Tele-otology: planning,design, development and implementation

The view of the tympanic membrane of the ear provides the specialist with important information for the assessment of ear disease and for treatment planning. In rural and remote areas, the incidence of ear disease is high but access to ear specialists is limited. As part of a project to deliver tele-otoscopy services to remote Western Australia, we have investigated various aspects of a tele-otoscopy system. We found that the MedRX video-otoscope is relatively safe to use and produces images of very good quality. A confident diagnosis could be made from still images compressed to 20 kByte. Video sequences could be compressed to a ratio of 1:300. Furthermore, a software package has been developed, and we are developing a training course for health-care workers in remote areas.     

A tele-otology course for primary care providers

The shortage of otolaryngologists and the high incidence of ear disease in remote areas are major problems in Australia. We have developed a multimedia course for primary care providers that incorporates material about ear anatomy and physiology, ear disease, video-otoscopy and telemedicine software. The computer-based course was followed by a practical one-day course. A multiple-choice test was given to participants before and at the end of the course and a form was used to record feedback. The course was conducted with 30 aboriginal health workers. The participants were able to obtain images of reasonable to good quality after a short period of training. There was an average improvement of about 25% in the test scores, and the feedback regarding the course was extremely positive. The CD-ROM and the Website provide a valuable resource to assist primary care providers in their care of patients with ear disorders.     

Tele-ophthalmology screening for retinal and anterior segment diseases

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera used as gold standards. Images (390 x 300 pixels x 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup-disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.     

Cervical cancer mortality in Australia: contrasting risk by Aboriginality, age and rurality

BACKGROUND: The poor health status of Australia's indigenous population is reflected in relatively high mortality rates from almost all causes, including preventable causes such as cervical cancer, where the rate is six to eight times that of non-Aboriginal women. However, there is little information on the geographical distribution of risk, an important issue for service deployment. This study examined the risk of death from cervical cancer in relation to Indigenous status, age and rurality. METHODS: Data from death registers from Australian states and territories who have identified Aboriginal people were examined for 1986-1997 to obtain a list of all deaths where the primary cause was cancer of the cervix. The data categorized females by 5-year age group, by metropolitan, rural or remote category and by Indigenous status. Mean age at death and standardized mortality ratios for deaths from cervical cancer were calculated for Aboriginal compared with non-Aboriginal women in metropolitan, rural and remote areas. RESULTS: The risk of death from cervical cancer for Aboriginal women compared with non-Aboriginal women increased by 4.3-fold for metropolitan areas, 9.7-fold for rural areas and 18.3-fold for remote areas. CONCLUSIONS: Aboriginal women in rural and remote areas of Australia are at significantly higher risk of death from cancer of the cervix than either Aboriginal women in metropolitan areas or non-Aboriginal women in any area. This result raises questions about access to services for prevention and early diagnosis and other factors that might impact on the incidence and natural history of the disease.     

Diagnosis of glaucoma using telemedicine--the effect of compression on the evaluation of optic nerve head cup-disc ratio

A photograph of the optic nerve head requires a lot of disk space (over 1 MByte) for storage and may require substantial bandwidth and time for transmission to a remote practitioner for a second opinion. To test whether compression degrades the image quality of the images, 302 slides were digitized at an optical resolution of 2400 pixels/inch (945 pixels/cm) and 30 bit/pixel. The images were saved both in non-compressed TIFF format and in compressed JPEG (compression ratio of 60) format. A blinded observer measured the optic nerve head cup-disc ratio for all three groups: the original slides, uncompressed TIFF and compressed JPEG images. The results showed that digital images were less accurate than slides. However, compression, even up to a ratio of 40, did not make matters worse.     

Non-government organisations to combine for work on chronic disease in Aboriginal peoples, Torres Strait Islanders and rural and remote populations

ABSTRACT: As a result of the National Health Priority Area Report on Cardiovascular Health and in particular, its remote and indigenous section, a consortium of five organisations ran a national workshop in Townsville in October 1999 on heart disease in Aboriginal peoples, Torres Strait Islanders and rural and remote populations. One of the priority areas identified at this workshop was the need for a more coordinated approach to chronic diseases and for the formation of an alliance of non-government organisations (NGOs) to work towards this and to undertake a lobbying and advocacy role. A meeting of a wide range of NGOs working in chronic disease, led by the National Heart Foundation of Australia, was held in Sydney in May 2000. At the Sydney meeting it was agreed that an alliance of NGOs could be formed for the development of a chronic disease strategy for Aboriginal peoples, Torres Strait Islanders and rural and remote populations. The NGOs drafted a 'Statement of Intent', which would inform their work on both heart disease and on broader work to address chronic preventable disease in the target populations. There is a considerable amount of procedural work to be done before the proposed alliance becomes a reality but the prospect of closer collaboration between the NGOs working in chronic disease has much to offer, especially for the population groups that were the focus of the Townsville workshop. This 'alliance' initiative comes at a time when there are national and State/Territory moves on broader aspects of what could become a 'national chronic disease prevention and management strategy'.     

A comparison study of SPECT and MRI in remote effects of chronic cerebrovascular disease

A comparison study of SPECT and MRI was performed to investigate remote effects in 10 patients with chronic cerebrovascular disease. Hypoperfusion in the cerebellar hemisphere contralateral to supratentorial lesions, the overlying cerebral cortex ipsilateral to subcortical lesions, the thalamus ipsilateral to cortical lesions, and the visual cortex distant to optic radiation lesions was demonstrated using SPECT with 123I-IMP. Although hypoperfusion in these remote areas was considered to be related to irreversible degenerative processes in the chronic phase, MR images did not reveal any abnormalities.     

专题制图仪影像分析湖区水位变化对钉螺孳生分布的影响

目的 探索水位变化对湖区钉螺孳生分布的影响,并初步探索利用遥感影像反映水位信息预测螺情变化趋势的可能性.方法 收集1997-2007年星子水文站的水位资料,以及鄱阳湖区1998-2006年间的12景专题制图仪(thematic mapper,TM)图像,采用校正的归一化水体指数(MNDWI)阈值法提取水体面积,分析其与水文站水位之间的相关关系;2007年选取星子县渚溪村马家湾及门前滩作为研究现场设框查螺2991框,并收集其1998-2006年螺情资料,分析其与水位之间的相关关系.结果 根据1998-2006年间的12景遥感影像提取的鄱阳湖区水域面积在1658.73～5873.48 km~2间,相应的星子水文站当日水位在9.96～21.72 m之间,经相关分析,两者之间呈正相关,r=0.96(P<0.01),两者之间建立模型为S=5189.96×ln(h)-10 284.97;1998-2007年渚溪村活螺框出现率在28.33%～77.46%之间,1997-2006年星子站8月份月平均水位在13.19～21.96 m之间,年最高水位在15.97～21.96 m之间,经相关分析,渚溪村活螺框出现率与相应的星子站上一年度8月份月平均水位及年最高水位间均呈负相关,r值分别为-0.69(P<0.05)及-0.77(P<0.01).结论 遥感影像提取的水域面积可以很好地反映实际水位变化情况,而查螺前一年的年最高水位变化影响着钉螺的分布,从而推断可根据遥感影像判断湖区钉螺孳生分布的变化状况.     

南水北调中线钟祥地区血吸虫病地理信息系统数据库的建立与分析

目的应用地理信息系统（GIS）与遥感（RS）技术建立湖北省钟祥地区血吸虫病相关数据库的地理分布图，并对疾病的分布现状和南水北调中线工程后的发展趋势进行纵向分析。方法收集钟祥地区近30年的血吸虫病流行病学数据及相关的气象、水文数据，通过构建遥感图像分类的神经网络及网络训练，建立相应的GIS数据库及显示图像。结果完成钟祥地区及周边区域血吸虫病流行的GIS数据库及1幅钟祥地区疫情图，依据图像计算，有螺面积（公顷，hm^2）分别为4．4、8．2、24、130．4、8．13,11753。结论GIS和RS技术制作的图像清晰、简明、直观，支持复杂的空间和属性查询，便于血吸虫病资料的保存与分析，为相关区域血吸虫病防治信息的现代化管理提供新手段。     

Use of mobile telemedicine for cervical cancer screening

Visual inspection of the cervix with application of 4% acetic acid (VIA) is an inexpensive alternative to cytology-based screening in areas where resources are limited, such as in many developing countries. We have examined the diagnostic agreement between off-site (remote) expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA. The images for remote evaluation were taken with a mobile phone and transmitted by MMS. The study population consisted of 95 HIV-positive women in Gaborone, Botswana. An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives. The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist. The positive nurse PIA readings were concordant with the positive expert PIA readings in 82% of cases, and the negative PIA readings between the two groups were fully concordant in 89% of cases. These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA 'see-and-treat' method.     

64层螺旋CT轴位薄层扫描在颞骨检查中的临床价值

目的：评价多平面重建技术（MPR）与容积再现技术（VRT）对正常内耳的显示能力。方法：将40名非内耳疾病志愿者分别采用HRCT扫描（20例，40耳）和轴位薄层扫描（20例，40耳），后者行MPR和VRT重建，并且，将前者轴、冠状扫描图像与相应的重建图像的显示质量进行统计评分处理，验证能否达到各向同性。结果：两组图像均达到各向同性（P〉0.05）,MPR图像清晰显示了正常内耳的内部骨性结构，半规管、耳蜗、听骨链和面神经管等结构实现了最佳同层显示，VRT图像清晰显示了正常内耳的空间立体结构。结论：MPR和VRT可清晰显示正常内耳结构，对内耳病变的诊断有重要帮助。     

Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999

OBJECTIVES: We sought to describe the pattern and magnitude of urban-rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. METHODS: We used routine population and health data on the population aged 40-74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators-mortality rates (deaths per 100,000 population), rates of continuous hospital stays (discharges per 100,000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. RESULTS: Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. CONCLUSIONS: Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.     

枣庄市偏远山区老年村民健康体检依从性及影响因素调查

目的 调查分析偏远山区老年村民对健康体检的依从性及其影响因素,为制定农村村民健康体检工作的改进措施提供依据.方法 按照村民居住地,选取居住偏远山区的老年村民485人,采取面对面访谈形式调查其健康体检行为、意识及其影响因素.结果 有295名（60.8％）老年村民能够按时参加体检,健康体检依从性与经济收入、文化程度呈正相关与年龄呈负相关.未能按时参加体检的主要原因依次为：路途遥远,交通不便;害怕查出病没钱治或治不好会加重心理负担及担心疾病发展;因身体不适,行动不便;对健康体检信息不知情或对免费健康体检工作不信任;认为自己没病就不需要检查等.结论 偏远山区老年村民对健康体检存在着客观条件的限制和主观认知的不足,对健康体检的依从性亟待提高,应采取相应措施,建立完善的农村健康体检模式.     

基于CBERS CCD图像的焦家坡垃圾填埋场动态变化监测

利用多时相国产CBERS CCD遥感图像数据,通过整合SAVI植被指数计算和决策树分类技术,对焦家坡垃圾填埋场动态变化进行监测,结果表明:焦家坡垃圾填埋场建成后,其覆盖面积逐年增加,裸露度逐年减小。多时相CBERS CCD遥感图像可以满足普查阶段城市垃圾填埋场动态变化监测的需要。     

AGE-STANDARDISED MORTALITY AND PROPORTIONAL MORTALITY ANALYSES OF ABORIGINAL AND NON-ABORIGINAL DEATHS IN METROPOLITAN, RURAL AND REMOTE AREAS

ABSTRACT: The study's aim was to assess how much of the variation in disease-specific mortality between metropolitan, rural and remote areas is specific to those diseases or reflects the all-cause mortality pattern. The ranges and variances of disease-specific standardised proportional mortality ratios between geographical areas were compared to those of the corresponding standardised mortality ratios. For most chapters in the International Classification of Diseases, the ranges and variances of the standardised proportional mortality ratios were less than 40% of those of the corresponding standardised mortality ratios. Only a small proportion of the variation in mortality can therefore be attributed to a specific disease component; the remainder must be attributed to an underlying force of mortality. Research, programs and policies addressing the socio-economic disadvantages of living in remote areas may lead to a greater improvement in mortality than those targeting specific diseases.     

Indigenous mortality in remote Queensland, Australia

OBJECTIVES: To quantify Indigenous mortality, compare it with non-Indigenous mortality, and identify causes of excess Indigenous mortality by remoteness in Queensland, 1997-2000. DESIGN: Cross-sectional survey of all deaths of Queensland residents registered in Australia during the study period. MAIN OUTCOME MEASURES: Mortality rates were standardised to the concurrent non-Indigenous population and categorised by age and sex. RESULTS: Death rates in Indigenous people were higher in remote areas. The difference between Indigenous and non-Indigenous mortality was also highest in remote areas. The leading causes of deaths were ischaemic heart disease, diabetes mellitus, respiratory diseases, malignant neoplasms, and injury, which accounted for more than 60% of excess deaths. CONCLUSIONS: Despite limitations with Indigenous identification, particularly in urban areas, Indigenous people, compared with the non-Indigenous population, have elevated mortality rates that increase by remoteness. This is in agreement with past work. To the extent that some of the causes of excess mortality can be attributed to lifestyle conditions, the health of Indigenous Australians can be substantially improved.     

Factors that affect the occurrence of fumonisin

The two important Fusarium ear rots of corn, Gibberella ear rot (Fusarium graminearum, formally F. moniliforme and allied species) and Fusarium ear rot (F. verticillioides and allied species) grow under different environmental conditions. F. graminearum grows well only between 26 and 28 degrees C and requires rain both at silking and during disease progression. F. verticillioides grows well at higher temperatures, and ear rot and fumonisin accumulation are associated with drought and insect stress and growing hybrids outside their areas of adaptation. In southern Transkei, where esophageal cancer has been associated with the consumption of F. verticillioides and fumonisin-contaminated corn, environmental conditions favor this fungus in most years. In the nearby areas where the soils, crops, food consumption, and populations are the same and where esophageal cancer is low, temperatures are cooler and F. graminearum is favored. Although F. verticillioides is associated with a disease of corn, it may be that this fungus is a mutualistic endophyte of the plant. Perhaps because of this, breeding for resistance to Fusarium ear rot has produced inconclusive results to date. The best available strategies for reducing the risk of fumonisin contents of maize are to ensure that hybrids are adapted to the environment and to limit drought stress and insect herbivory. It may also be necessary to make use of alternative strategies such as producing hybrids that contain enzymes to degrade fumonisin as it is produced.     

利用遥感技术对洪涝灾区县界定分级的研究

目的 借助遥感技术，对洪涝灾区县界定分级指标和标准进行研究，为洪涝灾害救灾防病提供科学依据。方法 选择洪涝灾区县界定分级指标，依据1998年江西省洪涝灾害3次遥感淹没资料描述性分析的结果，确定洪涝灾区县界定分级标准。结果 依据遥感资料可以将洪涝灾区县划分成3大类：3次遥感资料中有1次遥感淹没面积超过6700hm^2的灾区县属于一类灾区县；3次遥感淹没面积均低于6700hm^2的灾区县属于二类灾区县；3次遥感资料均未显示有淹没存在的其它上报灾区县属于三类灾区县。结论 借助遥感、地理信息系统技术可以实现对洪涝灾区县及时、准确的界定分级，为洪涝灾害救灾防病疫情统计服务。     

基于JPEG2000算法的传统X光片数字化处理与质量评价

目的用JPEG2000算法对传统X光胶片进行数字化处理及有效压缩，并对有损压缩造成的图像信息缺失对临床诊断影响程度进行质最评价。方法选取80幅保存较好的传统X光胶片，通过专用胶片扫描仪对其进行数字化转换，用JPEG2000压缩软件对数字化图像分别进行无损压缩与有损压缩处理，采用主观图像质量测量方法对压缩图像进行质量评估。结果统计结果表明标准有损压缩与无损压缩的图像质量无明显差异，高压缩比有损压缩（20：1）与无损压缩存在图像质量差异，但不影响诊断。结论对传统X光胶片的数字化处理可以进行适度的有损压缩（低于20：1）。     

Production of transmission foci for cutaneous leishmaniasis: the case of Pau da Fome, Rio de Janeiro, Brazil

This study analyzes the characteristics of one of the main foci for cutaneous leishmaniasis transmission in the city of Rio de Janeiro, Brazil, examining its territorial configuration and the relations with spatial organization processes. An analytical model was applied to the process of occupation and organization of urban space on a local scale, considering the new functions acquired by the spatial elements expressed by different work relations, land use, and land value. The study employed geoprocessing techniques and classification of images obtained by remote sensing, localization of households, and cases of cutaneous leishmaniasis, associated with qualitative data on the historical process of land occupation and use. The analysis detected areas with distinct conditions of vulnerability and showed that changes in these conditions allowed production of the epidemic in a given time period and its subsequent reduction. The study contributes to monitoring of the disease at the local level and application of effective measures for cutaneous leishmaniasis surveillance and control.