Objectives and achievements of the HUMN project on its 26th anniversary.

Micronuclei (MN) are a nuclear abnormality that occurs when chromosome fragments or whole chromosomes are not properly segregated during mitosis and consequently are excluded from the main nuclei and wrapped within nuclear membrane to form small nuclei. This maldistribution of genetic material leads to abnormal cellular genomes which may increase risk of developmental defects, cancers, and accelerated aging. Despite the potential importance of MN as biomarkers of genotoxicity, very little was known about the optimal way to measure MN in humans, the normal ranges of values of MN in healthy humans and the prospective association of MN with developmental and degenerative diseases prior to the 1980's. In the early 1980's two important methods to measure MN in humans were developed namely, the cytokinesis-block MN (CBMN) assay using peripheral blood lymphocytes and the Buccal MN assay that measures MN in epithelial cells from the oral mucosa. These discoveries greatly increased interest to use MN assays in human studies. In 1997 the Human Micronucleus (HUMN) project was founded to initiate an international collaboration to (i) harmonise and standardise the techniques used to perform the lymphocyte CBMN assay and the Buccal MN assay; (ii) establish and collate databases of MN frequency in human populations world-wide which also captured demographic, lifestyle and environmental genotoxin exposure data and (iii) use these data to identify the most important variables affecting MN frequency and to also determine whether MN predict disease risk. In this paper we briefly describe the achievements of the HUMN project during the period from the date of its foundation on 9th September 1997 until its 26th Anniversary in 2023, which included more than 200 publications and 23 workshops world-wide.

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia.

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.

Developing an Indonesia's health literacy short-form survey questionnaire (HLS-EU-SQ10-IDN) using the feature selection and genetic algorithm.

BACKGROUND AND OBJECTIVE: Measuring health literacy becomes more important because its association with health status and healthcare outcomes. Studies have developed at least 133 measurement tools for health literacy. HLS-EU-Q47 is a questionnaire consisting of 12 sub-dimensions and 47 questions developed by the Europe Health Literacy Consortium. Many countries in Europe and Asia have used HLS-EU-Q47 as a tool for measuring health literacy in the general public. Indonesia has conducted general health literacy survey using HLS-EU-Q47 but finding the difficulties because of the time-consuming interview. A shorter version of HLS-EU-Q47 is needed to apply in health literacy researches in Indonesia. This paper reports the results of feature reduction to develop a short Indonesian version HLS-EU questionnaire and measures the accuracy of the model compared with other short form like HLS-EU-SQ16 or HLS-SF12. METHOD: The analysis was performed on a population-based dataset from Indonesia-Semarang Health Literacy Survey for which there were specific target variables as the classification of health literacy level. All attributes were assessed as potential targets in the models derived from the full dataset and its subsets. The feature selection methods with genetic algorithm were used as the filter as well as validation (cross validation) and classification (k-NN:k-nearest neighbor). The predictive accuracy of health literacy level and the complexity of models based on the reduced datasets were compared among the methods and other short versions such as HLS-EU-SQ16, HLS-SF12. RESULT: The accuracy of the existing short form models were 90.64% with the HLS-EU-SQ16 and 88.67% with the HLS-SF12. This study proposed a model with 10 features as the construct of a short Indonesian-version (proposed as the HLS-EU-SQ10-IDN) since the model was with higher accuracy than the HLS-SF12, but fewer features for measuring general health literacy index. Moreover, the short version only completed part of 12 dimensions of the full questionnare. CONCLUSION: A data mining technique using feature selection with combination of genetic algorithm and k-NN algorithm was applied to develop a short version questionnaire and proved to have better accuracy, as compared with the short version developed by traditional statistical technique.

Health-related behaviors moderate the association between age and self-reported health literacy among Taiwanese women.

The role of health-related behaviors in the association between age and health literacy has not been well-elucidated. The present cross-sectional study evaluated the interactions between age and health-related behaviors in 942 women in Taiwan between February and October 2013. Women aged 18-78 years were randomly sampled and recruited from the national administrative system. Self-reported health literacy was measured by the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in Mandarin, asking about sociodemographics and essential health-related behaviors (watching health-related television, community involvement). The interviews were conducted confidentially by well-trained interviewers after having participants' consent. In multiple linear regression models adjusted for education attainment, self-perceived social status, ability to pay for medication, and health-related behaviors, health literacy was significantly negatively related to age (unstandardized regression coefficient, B = -0.04; 95% confidence interval [CI] = (-0.07; 0.00); p = .03). The lower health literacy among older women was significantly modified by watching health-related television programs (from "rarely/not-at-all", B = -0.08 (-0.12, -0.04), p < .001 to "often"; B = 0.10 (0.07, 0.12); p < .001) and community involvement (from "rarely/not-at-all", B = -0.06 (-0.10, -0.03); p = .001 to "often", B = 0.06 (0.03, 0.08); p < .001). Specific health behaviors were protective of older women's health literacy and likely their health.

30 years follow-up and increased risks of breast cancer and leukaemia after long-term low-dose-rate radiation exposure.

BACKGROUND: The current study followed-up site-specific cancer risks in an unique cohort with 30 years' follow-up after long-term low-dose-rate radiation exposure in Taiwan. METHODS: Six thousand two hundred and forty two Taiwanese people received extra exposure in residential and school buildings constructed with Co-60-contaminated steel from 1982 until informed and relocated in early 1990s. The additional doses received have been estimated. During 1983-2012, 300 cancer cases were identified through the national cancer registry in Taiwan, 247 cases with minimum latent periods from initial exposure. The hazard ratios (HR) of site-specific cancers were estimated with additional cumulative exposure estimated individually. RESULTS: Dose-dependent risks were statistically significantly increased for leukaemia excluding chronic lymphocytic leukaemia (HR100mSv 1.18; 90% CI 1.04-1.28), breast cancers (HR100mSv 1.11; 90% CI 1.05-1.20), and all cancers (HR100mSv 1.05; 90% CI 1.0-1.08, P=0.04). Women with an initial age of exposure lower than 20 were shown with dose response increase in breast cancers risks (HR100mSv 1.38; 90% CI 1.14-1.60; P=0.0008). CONCLUSIONS: Radiation exposure before age 20 was associated with a significantly increased risk of breast cancer at much lower radiation exposure than observed previously.

Health Literacy among Visitors of District Polyclinics in Almaty, Kazakhstan.

BACKGROUND: This study aimed to evaluate health literacy levels of patients in Almaty City, Kazakhstan and to identify socio-demographics and socio-economic factors related to their health literacy. METHODS: An international survey instrument HLS-EU-Q developed by the European Health Literacy Consortium was used in a cross-sectional study with 1000 citizens in the Almaty City at the age of 18 and over who visited the out-patient departments in the polyclinics between Feb and Oct 2014. RESULTS: There were 552 women and 446 men completed the survey, with mean ages as (41.8 ± 13.9) and (44.7 ± 15.2) yr old respectively, and women were significantly younger than men (P<0.001). Their general health literacy was (34.0 ± 8.6) for men and (33.49 ± 9.4) for women, without significant difference. In them, 15.5% or 30.0% were with inadequate or problematic health literacy. Multivariate linear regression analysis showed that higher general health literacy was positively and significantly associated with high self-assessed social status (B=3.86, P<0.001), ability to pay for medications (B=3.42, P<0.001), low frequency of watching health related TV programs (B=2.37, P<0.001), moderate community involvement (B=2.23, P=0.03). CONCLUSION: Specific demographic and socio-economic determinants related to health literacy were identified the first time in Kazakhstan. This would facilitate programs to improve health outcomes in Kazakhstan.

A New Comprehensive Short-form Health Literacy Survey Tool for Patients in General.

PURPOSE: To validate a conceptual short-form health literacy 12 items questionnaire (HL-SF12) in patient populations. METHODS: A cross-sectional study was conducted via a convenient sample of 403 patients from three departments of a community general hospital in the northern Taiwan. Patients' health literacy was assessed with a validated HL-SF12, derived from the full scale, the European Health Literacy Survey Questionnaire (HLS-EU-Q), as well as a single-item from Chew's Set of Brief Health Literacy Question. A reference population in Northern Taiwan (n=928) via the HLS-EU-Q in 2013-2014 was used as a reference to compare the health literacy between that of the general public and the patients. Data was analyzed by confirmatory factor analysis (CFA), internal consistency analysis, correlation analysis, and linear regression models. RESULTS: Patients' health literacy assessed with the HL-SF12 was shown with high internal consistency (Cronbach α=.87), and moderately correlated with the single-item from Chew's Set of Brief Health Literacy Question, with satisfactory item-scale convergent validity (item-scale correlation ≥ .40), without floor/ceiling effect, and with satisfactory goodness of fit indices of the three-factor construct model for most of the patients. Their health literacy was significantly positively associated with female gender, higher income, and more often watching health-related TV programs. On the other hands, patients were reported with significantly higher healthcare health literacy than the general public, but not in general health literacy, disease prevention health literacy, or health promotion health literacy. CONCLUSION: The comprehensive HL-SF12 was a valid and easy to use tool for assessing patients' health literacy in the hospitals to facilitate healthcare providers in enhancing patients' health literacy and healthcare qualities.

Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries.

BACKGROUND: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. METHODS: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. RESULTS: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity. CONCLUSIONS: The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

Health Literacy in Taiwan: A Population-Based Study.

Data on health literacy (HL) in the population is limited for Asian countries. This study aimed to test the validity of the Mandarin version of the European Health Literacy Survey Questionnaire (HLS-EU-Q) for use in the general public in Taiwan. Multistage stratification random sampling resulted in a sample of 2989 people aged 15 years and above. The HLS-EU-Q was validated by confirmatory factor analysis with excellent model data fit indices. The general HL of the Taiwanese population was 34.4 ± 6.6 on a scale of 50. Multivariate regression analysis showed that higher general HL is significantly associated with the higher ability to pay for medication, higher self-perceived social status, higher frequency of watching health-related TV, and community involvement but associated with younger age. HL is also associated with health status, health behaviors, and health care accessibility and use. The HLS-EU-Q was found to be a useful tool to assess HL and its associated factors in the general population.

Perceived environmental and health risks of nuclear energy in Taiwan after Fukushima nuclear disaster.

After the nuclear disaster in Fukushima in Japan in 2011, a nation-wide survey using a standardized self-administered questionnaire was conducted in Taiwan, with a sample size of 2,742 individuals including the residents who live within and beyond 30 km from a nuclear power plant (NPP), to evaluate the participants' perceived nuclear risk in comparison with their perceived risks from selected environmental hazards and human behaviors. The three leading concerns of nuclear energy were "nuclear accidents (82.2%)," "radioactive nuclear waste disposal (76.9%)" and "potential health effects (73.3%)." Respondents (77.6%) perceived a higher relative risk of cancer incidence for those who live within 30 km from an NPP than those who live outside 30 km from an NPP. All the participants had a higher risk perception of death related to "nuclear power operation and nuclear waste" than cigarette smoking, motorcycling, food poisoning, plasticizer poisoning and traveling by air. Moreover, the residents in Gongliao where the planned fourth NPP is located had a significantly higher perceived risk ratio (PRR) of cancer incidence (adjusted odd ratio (aOR)=1.84, p value=0.017) and perceived risk of death (aOR=4.03, p value<0.001) related to nuclear energy. The other factors such as female gender (aOR/p value, 1.25/0.026 and 1.34/0.001 respectively), lower education levels (aOR/p value: 1.31/0.032; 2.03/<0.001) and the participants' concerns about nuclear accidents (aOR/p value: 1.33/0.022; 1.51/<0.001) and potential health effects (aOR/ p value: 2.95/ <0.001; 2.56/<0.001) were found to be commonly associated with the PRRs of "cancer incidence" and "perceived risk of death" related to nuclear energy, respectively. In addition, the respondents' concerns about nuclear waste disposal and possible eco-environmental damage made significant contributions (aOR/ p value: 1.39/ 0.001; 1.40/<0.001) to predict their perceived risk of death related to nuclear power. These factors are considered as important indicators and they can be used for suggesting future policy amendments and public referendum on the decision of the operation of the planned NPP.

Risk perception of nuclear power plants among university students in Northeast Asia after the Fukushima nuclear disaster.

To examine the perception of nuclear energy risks among Asian university students following the Fukushima nuclear disaster, a standardized questionnaire survey was conducted since July 2011 after the Fukushima disaster. A total of 1814 respondents from 18 universities in China, Japan, Korea, and Taiwan participated in this survey. It showed that students with the following characteristics had a higher preference for "a clear schedule to phase out nuclear power plant (NPP)": females (adjusted odds ratio [aOR] = 1.84, 95% confidence interval [CI] = 1.44-2.34), in Japan (aOR = 2.81, 95% CI = 2.02-3.90), in China (aOR = 1.48, 95% CI = 1.04-2.09), and with perceived relative risks of cancer incidence greaterthan 1 (aOR = 1.42, 95% CI = 1.07-1.88). "If nuclear energy were phased out," the opinions on potential electricity shortage were as follows: Japan, aOR = 0.53, 95% CI = 0.40-0.69; China, aOR = 2.46, 95% CI = 1.75-3.45; and associated with academic majors (science/technology, aOR = 0.43, 95% CI = 0.31-0.59; medicine/health science, aOR = 0.64, 95% CI = 0.49-0.84). The results carried essential messages for nuclear energy policy in East Asia.

Risk perception, trust, and factors related to a planned new nuclear power plant in Taiwan after the 2011 Fukushima disaster.

After the Fukushima nuclear disaster in March 2011, an international review of nuclear safety indicated that two of the three nuclear power plants (NPPs) operating in Taiwan were listed as the most dangerous in the world. To understand the perception of NPP risks by the public in Taiwan and their attitudes regarding a planned fourth NPP after the Fukushima nuclear incident in 2011, a study was conducted in August 2011. A sample of 2819 individuals responded to the survey, with 66% perceiving that Taiwan's safety management of NPPs was inferior to Japan's, while 40% perceived a higher possibility of nuclear accidents like that in Japan. On average, a 'safe' distance of 94 km from an NPP was expected. 56% opposed the planned fourth NPP, with females (adjusted odd ratios (aOR) 2.03; 95% confidence interval (CI) 1.71-2.41), residence near the planned fourth NPP (aOR/CI 13.90/7.79-24.80), distrust of safety management (aOR/CI 1.98/1.45-2.69) and emergency planning (aOR/CI 1.89/1.49-2.40) as the main determinants. Others included those who expected larger safe distances from an NPP (trend test, p < 0.001), perceived excess cancer risks of living within 30 km of an NPP (aOR/CI 2.74/2.02-3.71), and projection of no electric shortage without NPPs (aOR/CI 1.93/1.50-2.49). Given that Taiwan's large population lives close to the existing NPPs and long-term concerns about the safety of these nuclear plants, the Fukushima incident in Japan likely augmented public risk perceptions on nuclear power in general and on the planned fourth NPP.

Myocardial perfusion scintigraphy in Taiwan from 2005 to 2009.

OBJECTIVE: To analyze the utilization of myocardial perfusion scintigraphy (MPS) in Taiwan within the universal healthcare system, the National Health Insurance (NHI) from 2005 to 2009, and to compare with European surveys. METHODS: On the basis of Taiwan's National Health Insurance Research Database of 2005-2009, a retrospective population-based analysis was conducted. Descriptive statistics were provided on the frequencies of and distributions in the utilization of MPS during the period. In addition, correlation analysis was applied to identify correlated factors in the utility of MPS. RESULTS: The annual number of MPS procedures performed was estimated to be 76 448 on average in 2005-2009 and 3361 per million population (pmp) over the period. The frequency increased by 45%, from 3008 pmp in 2005 to 4371 pmp in 2009, with an annual increase rate of 11.9%. The expenditure on MPS increased by 51%, from 12.3 million USD in 2005 to 18.55 million USD in 2009, with an annual increase rate of 12.9%. The average cost of identifying a coronary artery disease (CAD) case with MPS was 248 USD, with a 2.6% annual increase rate. Most patients were more than 50 years old when they received the MPS examination, whereas inpatients were much older. In addition, most of the MPS practices were performed in medical centers and regional hospitals, although an apparent increase was seen in district hospitals on outpatients. As a consequence, the rate of CAD diagnoses by MPS decreased over time. CONCLUSION: The numbers, frequencies, and expenses of MPS practices have increased in Taiwan during the period 2005-2009, especially for outpatients. The application rate of MPS in Taiwan was higher than that in Europe, likely because of the high accessibility to MPS procedures within the NHI system. This experience in Taiwan may serve as a reference for illustrating the trends in the use of MPS procedures in countries with a universal healthcare system.

Utilization of nuclear medicine scintigraphy in Taiwan, 1997-2009.

OBJECTIVE: To analyze the utilization of nuclear medicine scintigraphy in the Taiwanese population within the national health-care system between 1997 and 2009. METHODS: Based on the Taiwan's National Health Insurance Research Database of 1997-2009, a retrospective population-based analysis was conducted. Descriptive statistics and regression analysis were employed to analyze the frequencies and longitudinal trends in the utilization of diagnostic nuclear medicine procedures during the period. In addition, correlation analysis was applied to determine the correlated factors in the utility of nuclear medicine scintigraphy. RESULTS: The annual total nuclear medicine scintigraphy was estimated to be 256,389 on average in 1997-2009 and 11.7 per 1,000 population over the period. The frequency had increased by 67% over the years, from 8.2 per 1,000 population in 1997 to 13.7 per 1,000 population in 2009. The most frequently performed procedures were whole-body bone scans (33.4% of total) and myocardial perfusion scans (29.4% of total), with 4,615 and 5,620 increments per year, respectively. Most patients were in the age group of 41-65 years old when taking examinations. In addition, male subjects were slightly more than female patients (51.5 vs. 48.5%). Furthermore, the frequencies of whole-body bone scans and PET scans were proportional to the incidences of cancers (correlation coefficients were 0.96 and 0.94, respectively). CONCLUSIONS: The utilization of nuclear medicine scintigraphy with the National Health Insurance system in Taiwan has been changed considerably in the past 13 years. Both whole-body bone scan and myocardial perfusion scan were performed most often with significantly increases. The trend of nuclear medicine scintigraphy may have potential impact on making health-care policy in Taiwan.

Prevalence of Schistosoma haematobium infection among schoolchildren in remote areas devoid of sanitation in northwestern Swaziland, Southern Africa.

A parasitological survey of Schistosoma haematobium infection among primary schoolchildren in the remote areas of Hhohho and Manzini Provinces in northwestern Swaziland was undertaken. Presence of infection in subjects was confirmed on detection of S. haematobium ova in urine or the presence of hematuria. The intensity of the infection was estimated by calculating the total number of S. haematobium ova present in a 10-ml urine specimen and was expressed in terms of geometric mean intensity (GMI). The prevalence of S. haematobium infection in these populations was 5.3% (21/395) with a GMI of 46.5. Boys had higher prevalence (7.1%, 13/182) and GMI (50.4) than girls (3.8%, 8/213; 40.0) did (P>0.05). Geographically, the prevalence in Manzini schoolchildren (14.6%, 12/82) was significantly higher than that in Hhohho schoolchildren (2.9%, 9/313; P<0.001); however, Hhohho schoolchildren had a higher GMI (70.2) than that observed in Manzini schoolchildren (21.9). Children from schools located in Lowveld had a significantly higher prevalence (11.4%, 19/166) than that in children from schools located in Highveld (0.6%, 1/162) (P<0.0001).

Perception of quality of life of a cohort population years after relocation from previous low-dose radiation exposure in Co-60 contaminated buildings in Taiwan.

PURPOSE: To evaluate measures of health-related quality of life in a cohort study in Taiwan to assess late health effects of protracted low-dose-rate γ-radiation exposure during 1982 to the mid-1990s. MATERIALS AND METHODS: In 2004, 1,407 cohort subjects were evaluated by a self-measured World Health Organisation-Brief quality of life Questionnaires (WHOQOL-BREF Taiwan version) during an annual medical check-up in a hospital. Results of their health-related quality of life (HRQoL) in physical, psychological, social relationship and environmental domains were compared with an unexposed reference population in the same city. RESULTS: The exposed population was shown to have significantly lower quality of life (QOL) scores in physical, psychological and social relationship domains, but not in the environmental domain compared to the unexposed population. These findings were observed in all age groups with the greatest decrease found among those younger than 25 years old. Female subjects were shown to have larger decrease than male subjects. CONCLUSIONS: More than 10 years after being informed of radiation exposure, the exposed populations were observed to have significantly lower perception of HRQoL even though no biomedical effects were apparent. It is recommended that appropriate intervention be carried out in the follow-up of post-event rehabilitation for the radiation exposed.