen predominantly in middle-aged male farmers and those from rural areas. The lesions commonly involved the lower extremity and were single or multiple in number. They clinically presented as verrucous or nodular growths. Out of these 13 cases, three were diagnosed clinically as squamous cell carcinoma and one as psoriasis. The histopathological features included sclerotic bodies in 12 cases (92%), microabscess formation in 10 cases (76.9%), pseudoepitheliomatous hyperplasia in nine cases (69.2%) and granuloma in eight cases (61.5%). CONCLUSION: Farming is the commonest occupation in patients with chromoblastomycosis. Early histological diagnosis helps in effective management of the condition. PMID: 17558050 [PubMed - indexed for MEDLINE]

378: West J Nurs Res. 2008 Feb;30(1):54-72. Epub 2007 Jun 8.


Clinical constructions by nurses in Korea, Norway, and the United States.

Kim HS, Ellefsen B, Kyung Ja Han , Alves SL. Buskerud University College, University of Rhode Island, USA. [email protected] Nursing practice involves engagement of nurses in clinical fields through deliberation and enactment. In the phase of deliberation, nurses observe, recognize, form ideas about and decide on clinical situations, and construct clinical pictures. Clinical pictures are critically connected to nursing enactments, thus it is important to discover how nurses arrive at clinical pictures. The purpose of this article is to describe how nurses construct meanings of clinical situations and arrive at specific clinical pictures. The results are from a clinical fieldwork study replicated in Korea, Norway, and the United States, with samples of nurses working in acute-care hospitals. Data were collected through participant observations and in-depth interviews. A general model of clinical construction was derived from the results, which specifies four dimensions (i.e., problem, progress, status, and particularism) as the bases for clinical picture evocations. Clinical pictures are constituted by nurses' elicitations of meanings of clinical situations on these dimensions. Publication Types:



379: Arch Psychiatr Nurs. 2007 Jun;21(3):132-40.


Effects of a bereavement intervention program in middle-aged widows in Korea. Kang HY, Yoo YS. Christian College of Nursing, Nam-gu, Gwangju, South Korea. [email protected] Dan-jeon is a meditative practice composed of both breathing and stretching exercises causing life energies to circulate blood throughout the body. Following a bereavement intervention program composed of Dan-jeon breathing sessions, a self-help group activity, and a health check, an experimental group showed significantly greater decrements in grief levels and symptoms of stress over a control group who received only a health check. Among the participants, there

were no significant differences in immune response, percentages of T lymphocytes, helper T lymphocytes (Th), suppressor T lymphocytes (Ts), B lymphocytes, natural killer cells, monocytes, and Th:Ts ratios. Publication Types:



380: BMC Infect Dis. 2007 Jun 6;7:54.


Imported Crimean-Congo hemorrhagic fever cases in Istanbul. Midilli K, Gargili A, Ergonul O, Sengöz G, Ozturk R, Bakar M, Jongejan F. Istanbul University, Cerrahpaşa Medical Faculty, Microbiology and Clinical Microbiology Department, Istanbul. [email protected] <[email protected]> We described a series of imported cases of Crimean-Congo Hemorrhagic Fever (CCHF) in Istanbul and investigated the genetic diversity of the virus. All the suspected cases of CCHF, who were applied to the health centers in Istanbul, were screened for CCHF virus (CCHFv) infection by using semi-nested Polymerase Chain Reaction (PCR) following RT-PCR. Simultaneous blood samples were also sent to the national reference laboratory in Ankara for serologic investigation. In 10 out of 91 patients, CCHFv was detected by PCR, and among 9 out of 10, anti-CCHFv IgM antibodies were also positive. Clinical features were characterized by fever, myalgia, and hemorrhage. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase were elevated, and bleeding markers were prolonged. All the cases were treated with ribavirin. There was no fatal case. All the strains clustered within the same group as other Europe/Turkey isolates. PMID: 17553137 [PubMed - indexed for MEDLINE]

PMCID: PMC1905914

381: J Nurs Res. 2007 Jun;15(2):117-26.


An oral historical study of the development of the discipline of military nursing in Taiwan from 1948 to 1970. Mu PF, Lin S. Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan. [email protected] In an attempt to redress the gap in Chinese nursing and military history, this study aims to provide an understanding of the nature of military nursing development from 1948 to 1970. The National Defense Medical Center (NDMC) was established in 1902 and is recognized as the first military medical school in Chinese history. In 1949, in order to continue her studies, Prof. Fu-I Chao followed the school, when it moved from mainland China to Taiwan. The school's move was a result of the defeat on mainland China of the nationalist government led by Generalissimo Chiang Kai-Shek. The researchers adopted an oral history approach. This consisted of a literature review, the collection of photographs, a review of formal documents and four face-to-face in-depth interviews with Prof. Chao. After data collection, content analysis was performed on the information collected. The study explored the development of the discipline of military nursing in its historical, social, and economic context. Four themes emerged. These were a personal history of experience and growth, the foundation phase of nursing, the developmental phase of nursing, and the historical developments and trends in nursing. Prof. Chao's comments reveal how the students missed their parents and families, the special friendships among them, and the love and care that they received from Chief Mei-Yu Chow and Director Chih-Teh Loo. Tribute is paid to their resilience in the face of hardship, and their industry during the initial development of the nursing profession. The results also provide the suggestions of creating a history of health-care that privileges new meanings about military nursing's past and worth. Publication Types:

• Historical Article • Research Support, Non-U.S. Gov't


382: Pediatr Endocrinol Rev. 2007 Mar;4(3):237-8.


The 40th Annual Meeting of the Japanese Society for Pediatric Endocrinology (JSPE), Hamamatsu, Japan, 27-29 September 2006. Tanaka T. Department of Clinical Laboratory Medicine, National Center for Child Health and Development, Tokyo, Japan. [email protected] Publication Types:

• Congresses


383: Ann Acad Med Singapore. 2007 May;36(5):338-42.


Improved median survival for glioblastoma multiforme following introduction of adjuvant temozolomide chemotherapy. Back MF, Ang EL, Ng WH, See SJ, Lim CC, Chan SP, Yeo TT. The Cancer Institute, National University Hospital, Singapore. [email protected] INTRODUCTION: The use of adjuvant temozolomide (TMZ) in patients managed with surgery and adjuvant radiation therapy (RT) for glioblastoma multiforme (GBM) has been demonstrated to improve median and 2-year survival in a recent large international multicentre study. To confirm this result in routine clinical practice, an audit of the management and outcome of patients with GBM at The Cancer Institute Radiation Oncology was performed. MATERIALS AND METHODS: All patients with GBM managed radically at The Cancer Institute Radiation Oncology from May 2002 to 2006 were entered into a prospective database. Patient, tumour and treatment factors were analysed for association with the outcome of median survival (MS). Survival was calculated using the Kaplan-Meier technique and correlation was assessed using Cox proportional hazards regression. RESULTS: Forty-one patients with GBM were managed with radical intent over the 4- year period. The median age was 54 years and 66% were Eastern Cooperative Oncology Group (ECOG) 0-1 performance status. Macroscopic, subtotal and biopsy alone procedures were performed in 61%, 29% and 10% of patients, respectively. The median time from surgery to RT was 26

days. Adjuvant TMZ was used in 44% of patients (n = 18). The MS of the total group was 13.6 months, with a 24% 2-year overall survival. The use of TMZ was associated with improved MS (19.6 versus 12.8 months; P = 0.035) and improved 2-year survival (43% versus 0%). A requirement of dexamethasone dose greater than 4 mg at the end of RT (P = 0.012) was associated with worse survival, but there was no association of MS with age, ECOG, tumour size or extent of surgery. CONCLUSION: The median and 2-year survival outcomes are comparable to the results of the European Multicentre Study and justify the continued use of TMZ in routine clinical practice. PMID: 17549280 [PubMed - indexed for MEDLINE]

384: Hong Kong Med J. 2007 Jun;13(3):221-7.


Delayed presentation and treatment of newly diagnosed pulmonary tuberculosis patients in Hong Kong. Leung EC, Leung CC, Tam CM. TB and Chest Service, Centre of Health Protection, Department of Health, Hong Kong. [email protected] OBJECTIVE: To measure patients' and providers' delays in the presentation and treatment of newly diagnosed pulmonary tuberculosis. DESIGN: Retrospective study using structured questionnaires. SETTING: Tuberculosis and Chest Service, Centre of Health Protection, Department of Health. PARTICIPANTS: Tuberculosis patients notified to the Department of Health, selected by systematic sampling of all notifications in the first 2 weeks of every even month in the year 2004. MAIN OUTCOME MEASURES: Health-seeking behaviour of pulmonary tuberculosis patients, including respective demographic, clinical, and disease factors. RESULTS: Of a total of 6262 notified tuberculosis patients in 2004, 1662 (26.5%) were recruited into the study; of these, 42.6% first presented to private doctors, and 57.4% to the public sector. The diagnosis of tuberculosis was made in 13.7% of these patients by the former and 86.3% by the latter. The median patient delay (elapsed time from symptoms to medical consultation) and provider delay (elapsed time from medical consultation to treatment) were both 20 days; 25th to 75th percentiles being 7-37 and 6-55 days, respectively. Longer patient delay was associated with positive sputum smear and culture, and more extensive radiological disease. On multiple regression analysis, unemployment independently predicted longer patient delay, while haemoptysis predicted shorter patient and total delay. Patients older than 60 years, with no initial sputum and chest X-ray examination predicted longer provider and total delays. CONCLUSIONS: Our patient and provider delays compared favourably with

those of other countries, and very likely reflect easy service access. Adverse social factors and non-specific presentations prolong patient delay, whilst older age and unavailable bacteriological/radiological evidence delay diagnosis and treatment. PMID: 17548911 [PubMed - indexed for MEDLINE]

385: BMC Public Health. 2007 Jun 5;7(147):96.


How do nurses and teachers perform breast self-examination: are they reliable sources of information? Demirkiran F, Balkaya NA, Memis S, Turk G, Ozvurmaz S, Tuncyurek P. Psychiatric Nursing, Adnan Menderes University School of Health, Genclik Cad, No:7, Aydin, Turkey. [email protected] BACKGROUND: Breast cancer is the most common cause of cancer-related deaths among women worldwide. The aim of the present study was to determine and compare knowledge, behavior and attitudes among female nurses and teachers concerning breast self-examination (BSE). METHODS: Two-hundred and eighty nine women working in Aydin, Turkey (125 nurses and 164 teachers) were included in the study. The data were collected using a questionnaire designed to measure the knowledge, attitudes and behavior of the groups. Analysis involved percentiles, chi2 tests, t tests and factor analysis. RESULTS: The knowledge of nurses about BSE was higher than that of teachers (81.5% versus 45.1%; p < 0.001). BSE practice parameters (i.e. age groups, indications, frequency) were similar (p > 0.05), whereas skills in performing self-examination were higher in nurses (p < 0.001). Fear of having breast cancer is the most frequent reason for performing BSE. Among nurses, the reasons for failure to perform BSE were the absence of prominent breast problems (82%) and forgetting (56.4%). The teachers who did not perform BSE said that the reasons were lack of knowledge on how to perform self-examination (68.9%) and absence of problems (54%). Both groups had unacceptable technical errors in the performance of BSE. CONCLUSION: We conclude that nurses and teachers should be supported with information enabling them to accomplish their roles in the community. To improve BSE practice, it is crucial to coordinate continuous and planned education. Publication Types:



PMCID: PMC1904443

386: East Mediterr Health J. 2007 Jan-Feb;13(1):160-7.


Internists in training; what do they know about inhalers? Alamoudi OS, Al-Mohammadi R. Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia. [email protected] The study tested the knowledge of internal medicine residents in recognizing the types and demonstrating the ways of using 6 different inhalers. Of the residents 61%, 49%, 78% and 90% were unable to recognize commonly used devices (a metered dose inhaler, Turbuhaler, Diskus and Diskhaler respectively), while 24%, 53%, 81% and 93% were unable to demonstrate the correct the ways of using them. None of the residents (0%) were able to recognize or to demonstrate the use of Rotahaler and Aerolizer correctly. None of them had received any formal education about the use of the inhalers during their training, while only 2% had attended sessions with medical educators. PMID: 17546918 [PubMed - indexed for MEDLINE]

387: Birth. 2007 Jun;34(2):123-30.


Effect of delivery method and timing of breastfeeding initiation on breastfeeding outcomes in Taiwan. Chien LY, Tai CJ. Institute of Clinical and Community Health Nursing, National Yang-Ming University, and Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taiwan. BACKGROUND: Few studies have examined the independent effect of delivery

method and timing of breastfeeding initiation on the prevalence of breastfeeding. The objectives of this study were to examine the effect of method of delivery and timing of breastfeeding initiation on the prevalence of breastfeeding at 1 and 3 months after delivery using a national sample from Taiwan. METHODS: The study population of 2,064 women who gave birth to infants without congenital anomalies at hospitals in Taiwan from June through October 2003, inclusively, participated in a postal questionnaire survey. RESULTS: Multivariate ordinal logistic regression analysis showed that women with cesarean delivery had a lower odds of breastfeeding at 1 and 3 months after delivery. Women with assisted vaginal delivery had lower odds of breastfeeding at 3 months after delivery compared with women with unassisted vaginal delivery. Initiation of breastfeeding within 30 minutes of delivery was associated with higher odds of breastfeeding at 1 and 3 months after delivery. Women who did not initiate breastfeeding during hospital stay but breastfed at 1 month after delivery had lower odds of breastfeeding at 3 months after delivery. CONCLUSIONS: The findings suggest the importance of conservative use of operative obstetrical intervention due to its negative impact on breastfeeding. Health professionals need to support mothers who have experienced cesarean and assisted vaginal delivery to increase their breastfeeding. Hospital staff should improve practice with respect to early initiation of breastfeeding. Publication Types:



388: Int J Clin Pharmacol Ther. 2007 May;45(5):264-70.


Atypical antipsychotic therapy for treatment of schizophrenia in Hong Kong Chinese patients--a cost analysis. Law WL, Hui HY, Young WM, You JH. Hospital Authority, Hong Kong SAR. OBJECTIVE: To evaluate the direct medical cost of atypical antipsychotic therapy for schizophrenia among Hong Kong Chinese patients and to identify factors affecting the cost of treatment. METHODS: In this retrospective database analysis, patient data were retrieved from three Hong Kong public hospitals. Patients aged 2 18 years who received an initial prescription for olanzapine, risperidone, quetiapine or amisulpride between April 1 and September 30, 2003;

and had an ICD-10-coded diagnosis of schizophrenia were included. Patient data were collected for a maximum duration of 1 year before and after treatment initiation. Primary outcome measures were the schizophrenia-related direct medical costs. Demographic and clinical factors were analyzed by multiple regression analysis to identify influential factors for the cost of atypical antipsychotic therapy. RESULTS: A total of 325 patient records were reviewed and 82 patients were included in the analysis. Cost per patient per month for clinic visits (US$ 67 +/- 41 versus US$ 78 +/- 41), medications (US$ 8 +/- 12 versus US$ 97 +/- 83), and the total cost per patient per month (US$ 314 +/- 898 versus US$ 431 +/- 914) increased significantly after treatment initiation (US$ 1 = HK$ 7.8). Previous duration of hospitalization (RR = 1.00, 95% CI = 1.00 1.01), history of substance abuse (RR = 1.26, 95% CI = 1.05 1.52) and use of depot antipsychotics (RR = 1.22, 95% CI = 1.05 - 1.42) were associated with higher cost of atypical antipsychotic therapy. CONCLUSION: The total direct medical cost increased significantly after initiation of atypical antipsychotic therapy in a cohort of Chinese patients with schizophrenia. History of drug abuse, use of depot antipsychotics and prior duration of hospitalization were positive predictors of cost of therapy. Publication Types:



389: J Contin Educ Nurs. 2007 May-Jun;38(3):122-31.


Outcomes of continuing education in the care of children with asthma for pediatric healthcare providers. Cheng YF, Hsu LN, Yang KD, Yeh SH, Shu SS. Department of Nursing, Chang Gung Memorial Hospital, Kohsiung, Taiwan. In this study, the authors assessed the knowledge of healthcare providers regarding asthma care, examined the outcomes of continuing education for asthma care, and explored the relationships among demographic characteristics of the healthcare providers and the improvement in asthma care knowledge. Thirty-one pediatricians and 38 nurses in the pediatric units of a medical center completed a questionnaire before and after an asthma care program. Pediatricians and pediatric nurses provided correct answers to asthma care questions 84.45% and 61.97% of the time, respectively, before the program and 93.06% and 88.03%

of the time, respectively, after the program, which was a significant improvement (p < .001). No significant correlations or differences were found between the changes in asthma care knowledge and the demographic characteristics of healthcare providers. Results from this study suggest that continuing education can improve the knowledge of asthma care among pediatric healthcare providers. Publication Types:

• Evaluation Studies • Research Support, Non-U.S. Gov't


390: Clin Rheumatol. 2008 Jan;27(1):29-33. Epub 2007 Jun 1.


Use of complementary and alternative medicine by rheumatoid arthritis patients in Korea. Lee MS, Lee MS, Yang CY, Lee SI, Joo MC, Shin BC, Yoo WH, Shin YI. Department of Rheumatology, School of Medicine, Wonkwang University, Iksan, South Korea. This study measured the prevalence of use of complementary and alternative medicine (CAM) in Korean patients with rheumatoid arthritis (RA). A trained nurse conducted 20-min questionnaire-based interviews at the hospitals when each patient visited as an outpatient. The questionnaire included questions on demographic information, clinical information, and the use of CAM. Of the 153 respondents, 125 (82%) had used CAM; 37% of those who used CAM had started taking CAM products following suggestions from family members and other relatives. In users of CAM, 35% considered that it improved the symptoms of RA, and 14% felt it was effective in achieving psychological relaxation. We categorized treatment into six CAM categories used by the respondents: 84.0% of patients used traditional Oriental medical treatments, 70.4% used plant- and animal-derived over-the-counter health care products, and 13.6% used manual therapies. Most RA patients (64%) would like to try a new type of CAM. About half of the respondents (48%) expected to receive information about CAM from their general practitioner even if most (72%) did not discuss their use of CAM with their doctor. Most of the RA patients in this study used CAM, and half reported beneficial effects. Despite the presence of adverse side effects, patients tended to use CAM without discussing it with their main physicians, suggesting

that physicians should be actively involved in the prescription and use of CAM. Publication Types:



391: Southeast Asian J Trop Med Public Health. 2007 Mar;38(2):328-38.


Program issues in delivering targeted STI services through the public sector in the Greater Mekong region. O'Farrell N. Pasteur Suite, Ealing Hospital, London, Unted Kingdom. [email protected] This review discusses the delivery of targeted STI services for both female sex workers (FSWs) and other high-risk groups through the public sector in the Greater Mekong region. Vaginal discharge algorithms for the general population are also discussed. High STI rates that justify targeted interventions have been reported recently amongst FSW in Cambodia, Lao PDR and Vietnam. Such interventions need to take into account the different patterns of sex work in the three countries. In Cambodia, there are large numbers of brothel-based FSWs although this pattern is changing as more brothels are closed by the authorities. In Lao PDR, services targeted towards reducing the burden of HIV/STI in FSW/service women are probably best delivered through NGO-led clinics. In Vietnam, commune based district health centers appear to offer better services for FSW than STI clinics. Male clients of FSW are an important group to target, but reaching such a heterogeneous population is difficult. Provision of quality STI drugs to those places where men present with STI symptoms should be a priority. The optimal way to manage STIs in FSWs is still unclear in this region. Clinical and laboratory specialists are keen to promote laboratory tests for STIs but there is an over reliance on direct staining techniques. In areas with high STI prevalences, periodic presumptive treatment could offer an effective option to reduce STI levels in high-risk groups until syndromic management algorithms are evaluated for local use. Social patterns of sex work are changing continually and require close monitoring in the future so that services can be adapted to these changes. Publication Types:

• Review


392: Southeast Asian J Trop Med Public Health. 2007 Jan;38(1):62-8.


Opportunistic infections and HIV clinical disease stage among patients presenting for care in Phnom Penh, Cambodia. Kong BN, Harwell JI, Suos P, Lynen L, Mohiuddin S, Reinert S, Pugatch D. University Research CO, LLC, Phnom Penh, Cambodia. This prospective, cross-sectional study sought to assess the spectrum of HIV-associated complications and disease stage among individuals presenting for first-time care in Phnom Penh, Cambodia between November 2001 and September 2002. One hundred patients participated in this study. All study participants presented with advanced stages of HIV disease. Seventy-four percent of the subjects had CD4 cell counts <50 cells/mm3. Tuberculosis was the most common AIDS-defining illness among participants, with a prevalence of 43%. A spectrum of other opportunistic infections, including cryptosporidiosis (13%), severe bacterial infections (12%), cryptococcosis (12%), and Pneumocystis jiroveci pneumonia (10%), was identified. These findings underscore the need for widespread HIV treatment and prevention in this setting. Increased screening for HIV and routine health maintenance for those infected are urgently needed in order to facilitate management of both opportunistic infections and the secondary prevention of HIV infection. Publication Types:



393: Med Teach. 2007 Feb;29(1):e22-5.


Physician assistants: education, practice and global interest.

Legler CF, Cawley JF, Fenn WH. College of Allied Health and Nursing, Department of Health Science, Nova Southeastern University, Ft. Lauderdale, FL 33328, USA. [email protected] BACKGROUND: In the United States, the physician assistant (PA) model has proven to be a cost-effective way to train quality primary care providers with a high degree of acceptance of the PA role by patients and other healthcare providers. AIM: Discuss PA model as it pertains to other countries. METHODS: Review of relevant literature related to physician assistant education, practice and global interest. RESULTS: Several countries including the United Kingdom, Scotland, Canada, The Netherlands, Taiwan, South Africa and Ghana are exploring or re-exploring the concept of the physician assistant as a way to quickly and efficiently train and employ autonomous and flexible health workers to address their nation's healthcare needs. CONCLUSIONS: Physician assistant education is efficient and flexible and the PA model can be easily adapted to the specific health system needs of other nations. In addition, many PA programs have affiliation agreements with institutions outside of the United States to host PA students for clinical rotations and there is an ever-growing interest by students in international rotations. The Physician Assistant Education Association along with the American Academy of Physician Assistants is actively involved with sharing information about the PA profession with other countries. PMID: 17538827 [PubMed - indexed for MEDLINE]

394: Int J Clin Pract. 2007 Jul;61(7):1086-90. Epub 2007 May 30.


Comment in:

• Int J Clin Pract. 2007 Jul;61(7):1074.

Comparison of risk-adjustment models using administrative or clinical data for outcome prediction in patients after myocardial infarction or coronary bypass surgery in Korea. Park HK, Yoon SJ, Ahn HS, Ahn LS, Seo HJ, Lee SI, Lee KS. Department of Health Policy and Management, College of Medicine, Cheju National University, Cheju University Street Jeju-city, Jeju Province, Korea.

OBJECTIVE: The objectives of this study were to compare the performance indicators of risk-adjustment models based on administrative and clinical data in Korea, and to assess whether administrative data alone is useful for comparing quality of care. METHODS: Outcome was defined as death within 30 days of discharge. For administrative data, the risk factors were; age, sex, and 11 past histories and two past major procedures, which were retrospectively chased in National Health Insurance database using patient Identification Number. For clinical data, the severity score of the three risk-adjustment measures [MedisGroups, Disease Staging (DS) and Computerized Severity Index (CSI)] was used as the independent predictors of 30-day mortality. Risk-adjustment models were developed by logistic regression analysis for 13,885 Acute Myocardial Infarction (AMI) and 2115 Coronary Artery Bypass Graft (CABG) patients based on administrative data and for 208 AMI patients and 478 CABG patients using clinical data. Performances of models were examined using c-statistic and Hosmer-Lemeshow statistic. RESULTS: The results obtained showed the superiority of the clinical model. For AMI, the c-statistic of the administrative model was 0.696, and those of the CSI, DS and MedisGroups models were 0.772, 0.861 and 0.988 respectively. For CABG, the c-statistic of the administrative model was 0.568, and those of the CSI, DS and MedisGroups models were 0.665, 0.731 and 0.816 respectively. CONCLUSION: Our results indicate that risk-adjustment model only using administrative data are probably not useful for assessing quality of care in Korea. Publication Types:

• Comparative Study • Multicenter Study • Research Support, Non-U.S. Gov't


395: Indian Pediatr. 2007 May;44(5):339-43.


Antiretroviral therapy in children: Indian experience. Natu SA, Daga SR. Department of Pediatrics, B.J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India. [email protected] BACKGROUND : There is a paucity of reports on Highly Active Antiretroviral

therapy (HAART) in children. We studied feasibility and effectiveness fixed dose combination (FDC) of lamivudine, nevirapine and stavudine in HIV infected children. DESIGN: Interventional study. SETTING: A Tertiary care center. SUBJECTS: Twenty five consecutive HIV positive antiretroviral naive children older than 18 months. METHODS: The study subjects were started on weight-appropriate doses of the FDC and followed up for 6 months. Weight, CD4 counts, absolute lymphocyte count (ALC) and number of episodes of illness were assessed before and after HAART. Adherence and barriers to adherence were studied. RESULTS: Mean weight increased from 15.2 to 16.8 kg (P < 0.001) while mean CD4 counts increased from 488/cmm to 765/cmm (P < 0.001). Only 2 cases of drug associated adverse event were encountered. Improvement in Center for Disease Control (CDC) immunological classification of the subjects was significant while that in World Health Organization (WHO) clinical staging was not statistically significant. Follow up visits were 95% of the expected 175 visits. The average distance traveled by the patient for every visit was 72 km (one way). CONCLUSIONS: Use of FDC in weight specific dosages is feasible and effective for treatment of Pediatric HIV in resource scarce setting. These preliminary results need to be tested in a different setting. PMID: 17536133 [PubMed - indexed for MEDLINE]

396: Biochem Cell Biol. 2007 Apr;85(2):157-63.


Cardiovascular diseases in China. Liu L. Clinical Trials and Research Centre, Chinese Hypertension League, Cardiovascular Institute and Fu Wai Hospital (CAMS & PUMC), Beijing, China. [email protected] Statistics from the National Population Census of China revealed a significant increase in the Chinese population, from 590 million in 1953 to 1.26 billion in 2000. The average life expectancy increased to 71.4 years in 2000 compared with the expectancy of 68.6 years a decade before. World Health Organization statistics on the death rate for total cardiovascular disease, coronary heart disease, and stroke in men and women aged 35-74 years revealed discrepancies between rural and urban parts of China. The China Multicenter Collaborative Study of Cardiovascular Epidemiology indicated that cardiovascular disease was the major cause of death for both men and women, with stroke accounting for over 40% of deaths. Ischemia was shown to be the most common subtype of stroke in both sexes. Smoking was an independent risk factor for cardiovascular disease. The

World Health Organization reported that the death rate attributable to tobacco was 6.0% worldwide and 9.2% in China in 1990. The latter is projected to reach 16.6% by 2020. In China, the prevalence of hypertension and diabetes mellitus, the two key risk factors of cardiovascular disease, have also increased significantly in the past 20 years. In addition, elevated blood pressure and plasma cholesterol were two important determinants of increased cardiovascular disease in eastern Asia. These studies indicate that an integrated management of comprehensive risk is urgently required to address China's increasing cardiovascular disease burden. Publication Types:

• Comparative Study • Review


397: Pediatr Int. 2007 Jun;49(3):380-6.


Clinical characteristics and survival of trisomy 13 in a medical center in Taiwan, 1985-2004. Lin HY, Lin SP, Chen YJ, Hsu CH, Kao HA, Chen MR, Hung HY, Ho CS, Chang JH, Huang FY, Tsai TC, Lin DS, Chan WT. Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan. BACKGROUND: This study investigated the survival and natural history of trisomy 13 in a series of patients, comparing the management and outcome before and after the implementation of Taiwan's National Health Insurance program (NHI). METHODS: A total of 28 cases of trisomy 13 seen at Mackay Memorial Hospital, Taipei, Taiwan, from 1985 to 2004 were retrospectively reviewed. Survival and management before (12 cases) and after (16 cases) the implementation of National Health Insurance were compared, and structural defects, imaging findings, and cytogenetic results were analyzed. The cases that were diagnosed prenatally, and finally terminated, were excluded from this study. The diagnosis of trisomy 13 was based on the postnatal chromosome analysis. RESULTS: All patients except one with trisomy 13 translocation died in their first year because of severe malformations of the cardiovascular or central nervous system. The median survival was 9 days. After implementation of National Health

Insurance, survival with trisomy 13 was significantly longer than before (P < 0.05). The three most common structural defects were abnormal auricular helices or low-set ears (89%), cryptorchidism and abnormal scrotum of male (73%) and cleft lip and/or palate (71%). Using echocardiography, the most commonly detected heart defects were patent ductus arteriosus (68%), ventricular septal defect (50%) and atrial septal defect (50%), and eight cases (36%) had complex congenital heart defects. The most common brain lesion was lenticulostriate vasculopathy (22%), followed by holoprosencephaly (17%), brain edema (13%) and subependymal cyst (13%). CONCLUSIONS: Early diagnosis and the survival patterns from the data collected should be used to inform parents and health-care professionals to assist in decision making. Although most patients with trisomy 13 die within the first weeks after birth, it is important to recognize that a few may survive the first year. When counseling families, the long-term survival prospects of trisomy 13 patients should be included. Publication Types:



398: J Altern Complement Med. 2007 May;13(4):461-9.


Promoting lifestyle self-awareness among the medical team by the use of an integrated teaching approach: a primary care experience. Ben-Arye E, Lear A, Hermoni D, Margalit RS. The Complementary and Traditional Medicine Unit, Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Technion-Israel Institute of Technology, Haifa, Israel. [email protected] OBJECTIVES: Healthy lifestyle is recommended in clinical guidelines for the prevention and treatment of chronic diseases such as cardiovascular disease and diabetes. Research previously identified a gap between lifestyle recommendations and their implementation in clinical practice. In this paper, we describe a pilot educational program aimed to promote providers' awareness of their own lifestyles, and to explore whether increased personal awareness enhances providers' willingness to engage in lifestyle-change discussion with patients. METHODS: Two primary-care urban clinics in Northern Israel participated in the program, which consisted of a series of six biweekly educational sessions, each

lasting 2-4 hours. Each session included both knowledge-based and experiential learning based on complementary medicine modalities. Surveys at the end of the program and a year later provided the program evaluation. RESULTS: Thirty-five personnel participated in the program. Thirteen (13) of the 20 participants (65%) reported an attitude change regarding eating habits after the program. At 1-year follow up, 24 of the 27 respondents (89%) stated that they were more aware of their eating habits and of their physical activity compared with precourse status. Twenty-three (23) of 27 respondents (85%) stated that after the program they were better prepared to initiate a conversation with their patients about lifestyle change. CONCLUSIONS: An integrated educational approach based on knowledge-based and complementary and alternative medicine experiential modalities, aimed to facilitate self-awareness, may enhance learners' attitude change. The findings demonstrate readiness of learners to reexamine their lifestyles. Increased self-awareness helped participants to make a positive attitude change regarding eating habits and physical activity and was associated with participants' increased engagement in lifestyle-change discussions with patients. The teaching approach had longstanding effect, noted in the one-year follow-up. PMID: 17532741 [PubMed - indexed for MEDLINE]

399: Soc Work Health Care. 2007;44(1-2):73-90.


An investigation of the practice of unsafe sex yet repeated HIV testing. Patinkin N, Werner B, Yust I, Yagil Y, Drory M, Burke M. Kobler Crusade Center, Clinical Immunology Unit, Tel-Aviv Souransky Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Department of Social Sciences, Israel. [email protected] RATIONALE: A purportedly heterogeneous group of people, who come to take tests at the Human Immunodeficiency Virus (HIV) Test-ing Clinic, includes young males and females who lead a normative lifestyle with no unique characteristics. Within this population, we have observed one distinct subgroup of predominantly male individuals, who return from time to time to take the HIV tests. They tend to partake in many occasional sexual encounters with numerous partners, and despite their obvious knowledge of the risks involved, they attest to not using condoms during sexual intercourse. The aim of this preliminary study was to investigate the patterns of their risky behavior in conjunction with their test taking conduct. METHODS: Ten self-referred volunteering subjects were recruited. Exclusion criteria: HIV-positive, drug and/or alcohol abusers, mentally ill, men who have sex with men (MSM) and minors. The study was carried-out

using semi-structured interviews (40-90 min each). The interviews were recorded, transcribed and content analyzed. FINDINGS: Data analysis showed several possible explanations for risky sexual behavior, such as applying of a variety of risk management mechanisms, refraining from impulse control behaviors, and self-destruction motives. The reasons for undergoing HIV testing were most frequently related to specific events, high-risk in nature, and not part of a routine behavioral practice. CONCLUSIONS: Our findings might suggest that within this population group, the prevailing primary preventive interventions would not satisfy the purpose of decreasing levels and frequency of risk-taking behaviors. In the opinion of the authors, there are two strategies that could be employed, simultaneously or separately. An indirect approach entails the increase and enhancement in utilizing widely spread media, e.g., feature films and television programs, to convey issues related to curbing risk-behavior. Direct emphasis should be put on secondary preventive measures, by encouraging frequent test-taking conduct, preferably accompanied by counseling, in order to decrease the risk of further transmitting the virus. PMID: 17521985 [PubMed - indexed for MEDLINE]

400: Allergol Int. 2007 Sep;56(3):249-55. Epub 2007 Jun 1.


Analysis of perimenstrual asthma based on questionnaire surveys in Japan. Suzuki K, Hasegawa T, Sakagami T, Koya T, Toyabe S, Akazawa K, Arakawa M, Gejyo F, Suzuki E; Niigata Asthma Treatment Study Group. Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. BACKGROUND: Perimenstrual asthma (PMA) has been documented in 30% to 40% of asthmatic women; the characteristics of PMA have also been well described. However, there have been few epidemiological investigations of PMA in practice. In this study, we analyzed PMA based on a questionnaire survey carried out in Japan and compared the results with those of studies reported previously. METHODS: For 8 weeks from September through October 2004, a questionnaire survey was administered to patients with bronchial asthma and their attending physicians. The questionnaire surveyed asthma control, asthma-related emergencies and satisfaction in daily life. The attending physicians were questioned about patient profiles and medications. All female patients who were menstruating during the survey period and who were known to have asthma exacerbation related to menstruation were allocated to the PMA group; those who

were not were allocated to the non-PMA group. RESULTS: The rate of PMA in female patients who were menstruating during the survey period was 11.3% in this study. Characteristic features of the PMA group (n = 54) included more severe disease, worsened disease control and more aggressive patient management, including increased oral corticosteroid use compared with the non-PMA group. The rates of emergency episodes in the PMA group were higher than in the non-PMA group. There was a significant increase in aspirin intolerant asthma (AIA, 25.5%) in the PMA group compared with the non-PMA group (8.4%). CONCLUSIONS: Attention should be paid to the lack of knowledge regarding PMA in patients with asthma in actual clinical settings. The low rate of PMA reported in this study may be due to the study method using self-reports of PMA by patients without sufficient knowledge, and may not be an accurate representation of the actual incidence of the disease. The clinical similarity of PMA to AIA in this study may also provide a new insight into the mechanism of PMA. PMID: 17519579 [PubMed - indexed for MEDLINE]

401: J Telemed Telecare. 2007;13(3):148-53.


Qualitative and quantitative assessment of video transmitted by DVTS (digital video transport system) in surgical telemedicine. Shima Y, Suwa A, Gomi Y, Nogawa H, Nagata H, Tanaka H. Information Center for Medical Sciences, Tokyo Medical and Dental University, Japan. [email protected] Real-time video pictures can be transmitted inexpensively via a broadband connection using the DVTS (digital video transport system). However, the degradation of video pictures transmitted by DVTS has not been sufficiently evaluated. We examined the application of DVTS to remote consultation by using images of laparoscopic and endoscopic surgeries. A subjective assessment by the double stimulus continuous quality scale (DSCQS) method of the transmitted video pictures was carried out by eight doctors. Three of the four video recordings were assessed as being transmitted with no degradation in quality. None of the doctors noticed any degradation in the images due to encryption by the VPN (virtual private network) system. We also used an automatic picture quality assessment system to make an objective assessment of the same images. The objective DSCQS values were similar to the subjective ones. We conclude that although the quality of video pictures transmitted by the DVTS was slightly reduced, they were useful for clinical purposes. Encryption with a VPN did not

degrade image quality. Publication Types:



402: J Clin Nurs. 2007 Jun;16(6):1191-3.


Comment on:

• J Clin Nurs. 2006 Feb;15(2):188-96.

Commentary on Liu JE, Mok E & Wong T (2006). Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China. Journal of Clinical Nursing, 15, 188-196. Chan CL, Leung PP. Department of Social Work and Social Administration and Director, Center on Behavioral Health, The University of Hong Kong, Hong Kong SAR, China. [email protected] Publication Types:

• Comment


403: J Clin Nurs. 2007 Jun;16(6):1173-9.


Effectiveness of hand-washing teaching programs for families of

children in paediatric intensive care units. Chen YC, Chiang LC. Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan. AIMS: The authors developed a video-centred teaching program based on social learning principles to demonstrate hand-washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand-washing skills. BACKGROUND: Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital-acquired infections. A number of studies have shown that increased compliance with hand-washing guidelines for health-care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first. STUDY DESIGN: Quasi-experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention. METHODS: A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups - one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand-washing skills using simple illustrations. A 20-item hand-washing checklist was used to examine hand-washing compliance and accuracy. RESULTS: No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels. CONCLUSION: The video-based teaching program was effective in increasing compliance and accuracy with a hand-washing policy among families with children in intensive care units. RELEVANCE TO CLINICAL PRACTICE: The education program is a simple, low-cost, low technology intervention for substantially reducing the incidence of nosocomial infection. Publication Types:

• Comparative Study • Randomized Controlled Trial • Research Support, Non-U.S. Gov't


404: J Clin Nurs. 2007 Jun;16(6):1141-50.


The comparison of effectiveness of two modalities of mental health nurse follow-up programmes for female outpatients with depression in Taipei, Taiwan. Hsiao FH, Yang TT, Chen CC, Tsai SY, Wang KC, Lai YM, Tsai CJ, Chang WY. College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan. [email protected] AIMS AND OBJECTIVES: This study compares the effectiveness of two modalities of mental health nurse three-month follow-up programmes: telephone counselling programme and group therapy programme for female outpatients with depression. BACKGROUND: The lifetime prevalence of major depression is 15% and is about twice as common in women as in men. Outpatients with depression often discontinue their treatment after the initial visits to their physicians. METHODS: This study used a quasi-experimental, pre-post-test comparison group design. Twenty-six female outpatients with depression were assigned to one of follow-up programmes: telephone counselling programme or group therapy programme. To qualify for group therapy programme, potential participants were required to come to group sessions weekly. To be accepted into telephone counselling programme, potential participants had to be able to be contacted by phone regularly. Mental health nurse three-month follow-up programmes included care management and structured psychotherapy. Patients in telephone counselling programme received 10 regular telephone calls of 30-60 minutes each. Patients in group therapy programme received 12 sessions of weekly group meetings of 90-120 minutes each. RESULTS: Wilcoxon signed ranks tests provided evidence that the group therapy programme (S = -52.5, p < 0.001; S = 31.5, p = 0.046) and telephone counselling programme (S = -36, p = 0.002; S = 25, p = 0.050) follow-up programmes were effective in terms of relieving depressed symptoms and improving quality of life. According to Quade's analysis of covariance, telephone counselling programme and group therapy programme appeared to have similar effects of relieving depressed symptoms (F(1,24) = 0.06, p = 0.813) and increasing quality of life (F(1,24) = 0.07, p = 0.792). While there was no significant difference in using emergency services ( chi(2)(1)= 0.89, p = 0.539) between telephone counselling programme and group therapy programme, the rate of adherence to scheduled outpatient appointments with psychiatrists was higher among patients in group therapy programme than patients in telephone counselling programme (chi(2)(3) = 8.67, p = 0.034). CONCLUSIONS: Establishing two modalities of mental health nurse follow-up programmes in Taiwan could benefit patients with different needs. RELEVANCE TO CLINICAL PRACTICE: Mental health nurses specialized in management of depression could provide not only care management but also structured psychotherapy.

Publication Types:

• Clinical Trial, Phase I • Comparative Study • Research Support, Non-U.S. Gov't


405: J Clin Nurs. 2007 Jun;16(6):1118-24.


Patients' experiences at home after day case cystoscopy. Erkal S. Ankara University, Cebeci School of Health, Ankara, Turkey. [email protected] AIM: To determine patients' problems with day case cystoscopy and their problem solving ways and patients' self-care at home. BACKGROUND: Day surgery has become increasingly common in the last 20 years. Cystoscopic procedures are increasingly being carried out as a diagnostic and therapeutic procedures. DESIGN AND METHOD: This descriptive/prospective study comprised 50 patients undergoing day case cystoscopic procedures in the university hospital of Turkey. The data were collected using telephone interview three days after the procedure. The two questionnaire used were Symptom Measurement Questionnaire and Symptom Management Questionnaire. Discharge information and written instruction was given to all patients. RESULTS: It was found in the investigation that the most common problems experienced by the patients were tiredness, haematuria, dysuria, pain over bladder and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary elimination problems were experienced by majority of the patients. At second day, these problems were also common. The mean score for all problems decreased after three days. The patients stated that they were able to deal with their symptoms either independently or to a lesser extent with assistance of a carer. But they were unable to deal with problems such as especially haematuria. CONCLUSION: Problems experiences by the patients at home after cystoscopy influenced some daily living activities. The problems related to voiding are more frequently observed after cystoscopy. Although some these problems are related to the procedures, some were present previously. RELEVANCE TO CLINICAL PRACTICE: This findings indicate that patient-centred care should be

strengthened at home in urological day surgery. PMID: 17518886 [PubMed - indexed for MEDLINE]

406: Lepr Rev. 2007 Mar;78(1):38-9.


Leprosy free India: clinical perspectives and challenges ahead. Kar HK. Department of Dermatology, Leprosy and STD, Dr R. M. L. Hospital, New Delhi 110001, India. [email protected] Publication Types:

• Letter


407: Disaster Manag Response. 2007 Apr-Jun;5(2):36-44.


Comment in:

• Disaster Manag Response. 2007 Apr-Jun;5(2):25-6.

Emergency department staff preparedness for mass casualty events involving children. Rassin M, Avraham M, Nasi-Bashari A, Idelman S, Peretz Y, Morag S, Silner D, Weiss G. Nursing Research Unit, Assaf Harofeh Medical Center, Zrifine, Bear Yaakov 70300, Israel. [email protected] BACKGROUND: In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces

hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. OBJECTIVES: The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. METHOD: The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. RESULTS: The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. IMPLICATIONS: On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region. Publication Types:



408: J Healthc Qual. 2005 Sep-Oct;27(5):28-33.


A computerized surveillance system for the quality of care in childhood asthma. Peled R, Tal A, Pliskin JS, Reuveni H. Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. [email protected] This article describes the development of a novel model for quality assurance of pediatric asthma using administrative data and clinical guidelines. Children for whom drugs for asthma were dispensed during 1998 were recruited from the

drug-dispensing registry of the largest health maintenance organization in the southern region of Israel. The Israeli clinical guidelines were translated into a list of six markers for inadequate treatment. This list was used for a computerized search in the drug registry, and cases with markers were noted as cases in which inappropriate treatment was provided. The model was validated by proving that there was an association between inappropriate treatment (markers) and bad outcomes (emergency room visits, hospitalizations, and healthcare utilization). This model creates an interface between administrative and clinical information and provides an easy-to-use tool for quality assurance. Publication Types:



409: Anadolu Kardiyol Derg. 2007 Jun;7(2):124-7.


Comparison of traditional risk factors, natural history and angiographic findings between coronary heart disease patients with age <40 and >or=40 years old. Yildirim N, Arat N, Doğan MS, Sökmen Y, Ozcan F. Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey. [email protected] OBJECTIVE: In this study we aimed to examine the angiographic findings, traditional risk factors and natural history of Turkish patients <40 and >or=40 years old with coronary heart disease (CHD). METHODS: The records of 491 patients with stable angina pectoris or acute coronary syndrome (ACS), who had undergone coronary angiography (CAG) were reviewed. The patients <40 years (group 1) and >or=40 years (group 2) were compared. RESULTS: The study population was classified as group 1 with 240 patients (mean age 35.7+/-3.4 years) and group 2 with 251 patients (mean age 61.0+/-9.7 years). Smoking, family history, hypercholesterolemia, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol were more prevalent in group 1 while diabetes mellitus, hypertension was higher in group 2. The common presentation among <40 years patients was ACS whereas stable angina was the most common presentation in patients >or=40 years old. Patients in group 1 showed a preponderance of single-vessel disease whereas patients of group 2 showed

dominance of multivessel disease. Early clinical course of patients with ACS in group 1 was better than in group 2. CONCLUSION: Our study shows a significantly different clinical, angiographic and biochemical profile in <40 years patients with CHD compared with >or=40 years patients. Dominance of smoking and dyslipidemias that are the preventable risk factors in premature CHD patients is an important threat for our community health. Healthy life styles should be encouraged beginning from young ages and new precautions about smoking must be taken. Publication Types:



410: Nurse Educ Today. 2008 Jan;28(1):48-54. Epub 2007 May 18.


Understanding the persona of clinical instructors: the use of students' doodles in nursing research. de Guzman A, Pablo LA, Prieto RJ, Purificacion VN, Que JJ, Quia P. College of Nursing, University of Santo Tomas, Manila 1015, Philippines. [email protected] BACKGROUND: While it is true that understanding the attributes and unique distinction of the nursing faculty has been the subject of most of the studies, little is known about how the use of doodles can help surface the persona of the clinical instructors. OBJECTIVE: This study aims to capture the essence or the lebenswelt of the concept of "clinical instructor" from the lens of students' doodles which have been considered as a powerful qualitative tool in articulating individual experiences. METHOD: A total of 195 senior nursing students recruited from a comprehensive university in the Philippines were the subjects in this qualitative study. Data were gathered from self-generated illustrations and written explanations made by the subjects to identify their concept of effective and ineffective clinical instructors. Phenomenological reduction was observed through a repertory grid, where doodles drawn were listed, categorized and thematised to reveal the qualities of the clinical instructor. CONCLUSIONS: The subjective nature of the findings, though not generalizable, has surfaced how doodling can be a potent tool in identifying collective interpretation of the essence of health professions construct such as the one under study. The doodles revealed that an effective clinical instructor (enlightening, engaging and embracing) is one who is

able to facilitate the learning of the students as well as being able to establish a harmonious learning atmosphere for and with the students. On the other hand, an ineffective clinical instructor (detrimental, dangling, and disturbing) impedes students' development in the clinical practice by causing conflict through their personal attitudes and their teaching strategies. This can have benefits for clinical instructors, to improve themselves and realize the impact of their attributes to the clinical learning of students. PMID: 17512640 [PubMed - indexed for MEDLINE]

411: J Infect. 2007 Jul;55(1):41-8. Epub 2007 May 18.


Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance. Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke C, Ulusoy S. Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bornova, Izmir, Turkey. OBJECTIVES: In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods. METHODS AND RESULTS: Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p<0.05). When all microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p<0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p<0.05). CONCLUSION: Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance. PMID: 17512598 [PubMed - indexed for MEDLINE]

412: Int J Nurs Stud. 2008 Jan;45(1):14-23. Epub 2007 May 18.


Effects of a breastfeeding empowerment programme on Korean breastfeeding mothers: a quasi-experimental study. Kang JS, Choi SY, Ryu EJ. Department of Nursing, Gyeong-Sang Hosipital, 92, Chilam-dong, Chinju 660-751, Republic of Korea. OBJECTIVES: This quasi-experimental study examined the effects of a new breastfeeding empowerment programme provided to post-partum mothers within 3 days of entering post-partum care centres on their breastfeeding empowerment, problems and practice rate. METHOD: The study employed a non-equivalent control group non-synchronized design. Participants who conformed with the selection criteria were selected from two post-partum care centres affiliated with hospitals in a city in South Korea. Each of the two study groups included 30 participants. The breastfeeding empowerment programme comprised four 60-minute sessions, and was applied for 4 weeks to mothers in the experimental group. RESULTS: The breastfeeding empowerment scores were higher in the experimental group than in the control group (p=0.007), and there were fewer breastfeeding problems in the former group (p=0.012) and the breastfeeding rates were higher in the former group (p=0.017, 0.002 and 0.002 at 4, 8 and 12 weeks post-partum, respectively). CONCLUSIONS: These results indicate that the provision of breastfeeding empowerment programmes to help mothers to identify and solve problems by themselves can improve breastfeeding empowerment, problem and practice rates, and hence should be considered useful as a post-partum nursing intervention in clinical settings. The effectiveness of the various components of the breastfeeding empowerment programme developed in this study should be verified in field trials. Publication Types:

• Controlled Clinical Trial • Multicenter Study


413: Reprod Health Matters. 2007 May;15(29):172-82.


Situation analysis of quality of abortion care in the main maternity hospital in Hai Phòng, Viet Nam. Nguyen MH, Gammeltoft T, Rasch V. Scientific Institute for Population, Family and Children, Viet Nam Commission of Population, Family and Children, Hanoi, Viet Nam. Six months after a Comprehensive Abortion Care project was implemented in Phu-San Hospital, the main maternity hospital in Hai Phòng, northern Viet Nam, a study of quality of abortion services was carried out. The study explored the interaction between providers and women seeking abortion and how cultural values influenced quality of care. A quantitative and qualitative approach was employed: a three-part structured survey with 748 women before and after they had an abortion, 20 in-depth interviews with women just after abortion, seven informal interviews with health care staff and 100 participant observations. Both the women and the staff equated quality of care mainly with improved technical performance of abortion. Insufficient knowledge and skills had a negative impact on provision of information and good quality counselling in relation to understanding and uptake of contraception, treating reproductive tract infection and preventing post-abortion infection. To further improve abortion care in hospitals such as Phu-San, training programmes are needed that integrate counselling and clinical skills and address the cultural factors that hinder health staff and women from interacting in an equitable manner. A supportive supervisory system that holds health staff accountable for conducting high quality information and counselling sessions should also be established. PMID: 17512388 [PubMed - indexed for MEDLINE]

414: BMC Public Health. 2007 May 18;7(147):84.


Costs of a successful public-private partnership for TB control in an urban setting in Nepal. Karki DK, Mirzoev TN, Green AT, Newell JN, Baral SC. Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences and Public Health Research, University of Leeds, Leeds, UK. [email protected] <[email protected]>

BACKGROUND: In South Asia a large number of patients seek treatment for TB from private practitioners (PPs), and there is increasing international interest in involving PPs in TB control. To evaluate the feasibility, effectiveness and costs of public-private partnerships (PPPs) for TB control, a PPP was developed in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. From the clinical perspective the PPP was shown to be effective. The aim of this paper is to assess and report on the costs involved in the PPP scheme. METHODS: The approach to costing took a comprehensive view, with inclusion of costs not only incurred by health facilities but also social costs borne by patients and their escorts. Semi-structured questionnaires and guided interviews were used to collect start-up and recurrent costs for the scheme. RESULTS: Overall costs for treating a TB patient under the PPP scheme averaged US$89.60. Start-up costs per patient represented 12% of the total budget. Half of recurrent costs were incurred by patients and their escorts, with institutional costs representing most of the rest. Female patients tended to spend more and patients referred from the private sector had the highest reported costs. CONCLUSION: Treating TB patients in the PPP scheme had a low additional cost, while doubling the case notification rate and maintaining a high success rate. Costs incurred by patients and their escorts were the largest contributors to the overall total. This suggests a focus for follow-up studies and for cost-minimisation strategies. Publication Types:



PMCID: PMC1888703

415: Quintessence Int. 2007 Mar;38(3):e143-50.


Satisfaction with oral status among adult school-attending Saudi women with and without posterior fixed partial dentures. Omar R, Al-Boaijan E, Al-Twaijri S, Akeel R. Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait. [email protected]

To conduct a preliminary investigation of the relationship between patient satisfaction with oral status and the presence of posterior fixed partial dentures (FPD). METHOD AND MATERIALS: A total of 150 women with intact anterior dental segments, randomly drawn from women's schools for adult education, participated (mean age, 33.8 years; SD, 10.4; range, 20 to 63 years). Each woman was assisted in completing a questionnaire on aspects of her oral health beliefs and satisfaction with oral function, and underwent an on-site clinical examination. Subjects were categorized according to general prosthodontic status: those with missing posterior teeth and no FPDs (MN), those with FPDs (PR), and those who were fully dentate (FD). Their responses to the questionnaire were compared. RESULTS: Value placed on oral health did not differ among the groups. Satisfaction with overall oral status, chewing function, and appearance did not differ between MN and PR, although overall satisfaction and appearance were each significantly greater in FD than in MN (P <.001 and P <.05, respectively). Overall satisfaction was negatively correlated with the mean number of missing teeth (P <.01), although perception of chewing ability did not differ among the groups, nor did it differ in relation to the number of posterior occluding pairs of teeth. CONCLUSIONS: The hypothesis that individuals with fixed prosthodontic replacements of their missing posterior teeth are more satisfied with their oral status than those without such replacements was not confirmed, while the question of the importance of patient satisfaction as a positive outcome of oral health care is raised. PMID: 17510723 [PubMed - indexed for MEDLINE]

416: Ann Emerg Med. 2007 Dec;50(6):635-42. Epub 2007 May 23.


Comment in:

• Ann Emerg Med. 2007 Dec;50(6):643-4.

Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest. Ong ME, Tan EH, Ng FS, Panchalingham A, Lim SH, Manning PG, Ong VY, Lim SH, Yap S, Tham LP, Ng KS, Venkataraman A; Cardiac Arrest and Resuscitation Epidemiology Study Group. Department of Emergency Medicine, Singapore General Hospital, Singapore City, Singapore. [email protected] STUDY OBJECTIVE: The benefit of epinephrine in cardiac arrest is

controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) system that previously did not use intravenous medications. METHODS: This observational, prospective, before-after clinical study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology project. Included were all patients who are older than 8 years, with nontraumatic out-of-hospital cardiac arrest conveyed by the national emergency ambulance service. The comparison between the 2 intervention groups for survival to discharge was made with logistic regression and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). RESULTS: From October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into the study, with 615 in the pre-epinephrine and 681 in the epinephrine phase. Demographic and EMS characteristics were similar in both groups. Forty-four percent of patients received intravenous epinephrine in the epinephrine phase. There was no significant difference in survival to discharge (pre-epinephrine 1.0%; epinephrine 1.6%; OR 1.7 [95% CI 0.6 to 4.5]; adjusted for rhythm OR 2.0 [95% CI 0.7 to 5.5]); return of circulation (pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9 [95% CI 0.6 to 1.2]), or survival to admission (pre-epinephrine 7.5%; epinephrine 7.5%; OR 1.0 [95% CI 0.7 to 1.5]). There was a minimal increase in scene time in the epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference 0.02 to 0.94 minutes). CONCLUSION: We were unable to establish a significant survival benefit with the introduction of intravenous epinephrine to an EMS system. More research is needed to determine the effectiveness of drugs such as epinephrine in resuscitation. Publication Types:

• Clinical Trial, Phase II • Comparative Study • Research Support, Non-U.S. Gov't


417: Lancet Neurol. 2007 Jun;6(6):533-43.


Erratum in:

• Lancet Neurol. 2007 Dec;6(12):1037.

Epidemiology, aetiology, and clinical management of epilepsy in

Asia: a systematic review. Mac TL, Tran DS, Quet F, Odermatt P, Preux PM, Tan CT. Institute of Neurological Epidemiology and Tropical Neurology, Limoges, France. Epilepsy is a significant, but often underappreciated, health problem in Asia. Here, we systematically review the literature on epidemiology, aetiology, and management of epilepsy in 23 Asian countries. Prevalence estimates are available for only 11 countries from door-to-door surveys and are generally low. Figures for annual incidence in China and India are similar to those in the USA and Europe but lower than those reported from Africa and Latin America. There is a peak in incidence and prevalence in childhood, but a second peak in elderly people, as seen in developed countries, has not been documented. The main causes are head injuries, cerebrovascular disease, CNS infections, and birth trauma. Availability of epilepsy care depends largely on economic factors. Imaging and neurophysiological facilities are available in most countries, but often only in urban centres. Costly drugs, a large treatment gap, limited epilepsy surgery, and negative public attitude to epilepsy are other notable features of management in Asia. An understanding of the psychosocial, cultural, economic, organisational, and political factors influencing epilepsy causation, management, and outcome should be of high priority for future investigations. Publication Types:

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


418: Aust N Z J Psychiatry. 2007 Jun;41(6):495-500.


Diagnostic stability 2 years after treatment initiation in the early psychosis intervention programme in Singapore. Subramaniam M, Pek E, Verma S, Chan YH, Chong SA. Institute of Mental Health, 10 Buangkok View, Singapore. OBJECTIVE: To evaluate the diagnostic stability of psychotic disorders over a 2

year period in patients presenting with first-episode psychosis. METHODS: One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. RESULTS: The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. CONCLUSION: It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized. Publication Types:



419: Sex Transm Dis. 2007 Oct;34(10):791-5.


Reproductive tract infections among women attending a gynecology outpatient department in Vientiane, Lao PDR. Sihavong A, Phouthavane T, Lundborg CS, Sayabounthavong K, Syhakhang L, Wahlström R. Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. [email protected] OBJECTIVES AND GOAL: To clinically and microbiologically identify reproductive tract infections (RTI), including sexually transmitted infections (STI), and to monitor the antibiotic susceptibility of Neisseria gonorrhoeae among women attending a gynecology outpatient department in Vientiane, Laos. STUDY DESIGN: Clinical and laboratory-based cross-sectional study. Women aged 15 to 49 years underwent a pelvic examination, and specimens were taken for laboratory testing. RESULTS: Of 1125 study participants, 82% clinically

presented with an RTI syndrome. However, only 64% had an etiologically diagnosed RTI, including 11% with an STI. Endogenous infections were most prevalent (candidiasis 40%; bacterial vaginosis 25%), followed by STI [Chlamydia trachomatis 4.1%; N. gonorrhoeae (NG) and Trichomonas vaginalis, both 3.7%]. The 41 NG isolates showed 20% resistance to ciprofloxacin, 98% to penicillin, and complete to tetracycline. CONCLUSIONS: High RTI/STI level combined with high NG resistance emphasizes that concurrent with syndromic case management, periodic evaluations of etiological diagnosis should be available to ensure adequacy of treatment algorithms and prescribed medications. Publication Types:



420: J Clin Virol. 2007 Jun;39(2):76-81. Epub 2007 May 15.


The differences of clinical manifestations and laboratory findings in children and adults with dengue virus infection. Kittigul L, Pitakarnjanakul P, Sujirarat D, Siripanichgon K. Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand. [email protected] BACKGROUND: Dengue haemorrhagic fever is an important public health problem and mainly occurs in children less than 15 years of age. Recently, the incidence of the disease have increased in adults but data on clinical and laboratory presentations of those affected are limited. OBJECTIVES: To assess and compare clinical manifestations and laboratory findings of dengue virus infected children and adults in Thailand. STUDY DESIGN: A 1-year study was conducted from September 2003 to August 2004 for dengue virus infected patients admitted to Phetchabun Provincial Hospital, Thailand. Physical signs, symptoms, and laboratory features were recorded. All dengue patients were confirmed using immunochromatographic test on convalescent sera. RESULTS: Based on serology-confirmed dengue virus infection, there was 286 dengue patients including 15 (5.3%) dengue fever and 271 (94.7%) dengue haemorrhagic fever (DHF). Among DHF cases, clinical classifications were DHF I, 40.9%; DHF II, 43%; and DHF III or dengue shock syndrome (DSS), 10.8%. Of all dengue patients, 231 cases (80.8%) were children aged less than 15 years and 55 cases (19.2%) were adults. The highest proportion of child cases was DHF I

(42.9%), whereas that of adults was DHF II (51%). Some clinical manifestations were more common in adult patients, such as petechiae, melena, headache, retro-orbital pain, joint pain, myalgia, nausea and vomiting (p-value<0.05). Signs found commonly in children were epistaxis, oliguria, and liver enlargement (p-value<0.05). Haemoconcentration, thrombocytopenia, increased alanine aminotransferase, and longer prothrombin time were found to be significantly higher in adults than in children (p-value<0.05). CONCLUSIONS: Some clinical presentations of dengue disease and laboratory findings in adults are different from those in children. Therefore, adults as well as pediatric cases of DHF need appropriate and prompt case management to reduce the mortality rate of DHF. Publication Types:



421: Medicine (Baltimore). 2007 May;86(3):138-44.


Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients. Lee CC, Chen SY, Chang IJ, Chen SC, Wu SC. Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan. [email protected] Valid studies comparing the clinical characteristics among adult, elderly, and the oldest old bacteremic patients are lacking. We conducted a prospective, observational study in the emergency department (ED) of a university medical center between June 2001 and June 2002. All patients >18 years of age who registered in the ED with a clinically significant, culture-positive, bloodstream infection (BSI) were enrolled. Patients were divided into 3 groups based on age: 1) oldest old (> or =85 yr), 2) elderly (65-84 yr), and 3) adult (18-64 yr). The clinical and laboratory manifestations and 30-day mortality were recorded. Group comparisons were performed using the chi-square test or analysis of variance (ANOVA) test, as indicated. Survival was analyzed using the Kaplan-Meier method and the Cox-regression model, adjusted for potential confounders.A total of 890 cases of community-acquired BSI were eligible for analysis. Compared to the adult group, both the elderly and the oldest old patients had more atypical clinical manifestations, a higher propensity to develop organ failure, and a worse

prognosis. Elderly patients had significantly less tachycardia (p = 0.001), but more acute respiratory (p = 0.007) and renal failure (p = 0.037); the oldest old patients had more afebrile episodes (p = 0.006), leukocytosis (p = 0.012), and more patients developed respiratory failure (p = 0.009), acute renal failure (p = 0.011), septic shock (p = 0.022), and altered mental status (p = 0.013). Urinary tract infections were the main source of BSI for both the elderly and oldest old, while the oldest old patients had significantly more pneumonia than the elderly or adults.As a group, older patients had fewer signs and symptoms of BSI, but a higher risk of organ failure and a worse prognosis than younger patients. Publication Types:



422: Br J Gen Pract. 2007 May;57(538):377-82.


Comment in:

• Br J Gen Pract. 2007 May;57(538):350-1.

Effect of the characteristics of family physicians on their utilisation of laboratory tests. Vinker S, Kvint I, Erez R, Elhayany A, Kahan E. Department of Family Medicine, Tel Aviv University, Israel. [email protected] BACKGROUND: The use of laboratory tests by family physicians has increased in recent years. AIMS: To evaluate the relationship between family physicians' characteristics and the number and type of laboratory tests requested, taking into account chronic diseases. DESIGN OF STUDY: Retrospective, cross-sectional study. SETTING: One hundred and sixty-two physicians treating 230 123 patients in one district of a health management organisation in Israel. METHOD: Physicians' use of 16 common types of laboratory tests was assessed in relation to physicians' demographic, professional, and clinic characteristics. The utilisation rate over 1 year was divided into quintiles for each laboratory test, and each physician was given a global laboratory score (for each test the physician got a

score from 1 (utilisation in the lower quintile) to 5 (higher quintile). The global score was the sum of scores of the individual tests. RESULTS: On logistic regression analysis, four background characteristics were associated with the global score for the utilisation of laboratory tests. The highest hazard ratios were for being a female doctor (3.2, 95% confidence interval [CI] = 1.5 to 6.5), working in an urban clinic (3.2, 95% CI = 1.1 to 9.8), and having a greater workload than doctors in rural clinics (1.4, 95% CI = 1.1 to 1.8). Being a graduate of a Western country or Israel had a negative association with the global score (0.4, 95% CI = 0.1 to 0.99). CONCLUSION: Female sex and working in a urban clinic were major factors in the use of laboratory tests in clinical practice. As more women enter the medical profession, an improved understanding of the sex differences in ordering medical tests is important. Publication Types:



PMCID: PMC2047012

423: J Am Med Dir Assoc. 2007 May;8(4):233-42.


Predictors of rehabilitation outcomes: a comparison of Israeli and Italian geriatric post-acute care (PAC) facilities using the minimum data set (MDS). Gindin J, Walter-Ginzburg A, Geitzen M, Epstein S, Levi S, Landi F, Bernabei R. Geriatric Institute for Education and Research, Kaplan Medical Center, Rehovot, Israel. OBJECTIVES: To understand the relative contribution of sociodemographic, clinical, and health care features to rehabilitation outcomes in Israel and in Italy in post-acute care (PAC) facilities. DESIGN: Prospective cross-national study SETTING: Two hospital geriatric PAC departments: Harzfeld Geriatric Hospital, Gedera, Israel, and Catholic University of Sacred Heart Geriatric Hospital, Rome, Italy. PARTICIPANTS: Post-acute care patients aged 65 and older admitted consecutively for stabilization, improvement, or rehabilitation to 3 departments in

Harzfeld Geriatric Hospital, Gedera, Israel from April, 1999 through February, 2002 (N = 364), and to the post-acute Geriatric Rehabilitation Unit of the "A. Gemelli" Hospital, Catholic University of Sacred Heart, Rome, Italy, between February, 1999, and April, 2002 (N = 351), for whom there were complete assessments at admission and discharge (the total number admitted in Israel was 505, and in Italy, 409). MEASUREMENTS: Minimum Data Set for Post-Acute Care (MDS-PAC) assessments conducted within 4 days of admission and at discharge; data collected identically in both sites. Predictors of functional recovery> were identified using multivariate binary logistic regression. The dependent variable: improvement of 1 or more points in the ADL scale. RESULTS: The staffing pattern of the PAC department in Italy had about double the physicians and physio- and occupational therapists than in Israel, but about the same number of nurses and somewhat fewer aides than in Israel. Multivariate binary logistic regression that includes country, age, sex, and marital status, found that the patients in Italy had about triple the probability of improvement in ADL function (OR 3.3, CI 2.4-4.6) (P < .001) than PAC patients in Israel. Even after health system characteristics were added to the model, ADL improvement was most significantly associated with higher cognitive ability and a diagnosis of hip fracture, as well as longer length of stay and being admitted to PAC directly from an acute hospital. For each additional point (worse cognition) in a cognitive scale, there was a 30% decrease in the probability of ADL improvement (OR 0.7, CI 0.6-0.8, P < .001). Those who had a stroke were about half as likely to show ADL improvement (OR 0.5, CI 0.3-0.7) than those without stroke, but those with a hip fracture had more than double the probability of ADL improvement (OR 2.7, CI 1.7-4.2) than those without hip fracture. Those who stayed in the PAC ward an additional block of time had a 30% higher probability of ADL improvement (P < .1), and those who were admitted directly to PAC from an acute hospital had more than 4 times the probability of ADL improvement (OR 4.1, CI 2.3-7.0, P < .001) than those who were admitted from a private home. CONCLUSIONS: We found support for the hypothesis that differences in sociodemographic and clinical factors cannot account for all differences in ADL improvement, and that the organization of care and constraints of the health system also influence functional outcomes. Policymakers should examine the policy-amenable features of the Italian and Israeli systems so that optimal ADL recovery can be encouraged. Any reduction in disability will help both patients and the health care system; slightly higher short-term PAC treatment costs may have large long-term future benefits, if they result in the reduction of ADL disability. This study is one of the first to examine outcomes of PAC in 2 countries, and can provide an initial assessment of how rehabilitation can be enhanced or limited by health policies and staffing patterns. Publication Types:



424: Nurs Res. 2007 May-Jun;56(3):202-9.


Evaluation of an integrated communication skills training program for nurses in cancer care in Beijing, China. Liu JE, Mok E, Wong T, Xue L, Xu B. School of Nursing, Capital Medical University, Beijing, China. [email protected] BACKGROUND: Nurses have considerable needs for communication skills training in cancer care because of the general lack of education and training on oncology-specific communication skills in Mainland China. OBJECTIVES: To evaluate the effectiveness of an integrated communication skills training program, in which an intensive learning session was combined with practice in the clinical unit to create a supportive ward atmosphere where nurses could practice skills in the workplace and obtain support of head nurses. METHODS: To implement the communication skills training for 129 nurses, a quasi-experimental research design with a nonequivalent control group was used. Measures, including basic communication skills, self-efficacy in oncology-specific communication skills, communication outcome expectancies, and self-perceived support for communication, were administered at pretraining evaluation, formative evaluation (1 month after training), and summative evaluation (6 months after training) in the training group. Formative evaluation was not administered in the control group. RESULTS: There was continued significant improvement in the overall basic communication skills, self-efficacy, outcome expectancy beliefs, and perceived support in the training group. No significant improvement was found in the control group over the same period. DISCUSSION: Nurses' communication skills could be developed and consolidated under the integrated communication skills training model. Development of effective interventions to change nurses' negative outcome expectancies in communication with cancer patients is needed in further study. Publication Types:

• Randomized Controlled Trial • Research Support, Non-U.S. Gov't


425: Avian Dis. 2007 Mar;51(1 Suppl):501-3.


EFSA scientific risk assessment on animal health and welfare aspects of avian influenza (EFSA-Q-2004-075). Serratosa J, Ribó O, Correia S, Pittman M. Animal Health and Animal Welfare Unit, European Food Safety Authority, Largo Palli Natale S/A, 43100 Parma, Italy. Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds culled or dead. The circulation of H5N1 in Asia could represent the origin of a human pandemic. Questions have been raised to combat the ongoing AI crisis. HPAI H5N1 has spilled over to resident and migratory wild bird populations which could represent a means of the virus reaching the EU, but lack of data make any forecast imprudent. Poultry holdings located close to migratory bird breeding and resting sites are considered at greater risk of exposure and methods to prevent exposure should be implemented. Legal safeguards for importation of poultry commodities currently only apply to HPAI and rely on detection of clinical signs that may not be observable during incubation period. Illegal imports represent an additional risk. Insufficient data on the effectiveness of commodity processing are available and few indications can be deducted. Biosecurity is the primary tool to prevent AI introduction and secondary spread. Massive spread was observed in densely populated poultry areas resulting in vaccination programs. Vaccination should be used to support eradication together with enhanced biosecurity and restriction measures, which shall also be implemented in case of prophylactic vaccination. Animal welfare aspects of AI include use of appropriate culling methods, correct vaccine application, and availability of trained staff. EFSA has recently set up a new scientific work group to further assess the risk of HPAI introduction and spread posed in particular by wild, migratory birds, as well as further follow-up of recent AI developments. PMID: 17494619 [PubMed - indexed for MEDLINE]

426: Nurse Res. 2007;14(3):46-59.


Lost in translation? Undertaking transcultural qualitative research. Irvine FE, Lloyd D, Jones PR, Allsup DM, Kakehashi C, Ogi A, Okuyama

M. School of Nursing, Midwifery and Health Studies, University of Wales, Bangor. If nurses are to undertake rigorous transcultural research, they must take account of the cultural and linguistic diversity of the countries in which they propose to complete their work. Fiona Elizabeth Irvine and colleagues describe the experiences of researchers undertaking the qualitative phase of a study of Japanese and UK nurse educators, and consider the measures that can be taken to enhance the rigour of transcultural research. Publication Types:



427: Int Nurs Rev. 2007 Jun;54(2):179-82.


A nursing tool validated as an effective measure over MMSE and FAB in dementia. Yamashita M, Kubota T, Fuchita E, Yokoyama K, Hayashi H, Okamoto S, Sano E, Matsuo A, Shimasue N, Watanabe T, Kawashima R, Sugimoto K. Department of Nursing, School of Health Sciences, Saitama Prefectural University, Saitama, Japan. [email protected] AIM: To evaluate the clinical use of the Abilities Assessment Instrument (AAI) when used together with Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB), thus examining the concurrent validity of the instrument. Also, to evaluate the effect of a learning program administered for elders with dementia. METHODS: Fourteen older people, who were afflicted with Alzheimer's disease or related dementias, were invited into a learning program. Measures were taken at baseline, at 3 months and 6 months to see the effects of the program. Instruments used in the study were the AAI, the MMSE and the FAB. FINDINGS: There were statistically significant differences measured by the Japanese version of the AAI in the subjects' abilities to perform the learning tasks between 3 and 6 months after intervention. No statistical significant differences were noted at any points in time measured by the MMSE or the FAB.

CONCLUSION: The translated AAI promises to be a valid instrument for nurses' use in their day-to-day assessment of Japanese elders. The AAI appears also to be useful in learning programs with this population, and may have value as a screening tool. Publication Types:

• Comparative Study • Research Support, Non-U.S. Gov't • Validation Studies


428: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2007 Feb;15(1):184-7.


[Research on Zhejiang blood information network and management system] [Article in Chinese] Yan LX, Xu Y, Meng ZH, Kong CH, Wang JM, Jin ZL, Wu SD, Chen CS, Luo LF. Blood center of Zhejiang Province, Key Laboratory of Blood Safety Ministry of Health, Hangzhou 310006, China. This research was aimed to develop the first level blood information centralized database and real time communication network at a province area in China. Multiple technology like local area network database separate operation, real time data concentration and distribution mechanism, allopatric backup, and optical fiber virtual private network (VPN) were used. As a result, the blood information centralized database and management system were successfully constructed, which covers all the Zhejiang province, and the real time exchange of blood data was realised. In conclusion, its implementation promote volunteer blood donation and ensure the blood safety in Zhejiang, especially strengthen the quick response to public health emergency. This project lays the first stone of centralized test and allotment among blood banks in Zhejiang, and can serve as a reference of contemporary blood bank information systems in China. Publication Types:



429: Ind Health. 2007 Apr;45(2):232-6.


The effectiveness of an education program on stages of smoking behavior for workers at a factory in Turkey. Gunes G, Ilgar M, Karaoglu L. Department of Public Health, Inonu University Medical School, Malatya, Turkey. The aim of the study was to determine the smoking behavior based on "stages of change" model of the workers and to assess the effectiveness of a education program at a workplace. The first step was descriptive and the second step was an experimental study. The intervention group received an smoking cessation education. Before intervention 36% of the intervention group were at precontemplation stage. Six months after the intervention decline the percentage of those at precontemplation stage was significantly lower. In the control group there was not a significant reduction in the percentages of smokers at precontemplation stage before and after the intervention. After the 6 months the "maintenance" stage rates were 6% and 2% in the intervention and control groups, respectively. The study showed that the education in factory for workers could not be successful in quiting, however it impacted the intention and preparation of to quit in the future. Publication Types:

• Clinical Trial


430: Mil Med. 2007 Apr;172(4):431-5.


Effect of a computerized online grading system on patient satisfaction in a military primary health care setting. Levy G, Goldstein L, Barenboim E, Bar-Dayan Y.

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

• Clinical Trial


431: Ann Acad Med Singapore. 2007 Apr;36(4):233-8.


Extracranial non-vestibular head and neck schwannomas: a ten-year experience. Kang GC, Soo KC, Lim DT. Department of General Surgery, Singapore General Hospital, Singapore. INTRODUCTION: We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome. MATERIALS AND METHODS: Clinical records of all patients with head and neck schwannomas treated at our department from

April 1995 to July 2005 were retrospectively reviewed. RESULTS: There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred. CONCLUSION: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment. PMID: 17483850 [PubMed - indexed for MEDLINE]

432: J Pain Symptom Manage. 2007 May;33(5):628-33.


Jordan palliative care initiative: a WHO Demonstration Project. Stjernswärd J, Ferris FD, Khleif SN, Jamous W, Treish IM, Milhem M, Bushnaq M, Al Khateib A, Al Shtiat MN, Wheeler MS, Alwan A. Cancer Control and Palliative Care, World Health Organization, World Health Organization Collaborating Center for Palliative Cancer Care, Oxford, UK. [email protected] A model for pain relief and palliative care for the Middle East has been established in Jordan. King Hussein Cancer Centre (KHCC) in Amman is now a truly comprehensive cancer center as it includes palliative care for inpatients, outpatients, and patients at home. This is especially important in a country and a region where over 75% of the cancer patients are incurable when diagnosed. To support effective palliative care delivery, there have been many significant changes in Jordan between 2001 and 2006. Regulations governing opioid

prescribing have been changed to facilitate effective pain management. The national opioid quota has been increased. Cost-effective, generic, immediate-release morphine tablets are being produced in Jordan. Intensive, interactive bedside training courses for doctors, nurses, and clinical pharmacologists have started to overcome opiophobia and motivate health care professionals to take up palliative care as a profession. "Champions" for palliative care have emerged who are leading the development of palliative care in Jordan's health care systems and starting to support neighboring countries to develop pain relief and palliative care. While before 2003, fewer than 250 patients per year received palliative care, by 2006 more than 800 patients per year were receiving pain relief and palliative care through the KHCC and Al Basheer Hospital. The achieved changes and the unusually rapid and effective institutionalization of palliative care serve as a model for other countries in the Middle East region as to what should be done and how. Publication Types:

• Review


433: J Altern Complement Med. 2007 Apr;13(3):387-91.


Educating CAM practitioners about integrative medicine: an approach to overcoming the communication gap with conventional health care practitioners. Frenkel M, Ben-Arye E, Geva H, Klein A. The Complementary and Traditional Medicine Unit, Department of Family Medicine, The Bruce Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel. [email protected] OBJECTIVE: To assess an educational initiative that teaches complementary and alternative medicine (CAM) students how to communicate more effectively with conventional physicians about CAM. DESIGN: We introduced an educational initiative in integrative medicine to CAM students in their final year of study, emphasizing evidence-based learning, patient-centered care, and communication skills with conventional health care providers. A precourse semistructured questionnaire and an anonymous open essay about the students' experiences at the end of the course were used as tools for assessment. The precourse questionnaires

and the postcourse essays were evaluated, using content analysis for parallel responses to determine whether students' views changed during the course. RESULTS: We evaluated the experience in 62 students exposed to the initiative during 4 academic years, 2001-2005. We found that CAM students perceive that they need practical communication tools in order to communicate effectively with conventional practitioners. After the educational experience, the students confirmed that critical thinking training is important, and reported feeling more empowered and more confident in their work as well as in communicating with physicians. CONCLUSIONS: The results of this study suggest that CAM practitioners feel better equipped to communicate with conventional health care practitioners after exposure to a structured educational initiative that emphasizes critical thinking, patient-centered care, and communication skills with conventional practitioners. PMID: 17480142 [PubMed - indexed for MEDLINE]

434: Am Heart Hosp J. 2007 Spring;5(2):100-2.


Cardiac services in Sarawak, Malaysia. Sim KH, Yip Fong AY. Deaprtment of Cardiology & Clinical Reearch Centre, Sarawak General Hospital, Kuching, Sarawak, Malaysia. [email protected] PMID: 17478976 [PubMed - indexed for MEDLINE]

435: Diabetes Res Clin Pract. 2007 Sep;77 Suppl 1:S82-6. Epub 2007 Apr 30.


Present state of diabetes management in the elderly, Japan. Fujisawa T, Ikegami H, Nojima K, Kawabata Y, Noso S, Asano K, Hiromine Y, Fukai A, Shindo N, Ogihara T. Department of Geriatric Medicine, Osaka Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. [email protected] A recent dramatic increase in elderly patients with diabetes mellitus has made the

proper management of the disease in this population more important. Here, we discuss the present status of diabetes management in the elderly in Japan. As a characteristic feature of elderly persons, body weight reduction is difficult, because of the profound adaptive reduction in resting energy expenditure under calorie restriction in the elderly. However, hyperglycemia increases the risk for diabetic complications, except proliferative retinopathy, similarly in elderly and non-elderly. Of note, there is marked clinical heterogeneity in this generation in the following aspects: duration, complication status (past aspect), insulin secretion, insulin sensitivity, familial support and physical exercise/activity (present aspect), as well as the expected lifespan (future aspect). This heterogeneity among the elderly should render diabetes treatment diverse, and in fact, one of the largest surveys in Japan demonstrated significant diversity in diabetes management in the elderly. In Japan, thus, the present management of diabetes in the elderly is considerably diverse, reflecting the clinical heterogeneity among elderly patients with diabetes. Further clinical evidence is awaited for the establishment of proper and safe management of diabetes in the elderly. Publication Types:



436: Int J Gynecol Cancer. 2008 Jan-Feb;18(1):110-5. Epub 2007 Apr 26.


Silent killer of the night: a feasibility study of an outreach well-women clinic for cervical cancer screening in female sex workers in Hong Kong. Wong WC, Wun YT, Chan KW, Liu Y. Department of Community and Family Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. [email protected] The purpose of this study was to see if an outreach model could be a feasible option for early detections of preinvasive cervical cancer in women with double identities of female sex workers (FSW) and illegal migrant workers in Hong Kong who most needed cervical screening but were often deprived of such a service. High turnover rates, acceptability, and compliance for follow-ups could potentially render such a clinical model unsuccessful. A total of 245 FSW were

screened at the outreach clinic from January 2004 to December 2005, which was set up in a nongovernmental organization in a red light district. A questionnaire regarding their lifestyles and demographic details was used before a gynecological history, Papanicolaou (PAP) smear, and other health checkup were conducted. Chi-square test and multinomial logistic regression were used to analyze the results. Of 235 women tests, 9.8% of them had CIN I-III, and places of origin were found to be important risk factors for abnormal PAP smears. The nonlocal workers were significantly more likely to have abnormal PAP smears (chi(2)= 10.55, P= 0.04). Among the women, 88.1% of them who had the tests returned for follow-up with poorer compliance among those with an abnormal result. We conclude that an outreach well-women clinic seems to be an acceptable option for these women and an effective way for the early detection of cervical cancer. PMID: 17466035 [PubMed - indexed for MEDLINE]

437: Regen Med. 2006 Sep;1(5):671-83.


China and the global stem cell bioeconomy: an emerging political strategy? Salter B, Cooper M, Dickins A. Institute of Health, Global Biopolitics Research Group, University of East Anglia, Norwich, UK. [email protected] There is a growing consensus, amongst policy analysts and scientists alike, that China is likely to play a key role in the scientific, clinical and commercial development of stem cell research. However, to date, there exist few detailed analyses of China's current investment in the field. After introducing the UK's recent political strategy on stem cell science, this article develops an in-depth discussion of the formal organization of China's research and development in the area, as well as its rapidly evolving commercial, regulatory and ethical environment. From here, we go on to assess the probability of China's emergence as a global player in the increasingly internationalized business of stem cell biomedicine. Publication Types:



438: Australas Psychiatry. 2007 Apr;15(2):140-3.


Six months in Aceh. Hugo M. Central Northern Adelaide Health Service, Mental Health Division, SA, Australia. [email protected] OBJECTIVE: Brief case histories are presented of people with schizophrenia treated in the Indonesian province of Aceh, where the author worked as a clinical psychologist for Medecines Sans Frontieres in 2005. Aceh was severely affected by the December 2004 tsunami, with significant destruction and loss of life. CONCLUSIONS: The case studies highlight the needs of patients and the current opportunities to establish more effective mental health services. The role of culture as a significant consideration and a possible barrier to accessing care is also discussed. Publication Types:

• Case Reports


439: Acta Paediatr. 2007 May;96(5):693-6.


Characteristics of severely malnourished under-five children hospitalized with diarrhoea, and their policy implications. Chisti MJ, Hossain MI, Malek MA, Faruque AS, Ahmed T, Salam MA. Clinical Sciences Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh.

AIM: Identify clinical and nutritional features, and complications among severely malnourished, under-five children in an urban diarrhoeal disease facility in Bangladesh. METHODS: For this case-control design, children of both sexes, aged 0-59 months were studied. Severely (< -3 z-score) underweight, stunted or wasted constituted cases and those with better nutritional status (z-score > or = -3) constituted controls. RESULTS: During 2000-2005, of the total 6881 children, 1103 (16%) were severely underweight, 705 (11%) severely stunted and 217 (3%) severely wasted. In logistic regression analysis, severely underweight children were more likely to be older than 11 months (OR 3.7, 95% CI 3.1-4.3, p < 0.001), non-breastfed (OR 1.5, 95% CI 1.3-1.8, p < 0.001), have illiterate mothers (OR 2.6, 95% CI 2.2-3.0, p < 0.001), non-sanitary toilet (OR 1.4, 95% CI 1.2-1.6, p < 0.001), a history of measles in preceding 6 months (OR 1.7, 95% CI 1.3-2.4, p = 0.001), dehydrating diarrhoea (OR 1.9, 95% CI 1.6-2.2, p < 0.001), abnormal findings in lung auscultation (OR 1.7, 95% CI 1.3-2.3, p < 0.001) and require hospitalization > or = 48 h (OR 2.2, 95% CI 1.8-2.5, p < 0.001). CONCLUSION: There thus is a need to incorporate appropriate, cost-effective and sustainable preventive strategies and improved management policies in the health systems as well as in social support systems in Bangladesh. Publication Types:

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


440: J Clin Nurs. 2007 May;16(5):963-70.


A survey of Chinese nurses' current knowledge of pain in older people. Yu HD, Petrini MA. Faculty of HOPE, School of Nursing, Wuhan University, Wuhan, China. [email protected] AIM: To investigate the current level of Chinese nurses' knowledge of pain and pain management in older people. BACKGROUND: Most research about nurses' knowledge regarding pain has taken place in developed countries; however, limited research in this area has taken place in developing countries and particularly in China. METHODS: Registered Nurses (n = 621) in three different

hospitals were surveyed with the questionnaire about pain and pain management with respect to older people. RESULTS: The finding showed that a significant knowledge deficit in this area exists. There were no significant differences among nurses in terms of education background, position and whether or not there was attendance in an educational session on pain management. However, there were statistically significant differences based on age; hospital of employment and clinical area in which employed. CONCLUSION: This survey suggested that nurses' knowledge of pain in older people should be improved. Basic and continuing education of nurses in this area should be enhanced and their active participation in pain management should be encouraged. RELEVANCE TO CLINICAL PRACTICE: The findings in this survey highlight a significant pain management knowledge deficit among the nurses in the clinical practice. The findings may help the nurses realize their knowledge deficit in this area and may also suggest curriculum changes for the nurses to improve pain management knowledge. Publication Types:



441: J Clin Nurs. 2007 May;16(5):928-36.


Effectiveness of bran supplement in older orthopaedic patients with constipation. Kaçmaz Z, Kaşiçi M. Erzurum Health School of Ataturk University Erzurum, Turkey. AIM: The purpose of the study was to evaluate the effectiveness of planned nursing interventions, including bran supplement, on the bowel management of older orthopaedic patients. BACKGROUND: Constipation is prevalent among older people. Constipation is also well-known to be a problem for a range of orthopaedic patients. Orthopaedic diseases or conditions may, because of the specific problems, cause this. The problem may also arise as a result of the orthopaedic treatment options undertaken by patients. DESIGN: A quasiexperimental design was employed. METHODS: The patients were recruited from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey. Descriptive statistics, independent sample test t-test, chi-square and McNemar test

were used to analyse the data. Constipation problems were identified through interviews by using the Constipation Diagnosis Form. Interviews were performed within the fourth postoperative day. After that, while the patients in the control group received routine nursing care according to clinic routine, the patients in the experimental group received bran supplement together with planned nursing interventions. The patents in both groups were followed by using the Constipation Follow Form. RESULTS: While patients in the experimental group showed significant improvements in most characteristics of bowel elimination such as time of defecation, intensity of faeces, colour of faeces and amount of faeces, the control group showed a significant improvement in only duration of defecation. CONCLUSIONS: The results of the study indicate planned nursing interventions including bran supplement are more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. RELEVANCE TO CLINICAL PRACTICE: Nurses have an important part to play in both prevention and management of constipation. Constipation is a problem especially for older orthopaedic patients. Planned nursing interventions that include bran supplements may be more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. Publication Types:

• Controlled Clinical Trial • Research Support, Non-U.S. Gov't


442: Nurs Ethics. 2007 May;14(3):309-19.


Differences in moral judgment between nursing students and qualified nurses. Kim YS, Park JH, Han SS. Ajou University, Suwon, Korea. This longitudinal study examined how nursing students' moral judgment changes after they become qualified nurses working in a hospital environment. The sample used was a group of 80 nursing students attending a university in Suwon, Korea, between 2001 and 2003. By using a Korean version of the Judgment About Nursing Decisions questionnaire, an instrument used in nursing care research,

moral judgment scores based on Ketefian's six nursing dilemmas were determined. The results were as follows: (1) the qualified nurses had significantly higher idealistic moral judgment scores than the nursing students; (2) the qualified nurses showed significantly higher realistic moral judgment scores than the nursing students; and (3) when comparing idealistic and realistic moral judgment scores, both the qualified nurses and the nursing students had higher scores for idealistic moral judgment. Further study is recommended to examine changes in moral judgment. Publication Types:



443: Percept Mot Skills. 2007 Feb;104(1):166-70.


Attitudes of physical education majors in Turkey towards disability are changed by adaptive physical education training. Gürsel F. School of Physical Education, Ankara University, Kenedi caddesi 119/14 06700, Kavaklidere Ankara, Turkey. [email protected] This study was designed to investigate the attitudes of university students who are prospective physical education teachers toward individuals with physical disabilities. 47 college students majoring in physical education (Study group) and 34 students from other sports-related departments, i.e., sports management and training (Control group), participated in the study. The study group took a 14-week course on Adapted Physical Education (APE), whereas the control group did not. The Attitude Toward Disabled Persons scale, Form O was used to compare the attitudes of the groups. Analyses showed no significant difference between the groups in terms of attitude towards individuals with physical disabilities at the beginning of the semester but a significant difference at semester end. Results indicated that the APE course positively influenced attitude of the prospective physical education teachers towards individuals with physical disabilities. Publication Types:



444: Ann Acad Med Singapore. 2007 Mar;36(3):165-8.


Demographic and clinical features of 150 pathological gamblers referred to a community addictions programme. Teo P, Mythily S, Anantha S, Winslow M. Community Addiction Management Programme, Institute of Mental Health, Singapore. INTRODUCTION: Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The present study reports on the sociodemographic features, gambling activity, comorbidity and legal problems in a sample of 150 pathological gamblers who sought treatment from the Community Addiction Management Programme (CAMP), Singapore over a 4-year period from 2002 to 2006. MATERIALS AND METHODS: Data were collected on 150 consecutive subjects who sought treatment at CAMP. Patients were administered a semi-structured interview to elicit demographic data, age of onset, family history, onset games and types of games ever played, largest debt incurred due to gambling, triggers, illegal activities and suicidal attempts by their counsellor. Patients were then assessed by the clinicians to establish the primary and comorbid diagnoses. RESULTS: The mean age of the subjects was 42.5 [standard deviation (SD) 10.2] years. The majority of them were males (87.3%) and of Chinese origin (97.3%). The most common comorbid disorders were mood disorders (n = 22, 14.7%), substance abuse (n = 11, 7.3%) and alcohol abuse or dependence (n = 7, 4.7%). Sixteen (10.7%) subjects had a history of suicidal attempts which had been precipitated by gambling-related issues. CONCLUSIONS: Pathological gambling in our subjects appears to be associated with significant comorbidity and financial problems. These are the preliminary findings and further research is needed regarding the phenomenology, profile, course and response to treatment of pathological gambling disorders. PMID: 17450260 [PubMed - indexed for MEDLINE]

445: J Korean Med Sci. 2007 Apr;22(2):270-6.


Clinical outcome of urgent coronary artery bypass grafting. Kim DK, Yoo KJ, Hong YS, Chang BC, Kang MS. Department of Thoracic and Cardiovascular Surgery, Severance Hospital Cardiovascular Center, 134 Sinchon-dong, Seodaemun-gu, Seoul, Korea. Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. The purpose of this study was to evaluate the clinical outcome of urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent CABG. All patients required an urgent surgical revascularization within 24 hr of diagnostic coronary angiography. In-hospital mortality after urgent CABG was 17.3% (18/104). We compared preoperative characteristics and postoperative clinical outcomes between the survival group (n=86) and the mortality group (n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of mortality was low cardiac output. The independent preoperative risk factors of mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492, p=0.034). Other risk factors of mortality included prolonged cardiopulmonary bypass time, prolonged ventilator use, and extended intensive care unit stay. The 10-yr actuarial survival rate was 61%. Although the operative mortality rate was high after urgent CABG, a favorable long-term clinical outcome can be expected if the patients survive. Publication Types:



446: Pediatr Diabetes. 2007 Apr;8(2):60-6.


Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel population, 1997-2003. Koton S; Israel IDDM Registry Study Group - IIRSG. The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel. [email protected]

BACKGROUND: Recent reports from different countries have shown an increased incidence of type 1 diabetes mellitus (T1DM). A national juvenile diabetes register was established by the Israel Pediatric Endocrine Society and the Israel Center for Disease Control (ICDC) in 1997. OBJECTIVE: This article reports the epidemiology of T1DM in children in the age-group 0-17 yr in Israel during 1997-2003. METHODS: The Israel juvenile diabetes register is a population-based anonymous registry. Newly diagnosed cases of all types of diabetes in children and adolescents are reported to the ICDC by all the endocrinologists in all the pediatric diabetes centers. Overall incidence rates and rates by sex, age, and population group are presented. Comparisons are made by year, sex, age, and population group. RESULTS: During 1997-2003, 1485 children and adolescents with T1DM were reported in the age-group 0-17 yr. The annual incidence rate of T1DM increased by 34% during 1997-2003, from 8.0 per 100 000 [95% confidence interval (CI) 6.8-9.3] to 10.7 per 100 000 (95% CI 9.4-12.1). Incidence rates were higher for Jews than for Arabs. Among Jews, children of Yemenite origin had the highest incidence rate (26.1 per 100 000; 95% CI 13.3-38.9). Incidence peaked at an earlier age in girls. A first-degree family history of T1DM was found in 9.1% of the cases. CONCLUSIONS: The incidence of T1DM is increasing in the Israeli population, particularly in the Arab population. The culturally varied composition of the Israeli population provides important areas for future studies based on data collected in this national register. Publication Types:

• Clinical Trial


447: Wilderness Environ Med. 2007 Spring;18(1):2-9.


Snakes of medical importance in India: is the concept of the "Big 4" still relevant and useful? Simpson ID, Norris RL. WHO Snakebite Treatment Group. [email protected] Snakebites continue to be a major medical concern in India. However, there is very little hard evidence of a numerical nature to enable us to understand which species are responsible for mortality and morbidity. For many decades, the concept of the "Big 4" Snakes of Medical Importance has reflected the view that 4

species are responsible for Indian snakebite mortality--the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), the Russell's viper (Daboia russelii) and the saw-scaled viper (Echis carinatus). However, a recent discovery that another species, the hump-nosed pit viper (Hypnale hypnale), is capable of causing lethal envenomation, and that this problem was being concealed by systematic misidentification of this species as the saw-scaled viper, has necessitated a review of the concept of the "Big 4." The concept of the "Big 4" snakes is reviewed to demonstrate its failure to include all currently known snakes of medical significance in India, and its negative effects related to clinical management of snakebite. The emergence of the hump-nosed pit viper (Hypnale hypnale) as a snake of medical significance has rendered the "Big 4" obsolete in terms of completeness. The concept of the "Big 4" is restricting sound epidemiological work and the development of effective snake antivenoms. It should be replaced by the model introduced in the 1980s by the World Health Organization, which has not received adequate circulation and implementation. PMID: 17447706 [PubMed - indexed for MEDLINE]

448: Midwifery Today Int Midwife. 2007 Spring;(81):48-51.


My midwifery practice in Israel. Shemesh I. PMID: 17447702 [PubMed - indexed for MEDLINE]

449: Trop Med Int Health. 2007 Apr;12(4):540-6.


Diagnosis and management of malaria by rural community health providers in the Lao People's Democratic Republic (Laos). Mayxay M, Pongvongsa T, Phompida S, Phetsouvanh R, White NJ, Newton PN. Wellcome Trust - Mahosot Hospital - Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR. We assessed the knowledge of malaria diagnosis and management by community health providers in rural Vientiane and Savannakhet Provinces, Lao PDR. Sixty

health providers (17 pharmacy owners/drug sellers and 43 village health volunteers) were interviewed. All diagnosed malaria using symptoms and signs only; 14% were aware of >2 criteria for the diagnosis of severe malaria. Although chloroquine and quinine, the then recommended Lao national policy for uncomplicated malaria treatment, were the most common antimalarials prescribed - 65% gave incorrect doses and 70% did not know the side effects. Although not recommended by the then national policy, 27% of the health providers used combinations of antimalarials as they considered monotherapy ineffective. This study strongly suggests that further training of Lao rural health providers in malaria diagnosis and management is needed to improve the quality of health services in areas remote from district hospitals. Publication Types:



450: Kekkaku. 2007 Mar;82(3):201-16.


[Preventive measures against tuberculosis in working facilities and companies] [Article in Japanese] Suzuki K, Satou K. Chiba Foundation for Health Promotion and Disease Prevention, 32-14, Shinminato, Mihama-ku, Chiba-shi, Chiba 261-0002, Japan. [email protected] The health care program in working facilities and companies have played a significant part in prevention of tuberculosis. However, the ordinary national tuberculosis survey policy was abolished in April, 2005 and the tuberculosis survey for salary-earners is on the brink of drastic change. In this symposium the current status of the prevailing survey of tuberculosis in working facilities and companies was reviewed and the future direction of the tuberculosis survey in comparison to that in lung cancer survey was discussed. 1. Epidemiological trends of tuberculosis from the tuberculosis surveillance data: Masako OHMORI (Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association). The estimated rate of tuberculosis case discovery by periodical mass screening in the working facilities was 0.033% and it was higher than that in general adult

population. The detection rate of tuberculosis in nurses who suffered from tuberculosis reached 40.4% by an aid of mass X-ray screening and 8.7% by contact tracing. The risk of onset of the disease was 4.3 times higher nurses than in general at the same years of age. The importance of infection control measures in the medical facilities was emphasized. 2. Current status and problems in tuberculosis control in a large-sized company: Yusuke NAKAOKA (Department of Occupational Health, Osaka Railway Hospital, West Japan Railway Company). Some preventive modalities against TB such as periodical medical check-up and awareness programs have been done for the purpose of prevention in our company. The prevalence of the disease has significantly reduced in number. The specific circumstances in large-sized company should be taken into consideration, and it is important for company workers and health professionals to recognize their roles in preventing the infectious disease. 3. Are there any differences between clinical cases and control people working for small-sized companies in the onset of tuberculosis?: Osamu NAKASHIMA, Kohei IMOTO (Taito Health Center, Tokyo) and Toru MORI (Research Institute of Tuberculosis, JATA). We surveyed environmental conditions in working places and domestic conditions of employees who were working for small-sized companies located in Taito ward, based on written questionnaires. The companies were selected as those which had the patients of tuberculosis in the past one-year period, and the number of employees was less than ten. Compared with control people, TB patients had more frequent smoking habit (p < 0.05), and tended to have been less exposed to the sunshine at their residency and to have nutritionally poor meals and deficits of their meals. These results suggest that these factors alone or in combination may contribute to accelerated onset of tuberculosis. 4. Current status and problems in tuberculosis management among high prevalence population and in health check-up for personnel with unspecified and high occupational contact with tuberculosis patients: Hidetoshi IGARI (Division of Control and Treatment of Infectious Diseases, Chiba University Hospital), Kiminori SUZUKI (Chiba Foundation for Health Promotion and Disease Prevention). Tuberculosis prevalence is as high as 500-1500 per 100,000 peoples among the homeless and construction workers living in "Hanba", a bunkhouse. We surveyed their medical conditions through periodical or extraperiodical health check-up. We retrospectively analyzed some medical factors contributing to successful treatment of the disease. Hospital admission and enhancement of counseling opportunities were two factors leading to the success of the treatment. The ambulance attendants have a significant possibility to contact patients with TB and are high at risk of acquiring the infection. As there are often limited information on TB in patients in an emergency condition, it is difficult to protect themselves from its contagion properly. Periodical and extraperiodical health check-up is important for these personnel and application of QuantiFERON-TB 2nd generation to the personnel is new and useful for diagnosis of the latent tuberculosis infection. 5. A role of chest X-ray examination for lung cancer detection among company workers: Takeo TESHIMA (Koseikan Clinic, Miyagi Branch, Japan Anti-Tuberculosis Association). Detection rates of lung cancer in company workers and in general population under the age of 60 years were compared. Chest X-ray survey was

done using 10 cm x 10 cm indirect chest X-ray films of the chest. The detection rates of lung cancer in patients with definite or suspicious diagnosis in 265,620 company workers were 2.3 and 2.6 per 100,000, respectively. On the other hand the rates were 9.9 and 8.8 per 100,000 in a general population of 811,391. Twenty-four percent of patients with suspicious diagnosis were eventually made a definite diagnosis. The corrected detection rate reached to 21.0 for male patients and 8.3 for female patients and 12.1 totally. The detection rates of lung cancer in company workers and in general population under the age of 60 years exceeded the rate of pulmonary tuberculosis. Chest X-ray examination for the detection of lung cancer and pulmonary tuberculosis is still recommended under various working and social circumstances. Publication Types:



451: Int J Dermatol. 2007 Apr;46(4):388-92.


Mycotic cysts: report of 21 cases including eight pheomycotic cysts from Saudi Arabia. Sheikh SS, Amr SS. Pathology Services Division, Dhahran Health Center, Dhahran, Saudi Arabia. [email protected] BACKGROUND: Mycotic cysts are subcutaneous cystic granulomas caused by either dematiaceous (pigmented) fungi (pheomycotic cysts) or eumycotic (nonpigmented fungi) present in soil, wood, and decaying plant material. These fungi gain access to the tissues via a wooden splinter or thorn. No deep tissue involvement or extension to bone is known to occur. METHODS: We reviewed our surgical pathology files for the last 32 years. All cases with the diagnosis of cysts with fungi, thorns, or splinters and associated granulomatous and acute inflammation were reviewed. Gomori's silver and periodic acid-Schiff stains were performed in all cases. RESULTS: Twenty-one cases of mycotic cyst were found, including eight pheomycotic cysts (one with a recurrent lesion seen 11 months after the initial excision of the cyst). Thirteen cysts had nonpigmented fungal hyphae. There were 14 males and seven females, with an age range of 5-76 years. The dorsum of the foot was the most frequently affected site (12 cases). Four

cases involved the fingers, two involved the knee area, two involved the big toe, and one each involved the leg, ankle, and forearm. The cysts measured 0.6-4.5 cm in diameter. Histologically, there was granulomatous inflammation with a variable degree of neutrophilic infiltrate giving central abscess formation. Twelve cases showed a wooden splinter. All cases were positive for fungal organisms, mostly septate hyphae and spores that were highlighted by special stains. Fungal pigment, ranging from yellow-brown to light brown to black, was observed in eight cases. No extension to deep tissues was noted. The clinical impression varied widely including ganglion, sebaceous cyst, giant cell tumor of the tendon sheath, and lipoma. One patient was immunosuppressed following renal transplantation. All patients were treated by simple excision. No antifungal chemotherapy was needed or administered in any of the patients. One patient had a recurrence of his lesion within 1 year as a result of inadequate initial excision. A second re-excision was curative. CONCLUSION: Mycotic cysts are uncommonly encountered lesions that can be easily missed, especially in cases with scant fungal elements, thus requiring special stains to detect the organisms. We reported 21 cases of mycotic cyst, including eight pheomycotic cysts, with emphasis on the histopathologic recognition of this unusual entity. PMID: 17442079 [PubMed - indexed for MEDLINE]

452: Dig Dis Sci. 2007 Nov;52(11):3043-8. Epub 2007 Apr 10.


Noncardiac chest pain--an Asia-Pacific survey on the views of primary care physicians. Cheung TK, Lim PW, Wong BC. Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. Noncardiac chest pain (NCCP) is common and has a significant impact on health care. Primary care physicians (PCPs)' attitudes, clinical approach, preference of diagnostic tests, referral patterns, and comfort in managing patients with NCCP in the Asia-Pacific region are not known. Consequently, we performed this survey in the Asia-Pacific region. The self-completed questionnaire was sent to PCPs in the Asia-Pacific region. A 28-item questionnaire contained questions on demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, treatment plans, and opinion on Helicobacter pylori and NCCP. A total of 108 (74%) PCPs returned the questionnaire. A mean of 18% of the patients were diagnosed with NCCP by PCPs in the past 6 months. Ninety-four percent of PCPs had treated NCCP patients in the last 6 months. Only 38% of the PCPs were comfortable in diagnosing NCCP but 85.2% believed that they should manage

NCCP patients. PCPs in Malaysia and Philippines were more likely to refer patients to subspecialists. Fifty-seven and four-tenths percent of PCPs believed that H. pylori infection plays a role in the development of NCCP. The study demonstrates clearly that the understanding, diagnostic strategies, and treatment strategies of NCCP in the Asia-Pacific region are suboptimal and thus highlights the importance of educational and training programs tailored for PCPs in NCCP. Publication Types:



453: Taehan Kanho Hakhoe Chi. 2007 Mar;37(2):185-91.


The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms. Kim MS, Kim JS, Jung IS, Kim YH, Kim HJ. Department of Nursing, Ulsan College, Ulsan, Korea. [email protected] PURPOSE: The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. METHODS: A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. RESULTS: The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. CONCLUSION: Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

Publication Types:



454: Health Policy Plan. 2007 May;22(3):156-66. Epub 2007 Apr 12.


Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection. Lönnroth K, Aung T, Maung W, Kluge H, Uplekar M. TB Strategy and Health Systems, Stop TB Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, 27, Switzerland. [email protected] This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme

in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further. Publication Types:



455: Contemp Clin Trials. 2007 Nov;28(6):677-83. Epub 2007 Mar 23.


Industry-sponsored research in developing countries. Abbas EE. Saif Bin Gobash and Ibrahim Bin Hamad Obaidullah Hospitals, Ras Alkhaima, United Arab Emirates. [email protected] BACKGROUND: Industry has become an important source of funding for clinical research; guidelines governing the relationship between industry and medical institutions are not clear in developing countries and hence we wanted to test attitudes and practices in those countries and compare them to developed countries. We conducted a survey amongst medical practitioners in developed and Arab countries representing developing countries, in order to document their views towards industry-sponsored research and their actual practice in this regard. METHODS: A structured questionnaire was distributed by email, mail and through personal contacts. The questionnaire included information on characteristics of the practitioners involved, their attitudes towards industry-sponsored research and their actual practices. The questionnaire was distributed to 510 medical practitioners of countries in both groups. Practitioners representing developed countries were from the United States, United Kingdom, Australia and New Zealand. Those representing developing countries included Arab countries from Asia and Africa. RESULTS: We found that there were contrasting views and practices between the two groups although more than 80% in both groups agreed that industry-sponsored research is necessary. 69.7% of respondents in developed countries participated in industry-sponsored research while only 30.1% did so in developing countries. Guidelines governing such research were better adhered to in developed countries than in developing countries. Where there were no authors who were not part of investigators in developed countries, 16.3% of industry-sponsored research in developing countries included authors who were

not part of the investigators. Research ethics committees were present in 94% and 58% of institutions in developed and developing countries respectively. Review bodies were available in 57% and 41% in developed and developing countries. CONCLUSIONS: Industry-sponsored research is necessary; it is much more common in developed countries. Clear guidelines governing industry-sponsored research should be adopted in developing countries, including the establishment of research ethics committees and review bodies to monitor such research. PMID: 17434813 [PubMed - indexed for MEDLINE]

456: Int Psychogeriatr. 2007 Aug;19(4):669-78. Epub 2007 Apr 16.


The diagnosis of dementia in the community. Jacob KS, Kumar PS, Gayathri K, Abraham S, Prince MJ. Department of Psychiatry, Christian Medical College, Vellore, India. [email protected] BACKGROUND: Different interview schedules and diagnostic criteria for dementia have contributed to differing incidence and prevalence rates. AIM: This study aimed to examine the effect of different diagnostic criteria on the prevalence of dementia in the community. METHODS: Some 1000 subjects (>65 years) were recruited in Kaniyambadi Block, Vellore, India, using a one-stage assessment procedure. RESULTS: The prevalence of dementia by Diagnostic and Statistical Manual IV standard, the Community Screening instrument for Dementia DF Score, the education adjusted 10/66 Dementia Research Group criteria, and the Geriatric Mental State was 0.8%, 6.2%, 10.6%, 63.2% respectively. CONCLUSION: Differences in information, interview schedules, diagnostic criteria and settings contribute to variation in identification of people with dementia. Minor variations in criteria have a significant impact on diagnosis. The assessment of the clinical state is influenced by education, level of baseline function, impairment in current functioning, life style and demands on the person, tolerance of impairment and expectation by relatives and by differences between patients attending hospitals and those living in the community. The variation in rates demands a debate on the criteria for dementia in the community in general and for less literate populations in particular. PMID: 17433119 [PubMed - indexed for MEDLINE]

457: Minn Med. 2007 Mar;90(3):26-30.


Erratum in:

• Minn Med. 2007 May;90(5):6.

Global health hot zone. Hequet M. PMID: 17432753 [PubMed - indexed for MEDLINE]

458: Rinsho Shinkeigaku. 2006 Nov;46(11):955-7.


[Japanese guidelines for the management of herpes simplex encephalitis; comparison with those from the International Management Herpes Forum] [Article in Japanese] Shoji H. The School of Rehabilitation Sciences, International University of Health and Welfare. Herpes simplex encephalitis (HSE) is still recognized as a severe sporadic encephalitis, although the mortality and morbidity rates have been decreased to 10% and 30%, respectively. This disease is diagnosed using clinical symptoms, CSF, EEG, CT, MRI, and virologic tests such as polymerase chain reaction (PCR) or enzyme immunosorbent assay (EIA). Early diagnosis and treatment are essential for HSE. However, the early symptoms of this disease are various, and the laboratory diagnostic criteria are unclear to the non-specialist. In 2005, Japanese guidelines for the management of HSE have been issued via two sets of Workshops at the Japanese Neuroinfectious Disease Congress. The diagnostic and therapeutic criteria were discussed in comparison with those from the International Management Herpes Forum (IMHF) in 2004. For a definitive diagnosis, CSF PCR for herpes simplex virus (HSV) is recommended, and the detection rate has been reported to be 60 to 80% within the 7th day of the illness. In the IMHF, the PCR method has also been the primary method for early diagnosis and for monitoring the therapy. Further, quantitative real-time PCR has become available for measuring the effectiveness of aciclovir therapy. To

measure HSV antibody levels, complement antibody (CF), neutralizing antibody (NT), or enzyme-linked immunosorbent assay (ELISA or EIA) are available. Significant elevation of EIA IgG or intrathecal HSV antibody production should be shown, although these antibody responses often appear two weeks after the onset of HSE. Regarding anti-herpesvirus drugs, in both Japanese and IMHF guidelines aciclovir is consistent with the first choice, and it is recommended that its administration would be started as soon as HSE is suspected on the basis of clinical pictures, CT * MRI, EEG, or CSF findings. However, antiviral therapy may be discontinued if a negative CSF HSV PCR is obtained at > 72 hours after onset. A recent Japanese study shows the efficacy of a combination therapy of aciclovir and corticosteroid for this disease. Further prospective investigation is expected. Publication Types:

• Comparative Study • English Abstract


459: J Psychiatr Ment Health Nurs. 2007 May;14(3):239-42.


The Bali bombings and the evolving mental health response to disaster in Australia: lessons from Darwin. Guscott WM, Guscott AJ, Malingambi G, Parker R. Top End Mental Health Service, Parap, NT, Australia. [email protected] The Bali bombing in 2002 initiated a new phase of trauma response for public health services in Australia, and the Royal Darwin Hospital in particular. The mental health response to the initial disaster was limited to a debriefing of Royal Darwin Hospital staff some time after the disaster. Following this initial episode, a number of important developments occurred within the Royal Darwin Hospital and nationally to further develop mental health resources. A mental health consultation liaison nursing position was established within the hospital. The Director of Mental Health for the Northern Territory, along with the Director of Psychiatry, was involved with an evolving national mental health response to mass trauma through the National Planning Group of Mental Health Response to Trauma. The improved recognition of mental health in disaster response, along with increased recognition and confidence in the consultation liaison nursing

staff, considerably improved the mental health services available to patients and Royal Darwin Hospital staff following the second Bali blast in October 2005. PMID: 17430446 [PubMed - indexed for MEDLINE]

460: Semin Thromb Hemost. 2007 Apr;33(3):265-72.


External quality assessment scheme for hemostasis in India. Mammen J, Nair SC, Srivastava A. Department of Clinical Pathology and Blood Bank, Christian Medical College, Vellore, India. Regular participation in an external quality assessment scheme (EQAS) is critical for ensuring acceptable laboratory performance. However, participation in such programs is uncommon for laboratories performing tests of hemostasis in developing countries. There are several reasons, including lack of awareness of its significance, absence of locally administered and easily accessible programs, and costs associated with some of the international schemes. To address this problem, we initiated an EQAS for hemostasis in India in the year 2000. This initially was limited to approximately 25 laboratories associated with the chapters of the Hemophilia Federation (India), with samples and analysis of results supported by United Kingdom National External Quality Assessment Scheme. This was converted to a national program in 2003, in association with the Indian Society of Haematology and Transfusion Medicine. Local manufacture of survey samples began in 2004, along with analysis of results. Currently, more than 100 laboratories are registered in the program. They receive samples three times a year for the following tests: prothrombin time, activated partial thromboplastin time, and factor assays. Some surveys also include samples for fibrinogen and von Willebrand factor assays. In recent surveys, 60 to 95% of laboratories had their clotting times and 57 to 77% of laboratories had their factor assays within consensus. The program has helped identify causes of unacceptable performance. The challenges ahead are to increase participation, improve reporting of results, and provide individualized support to laboratories to improve performance when necessary. PMID: 17427061 [PubMed - indexed for MEDLINE]

461: J Trauma. 2007 Apr;62(4):940-5.


Comment in:

• J Trauma. 2007 Aug;63(2):451-2; author reply 452.

Predictive model for estimating risk of crush syndrome: a data mining approach. Aoki N, Demsar J, Zupan B, Mozina M, Pretto EA, Oda J, Tanaka H, Sugimoto K, Yoshioka T, Fukui T. School of Health Information Sciences, University of Texas Health Science Center, Houston, Texas 77030, USA. [email protected] BACKGROUND: There is no standard triage method for earthquake victims with crush injuries because of a scarcity of epidemiologic and quantitative data. We conducted a retrospective cohort study to develop predictive models based on clinical data for crush injury in the Kobe earthquake. METHODS: The medical records of 372 patients with crush injuries from the Kobe earthquake were retrospectively analyzed. Twenty-one risk factors were assessed with logistic regression analysis for three outcomes relating to crush syndrome. Two types of predictive triage models--initial evaluation in the field and secondary assessment at the hospital--were developed using logistic regression analysis. Classification accuracy, Brier score and area under the receiver operating characteristic curve (AUC) were used to evaluate the model. RESULTS: The initial triage model, which includes pulse rate, delayed rescue, and abnormal urine color, has an AUC of 0.73. The secondary model, which includes WBC, tachycardia, abnormal urine color, and hyperkalemia, shows an AUC of 0.76. CONCLUSIONS: These triage models may be especially useful to nondisaster experts for distinguishing earthquake victims at high risk of severe crush syndrome from those at lower risk. Application of the model may allow relief workers to better utilize limited medical and transportation resources in the aftermath of a disaster. PMID: 17426552 [PubMed - indexed for MEDLINE]

462: J Prev Med Pub Health. 2007 Mar;40(2):150-4.


[The determinants of purchasing private health insurance in Korean cancer patients] [Article in Korean]

Lim JH, Kim SG, Lee EM, Bae SY, Park JH, Choi KS, Hahm MI, Park EC. Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Korea. OBJECTIVES: The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. RESULTS: Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of won 65,311 and an average benefit amount of won 19 million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. CONCLUSIONS: About half of Korean people have supplementary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits. Publication Types:



463: Nurs Ethics. 2007 Mar;14(2):203-14.


Professional ethics as an important factor in clinical competency in nursing. Memarian R, Salsali M, Vanaki Z, Ahmadi F, Hajizadeh E. Tarbiat Modares University, Faculty of Medical Sciences, Tehran, P.O. Box 14115-331, IR Iran. [email protected]

It is imperative to understand the factors that influence clinical competency. Consequently, it is essential to study those that have an impact on the process of attaining clinical competency. A grounded theory approach was adopted for this study. Professional competency empowers nurses and enables them to fulfill their duties effectively. Internal and external factors were identified as affecting clinical competency. A total of 36 clinical nurses, nurse educators, hospital managers and members of the Nursing Council in Tehran participated in this research. Data were obtained by semistructured interviews. Personal factors and useful work experience were considered to be significant, based on knowledge and skills, ethical conduct, professional commitment, self-respect and respect for others, as well as from effective relationships, interest, responsibility and accountability. Effective management, education systems and technology were named as influential environmental factors. Personal and environmental factors affect clinical competency. Ethical persons are responsible and committed to their work, acquiring relevant work experience. A suitable work environment that is structured and ordered also encourages an ethical approach by nurses. Publication Types:



464: Nurs Ethics. 2007 Mar;14(2):194-202.


Whistleblowing in Japan. Davis AJ, Konishi E. University of California, San Francisco, USA. This article, written from research data, focuses on the possible meaning of the data rather than on detailed statistical reporting. It defines whistleblowing as an act of the international nursing ethical ideal of advocacy, and places it in the larger context of professional responsibility. The experiences, actions, and ethical positions of 24 Japanese nurses regarding whistleblowing or reporting a colleague for wrongdoing provide the data. Of these respondents, similar in age, educational level and clinical experience, 10 had previously reported another nurse and 12 had reported a physician for a wrongful act. These data raise questions about overt actions to expose a colleague in a culture that values group loyalty and saving

face. Additional research is needed for an in-depth understanding of whistleblowing, patient advocacy and professional responsibility across cultures, especially those that value group loyalty, saving face and similar concepts to the Japanese Ishin Denshin, where the value is on implicit understanding requiring indirect communication. Usually, being direct and openly discussing sensitive topics is not valued in Japan because such behavior disrupts the most fundamental value, harmony (wa). PMID: 17425148 [PubMed - indexed for MEDLINE]

465: J Clin Nurs. 2008 Jan;17(1):135-43. Epub 2007 Apr 5.


Sleep patterns and insomnia management in Korean-American older adult immigrants. Sok SR. College of Nursing Science, Kyung Hee University, Seoul, Korea. [email protected] AIMS: This study aimed to describe sleep patterns and insomnia management in first generation Korean-American older adult immigrants. Specifically, this research examined differences in sleep interruption factors, use of sleep promotion aids, sleep characteristics and insomnia management between men and women who are first generation Korean-American older adult immigrants. BACKGROUND: Older adults feel that their sleep is shallow, interrupted frequently and is insufficient. If sleep changes are severe, it is difficult for older adults to maintain an awakened state during the day. DESIGN: This was a descriptive survey study. METHODS: The survey included a set of four questionnaires. All measures were self-administered. In the data analysis, descriptive statistics was used to analyse demographic characteristics. The chi-squared test and t-test were used to examine the differences between men and women. RESULTS: Most subjects experienced sleep interruption (n = 43, 82.6%) and were not satisfied with their sleep (n = 42, 80.8%). A quarter of the subjects had experience with complementary/alternative therapies to manage insomnia, although 40 subjects (76.9%) wanted to use complementary/alternative therapies to manage their insomnia. CONCLUSIONS: The study shows that first generation Korean-American older adult immigrant men and women report sleep interruptions and dissatisfaction with the quality of their sleep. Women were more likely in want of using complementary/alternative therapies for insomnia management than men. Women may have longed more for their traditional healthcare practices. The high degree of sleep disruption in this sample may relate

to living in a different culture. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to assess sleep patterns and consider an array of methods including complementary/alternative therapies to manage insomnia. PMID: 17419793 [PubMed - indexed for MEDLINE]

466: Cancer Detect Prev. 2007;31(2):173-83. Epub 2007 Apr 6.


"Health is strength": a community health education program to improve breast and cervical cancer screening among Korean American Women in Alameda County, California. Moskowitz JM, Kazinets G, Wong JM, Tager IB. 140 Warren Hall, Center for Family and Community Health, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA. [email protected] BACKGROUND: A 48-month community intervention was conducted to improve breast and cervical cancer (BCC) screening among Korean American (KA) women in Alameda County (AL), California. KA women in Santa Clara (SC) County, California served as a comparison group. METHODS: Random samples of KA women from each county were surveyed by telephone in 1994 (n=818) and 2002 (n=1084). Propensity score analyses were used to estimate the difference between counties in changes over time in screening (Pap tests, breast self-examinations, clinical breast examinations, and mammography), and to estimate differences in screening between participants and non-participants in an educational workshop among women in AL in 2002. RESULTS: Mammography screening and clinical breast examinations increased over time in both counties. Pap tests increased in AL but not SC, and breast self-examinations did not change significantly in either county. None of the intervention-comparison group differences over time were significant. In 2002, compared to non-participants, women who attended a workshop were more likely to report a recent Pap test (P<.08). CONCLUSIONS: Although our overall intervention did not appear to enhance screening practices at the community-level, attendance at a women's health workshop appears to have increased cervical cancer screening. Publication Types:

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


467: J Clin Gastroenterol. 2007 Apr;41(4):394-9.


Diagnostic yield and safety of colonoscopy in Israeli patients in an open access referral system. Rainis T, Keren D, Goldstein O, Stermer E, Lavy A. Gastroenterology Unit, Bnai-Zion Medical Center, Haifa, Israel. [email protected] BACKGROUND: Open access endoscopy allows reference of patients for endoscopic procedures without prior gastrointestinal consultation, allowing the procedure to be more accessible. This practice is becoming increasingly widespread in the United States and other countries and has become commonplace in clinical practice in Israel. The objective of our study is to bring forward our experience with an open access referral system for colonoscopy and to measure the yield and safety of colonoscopy in this system. METHODS: Between January 2001 and September 2003, 10,866 colonoscopies were performed. Patient's charts were reviewed for the following data: demographics, indication for endoscopy, endoscopic and histopathologic findings, and complications. The practice guidelines of the American Society for Gastrointestinal Endoscopy were used to assess appropriateness of colonoscopy. RESULTS: 3533 pathologic findings were found, in 2978 colonoscopies. 2336 polyps were removed, including 18% hyperplastic, 26% tubular adenomata, 13% villous adenomata, 11% tubulovillous adenomata. Advanced disease was found in 41% of pathologic findings, 11% were invasive cancer. Rate of colonoscopies "generally indicated" according to American Society for Gastrointestinal Endoscopy guidelines was 78% with a rate of colonoscopies "generally not indicated" of 22%. Colonoscopy was completed successfully to the cecum in 93% of patients. 0.08% had serious complications during or immediately after colonoscopy. CONCLUSIONS: Our results suggest that open access colonoscopy is a reliable and safe method for screening average risk population. As colonoscopy is becoming the recommended screening model for colorectal cancer this attitude of performing screening in an open access system could both cut costs in the future and improve availability, in an aim to become common practice. PMID: 17413609 [PubMed - indexed for MEDLINE]

468: AIDS. 2007 Apr;21 Suppl 2:S99-102.


Role of the data safety and monitoring board in an international trial. NIMH Collaborative HIV/STD Prevention Trial. OBJECTIVE: To describe the composition and role of the data safety and monitoring board (DSMB) for the National Institute of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial. DESIGN: NIMH appointed to the DSMB nine members representing the following areas of expertise: prevention science, ethnography, infectious diseases (especially HIV and sexually transmitted diseases), laboratory diagnostics, clinical practice, methodology, international trial experience, statistics, and ethics. METHODS: The DSMB assessed the overall study for any concern about plans or implementation and reviewed cumulative study data to evaluate the safety of study participants, the ongoing conduct of the study, and the scientific validity and integrity of the Trial. Because of the Trial's international scope, the DSMB examined the effects of cultural differences on study implementation and fidelity. RESULTS: Among the DSMB recommendations that strengthened the Trial was one to conduct initial epidemiological studies of the venues selected for the intervention to verify risk and to establish intraclass correlation coefficients that could be used to calculate appropriate sample sizes. CONCLUSIONS: The DSMB played a critical role in this Trial. Because members have the expertise required to monitor the Trial, are not involved in the daily management of the Trial, and can review interim analyses and adverse event reports, they are in an excellent position to provide expert advice to ensure that the Trial's goals are achieved and that NIH funds are well invested. PMID: 17413269 [PubMed - indexed for MEDLINE]

469: Eur J Public Health. 2007 Oct;17(5):419-23. Epub 2007 Apr 4.


Comment in:

• Eur J Public Health. 2007 Oct;17(5):409.

Barriers in accessing to tuberculosis care among non-residents in Shanghai: a descriptive study of delays in diagnosis.

Wang W, Jiang Q, Abdullah AS, Xu B. Department of Epidemiology, School of Public Health, Fudan University, China. OBJECTIVES: To describe accessibility to tuberculosis (TB) diagnosis in non-resident TB patients in Shanghai, China, and to identify factors associated with delay in diagnosis. METHODS: A face-to-face interview of 222 newly diagnosed, non-resident TB patients registered in two districts of Shanghai: Changning District and Putuo District, was conducted using a structured questionnaire. RESULTS: Among the 222 non-resident TB patients, median patient's delay was 21 days and median doctor's delay was 8 days. The duration of doctor's delay was significantly longer in Changning District than Putuo District (13 vs. 5 days, P < 0.001). One-fourth of the subjects had a patient's delay longer than 42 days and a doctor's delay longer than 15 days. Logistic regression model shows that patients at lower income level, and who did not have haemoptysis symptom were more likely to have longer patient's delay. Patients who registered in Changning were more likely to have a longer doctor's delay. The proportion of diagnosis or consideration as suspected TB for referral was significantly higher in hospitals than non-hospitals. CONCLUSION: The results of this study indicate that patient- and doctor-related factors contribute significantly to delays in the diagnosis of non-resident TB patients in Chinese cities. Non-resident's poor economic status, clinical status, complexities in referral and diagnostic procedure at different districts accounted for delayed TB care-seeking and diagnosis. Publication Types:



470: BMC Health Serv Res. 2007 Apr 5;7:49.


Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians. Akl EA, Maroun N, Major S, Chahoud B, Schünemann HJ. Department of Medicine, University at Buffalo, NY, USA. [email protected] BACKGROUND: As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income

countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG). METHODS: We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries. We evaluated the historical trends using the 1978-2004 historical files of the AMA-PPD. We analyzed the characteristics of all LMG and compared them to a random sample of 1000 USMG and a random sample of 1000 IMG using the 2004 AMA-PPD. RESULTS: In 2004, there were 2,796 LMG in the US, constituting 1.3% of all IMG. Compared to other foreign countries contributing to the US physician workforce, Lebanon ranked 2nd after adjusting for country population size (about 4 million) and 21st overall. About 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US. Since 1978, the number of LMG in the US showed a consistent upward trend at a rate of approximately 71 additional graduates per year. Compared with USMG and IMG, LMG were more likely to work in medical research (OR = 2.31; 95% Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01, respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR = 2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice (OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26, respectively). CONCLUSION: Given the magnitude and historical trends of migration of LMG to the US, further exploration of its causes and impact is warranted. High income countries should consider the consequences of their human resources policies on both low income countries' and their own healthcare systems. Publication Types:



PMCID: PMC1854889

471: J Thorac Oncol. 2006 Nov;1(9):965-71.


The role of gefitinib treatment for Korean never-smokers with advanced or metastatic adenocarcinoma of the lung: a prospective

study. Lee DH, Han JY, Yu SY, Kim HY, Nam BH, Hong EK, Kim HT, Lee JS. Research Institute and Hospital, Research Institute for National Cancer Control and Evaluation, Gyeonggi, Korea. PURPOSE: This prospective trial was conducted to evaluate the role of gefitinib in never-smokers with advanced or metastatic adenocarcinoma of the lung. PATIENTS AND METHODS: The main inclusion criteria were stage IIIB/IV adenocarcinoma of the lung and status as a lifetime never-smoker. Patients received a 250-mg single oral daily dose of gefitinib until disease progression, unacceptable toxicity, or patient's refusal. Tumor response was assessed after every two 4-week cycles according to the World Health Organization response criteria. Additional analyses were performed to identify predictors of response and survival. RESULTS: Between August 2003 and March 2005, 72 Korean patients were enrolled; 55 chemotherapy naive, 17 previously treated; 6 male, 66 female; and ECOG PS 0/1/2, 24/42/4. All patients were assessed for response, toxicity, quality of life, and survival. Overall objective tumor response rate was 55.6% (95% confidence interval [CI], 43.4-67.3%). With a median follow-up of 23 months, the median survival time was 19.7 months (95% CI, 18.5-21.0 months) with a 1-year survival rate of 76.3%. The median duration of response was 6.8 months (95% CI, 4.7-9.0 months). Therapy-related improvement of symptoms and quality of life was observed within 2 to 4 weeks after the commencement of therapy in the responders. In a multivariate Cox proportional hazard model, good performance status and no prior history of chemotherapy were the two significant predictors of better survival (p = 0.005 and 0.042). CONCLUSION: Gefitinib showed very promising antitumor activity and survival outcome in Korean never-smokers with adenocarcinoma of the lung. It seems to be a good alternative to standard chemotherapy as a first-line therapy for this subgroup. Publication Types:

• Clinical Trial • Research Support, Non-U.S. Gov't


472: Hong Kong Med J. 2007 Apr;13(2):100-5.


Determinants of preference for elective caesarean section in Hong

Kong Chinese pregnant women. Pang SM, Leung DT, Leung TY, Lai CY, Lau TK, Chung TK. Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. [email protected] OBJECTIVE: To find the clinical and socio-demographic determinants for Hong Kong Chinese women who preferred elective caesarean section. DESIGN: Cross-sectional interview survey. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS: A cohort of consecutive Hong Kong Chinese pregnant women (n=660) attending a government-funded obstetric unit catering deliveries in the New Territories in Hong Kong in 2002. MAIN OUTCOME MEASURES: The clinical and socio-demographic determinants of preference for elective caesarean section, in women who could have a trial of vaginal delivery. RESULTS: The overall prevalence for maternal preference for elective caesarean section was 16.7% (95% confidence interval, 13.8-19.6). The factors associated with preferring elective caesarean section were: previous elective caesarean section (odds ratio=7.6; 95% confidence interval, 2.0-28.7) and previous emergency caesarean section (3.8; 1.8-8.2). Among nulliparous women, the prevalence of preference for elective caesarean section was 16.8% (95% confidence interval, 13.0-20.6). Conception by in-vitro fertilisation was found to be significantly associated with preferring elective caesarean section in nulliparous women (odds ratio=5.2; 95% confidence interval, 1.0-26.4). CONCLUSION: Previous caesarean section and conception by in-vitro fertilisation were determinants for women preferring elective caesarean section. PMID: 17406036 [PubMed - indexed for MEDLINE]

473: Gesundheitswesen. 2007 Feb;69(2):105-9.


[Dental health in German and Turkish school children--a 10-year comparison] [Article in German] Heinrich-Weltzien R, Kühnisch J, Goddon I, Senkel H, Stösser L. Poliklinik für Präventive Zahnheilkunde, Zentrum für Zahn-, Mund- und Kieferheilkunde, Friedrich-Schiller-Universität Jena, Jena, Germany. [email protected] The purpose of this cross-sectional study was to assess the changes in dental

health in 12- and 15-year-old Turkish immigrants and German students who were included in a school-based caries-preventive programme for ten years (1993-2003). In 1993 352 and 402 12- and 15-year-olds and in 2003 352 and 402 12- and 15-year-olds were investigated, respectively. 23.6% of the 12-year-olds and 21.5% of the 15-year-olds were of Turkish origin. The clinical examination was performed with support of artificial light at school. Caries was diagnosed according to the WHO standard using the DMFT Index for permanent dentition. Within the ten-year period the highest increment of caries-free dentitions was found in 12- and 15-year old Germans attending grammar schools with 41,5% and 27% and secondary modern schools with 22,3% and 17%, respectively. The proportion of caries-free Turkish students attending secondary modern schools, only increased imperceptible in both age groups (1.2%). A significant caries decline of 1.5 DMFT was observed in 12-year old Germans at grammar schools, only. In 15-year olds caries declined in German students at secondary modern schools (2.5 DMFT), and at Grammar schools (2.2 DMFT), significantly, however caries experience in Turkish students remained nearly unchanged (0.3 DMFT). A strong polarisation of dental caries was found in 2003. Among the 12-year-olds 23% of those at secondary modern school accumulated 70% of the total caries experience (>3 DMFT) and at grammar school 9% of students accumulated 76% of the whole amount of caries (>1 DMFT). Among the 15-year-olds 73% of the total caries experience (>3 DMFT) was concentrated in 32% of the students at secondary modern schools, while 25% of the students at grammar schools exhibited 84% of the whole amount of caries (>1 DMFT). Intended concepts in caries prevention in the future should aim to improve dental health especially in Turkish students at secondary modern schools while taking social inequality of this risk group into account. Publication Types:

• Comparative Study • English Abstract


474: J Clin Nurs. 2007 Apr;16(4):786-93.


Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. Chan EA, Chung JW, Wong TK, Lien AS, Yang JY.

School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong. [email protected] AIM: This study examines the usability and effectiveness of virtual reality in reducing pain in wound-care procedures for pediatric burn patients in Taiwan. BACKGROUND: Virtual reality has continuously gained prominence in the medical arena, for instance, the telepresence for surgery, the management of mental health disorders and pain control of the paediatric burn. Notwithstanding an increased application of virtual reality in the medical arena in North America, there have been no studies investigating its use for paediatric burn patients in Asia. METHODS: This descriptive study has two phases: Phase I: the development of a virtual reality prototype. Phase II: the implementation of the prototype to discern its usability and efficacy with paediatric burn patients at a local hospital. RESULTS: The findings suggest that a significant difference is found in the children's reported pain, with or without the virtual reality intervention, over the three phases: before, during and after the dressing change. However, less pain was noted in the intervention group during and after the dressing change. CONCLUSION: Adding to the existing clinical value of virtual reality identifies the nature of and different children's responses to pain with the use of virtual reality. RELEVANCE TO CLINICAL PRACTICE: This study is significant since it demonstrates a difference in the child's response to pain based on the nature of presence and distraction. Moreover, given the evidence that a decrease in anxiety was experienced after the dressing change with virtual reality intervention, timing of using the virtual reality intervention before the child develops conditioning anxiety and anticipated pain for the procedure would be of importance. Publication Types:



475: J Clin Nurs. 2007 Apr;16(4):646-53.


The Turkish version of the Newcastle Satisfaction with Nursing Care Scale used on medical and surgical patients. Akin S, Erdogan S. Istanbul University Florence Nightingale School of Nursing, Istanbul, Turkey.

[email protected] AIM AND OBJECTIVES: The aim of this study is to test the validity and reliability of the modified version of the Newcastle Satisfaction with Nursing Care Scale on medical and surgical patients. BACKGROUND: Measuring patient satisfaction with nursing care is important in evaluating the extent to which patients' needs are met and for determining the appropriate nursing care. In recent years there has been increasing interest in patient satisfaction with nursing care in Turkey, but there are no validated scales available to measure this. DESIGN: It is an evaluative study. METHODS: The data were collected using the Newcastle Satisfaction with Nursing Care Scale and by a demographic information questionnaire. After translinguistic study, the content validity of the scale was confirmed and tested on 200 patients who were recruited at Istanbul University Hospital on the day of discharge. Internal consistency of the scale was tested by Cronbach's alpha. Demographic variables related to the satisfaction scores were analysed using the Spearmen correlation, the Mann-Whitney U- and Kruskal-Wallis tests. RESULTS: The Turkish version of the Satisfaction with Nursing Care Scale, with a total of 19 items, was determined to be suitable for measuring patient satisfaction with nursing care. Patients were generally satisfied with the nursing care received. The items with the most positive rating were respectively: the amount of freedom they were given on the ward, the amount of privacy they were given by nurses and how quickly nurses responded to their requests. The study found that female patients, older patients and those who had health insurance were the most satisfied. CONCLUSION: The Turkish version of the Satisfaction with Nursing Care Scale showed an adequate reliability and validity for its use on adult Turkish patients. RELEVANCE TO CLINICAL PRACTICE: Nurses can use the Satisfaction with Nursing Care Scale of Newcastle Satisfaction with Nursing Scales in evaluating and improving the nursing care in clinical practice. Publication Types:

• Validation Studies


476: Int J Nurs Educ Scholarsh. 2007;4:Article2. Epub 2007 Jan 23.


Comparing teaching practices about humor among nursing faculty: an international collaborative study. Adamle KN, Chiang-Hanisko L, Ludwick R, Zeller RA, Brown R.

Kent State University, USA. [email protected] Humor has been recognized by nurse researchers as a therapeutic intervention known to have positive psychological and physiological outcomes for patients. There is, however, no research that examines how nurses learn about humor. The purpose of this preliminary study was to examine nursing faculty members' teaching practices about humor education in the classroom and in clinical settings. Nursing faculty members from four nursing programs, two in the United States, one in Northern Ireland, and one in Taiwan, were surveyed about the inclusion of humor in the nursing curriculum. Findings revealed that substantially more humor education was included in clinical settings in the USA and Northern Ireland than in the classroom. In Taiwan, however, humor education was included more in the classroom than in clinical settings. Older and more experienced nurses with higher levels of education reported using less humor in teaching practices. Publication Types:



477: Aust Health Rev. 2007 Apr;31 Suppl 1:S116-21.


Anaesthesia underpins acute patient care in hospitals. Thompson WR, Phillips GD, Cousins MJ. Australian and New Zealand College of Anaesthetists, Melbourne, VIC. [email protected] The Australian and New Zealand College of Anaesthetists (ANZCA) carried out a review of the roles of anaesthetists in providing acute care services in both public and private hospitals in Europe, North America and South-East Asia. As a result, ANZCA revised its education and training program and its processes relating to overseas-trained specialists. The new training program, introduced in 2004, formed the basis for submissions to the Australian Medical Council, and the Australian Competition and Consumer Commission/Australian Health Workforce Officials' Committee review of medical colleges. A revised continuing professional development program will be in place in 2007. Anaesthetists in Australia and New Zealand play a pivotal role in providing services in both public

and private hospitals, as well as supporting intensive care medicine, pain medicine and hyperbaric medicine. Anaesthesia allows surgery, obstetrics, procedural medicine and interventional medical imaging to function optimally, by ensuring that the patient journey is safe and has high quality care. Specialist anaesthetists in Australia now exceed Australian Medical Workforce Advisory Committee recommendations. PMID: 17402896 [PubMed - indexed for MEDLINE]

478: Bull Soc Pathol Exot. 2007 Feb;100(1):32-5.


[The management of stroke in Phnom Penh, Cambodia] [Article in French] Chan S, Ros S, You KY, Nhem S, Salle JY, Dudognon P, Daviet JC. Service de médecine A, Hôpital Calmette, Phnom Penh, Cambodge. Stroke ranks first among nervous pathologies in Kampuchea. It's a main cause of disability and mortality in our country. We conducted a prospective study including 100 patients hospitalized in the service of general medicine at the Calmette hospital in Phnom Penh. We analyzed the principal risk factors, clinical signs, nature of stroke, complications and markers of the vital and functional prognosis. This work shows the difficulties encountered in the initial care of stroke: delay or absence of hospitalization, cost of complementary examinations to be carried out to determine the nature and the aetiology of stroke and very low level of follow-up to ensure secondary prevention and functional rehabilitation. It can be explained in part by the socioeconomic and cultural level. Research like this one which assesses local needs for stroke prevention, treatment and rehabilitation should be conducted in developing countries to inform the planning and allocation of health care resources in order to reduce the burden of illness associated with stroke. The progressive improvement of the medical structures, and of the socioeconomic and cultural level will facilitate stroke care management. Publication Types:



479: Tuberk Toraks. 2007;55(1):59-63.


[Does tumor type and sex distribution of primary lung cancer change? The comparison of the results of 2004 and previous years] [Article in Turkish] Sulu E, Damadoğlu E, Nergiz S, Ertuğrul M, Saltürk C, Oğütçü Karabay E, Yilmaz A. Department of Chest Diseases, Süreyyapaşa Thoracic and Cardiovascular Diseases Training and Investigation Hospital, Istanbul, Turkey. [email protected] The aim of the present study was to evaluate the tumor cell type and sex distribution of patients diagnosed with primary lung cancer during 2004. Patients with primary lung cancer were detected from pathology records. Clinical files of patients were analyzed retrospectively. 1403 patients with primary lung cancer were included in the study. 1238 (88.2%) patients were male and 165 (11.8%) were female and female to male ratio was 1/7.5. When the ratio was compared with 1/10.9 in 1998, the ratio of female patients was determined to increase. Tumor cell type was squamous cell carcinoma in 577 (41.1%) patients, adenocarcinoma in 359 (25.6%), small cell carcinoma in 184 (13.1%), nonsmall cell carcinoma in 115 (8.2%) and other malign tumors in 21 (1.5%) patients. Tumor cell type was not detected in 147 (10.5%) patients. When 147 patients were excluded from the study, the frequency of squamous cell carcinoma was 45.9%, adenocarcinoma was 28.6% and small cell carcinoma was 14.6%. The results of our study show that squamous cell carcinoma is the most frequent tumor cell type in our center and the ratio of female patients is increasing. Publication Types:



480: Chest. 2007 Aug;132(2):373-9. Epub 2007 Mar 30.


Comment in:

• Chest. 2007 Aug;132(2):365-7.

Registry and survival study in chinese patients with idiopathic and familial pulmonary arterial hypertension. Jing ZC, Xu XQ, Han ZY, Wu Y, Deng KW, Wang H, Wang ZW, Cheng XS, Xu B, Hu SS, Hui RT, Yang YJ. Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Rd, Beijing 100037, People's Republic of China. [email protected] BACKGROUND: To evaluate the clinical features and survival data of patients with idiopathic pulmonary arterial hypertension (PAH) and familial PAH in Chinese patients. METHODS: Seventy-two patients with idiopathic PAH and familial PAH were enrolled in the study from 1999 to 2004 and were classified into two groups according to World Health Organization (WHO) functional class (I/II and III/IV). Clinical and hemodynamic data were recorded. RESULTS: The mean age of the 72 patients was 35.9 years with female patient/male patient ratio of 2.4:1. A significant difference was identified in the clinical presentation between two WHO functional class groups at baseline. Echocardiography showed a mean pulmonary systolic pressure of 98 mm Hg. Left ventricular end-diastolic diameter was significantly smaller in the group of patients in WHO functional class III/IV than in those in class I/II group. After follow-up for a mean (+/- SD) duration of 40.1 +/- 20.0 months, the survival rates at 1, 2, 3, and 5 years were 68.0%, 56.9%, 38.9%, and 20.8%, respectively. A significant difference was identified in survival rate between the class I/II and class III/IV groups (p = 0.02 [log rank test]). CONCLUSIONS: The baseline characteristics and survival rates of our cohort study are close to those of the National Institutes of Health Registry in the 1980s, and the 1-year survival rate is obviously lower for patients in this registry than for those in the French registry between 2002 to 2003. Lack of effective treatment was the main cause of poor survival in this study. Our results support the need of an appropriate treatment strategy for this devastating disease in China. Publication Types:



481: Seishin Shinkeigaku Zasshi. 2007;109(2):110-27.


[Maternal filicide in Japan: analyses of 96 cases and future directions for prevention] [Article in Japanese] Taguchi H. Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Ph.D. Course of Graduate School of Tokyo Medical and Dental University. OBJECTIVE: Maternal filicide is not an isolated phenomenon. When a mother kills her child, she may be affected by many factors and confronted with different problems based on the child's developmental stage. In this study in Japan, a judicial sample of 96 adult women, convicted in their first trial for the murder or attempted murder of their children, was divided into four groups of mothers according to the age of the victim (25 women killed neonates, 22 women infants, 27 women preschool children, and 22 women schoolchildren and/or teenagers) in order to identify the factors that have a major impact on filicide in each group. METHODS: The socio-demographic, clinical, forensic, circumstantial, and offense characteristics, and legal disposition of 96 cases drawn from judicial records were compared among the four groups using the Kruskal-Wallis test; comparison of two groups was conducted using the Mann-Whitney test. RESULTS: Neonaticide cases were distinguished from the other three groups by marked differences: a significantly higher rate of unmarried mothers, financial difficulties, absence of mental illness, and admission of not wanting an illegitimate child. In the other groups, mental disorders were frequent; in particular, post-partum depression was the primary cause of infanticide. For the two groups of cases involving a child older than one year, filicidal mothers were more affected by circumstantial factors such as health problems of the child or severe marital discord. These problems may then have caused a reactive mental disorder among these mothers. The risk of fatal abuse or neglect was higher for handicapped preschool children. Filicide-suicide was most frequently seen among school-aged children and/or teenagers who had serious behavioral problems, and these children often had a mental disorder. CONCLUSIONS: The classification of maternal filicide by age of the child demonstrated that there are specific issues for each group. Based on these findings, future directions for prevention include: appropriate sex education for youths to avoid unwanted pregnancy; organization of specialized mental health services for mothers with post-partum mental disorder; careful psychiatric risk assessment of mentally ill mothers; and development of diversified social support measures for child-bearing parents,

especially those with identifiable financial or social difficulties. Publication Types:



482: Stroke. 2007 May;38(5):1430-5. Epub 2007 Mar 29.


Comment in:

• Stroke. 2007 Nov;38(11):e151.

Radiological findings, clinical course, and outcome in asymptomatic moyamoya disease: results of multicenter survey in Japan. Kuroda S, Hashimoto N, Yoshimoto T, Iwasaki Y; Research Committee on Moyamoya Disease in Japan. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan. [email protected] BACKGROUND AND PURPOSE: Although the development of a noninvasive MR examination has increased the opportunity to identify asymptomatic patients with moyamoya disease who have experienced no stroke episodes, their clinical features are still unclear. This was the first multicenter, nation-wide survey focused on asymptomatic moyamoya disease in Japan and was designed to clarify their clinical features. METHODS: A clinical database of asymptomatic patients with moyamoya disease was collected from 12 participating hospitals in Japan between 2003 and 2006. In total, 40 patients were enrolled in this historical prospective cohort study. Of these, 6 underwent surgical revascularization, including superficial temporal artery to middle cerebral artery anastomosis and/or pial synangiosis. Their demographic and radiological findings as well as outcome were evaluated. RESULTS: On initial evaluation, cerebral infarction and disturbed cerebral hemodynamics were detected in approximately 20% and 40% of the involved hemispheres, respectively. Angiographical stage was more advanced in more elderly patients. Of 34 nonsurgically treated patients, 7 experienced transient ischemic attack (n=3), ischemic stroke (n=1), or intracranial bleeding (n=3) during follow-up periods (mean, 43.7 months). The annual risk for

any stroke was 3.2%. Disease progression was associated with ischemic events or silent infarction in 4 of 5 patients. No cerebrovascular event occurred in the 6 patients who underwent surgical revascularization. CONCLUSIONS: The findings revealed that asymptomatic moyamoya disease is not a silent disorder and may potentially cause ischemic or hemorrhagic stroke. Asymptomatic patients with moyamoya disease should be carefully followed-up to further clarify their outcome and to establish the management guideline for them. Publication Types:

• Multicenter Study • Research Support, Non-U.S. Gov't


483: BMC Fam Pract. 2007 Mar 29;8:14.


Does Family Medicine training in Thailand affect patient satisfaction with primary care doctors? Jaturapatporn D, Dellow A. Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. [email protected] BACKGROUND: Recent national healthcare reforms in Thailand aim to transfer primary care to family physicians, away from more expensive specialists. As Family Medicine has yet to be established as a separate discipline in Thailand, newly trained family physicians work alongside untrained general doctors in primary care. While it has been shown that Family Medicine training programs in Thailand can increase the quality of referrals from primary care doctors to specialists, information is lacking about whether such training affects the quality of patient care. In the Department of Family Medicine at Ramathibodi Hospital, trained family physicians work with residents and general doctors. Although this situation is not typical within Thailand, it offers us the opportunity to look for variations in the levels of satisfaction reported by patients treated by different types of primary care doctor. METHODS: During a two-week period in December 2005, 2,600 questionnaires (GPAQ) were given to patients visiting the Department of Family Medicine at Ramathibodi Hospital. Patients were given the choice of whether or not they wanted to participate in the study. A cross-sectional analysis was performed on the completed questionnaires. Mean GPAQ scores

were calculated for each dimension and scored out of 100. Student t-tests, ANOVA with F-test statistic and multiple comparisons by Scheffe were used to compare the perceived characteristics of the different groups of doctors. Five dimensions were measured ranging from access to care, continuity of care, communication skills, enablement (the patient's knowledge of a self-care plan after the consultation) and overall satisfaction. RESULTS: The response rate was 70%. There were significant differences in mean GPAQ scores among faculty family physicians, residents and general doctors. For continuity of care, patients gave higher scores for faculty family physicians (67.87) compared to residents (64.57) and general doctors (62.51). For communication skills, patients gave the highest GPAQ scores to faculty family physicians (69.77) and family medicine residents (69.79). For enablement, faculty family physicians received the highest score (82.44) followed by family medicine residents (80.75) and general doctors (76.29). CONCLUSION: Faculty family physicians scored higher for continuity of care when compared with general doctors and residents. General doctors had lower GPAQ scores for communication skills and enablement when compared to faculty family physicians and residents. Faculty family physicians had the highest GPAQ scores in many dimensions of family practice skills, followed by residents and general doctors. Publication Types:



PMCID: PMC1852109

484: J Clin Nurs. 2007 Jun;16(6):1061-7.

The relationship between personal traits and job satisfaction among Taiwanese community health volunteers. Lin MC, Li IC, Lin KC. Purchase & Maintenance, Dong Guang Junior High School, Yilan County, Taiwan. AIM: The purpose of the study was to understand the relationship between job satisfaction and personal traits in health volunteers in one community in Taiwan. BACKGROUND: Among different kinds of community resources, the human

resource is most essential for the process of developing healthy communities and cities. However, it is not easy to keep voluntary workers as part of health programmes even though they have been trained. Previous research has shown that to increase the job satisfaction of such a person, the volunteer needs to improve effectively his/her need to achieve. The need to achieve is an important part of a person's personal traits. METHODS: A cross-sectional survey design was used to interview 317 health volunteers in various community health centres in I-lan county, northern Taiwan. The research instruments of this study included the 'locus of control orientation scale' for personality measurement, the 'achievement orientation scale' and the 'job satisfaction scale'. RESULTS: Most of the sample volunteers were female with an average age of 49.55 years; the majority was married and living with their spouses. In terms of the volunteers' personal traits, most of them are internal control orientation. The job satisfaction of the volunteers who took part in this research was extremely high. Significant variables correlating with job satisfaction in this study were gender, educational level, religious preference, participation in training, working to promote community health, the willingness to work, the frequency of participating in job training, and cooperation with other volunteer partners. The explainable variance for the prediction of job satisfaction from a combination of achievement orientation and the frequency of collaboration with other people was 9.1%. RELEVANCE TO CLINICAL PRACTICE: The results suggest that there is a need to strengthen cooperative relationships among volunteer by initiating well-planned volunteer training programmes and growth groups with the aim of enhancing their interpersonal relationships. PMID: 17394541 [PubMed - indexed for MEDLINE]

485: J Nurs Scholarsh. 2007;39(1):46-53.

Nurses' tobacco-related knowledge, attitudes, and practice in four major cities in China. Chan SS, Sarna L, Wong DC, Lam TH. Department of Nursing Studies, L.K.S. Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. [email protected] PURPOSE: To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses. Design: A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003. METHODS: 2,888 registered nurses working in hospitals

affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity. FINDINGS: 2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions. CONCLUSIONS: Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives. Publication Types:



486: J Vasc Access. 2007 Jan-Mar;8(1):21-7.

Increased use of catheters as vascular access: is it justified by patients' clinical conditions? Di Benedetto A, Basci A, Cesare S, Marcelli D, Ponce P, Richards N. NephroCare-Italy, Naples, Italy. [email protected] BACKGROUND: Over the last years many technical improvements have been made in hemodialysis treatment. Vascular access (VA) still remains an important problem. Although the use of indwelling vascular catheters is discouraged, in Europe there is an increasing use of them. The K/DOQI Guidelines recommend a native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there is considerable geographic variation in the distribution of type of VA used amongst hemodialysis patients. The aim of this study was to evaluate the time patients in four European countries have to wait before undergoing their first surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics network between October 1, 2002 and September 30, 2004 were considered. Data

were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients (males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy and Portugal had a higher proportion of elderly patients. At time of admission, the proportion of patients starting dialysis with AVF ranged between 23% and 60% from Turkey to Italy respectively. Patients with an indwelling catheter at admission are expected to undergo VA surgery as soon as possible. After 3 months of follow-up, about 75% of all patients had undergone surgery, however in the UK less than 50% of the patients had had a VA procedure. Overall, males have significantly higher probability of undergoing surgery, whilst elderly patients have a lower probability (27% and 14% respectively). CONCLUSION: Significant differences exist between countries in the time interval from referral to creation of VA. Health care system related problems seem to be the major reason to explain such differences. Patients in the UK have longer waiting times than the other countries studied. Publication Types:



487: Diabetes Care. 2007 Apr;30(4):989-92.

Erratum in:

• Diabetes Care. 2007 Aug;30(8):2175-6.

Microalbuminuria is common in Japanese type 2 diabetic patients: a nationwide survey from the Japan Diabetes Clinical Data Management Study Group (JDDM 10). Yokoyama H, Kawai K, Kobayashi M; Japan Diabetes Clinical Data Management Study Group. Department of Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan. [email protected] Publication Types:



488: Asia Pac J Clin Nutr. 2007;16 Suppl 1:329-38.

Health economics of weight management: evidence and cost. Kouris-Blazos A, Wahlqvist ML. Asia Pacific Health and Nutrition Centre, Monash Asia Institute, 8th Floor Menzies Building, Monash University, Victoria 3800, Australia. [email protected] The World Health Organization estimates that around one billion people throughout the world are overweight and that over 300 million of these are obese and if current trends continue, the number of overweight persons will increase to 1.5 billion by 2015. The number of obese adults in Australia is estimated to have risen from 2.0 million in 1992/93 to 3.1 million in 2005. The prevalence of obesity has been increasing due to a convergence of factors--the rise of TV viewing, our preference for takeaway and pre-prepared foods, the trend towards more computer-bound sedentary jobs, and fewer opportunities for sport and physical exercise. Obesity is not only linked to lack of self esteem, social and work discrimination, but also to illnesses such as the metabolic syndrome and hyperinsulinaemia (which increases the risk of developing heart disease, diabetes, hypertension, fatty liver), cancer, asthma, dementia, arthritis and kidney disease. It has been estimated that the cost of obesity in Australia in 2005 was $1,721 million. Of this amount, $1,084 million were direct health costs, and $637 million indirect health costs (due to lost work productivity, absenteeism and unemployment). The prevalence cost per year for each obese adult has been estimated at $554 and the value of an obesity cure is about $6,903 per obese person. Government efforts at reducing the burden remain inadequate and a more radical approach is needed. The Australian government, for example, has made changes to Medicare so that GPs can refer people with chronic illness due to obesity to an exercise physiologist and dietitian and receive a Medicare rebate, but so far these measures are having no perceptible effect on obesity levels. There is a growing recognition that both Public Health and Clinical approaches, and Private and Public resources, need to be brought to this growing problem. Australian health economist, Paul Gross, from the Institute of Health Economics and Technology Assessment claims there is too much reliance on health workers to treat the problem, especially doctors, who have not been given additional resources to manage obesity outside a typical doctor's consultation. Gross has recommended that further changes should be made to Medicare, private health insurance, and workplace and tax legislation to give people financial incentives to change their behaviour because obesity should not just be treated by governments as a public health problem but also as a barrier to productivity and a drain on

resources. A Special Report of the WMCACA (Weight Management Code Administration Council of Australia) (www.weightcouncil.org) on the "Health Economics of Weight Management" has been published in the Asia Pacific Journal of Clinical Nutrition in September 2006. This report explores the cost benefit analysis of weight management in greater detail. Publication Types:

• Review


489: Asia Pac J Clin Nutr. 2007;16 Suppl 1:22-6.

Sucrose consumption in Thai undergraduate students. Promdee L, Trakulthong J, Kangwantrakul W. Department of Clinical Chemistry, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand 40002. [email protected] Highly added sugar diets have been associated with various health problems such as dental caries, dyslipidemia, obesity and poor quality of life. Unfortunately, sugar consumption, especially sucrose, has increased continuously worldwide. The purpose of the study was to examine sources of sugar consumption and amount of added sucrose consumed in Thai undergraduate students. This study was carried out at Khon Kaen University, Thailand, between the years 2004-2005. A complete 3-day record of items and amounts of sweet consumption were obtained from 202 individuals--38 male and 164 female students. Added sucrose content of each sweetened food and drinks referred to in the record was determined by an enzymatic method. Mean intakes of sucrose were calculated from the sucrose content. The average of sucrose consumption in all subjects was 69+/-38 g/day, ranged from 4 to 182 g/day or 17 teaspoons of added sucrose per day. This amount accounted for 13.8% of total daily energy intake. There was a record of 337 kinds of sweetened foods and drinks found. The major source of added sucrose consumption was sweetened beverage, which was consumed 118 g/day averagely, or 60% of daily sugar consumption. Intake of sucrose per day in both male and female was not statistically difference, neither among different BMI groups. Intake of added sugar in the students was higher than the recommendation of the World Health Organization. These data would be helpful in a health promotion campaign aimed at a reduction of sugar consumption in Thai undergraduate students. Publication Types:



490: Urol Nurs. 2007 Feb;27(1):25-33.

Effectiveness of nursing care after surgery for stress urinary incontinence. Cayir G, Beji NK, Yalcin O. Istanbul Education and Research Hospital, Istanbul, Turkey. This study was conducted in two stages with 32 Turkish women undergoing surgery for correction of stress urinary incontinence. In Stage 1, 13 subjects (Group 1) were recruited for interviews and observations of their nursing care needs. Stage I also involved the development of a patient education pamphlet, nursing care protocol, and a standard nursing care plan. In Stage II, a new group of 19 subjects (Group 2) were recruited. Preoperative education and the patient education pamphlet developed during Stage I were provided to Group 2 subjects. A standard nursing care plan and nursing care protocol were also applied in the postoperative period for Group 2 subjects. The study protocol implemented by Turkish nurses and physicians is detailed. Study results are also described and discussed. Publication Types:

• Controlled Clinical Trial • Research Support, Non-U.S. Gov't


491: Health Aff (Millwood). 2007 May-Jun;26(3):w296-309. Epub 2007 Mar 27.

Variations in practice quality in five low-income countries: a conceptual overview. Das J, Gertler PJ. Development Research Group, World Bank, Washington, DC, USA.

[email protected] Country studies from Indonesia, Tanzania, India, Paraguay, and Mexico document the quality of medical advice and variation in practice quality across a number of dimensions. This overview paper serves three purposes. First, the studies use several different measures; we contextualize these measures and discuss how they relate to each other. Second, we propose a three-way decomposition to analyze variations in the quality of care. These variations can arise from inequalities in access, inequalities in choices, or inequalities arising from discrimination. We discuss common elements across the studies and draw policy implications for future research and advocacy. Publication Types:



492: Health Aff (Millwood). 2007 May-Jun;26(3):w352-66. Epub 2007 Mar 27.


Differences in access to high-quality outpatient care in Indonesia. Barber SL, Gertler PJ, Harimurti P. Institute of Business and Economic Research, University of California, Berkeley, USA. [email protected] Using a representative cross-section of health care providers in Indonesia, we describe variations in prenatal, child, and adult care quality. Quality is measured as knowledge about clinical guidelines. Public health centers offer above-average-quality prenatal care, and private physicians provide high-quality curative care. Private nurses offer below-average care, as do most providers in the more remote regions of Outer Java-Bali. The poor and wealthy have access to the same levels of quality; however, the poorest women report receiving fewer prenatal procedures. Recommendations include improving the professional development of nurses in private settings, testing quality improvements in Outer Java-Bali, and investigating wealth disparities in quality received. Publication Types:




493: World J Surg. 2007 May;31(5):1031-40.


Spectrum of breast cancer in Asian women. Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India. [email protected] INTRODUCTION: Breast cancer is the leading cause of cancer-related deaths in Asia, and in recent years is emerging as the commonest female malignancy in the developing Asian countries, overtaking cancer of the uterine cervix. There have been no studies objectively comparing data and facts relating to breast cancer in the developed, newly developed, and developing Asian countries thus far. MATERIAL AND METHODS: This multi-national collaborative study retrospectively compared the demographic, clinical, pathological and outcomes data in breast cancer patients managed at participating breast cancer centers in India, Malaysia and Hong Kong. Data, including those on the availability of breast screening, treatment facilities and outcomes from other major cancer centers and cancer registries of these countries and from other Asian countries were also reviewed. RESULTS: Despite an increasing trend, the incidence of breast cancer is lower, yet the cause-specific mortality is significantly higher in developing Asian countries compared with developed countries in Asia and the rest of the world. Patients are about one decade younger in developing countries than their counterparts in developed nations. The proportions of young patients (< 35 years) vary from about 10% in developed to up to 25% in developing Asian countries, which carry a poorer prognosis. In the developing countries, the majority of breast cancer patients continue to be diagnosed at a relatively late stage, and locally advanced cancers constitute over 50% of all patients managed. The stage-wise distribution of the disease is comparatively favorable in developed Asian countries. Pathology of breast cancers in young Asian women and the clinical picture are different from those of average patients managed elsewhere in the world. Owing to lack of awareness, lack of funding, lack of infrastructure, and low priority in public health schemes, breast cancer screening and early detection have not caught up in these under-privileged societies. CONCLUSIONS: The inadequacies of health care infrastructures and standards, sociocultural barriers, economic realities, illiteracy, and the differences in the clinical and pathological

attributes of this disease in Asian women compared with the rest of the world together result in a different spectrum of the disease. Better socioeconomic conditions, health awareness, and availability of breast cancer screening in developed Asian countries seem to be the major causes of a favorable clinical picture and outcomes in these countries. Publication Types:

• Comparative Study • Multicenter Study


494: Environ Geochem Health. 2007 Oct;29(5):413-28. Epub 2007 Mar 24.


Improving human micronutrient nutrition through biofortification in the soil-plant system: China as a case study. Yang XE, Chen WR, Feng Y. MOE Key Lab, Environmental Remediation and Ecosystem Health, Zhejiang University, 310029, Hanghzou, China. [email protected] Micronutrient malnutrition is a major health problem in China. According to a national nutritional survey, approximately 24% of all Chinese children suffer from a serious deficiency of iron (Fe) (anemia), while over 50% show a sub-clinical level of zinc (Zn) deficiency. More than 374 million people in China suffer from goiter disease, which is related to iodine (I) deficiency, and approximately 20% of the Chinese population are affected by selenium (Se) deficiency. Micronutrient malnutrition in humans is derived from deficiencies of these elements in soils and foods. In China, approximately 40% of the total land area is deficient in Fe and Zn. Keshan and Kaschin-Beck diseases always appear in regions where the soil content of Se in low. The soil-plant system is instrumental to human nutrition and forms the basis of the "food chain" in which there is micronutrient cycling, resulting in an ecologically sound and sustainable flow of micronutrients. Soil-plant system strategies that have been adopted to improve human micronutrient nutrition mainly include: (1) exploiting micronutrient-dense crop genotypes by studying the physiology and genetics of micronutrient flow from soils to the edible parts of crops; (2) improving micronutrient bioavailability through a better knowledge of the mechanisms of the enhancers' production and accumulation in edible parts and its regulation through

soil-plant system; (3) improving our knowledge of the relationship between the content and bioavailability of micronutrients in soils and those in edible crop products for better human nutrition; (4) developing special micronutrient fertilizers and integrated nutrient management technologies for increasing both the density of the micronutrients in the edible parts of plants and their bioavailability to humans. Publication Types:

• Case Reports • Research Support, Non-U.S. Gov't


495: Int J Cardiol. 2008 Jan 24;123(3):298-301. Epub 2007 Mar 23.


Pneumococcal endocarditis in children: a nationwide survey in Japan. Ishiwada N, Niwa K, Tateno S, Yoshinaga M, Terai M, Nakazawa M. Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan. [email protected] BACKGROUND: Infective endocarditis (IE) due to Streptococcus pneumoniae (S. pneumoniae) carries a high mortality rate. However, little is known about pneumococcal IE in children and no optimal therapy has been established. Thus, we attempted to identify the clinical features of this disorder through a Japanese nationwide survey. METHODS: Members of the Japanese Society of Pediatrics Cardiology and Cardiac Surgery registered 170 pediatric patients with IE diagnosed during a 5-year period (1997-2001). Nine of these patients (5.3%) had pneumococcal IE. The clinical course, treatment and outcome of these 9 patients, aged 7 months to 4 years, were analyzed. RESULTS: Pneumococcal IE was associated with congenital heart disease in 7 patients and accompanied by other systemic infections including meningitis, pneumonia and otitis media, in 4 patients. Five of the 9 (55.6%) strains isolated by blood culture were penicillin-resistant S. pneumoniae strains. Seven patients were treated with carbapenem. Three underwent cardiac surgery due to cardiac failure and/or vegetation. One died due to septic shock on the first day of hospitalization. CONCLUSIONS: In children, pneumococcal endocarditis is often accompanied by severe systemic infections. The majority of pediatric cases are caused by penicillin-resistant S. pneumoniae strains. Carbapenem is an effective for IE caused by penicillin-

resistant S. pneumoniae. This survey might be helpful to establish proper management strategies for pediatric pneumococcal IE. Publication Types:



496: Arch Gerontol Geriatr. 2007 Nov-Dec;45(3):327-34. Epub 2007 Mar 23.


Clinical and laboratory predictors of all-cause mortality in older population. Lan TY, Chiu HC, Chang HY, Chang WC, Chen HY, Tai TY. Division of Gerontology Research, National Health Research Institutes, Room 4110, 4F, No. 161, Ming-Chuan East Road, Sec. 6, Taipei 114, Taiwan. [email protected] Although some clinical and laboratory tests have been studied on their individual relationship with total mortality or cause-specific mortality such as cardiovascular mortality, the overall effect of these indicators on mortality has rarely been evaluated. The purposes of this study were to assess the relationship of clinical and laboratory measures and all-cause mortality and to evaluate their potential clinical importance in mortality prediction in older adults. A sample of 2086 persons aged 65 and older participating the population-based health examination in 1995 and 1996 in Kaohsiung City, Taiwan was followed until the end of 2003. All participants completed medical history and underwent clinical assessment and laboratory tests. Measures selected for analysis were pulse rate, blood pressure, height, weight, serum level of cholesterol, triglyceride, creatinine, and uric acid, fasting blood glucose (FBG), hemoglobin (HG) and red (RBC) and white blood cell (WBC) counts. Cox regression was used to select measures significant to total mortality. All participants were further classified into risk groups, based on disease history and values of measures identified from analyses, to evaluate mortality risk. A total of 409 deaths occurred during an average of 8.2 years of follow-up time. Among all 14 measures assessed individually, five (systolic blood pressure=SBP, creatinine, uric acid, FBG, and HG) were statistically related to total mortality. SBP (hazard ratio (HR)=1.22; 95% confidence interval (CI)=1.09-1.36), FBG (HR=1.18; CI=1.08-1.29), and HG (HR=0.81; CI=0.73-0.91) were further identified to have independent effect on total mortality in the multivariate analysis. Age- and sex-adjusted total mortality HRs for disease risk (with disease

history but with normal biomedical values), biomedical risk (without disease history but with abnormal biomedical values), and combined risk groups (with disease history and with abnormal biomedical values) were 1.94 (CI=1.22-3.10), 2.08 (CI=1.57-2.76), and 2.45 (CI=1.83-3.27) compared with low risk group (without diseases history and with normal biomedical values). Results from this study reveal the importance of incorporating clinical and laboratory measures on the assessment of mortality in older adults. Establishing mortality risk profile based on both diseases conditions and inexpensive biomedical measures (for example, SBP, FBG and HG identified in the study) may help physicians in evaluating older persons' prognosis. PMID: 17383026 [PubMed - indexed for MEDLINE]

497: Nurse Educ Today. 2007 Oct;27(7):808-18. Epub 2007 Mar 26.


A descriptive study of Bruneian student nurses' perceptions of stress. Burnard P, Haji Abd Rahim HT, Hayes D, Edwards D. School of Nursing and Midwifery Studies, Cardiff University, Wales, UK. [email protected] While much has been written about stress in nursing in the 'West', less research has been done on this issue in many 'Eastern' countries. This paper offers the findings of the first study of stress in student nurses in Brunei. The paper describes a study of 20 Brunei nursing students and their views about stress in nursing. A modified grounded theory approach was used in collecting and analysing data (and the 'modifications' are described). Findings were organised around the themes: stressors, moderators and outcomes [Carson, J., and Kuipers, E., 1998. Stress management interventions. In: Hardy, S., Carson, J., Thomas, B. (Eds.), Occupational Stress: Personal and Professional Approaches. Stanley Thornes, Cheltenham. pp. 157-174.]. Students often found their status as students caused them stress in the clinical setting: with other nurses, with doctors and even with patients. Academic related stressors included having to complete assignments and having to study in English. Various ways of moderating stress were reported including talking to 'trusted friends', engaging in sports or simply being quiet. Positive and negative outcomes of stress were identified: stress could lead to mental illness but, also, it could be motivating. This report concludes with a Weberian 'ideal type': a composite word-picture of the findings. PMID: 17379361 [PubMed - indexed for MEDLINE]

498: Eur J Gynaecol Oncol. 2007;28(1):33-8.


Supraclavicular lymph node metastases in cervical cancer. Qiu JT, Ho KC, Lai CH, Yen TC, Huang YT, Chao A, Chang TC. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. PURPOSE OF INVESTIGATION: To evaluate the outcome and prognostic factors of patients with supraclavicular lymph node (SCLN) involvement at primary diagnosis. METHODS: We reviewed the medical records of cervical cancer patients primarily treated at Chang Gung Memorial Hospital between 1987 and 2005. Thirty-three patients with histologically confirmed SCLN metastasis at primary diagnosis were eligible for analysis. Clinical and pathological features were analyzed for association with outcome. RESULTS: The 3- and 5-year survival rates of patients with SCLN metastasis were 16.5% and 16.5%, respectively. Multivariate analysis showed the serum level of squamous cell carcinoma antigen (SCC-Ag) < 15 ng/ml at initial diagnosis (p = 0.021) and staging/restaging including [18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) (p = 0.006) to be associated with a better prognosis. CONCLUSION: Primary SCLN metastasis in cervical cancer is not incurable. The benefit from PET findings might help in selecting appropriate patients for curative primary and/or salvage treatment. Publication Types:



499: J Trop Pediatr. 2007 Jun;53(3):171-8. Epub 2007 Mar 17.


Day-care management of children with severe malnutrition in an urban health clinic in Dhaka, Bangladesh. Ashraf H, Ahmed T, Hossain MI, Alam NH, Mahmud R, Kamal SM, Salam MA, Fuchs GJ.

Clinical Sciences Division, ICDDR, B, Dhaka 1212, Bangladesh. [email protected] Management of severely malnourished children with associated complications relies on hospital-based treatment. Implementation of a standardized protocol at the Dhaka Hospital, ICDDR,B reduced case fatality approximately 50%. We developed and prospectively evaluated a day-care clinic approach that provided antibiotics, micronutrients and feeding during the day with continued care by parents at home at night as an alternative to hospitalization. Severely malnourished children aged 6-23 months denied admission to hospital were enrolled at Radda Clinic, Dhaka and received protocolized management with antibiotics, micronutrients and milk-based diet from 8:00 am to 5:00 pm each day, while mothers were educated on continuation of care at home. They were transitioned to the day-care nutrition rehabilitation (NR) unit of Radda Clinic following resolution of acute illness, received NR diet (Khichuri, halwa and milk-based) daily until children attained 80% weight-for-length. From February 2001 to November 2003, 264 children were enrolled; 52% were boys and 78%, 21% and 1% had marasmus, marasmus-kwashiorkor and kwashiorkor, respectively. Only 13% had severe malnutrition alone while 35% had pneumonia, 35% had diarrhea and 17% had both pneumonia and diarrhea. The mean (SD) duration of acute and NR phases were 8 (4) and 14 (13) days, respectively. Children gained weight [mean (SD) g/kg day] more rapidly during acute 10 (7) than NR phase 6 (5). Successful management was possible in 82% (95% CI 77-86%) children, 12% discontinued treatment and 6% referred to hospitals. Only one child died during NR phase. Severely malnourished children can be successfully managed at existing day-care clinics using a protocolized approach. Publication Types:

• Clinical Trial • Research Support, Non-U.S. Gov't


500: Ann Trop Med Parasitol. 2007 Apr;101(3):187-93.

Cerebral malaria in adults -- a description of 526 cases admitted to Ispat General Hospital in Rourkela, India. Mishra SK, Mohanty S, Satpathy SK, Mohapatra DN. Department of Internal Medicine and Critical Care Unit, Ispat General Hospital,

Rourkela 769 005, Orissa, India. [email protected] Although the clinical picture of cerebral malaria in children has been reported extensively, scant information is available about cerebral malaria in adults. This report relates to one of the largest series of adult cases of cerebral malaria patients ever described. At Rourkela, in eastern India, 526 adults (aged >12 years) who each satisfied the World Health Organization's criteria for cerebral malaria were admitted to Ispat General Hospital between 1995 and 2001. These cases represented 18% of the 2994 adult patients who were admitted with Plasmodium falciparum malaria over the same period. Most (76%) of the adult cases of cerebral malaria were male, 48% were aged 21-40 years, and only 4% were older than 60 years. The most common presenting symptoms were fever (97.7%), vomiting (54.6%), headache (30.8%) and seizures (17.1%). Most (62.4%) of the cases had associated severe complications: jaundice (47.5%), acute renal failure (28.9%), and/or severe anaemia (9.7%). Overall, 175 (23%) of the cases were fatal, mortality being particularly high (59%) among those with multi-organ failure. Of the fatal cases, 107 (61%) died within the first 24 h of hospitalization, presumably indicative of late presentation. As the management of multiple complications may be inadequate at primary centres, early referral to higher centres is recommended. PMID: 17362593 [PubMed - indexed for MEDLINE]

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