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PubMed2000

[Achievements and challenges of the expanded immunization program in the Americas].

The Expanded Program on Immunization (EPI) was initiated in 1974 in The Americas, based on the WHA 2757 resolution passed by the World Assembly of Health. Its purpose was to improve immunization coverage and to decrease morbidity and mortality caused by vaccine preventable diseases through vaccination. Specific goals were to eradicate in determined time periods poliomyelitis, measles, neonatal tetanus, to eliminate tuberculous meningitis in children four years and younger, diphtheria, and tetanus. This article presents up to date information on vaccination coverage trends between 1990 and 1998 in 13 countries of the American Region, briefly describes implementation of surveillance programs required for appropriate monitoring of vaccine impact, and discusses the changes observed in morbidity attributable to vaccine preventable disease in these countries during four periods, 1968 before the existence of EPI, 1978, four years after its introduction, 1988 and 1998. Although much remains to be done, the impact of EPI in the Americas has been outstanding in decreasing morbidity caused by vaccine preventable diseases.

Americas↗
PubMed1975

Assessment of national family planning programs in developing countries.

Today, 34 developing countries have policies and programs to lower fertility, and an additional 32 countries provide family planning services for health and humanitarian reasons. Specific causal relationships and linkages between social and economic development, family planning programs, and fertility levels and changes remain mostly unclear at this point. Based on percent acceptors, percent users, and changes in fertility rates (the most commonly used measures to evaluate family planning program accomplishments), however, the performance of programs on the whole has been moderately encouraging.

Abortion, Legal↗
PubMed2001

Evaluation of tuberculosis control by periodic or routine susceptibility testing in previously treated cases.

SETTING: A national tuberculosis control programme (NTP) disposing of baseline drug resistance rates and using 2EHRZ/6TH in the treatment of new cases. OBJECTIVE: To estimate the extent of drug resistance created by the NTP. DESIGN: Resistance rates in 2EHRZ/6TH failure and relapse cases were compared to baseline, and resistance profiles of repeat isolates were checked. Numbers of observed resistant failures were compared to numbers expected due to pre-existing resistance. Trends of resistance in combined new and previously treated cases were extrapolated. RESULTS: High drug resistance rates were observed. Changes in resistance to streptomycin, the virtual absence of documented acquired resistance and a close match of observed with expected resistant failures all indicated accumulation of primary drug resistance as the main mechanism. Resistance in relapse/failure cases showed a significantly declining trend, and estimated combined drug resistance decreased rapidly. CONCLUSIONS: Drug resistance in previously treated cases seems to consist of passed-on primary rather than true acquired resistance. A one-time survey is thus confusing, but continuous routine testing may constitute the best drug resistance monitoring method. Cases previously treated with short-course chemotherapy may show drug resistance much more frequently than generally assumed, and all should receive a re-treatment regimen. The 2EHRZ/6TH regimen proved very safe under field conditions, causing no 'amplification' towards multidrug resistance and almost no acquired isoniazid resistance. Implementation of this regimen, together with a standardised re-treatment regimen, seemed to rapidly reduce isoniazid as well as multidrug resistance levels, despite the fact that directly observed treatment was not strictly applied.

Antitubercular Agents↗
PubMed2001

Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK.

PURPOSE: Prevention of visual impairment due to congenital cataract is an international priority. Estimates of incidence are required for implementation and assessment of preventive strategies, but are not widely available, despite routine monitoring of birth defects at a national level in many industrialized countries. The purpose of this study was to determine the incidence of new diagnosis of congenital and infantile cataract in the United Kingdom. METHODS: All children with newly diagnosed congenital and infantile cataract in the United Kingdom in 1 year from October 1995 through September 1996 were identified using independent ophthalmic and pediatric national active surveillance schemes. Capture-recapture analysis was used to estimate completeness of ascertainment. Annual age-specific and cumulative incidence were estimated and adjusted for ascertainment. RESULTS: Two hundred forty-eight children with newly diagnosed congenital or infantile cataract were identified-an estimated 92% of eligible cases. The adjusted annual age-specific incidence of new diagnosis of congenital and infantile cataract was highest in the first year of life, being 2.49 per 10,000 children (95% confidence interval [CI], 2.10-2.87). Adjusted cumulative incidence at 5 years was 3.18 per 10,000 (95% CI, 2.76-3.59), increasing to 3.46 per 10,000 by 15 years (95% CI, 3.02-3.90). Incidence of bilateral cataract was higher than that of unilateral, but incidence did not vary by sex or country of residence. CONCLUSIONS: These estimates of congenital and infantile cataract incidence were higher than reported previously from routine sources relying on passive notification around the time of birth. Studies of congenital ocular anomalies that are not always readily diagnosed at birth should consider the potential influence on disease frequency of diagnostic practices as well as of underlying disease risk.

Adolescent↗
PubMed2001

Selective screening for neonatal galactosemia: an alternative approach.

UNLABELLED: No universal consensus exists for population-based neonatal screening for galactosemia. In our institution, selective screening for classical galactosemia is carried out on infants under 2 wk of age and those with symptoms suggestive of this disorder. Eighteen cases were diagnosed from 25,099 tests done; 17 were symptomatic at the time of diagnosis. CONCLUSION: We suggest that improved clinical vigilance and selective screening would identify most infants with severe galactosemia as early as a population-based program.

Biomarkers↗
PubMed2001

A national register for surveillance of inherited disorders: beta thalassaemia in the United Kingdom.

OBJECTIVE: To demonstrate the value of a national register for surveillance of services for an inherited disorder. METHODS: Data from the United Kingdom Thalassaemia Register and the United Kingdom Register of Prenatal Diagnosis for Haemoglobin Disorders were combined in a database; these registers include all fetuses known to have been diagnosed with beta thalassaemia major, beta thalassaemia intermedia, or haemoglobin E/beta thalassaemia in the United Kingdom. Data were extracted to show outcomes (selective abortion or live birth) of all fetuses and the status of those born with a disorder (alive, dead, successful bone marrow transplant, or lost to follow-up) by parents' region of residence and ethnicity. FINDINGS: At the end of 1999 the register included 1074 patients, 807 of whom were alive and residing in the United Kingdom. A successful bone marrow transplant has been performed for 117 out of 581 (20%) patients born since 1975. Residents of Pakistani origin are now the main group at risk in the United Kingdom, replacing residents of Cypriot origin. This has led to a marked shift in the need for services from the south-east of England to the Midlands and the north of England. Despite the acceptability of prenatal diagnosis, the proportion of affected births remains 50% higher than would be expected, reflecting a widespread failure to deliver timely screening and counselling to carriers. Even though effective treatment is available the annual number of deaths is rising, indicating that better tolerated treatments are needed. CONCLUSION: A national diagnosis register is a powerful instrument for monitoring the treatment and prevention of inherited disorders and for highlighting correctable shortcomings. In view of the increasing possibilities for genetic screening there is a strong case for central funding for such databases within modern health services.

Adolescent↗
PubMed2002

Clinical phenotypes and molecular characterization of Hb H-Paksé disease.

BACKGROUND AND OBJECTIVES: Hemoglobin Constant Spring (Hb CS), caused by a termination codon mutation (TAA-->CAA) in the a2 gene, is the most common non-deletional type of a thalassemia in Southeast Asia. This mutation can most easily be detected by loss of an MseI-restriction site (T/TAA) spanning the termination codon. Recently, we sequenced the a globin genes from patients with a thalassemia in whom this MseI site was absent. This revealed, a previously described termination codon mutation (TAA-->TAT) associated with Hb Paksé. This prompted us to re-evaluate the molecular basis of a thalassaemia in other Thai patients with non-deletional types of Hb H disease. DESIGN AND METHODS: DNA samples from 30 patients, previously diagnosed as having Hb H-CS disease, were characterized by direct genomic sequencing and by using a mismatched polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Clinical and hematologic data were assessed. RESULTS: Hemoglobin electrophoresis in almost all 30 unrelated patients with non-deletional a thalassemia revealed a slow migrating band resembling Hb CS. Five of these patients were found to have Hb H-Paksé disease and the remainder had Hb H-CS disease. Comparing the hematology in patients with these two genotypes, no significant differences were found except that the proportion of Hb H was higher in patients with Hb H-Paksé disease. INTERPRETATION AND CONCLUSIONS: These results suggest that termination codon mutations may have been previously misidentified in many cases of non-deletional Hb H disease. Findings from six unrelated families described in this study suggest that the proportion of patients with the Hb Paksé mutation might be underestimated and that this mutation could be prevalent in Southeast Asia. Analysis of mismatched-PCR-RFLP, described here, was shown to provide an unequivocal diagnosis and will be applicable in population screening programs.

Adolescent↗
PubMed2002

Reporting of laboratory-confirmed chlamydial infection and gonorrhea by providers affiliated with three large managed care organizations--United States, 1995-1 999.

Surveillance for sexually transmitted diseases (STDs) depends on health departments receiving reports of positive STD test results from laboratories or of STD cases by clinicians. The completeness and timeliness of reporting can affect prompt sex partner notification and outbreak detection. In 1998, approximately 70% of chlamydia cases and 55% of gonorrhea cases were reported by private clinicians, including many affiliated with managed care organizations (MCOs). However, little is known about the completeness and timeliness of MCOs' STD case reporting practices. Three MCOs, three state health departments, and CDC evaluated reporting practices for chlamydial infection and gonorrhea by three large staff or group model MCOs that used different reporting procedures. The findings indicate that state health departments were notified of 78%-98% of chlamydia cases and of 64%-80% of gonorrhea cases identified in these MCOs; the median interval between specimen collection and state health department receipt of a case report was < or = 19 days. To improve surveillance quality, other MCOs, including network model MCOs, which provide most STD care in the United States, should evaluate surveillance quality and identify interventions for improvement.

Chlamydia Infections↗
PubMed2000

The impact of an aging population on curriculum development in Canadian undergraduate nursing education.

The rise in numbers of persons 65 years of age and older due to increased life expectancy is necessitating a revision in undergraduate nursing education. Since additional qualified nurses will be required to care for this expanding population, nursing programs must include sufficient relevant gerontological content delivered by competent faculty to prepare these practitioners. The authors review pertinent literature, present several surveys outlining the current status of gerontology content in nursing and other allied health programs, and argue for gerontological nursing to be a core component of undergraduate programs.

Aged↗