• Linking Russian Hospitals to the U.S. on E-Mail: Included under GCC Health committee umbrella, the U.S. Center for Disease Control and the Russian State Committee for Sanitary and Epidemiological Surveillance have an agreement to share information on, and specifically to create a data base for, communicable diseases.

    Another important area for information exchange identified by the Health Committee is diabetes. The responsibility on the Russian side for coordinating U.S.- Russian cooperation in this area has been delegated to Dr. Aleksandr Amentov of the Russian Medical Academy of the Post-graduate Institute. Dr. Amentov operates 18 diabetes centers in different hospitals throughout Russia which are linked together by e-mail that uses IREX 400 protocols. The Russian Medical Academy presently cooperates with the Pittsburgh and Minnesota Diabetic Centers

    Perhaps there is way to link the 18 Russian hospitals to U.S. counterparts on e-mail. The information that could be exchanged via e-mail would have to be limited to diabetes but could include other priority areas such as health education; promotion, prevention, and control of infectious diseases; tuberculosis treatment and control; as well as Health Reform Policy.

    ( Under a cooperative agreement with the US Agency for International Development (USAID), The American International Health Alliance, Inc. (AIHA) has established twenty-one health care partnerships in ten of the New Independent States (NIS) of the former Soviet Union. These partnerships allow American providers to assist their counterparts in the NIS to address significant mortality and morbidity issues, improve health care organization and introduce market-oriented solutions to hospital and health system delivery and finance problems. In addition to working with their specific institutional counterparts, AIHA partnerships are working with related ministries of health, local and regional health system administrations, and schools of health sciences to ensure that critical areas of health education and administration are adequately addressed at these higher institutional levels as well, and that the capacity to carry out other developmental assistance efforts is enhanced.

    As part of its technical assistance program, AIHA has worked continuously to improve communications and the flow of information to the NIS by taking advantage of the capabilities of the Internet. By providing computers, modems, and Internet accounts, AIHA has enabled health professionals at each of the partnership institutions to become integrated with the worldwide medical community. AIHA is presently exploring the possibilities of using more advanced technologies to develop teleconferencing and telemedicine applications.

    In addition to the partnership-wide strategy currently being developed, several of the partnerships have developed their own solutions to closing the information/communications gap. Specifically, a partnership linking the Pavlov Medical Institute in St. Petersburg, Russia with Georgia Baptist Medical Center in Atlanta, Georgia has implemented a teleradiology link that enables health professionals in Russia to consult with their colleagues in Georgia using medical images transferred through telephone lines. Similarly, a partnership between Emergency Hospital in Yerevan, Armenia and Boston University Medical Center has initiated a monthly teleconferencing session to provide ongoing training for nurses and other health professionals in Armenia. Other partnerships, including one between institutions in Philadelphia, Pennsylvania and Kyyiv, Ukraine, have been working with the National Library of Medicine to provide access to Medline and other medical information resources.

    To specifically address the information needs of the partnerships, AIHA has contracted with the National Public Health and Hospital Institute to create an Internet-based clearinghouse on health care and technical assistance in the former Soviet Union The primary mission of the AIHA Clearinghouse (also known as NISHEALTH) is to provide information support to the AIHA partnership program, to the broader community of health professionals in the former Soviet Union and Eastern Europe, and to representatives from other technical assistance organizations. The Clearinghouse provides information on a variety of subjects, including funding opportunities, translated educational materials, and updates on the activities of technical assistance projects currently involved in the NIS. One of the most critical elements of the Clearinghouse is the NISMEDINFO Project--a concentrated effort to provide up-to-date clinical and health policy information to health professionals throughout the NIS and CEE. Through NISMEDINFO, NIS/CEE health professionals receive a weekly digest of abstracts from major Western medical journals, including the Journal of the American Medical Association. NISMEDINFO also provides full-text educational materials, including the Association for Practitioners in Infection Control (APIC) Curriculum for Infection Control Practice, the CDC~s Morbidty/Mortality Weekly Reports, and a guide to public health resources on the Internet developed specifically for NIS users. All of the information produced through the Clearinghouse is provided on the Internet. Since many users in the NIS have limited Internet access, all information is available through electronic mail.

    ( Analysis of Disease Occurrence in the Bryansk Oblast of Russia, using the Technique of Anamorphoses (Density Equalizing Map Projections): A proposed collaborative project between scientists in the U.S. and Russia will use advanced computing and telecommunications techniques to investigate the geographic distribution of cases of disease in the Bryansk Oblast of Russia, which was affected by the Chernobyl accident. Funding will be requested from an international foundation.

    A computer algorithm for anamorphoses (density equalizing map projections) was published by Gusein-Zade and Tikunov, and independently implemented in a SUN Sparc 10 workstation at Lawrence Berkeley Laboratory (LBL). A statistical analysis which used the LBL program was successfully applied by Merrill in a epidemiological investigation of childhood cancer cases in four counties of California, USA. Similar techniques will be used to investigate the geographic distribution of disease in the Bryansk Oblast, using data provided by Akimenkov and his associates.

    Intermediate and final results from the study, including graphic displays, will be publicly available on the World Wide Web (WWW) server at LBL. For details of the previous work, consult the following WWW URL: