1603-2003: 400 years of public health in Norway
By the summer of 1603 dr. Villads Nielsen was appointed ordinarius medicus in Bergen and thus became the first public funded physician in Norway. During 2003 the 400 anniversary of the Public health services in Norway is celebrated all around the country. Medical information and medical literature have played a central role in the shaping of these services. Before taking on the future it might be helpful to have a look in the mirror and reflect over the centuries that have passed and the developments that have been made.

Managing health information – we’re in it together
As we enter the second Web decade, collaboration between libraries and other organizations at local, national and international levels is enabling Web resource developers to leverage the experiences and products of their colleagues.  Examples of collaborative efforts being facilitated by the National Library of Medicine include expanding PubMed Central; building an international document delivery network among medical libraries; and sharing MEDLINEplus health information with partners organizing local and regional health resources.  NLM is also working with other organizations to develop strategies for preserving materials in electronic form, an activity that is an important part of NLM’s mission, but can only be accomplished in partnership with others.

Access to knowledge, a precondition for collaboration: The experiences of the Task Force on Communicable Disease Control in the Baltic Sea Region
A short presentation of the Task Force on Communicable Disease Control in the Baltic Sea Region will be given. The Task Force is a political instrument for cross border collaboration on health. Criteria for successful collaboration will be discussed, and the key role of access to knowledge will be underlined. Based on a few easy-to-understand examples, a challenge to internet-based librarians will be presented.

What is HINARI? Is it working?

HINARI – Health InterNetwork Access to Research Initiative 

HINARI is a World Health Organization sponsored partnership whereby more than 30 publishers provide access to full text journals and other information to libraries in developing countries. Access in 69 countries where the annual GNP per capita is $1000 or less is free (HINARI Phase 1), and in 43 countries where the GNP is between $1001 and $3000, access is at nominal pricing (HINARI Phase 2). Institutions which benefit include medical, nursing and pharmacy schools, universities, not-for profit medical research institutions, and government health ministries and health policy units. More than 2100 of the world key biomedical research and healthcare journals are in the scheme, which is an entirely voluntary partnership between the publishers and the WHO. Other key partners include Yale University Library who provide much of the bibliographic and authentication support and the National Library of Medicine who supply  embedded links from PubMed to journals in the HINARI programme. Although the situation is improving, there are still great difficulties in the cost of hardware and Internet connectivity. Dr Gro Harlem Brundtland, Director General of WHO said “It is perhaps  the biggest step ever taken towards reducing the health information gap between rich and poor countries”. More than 800 institutions in 94 countries have registered for the programme. 

Disease control and health literacy: The Lithuanian experience
Studies have shown that education is a powerful and unique predictor of health
outcomes: the more education people have, the better their health and vice a versa. Health literacy, as the degree to which individuals have the capacity people to obtain, process, and understand basic health information and services needed to make appropriate health decisions, is directly related to literacy skills. Higher education and health literacy skills leads not only to a healthier society but also to smaller health expenditures.

The same situation cam be observed in an overview of  national health studies which were carried out in Lithuania during the last thirty years. A strong
relationship between health and education was found. Total mortality among
Lithuanian population with lower education was 1,5 times higher, than among these with university education. The risk factors related with unhealthy lifestyle
such as smoking, alcohol drinking, low physical activity, overweight, unhealthy
diet were more common among less educated adult men and women. Having in
mind the fact, that the above mentioned risk factors were responsible for the incidence of about 50% of new cases of  cardiovascular diseases, cancer and diabetes, the increase of population health literacy skills should be among the priority areas of national health programs.

Combatting infectious diseases in Northern Europe: The importance of information exchange
The new disease SARS has once again demonstrated the need for rapid information exchange in modern infectious disease epidemiology and control. Over the past five years, the Nordic countries, several regions of North West Russia and Estonia, Latvia and Lithuania have intensified their collaboration to combat infectious diseases. The communication platform EpiNorth (www.epinorth.org) has been developed to share information. Key features are: 1) The bilingual nature of the web site and the journal. 2) Low tech solutions that enable the pages to be read by older browsers. With over 5000 printed copies and 5000 monthly web visitors, the EpiNorth collaborations has demonstrated its usefulness.

Professional information and the development of the nursing profession
This presentation focuses on the social significances of professional information of nurses. This is primarily done through a literature study that reveals ways of regarding professional information as expressed within the Swedish nursing profession. These are analysed in relation to changes and development within the profession’s knowledge domain over time. The knowledge domain of nursing is portrayed through a chronological account of the organisation of the occupation, changes in nursing education, the institutionalisation of nursing research and the growth of the domain’s professional information (including libraries). The presentation reveals how the main focus in the knowledge domain of nursing has shifted. During the greater part of the 20^th century the core of nursing was based on science and medicine, but from the 1970’s onwards there has been an increasing interest in a more independent formal knowledge domain. It is also shown how important professional information and nurses’ seeking and use of it in nursing practice have become, in particular since the 1970’s. Through analysis of quotations taken from, among other sources, nursing journals, it is shown how expressions of this credence to professional information can be seen as information strategies on the occupational group level that mediate a new occupational identity. A close relation to professional information implies increased opportunities for nurses to share common norms and values concerning the practice of nursing but also seems to have a symbolic value in supporting nurses’ professional project.

Evidence-based nursing and libraries: Do we find what we are searching?
We cannot retrieve from the databases anything that is not stored there. If we want to search and find evidence-based nursing research, the evidence has to be indexed when analysing the contents and selecting the subject terms.

In the big, international databases, such as PubMed and Cinahl, indexing the evidence has been taken into account, but at varying degrees. In PubMed, we still have to search evidence-based nursing with the terms evidence-based medicine AND nursing. However, in PubMed, evidence-based research can be found systematically, although not completely satisfactorily, by the help of publication types and MeSH terms. In Cinahl the evidence is harder to retrieve, partly due to the fact that the definitions of evidence-based nursing are not as systematic and well established as in medicine with its longer traditions as an academic discipline. Cinahl gives quick limitations like research, publication types such as systematic review and subject terms like nursing practice, evidence-based  but the definitions behind these terms do not always convince. Behind the insecurity seems to be the lack of uniform concepts: what does nursing research mean with a systematic review or what are the criteria for evidence-based reasearch, is not always clear.

As to the vernacular health sciences/medical/nursing thesauri, the situation varies in the Nordic and Baltic countries. In Finland, FinMeSH includes terms denoting evidence-based research, but they are not used in indexing. The nursing thesaurus, which is being built up, also includes these terms, but in nursing science, indexing has not yet begun with this thesaurus.

Information literacy: Curriculum integration - an investment in lifelong learning
During the years of study it is essential that the medical students aquire information skills enabling them to handle the wealth of biomedical information. The skills of finding, critically appraising and implementing relevant, evidence-based information in patient treatment  or likewise in research, are of utmost importance. Information literacy is a competence to be developed together with the subject areas studied. To prepare for a career the students have to become life-long learners.
 
In all adult learning motivation and timing are crucial. Discussions and cooperation with medical faculty’s teaching staff will reveal where information literacy teaching will best fit in the curriculum. One of the main success factors is that information literacy teaching is scheduled and integrated in the curriculum, and consequently asked for at the examinations.

Library of medicine and health sciences has over the years offered scheduled library instruction and taught informations skills to medical students, supporting the pedagogic method chosen: PBL. More recently a closer cooperation with the Medical faculty is established. The presentation will deal with present work and future plans for curriculum integration.

A special sister library program (US and Latvia) crosses the ocean
In 1999 members of the Medical Library Association’s International Cooperation Section organized a committee named the Sister Library Initiative.  The purpose of the Sister Library Initiative was to select two needy libraries in the world and to solicit broad based support.

The two libraries are:

• The Medical Research Library at Latvia. 
• The Holberton Hospital Medical Library is on the island of Antigua, in the Caribbean.

This paper will only cover the Sister Program with the Latvian library.
Some of the major accomplishments have been:

• Obtaining Ariel for the Latvian Library, soliciting free interlibrary loans from  libraries in the US and Canada. 
• Establishing a plan for free shipments of books and journals from 2 central US cities to Latvia. 
• Soliciting current and useful books and journals from US libraries.
• Soliciting support from library vendors including: MDConsult, STAT! Ref, UpToDate, and Swets Blackwell.

This program has been extremely successful and the friendships and bonds of goodwill between librarians have enriched all those involved.

Elisabeth Husem
Library of Medicine and Health Sciences. Department of Psychiatry, Oslo  (Norway)

The Transfer of Knowledge Project : Evaluation of mutual benefits
Human contact and communication are all important in partnerships - to share information, develop professional skills and awareness, and promote the interchange of ideas. To be successful and sustainable there must be a two way process! (Jean Shaw, UK).

The Nordic/Baltic Health Libraries Programme was initiated in 1994.
Within the framework of the Nordic-Baltic Partnership Programme, Norway and Lithuania have established a special bilateral programme

Continuing education programmes for Baltic librarians have been organized in Kaunas since the year 2000.

The Lithuanians inherited a Soviet type of library with closed access to holdings and a heavy structure from the Soviet times. Political literature formed 20% of the holdings of the library. There was an absence of PC’s and library information systems, a lack of foreign professional literature and knowledge, and no contact with foreign libraries and professional associations. 

Through the Partnership Programme, Lithuanian librarians have gained a great deal of professional knowledge and skills for implementing new library technologies, have had the possibility to participate in the EAHIL conferences and workshops, and to get acquainted and to talk to colleagues from various countries.

Knowledge, which was acquired through the “Transfer of Knowledge” Programme, was a stimulus to organize training courses for library personnel, as well as for library users.  

We consider the Transfer of Knowledge Programme as a successful partnership. However, it is time to evaluate the mutual benefits.  What have we learned from this Transfer of Knowledge Project? Have we obtained an interchange of ideas? Has there been a two-way process?  

New roles for Libraries in Scientific Communication - Local Initiatives
This presentation focuses on traditional and new roles for librarians in the scholarly  information value chain. 

The publishing system is no longer working satisfactorily. One of the reasons is the dramatic price increases of scientific journals. At the same time there has been an increase in the commercialisation of publishing, and consolidation resulting in a small number of dominant publishers.

The price barriers restrict access to information. This is in breach of research’s fundamental principle of the optimal dissemination of research results – a free exchange of information. This is a global problem. No libraries – not even the richest ones – can now afford to acquire access to published research to the extent required. 

Another barrier is the changed, complex relationship involving ownership rights and the licensing of electronic material. Publishers are introducing new legal and technical obstacles to the use of expensively acquired information resources.

These barriers have made the world of research experiment with new forms of publishing, evaluation and financing. Many university libraries have started to publish research in open e-print archives, and there is a growing international movement encouraging open access.

Researchers and librarians all over the world have started to work on new strategies. The following local initiatives will be presented:

• Swedish Resource Centre for Scientific Communication
• 1st/2nd Nordic Conference on Scholarly Communication
• Intellectual Property Agreements
• University based electronic publishing - LU:research
•  Directory of Open Access Journals DOAJ

• ELIN@ Electronic Library Information Navigator

The nature of science is profoundly collective
Analogous to Open Source Software, science can be thought of as 'Open Source Knowledge'. That is how science would work at its most optimal: all the knowledge being freely and universally accessible and then extended, built upon, improved, verified or falsified, discussed, applied, accepted or rejected, et cetera. It is in the interest of science and of individual scientists that their work is seen, read, cited and used as widely as possible. Conventional, subscription-based publication does not make this possible; open access does. The global scientific enterprise and society at large would benefit tremendously from the optimisation and increased efficiency of science communication made possible by open access.

Peter Lindgren
The National Institute for Working Life Library  (Sweden)

On interactive reference chat - the Phibi adventure
Presents an inside view and a case-study of the digital reference service called Phibi set up at the National Institute for Working Life. The presentation will focus on giving a practical view of the process of setting up a chat reference service and exploring the consequences for users on both sides of the service. It will give some ideas for future demands and directions based on almost three years of  experience with chat reference online.

Combining digital reference with real life in the library
As we all know, libraries are changing. New patron services have evolved, and along with them, demands on library personel.  Today we are expected to answer reference questions and communicate with patrons without ever seeing them.  We even have "dialogues" on screens with people we can't see or hear.  Patrons expect answers right away, and often prefer to have information and material delivered to them on their computer screens at home.  At the same time we are expected to maintain the same level of service to those of our patrons who continue to visit us in person.

Digital reference services are exciting and challenging, but without the necessary funds to back them up, they are stressful to produce and maintain.  The challenge lies in finding a way to balance the demands they place on us while insuring good service to patrons on both sides of the fence.  This balance often feels like walking on a tightrope.  We need safety nets put into place, and fast, because we've already taken our first steps.

At the Oslo Public Library we are in the process of finding and setting up our safety nets, while keeping an eye on the librarians on the tightrope and the patrons watching from below.  Our presentation is not designed to give all the answers.  We will present our own digital reference services and share our experiences, problems, frustrations and questions.

PDAs: Information at your fingertips, or a handful of trouble?
PDAs (Personal Digital Assistants), or handheld computers, have been commercially available for more than a decade.  During that time technical advances in their design, coupled with the availability of a growing range of software, have led to their increasingly widespread adoption not just as personal leisure devices but also as an integral part of professional life. This paper will survey existing PDA technology, summarise the hardware options currently available, and discuss some anticipated technical developments.  It will explore the present and potential use of PDAs as information resources by healthcare professionals and students, reviewing current practice in a variety of healthcare settings, and will consider the implications of PDA use for the design and delivery of healthcare information services by librarians and information specialists.  In conclusion, the paper will examine the strengths and weaknesses of PDAs in the healthcare environment and, in the light of a recent decline in PDA sales, assess the prospects for their further development and utilisation.

The MeSH translation database:  From idea to reality
The conversion of the MeSH maintenance system to a concept-based system allowed the possibility of a database to support MeSH translation.  With explicit labelling of the relationship between entry terms and main headings, a translated term could be linked to an exact meaning.  The existence of a translation database might address a number of different areas of concern.  In addition to linking to an exact meaning, it would allow translators to see work in progress, thus making it easier for them to keep abreast of the changes which occur in the annual editions, and would relieve translators of much of the burden of maintaining software to support their efforts.  Inclusions of translations in the Unified Medical Language System would also be facilitated.