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Progress toward integrating hepatitis B vaccine into routine infant immunization schedules in the United States, 1991 through 1994. Connecticut Hepatitis B Project Group.

OBJECTIVE: We assessed progress toward universal infant immunization against hepatitis B, which was first recommended in November 1991. METHODS: Multiple data sources were used to describe vaccination policies and trends in infant hepatitis B vaccine coverage. RESULTS: As of June 1993, 51% of the 63 local, state, and territorial immunization programs recommended hepatitis B vaccination of all newborns shortly after birth. The number of first dosages of hepatitis B vaccine administered to infants in public sector clinics increased rapidly from late 1992 to 1993, and at the end of 1993 was approximately two thirds the number of first dosages of other infant antigens. In a nationwide survey of hospital nurseries 47% offered hepatitis B vaccine to all newborns. Of 3982 sampled newborns in these hospitals, 36.2% had been vaccinated before discharge. In San Francisco and Connecticut, where public health officials encouraged hospitals to offer hepatitis B vaccination, first-dose coverage at discharge was 82.3% in 1994 and 69.1% in 1993, respectively. Coverage was higher in healthier infants and lower in infants of older or better-educated mothers. Results from the National Health Interview Survey demonstrate that three-dose completion at 12 months of age increased form less than 1% of children born in 1989 to 40% of children born in the fourth quarter of 1992. Vaccination at birth increased from less than 1% of infants born in 1989 to 32% of infants born in the second half of 1993. CONCLUSIONS: Infant hepatitis B vaccination has expanded rapidly since national recommendations were made; however, universal coverage has not been achieved.

Connecticut↗

Fluoridation--the Israel experience.

In the early 1970s the dental health of Israeli children was poor. As the dental services were insufficient to cope with the high disease rate the only realistic way of improving dental health was by prevention. The central element of this strategy was water fluoridation. The first water fluoridation plant was opened in 1981 in Jerusalem. Now all three main population centres, namely Jerusalem, Tel Aviv and Haifa are all fluoridated and 42 per cent of the population of Israel receive the benefits of fluoridated water. Epidemiological studies have shown that 5- and 12-year-old children living in fluoridated areas have considerably less dental caries than those receiving unfluoridated water. Plans are being made to introduce new schemes and it is hoped that 82 per cent of the community will receive fluoridated water by the year 2000. A survey of dental fluorosis has indicated the presence of some mild fluorosis, the levels being higher in those areas with the highest mean daily temperatures. A small reduction in the fluoride levels of such areas may be considered.

Child↗

Community social alarm network in Slovenia.

The article deals with a case report on the technology transfer of the Lifeline community social alarm system to Slovenia. The main reason the project was initiated is the ageing of the Slovenian population (11% of the population is 65 or over). With this system we intend to support the public's wish to allow the elderly to remain in their own homes for as long as possible instead of placing them in institutional care. Between 1992 and 1995 the following results were achieved: the acceptability of the system in the social environment was increased; a pilot control centre in Ljubljana was established and has been operational for two-and-a-half years; a national dissemination plan was prepared; the integration of the programme into other information systems has been started. One of the main conclusions is that for the successful transfer of a technology which also affects social values in society, a social innovation must support the process.

Aged↗

Environmental health.

A short history of the close connections between human health an ambient environment (environmental health) in the global and national (Czech Republic) sense is presented. Concrete tasks and prospects for the near future are mentioned, including the human ecology education programme.

Czech Republic↗

How to make the most of village health promoters.

In a rural area of Bangladesh the methods used by village health promoters and the time available to them for their intended tasks were inadequate. Poverty and illiteracy in the community exacerbated their difficulties. Ways of tackling these problems are discussed below.

Bangladesh↗

Developing the 'health-promoting school'--a national survey of healthy schools awards.

The concept of the 'Health Promoting School' has been widely advocated as an approach to enhancing public health through school based health promotion. In many areas 'Healthy Schools Award' schemes have been set up to support the development of this concept, but there is no information on how widespread this practice is in the UK, how standards are evaluated, and what effect Healthy Schools Awards may have on young peoples' health. This UK national survey aimed to determine the extent and nature of existing award schemes and how they were being evaluated. A postal questionnaire was sent to all 200 health promotion units in the UK; the response rate corrected for mergers of units was 78.5%. Sixty-eight respondents (51%) were involved with an award scheme and 28 (21%) were planning them. Current award schemes were mostly jointly run by the health and education sectors, encompassing 845 participating schools of which two-thirds were primary schools. The most common issues addressed were; standard chronic disease risk behaviour, the environment and health education in the national curriculum; less frequently addressed were mental health, accident prevention, staff health and developing links with the wider community. Evaluation was usually by target setting and assessment of progress over a two year period. However, evaluation was rarely external or independent, raising doubts about the standards obtained and validity of the approaches. This survey highlights the rapid growth of healthy schools award schemes and the need for wider exchange of information on good practice. In particular there is a need for more explicit and measurable standards of achievement to ensure the quality of award schemes, and further research into their effectiveness.

Adolescent↗

Status of health promotion programme implementation in small-scale enterprises in Japan.

This study was conducted to determine the status of the implementation of health promotion programmes (HPPs) in Japanese small-scale enterprises (SSEs). A survey was conducted in 1996 using a questionnaire mailed to all the member construction companies (n = 772) of a health insurance society, and a response rate of 84% was obtained. Health examination was most frequently conducted (90%), followed by exercise/fitness programmes (17%), smoking measures (12%), health guidance (11%) and nutrition education (6%). Mental health programmes and the government-advocated Total Health Promotion Plan (THP) were implemented at less than 2% of SSEs. The implementation rates for these programmes, except for smoking measures and the THP, were higher at large enterprises than at SSEs. The employment rate for occupational physicians (OPs) was 9% and 49% at SSEs and large enterprises, respectively. The activity most frequently conducted by OPs was health examination, followed by curative services and health education. Advising employees to undergo re-examination or more valid examination after the annual health examination was most frequently conducted by non-health professionals.

Health Care Surveys↗