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PubMed1986

Cadmium in tissues of Japanese quail fed oat grain grown on municipal sludge-amended soil.

Oats were cultured on soil amended with municipal sewage sludge from Syracuse, N.Y., or on soil alone (control). The oats were fed to male and female Japanese quail through four generations. The extent of absorption of cadmium by the oats and its deposition in tissues and eggs of the first and fourth generations of birds were determined. The tissue levels of cadmium found in the first (F0) generation were kidney greater than liver greater than muscle approximately equal to eggs, with the quail from the sludge-treatment group consistently showing the higher respective tissue levels. Female birds showed consistently higher tissue levels than those of the corresponding males. Kidney and liver tissues and eggs from the fourth generation (F3) quail fed the sludge-treatment diets were also higher than the corresponding controls, but tissues of the male quail were most often higher than the corresponding females.

Animals↗
PubMed2005

[Tobacco control in South Africa].

The aim of this paper is to briefly describe South Africa's experience in tobacco control, and to highlight some of the lessons that are applicable to other developing countries. South Africa's tobacco control strategy is based on two main pillars: (1) rapidly increasing excise taxes on tobacco, and (2) comprehensive legislation, of which the most important features are banning all tobacco advertising and sponsorship, and prohibition of smoking in public and work places. As a result of the increases in the excise tax, the real (inflation-adjusted) price of cigarettes has increased by 115% between 1993 and 2003. Aggregate cigarette consumption has decreased by about a third and per capita consumption has decreased by about 40% since 1993. Despite the decrease in cigarette consumption, real government revenue from tobacco excise taxes has increased by nearly 150% between 1993 and 2003. Some important lessons can be drawn from South Africa's experience in tobacco control. Firstly, strong and consistent lobbying was required to persuade the government to implement an effective tobacco control strategy. Country-specific research, drawn from a variety of disciplines, was used to back up and give credibility to the lobbyists' appeals. Secondly, rapid increases in the excise tax on cigarettes are particularly effective in reducing tobacco consumption. An increase in the excise tax increases the price of cigarettes, which in turn reduces cigarette consumption. In South Africa a 10% increase in the real price of cigarettes decreases cigarette consumption by between 6 and 8%. Similar results have been found for many other developing countries. Thirdly, while an increase in the excise tax is generally regarded as the most effective tobacco control measure, tobacco control legislation also plays an important role in a comprehensive tobacco control strategy. Bans on tobacco advertising and bans on smoking in public and work places denormalise and deglamorise smoking, and are likely to make other tobacco control interventions more effective. Fourthly, the industry would typically claim that they want to be constructive partners in drafting "reasonable and sensible" tobacco control legislation. In South Africa's experience, when they were involved in the drafting process in 1993, the role of the industry was to delay and water down the legislation. In drafting an amendment to the original legislation in 1998, the industry's views were largely ignored, and the result was a more comprehensive and effective piece of legislation. Fifthly, tobacco control legislation, particularly laws banning smoking in indoor public places, is largely self-enforcing. It does not require heavy-handed police intervention, as is typically claimed by the industry. The legislation clarifies and explains that the rights of non-smokers to clean air supersede the right of smokers to smoke. Smokers typically refrain from smoking where smoking is not allowed.

Humans↗
PubMed1992

Contribution of phenazine antibiotic biosynthesis to the ecological competence of fluorescent pseudomonads in soil habitats.

Phenazine antibiotics produced by Pseudomonas fluorescens 2-79 and Pseudomonas aureofaciens 30-84, previously shown to be the principal factors enabling these bacteria to suppress take-all of wheat caused by Gaeumannomyces graminis var. tritici, also contribute to the ecological competence of these strains in soil and in the rhizosphere of wheat. Strains 2-79 and 30-84, their Tn5 mutants defective in phenazine production (Phz-), or the mutant strains genetically restored for phenazine production (Phz+) were introduced into Thatuna silt loam (TSL) or TSL amended with G. graminis var. tritici. Soils were planted with three or five successive 20-day plant-harvest cycles of wheat. Population sizes of Phz- derivatives declined more rapidly than did population sizes of the corresponding parental or restored Phz+ strains. Antibiotic biosynthesis was particularly critical to survival of these strains during the fourth and fifth cycles of wheat in the presence of G. graminis var. tritici and during all five cycles of wheat in the absence of take-all. In pasteurized TSL, a Phz- derivative of strain 30-84 colonized the rhizosphere of wheat to the same extent that the parental strain did. The results indicate that production of phenazine antibiotics by strains 2-79 and 30-84 can contribute to the ecological competence of these strains and that the reduced survival of the Phz- strains is due to a diminished ability to compete with the resident microflora.

Anti-Bacterial Agents↗
PubMed2002

Impact of infections on primary care--greater than expected.

Though infection has declined as a cause of death it consumes a major proportion of primary care resources, and because of antibiotic resistance is increasingly important. We examined the burden of illness attributable to infection in primary care by analysing data from the fourth practice-based national morbidity survey which monitored all consultations by diagnosis in 470,000 persons over a 12 month period from September 1991 to August 1992. Rates of persons consulting, new episodes of illness and consultations were calculated according to the list of infections published by Wilson and Bhopal (W&B list), and as amended by the Communicable Disease Surveillance Centre (CDSC list); selected comparisons were made with national data on hospital derived finished consultant episodes and deaths. Forty-one percent of all registered persons consulted on at least one occasion during the year for infection (estimated by either list). Infections accounted for 40% of all new episodes of illness and 29% of all consultations; respiratory infections accounted for approximately half the infection total. New episode rates were highest in children aged less than 1 year and lowest in males 25-54 years and females 55-64 years. Except in infancy, rates were higher in females. There were 734 episodes of infection annually per 1,000 population reported in general practice compared with 20 per 1,000 finished consultant episodes. The average episode of infection prompted 1.2 general practice consultations. Improved management through more precise diagnosis by near patient tests is desirable, but is unlikely to be obtained cost effectively if consultation numbers or the time spent is substantially increased. These results emphasise the importance of adequate training for general practitioners in the natural history, epidemiology, diagnosis and treatment (pharmacology) of infection.

Adolescent↗
PubMed2000

An overview of European Union tobacco control legislation.

The European Union (EU) has been active in tobacco control policy since 1985 when the Milan Council announced its intention to establish a Europe Against Cancer (EAC) Programme, although it had previously adopted several Directives on aspects of tobacco taxation prior to this date. Shortly after the establishment of the EAC first action plan the European Commission presented its first legislative proposals on tobacco control. Three of these proposals on labelling and maximum tar yields became Directives by 1992. The fourth on tobacco advertising finally became law in 1998 and is currently being transposed into national law in the 15 EU Member States. In 1996 the Commission published a Communication on the future of EU tobacco control and in 1999 at the 2nd European Conference on Tobacco or Health the Social Affairs Commissioner announced his intention to bring forward further legislative proposals to amend an consolidate existing EU legislation in this sector. This article is intended to present an overview of EU tobacco control legislation from 1970 until 1998 and to look at future options post year 2000.

Advertising↗
PubMed1992

Specific list for categorization of laboratory test systems, assays and examinations by complexity--PHS. Notice with comment period.

The Clinical Laboratory Improvement Amendments of 1988, Public Law 100-578, requires that the Secretary provide for the categorization of specific laboratory test systems, assays and examinations by level of complexity. 42 CFR 493.17, published in the Federal Register on February 28, 1992, established criteria for such categorization. It is the Department's intention to complete the categorization of all currently available clinical laboratory test systems, assays and examinations prior to the effective date of 42 CFR part 493. This notice announces the fourth of a series of lists containing specific clinical laboratory test systems, assays and examinations, categorized by complexity. This notice also includes deletions and corrections to the list of test systems, assays and examinations published on February 28, 1992. After publication and close of comment period on the published partial lists, a complete list of all laboratory test systems, assays and examinations, categorized by complexity, and responses to public comments received on the partial lists will be published in the form of a compilation of these Notices. Any clinical laboratory test system, assay or examination that is not on the compilation will be considered high complexity, until categorized otherwise as provided under 42 CFR 493.17. After publication of the compilation, applications will be taken to categorize (or re-categorize) other laboratory test systems, assays and examinations following the procedures delineated in 42 CFR 493.17(d). After the effective date of 42 CFR part 493, notices will be published periodically in the Federal Register to announce any additional test system, assay or examination that has been categorized (or re-categorized) during the preceding interval.

Clinical Laboratory Techniques↗
PubMed1990

[The 10th revision of the International Classification of Diseases].

The 43rd World Health Assembly approved the 10th Revision of the International Classification of Diseases (ICD-10) in May 1990 and recommended its implementation by January 1, 1993. The ICD-10 uses a new alpha-numeric code, which provides sufficient code-numbers for all new entities, included in ICD-10 and for further amendments in the future. The extended tabular list of ICD-10 contains HIV-disease (AIDS) and permits separate coding of HIV-disease resulting in various infections, neoplastic and other diseases, such as HIV-dementia complex. Extensions and rearrangements have been made in other groups of diseases, for instance in the chapter on diseases of the genitourinary system. ICD-10 now permits a clear distinction between glomerular and renal tubulointerstitial diseases. The different groups of glomerular diseases can be further characterized by a fourth-digit subdivision of the code-number according to the histopathological findings. Thus, ICD-10 reflects recent developments in medial science. The scientific and practical impact of ICD-coding on mortality statistics, however, largely depends on the use of precise diagnosis and their proper arrangement on the death certificate by the physician, certifying the death. This permits the underlying cause of death to be clearly identified by the coder. The role of the pathologist in this process is stressed. Exact and internationally unified formulation of the diagnosis will be supported in the future by the on-going project developing an International Nomenclature of Diseases (IND). A few volumes of the IND have already been published in English, others are in preparation.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Ordinance No. 24 amending Ordinance No. 9 of 27 July 1972 of the Ministry of Health for the implementation of the provisions relating to epidemiology of Law No. II of 1972 on health, 26 December 1988.

This Hungarian Ordinance amends Section 4 of Ordinance No. 9 of 27 July 1972 to read as follows: "1) Depending on their age, children shall be required to undergo vaccination against tuberculosis, diphtheria, whooping cough, tetanus, poliomyelitis, measles, and rubella. 2) The age for administering the vaccinations referred to in subsection 1 and the methods to be employed shall be laid down by notice of the Ministry of Social Affairs and Health. 3) The following compulsory vaccinations are prescribed: a) for diphtheria, whooping cough, and tetanus--three vaccinations before the end of the seventh year of life and b) for diphtheria and tetanus--a fourth vaccination, together with vaccination against poliomyelitis, measles, and rubella before the end of the fourteenth year of life."

Adolescent↗
PubMed1991

[Diltiazem poisoning: hemodynamic aspects].

A case is reported of a 50-year-old man who took a massive overdose of diltiazem (5,400 mg), together with 1,350 mg potassium clorazepate and 390 mg nordazepate, five months after having experienced a myocardial infarction (MI). On admission, systolic blood pressure was 80 mmHg, with an irregular heart rate of 60 b.min-1. There was superficial polypnea (40 c.min-1) with hypoxia (PaO2: 63.5 mmHg). The ECG revealed, besides the MI scar, complete sinus arrest. Endotracheal intubation and mechanical ventilation were rapidly required. The patient then had gastric lavage, and was given activated charcoal. Treatment with 1.5 mg atropine and 2 g intravenous calcium chloride were unable to amend the cardiac dysrhythmia. A continuous isoproterenol infusion restored a sinus rhythm, but this was not maintained because of the risk of side-effects. Cardiovascular collapse was treated with dobutamine (10 micrograms.kg-1.min-1). As the peripheral and pulmonary vascular resistances were greatly diminished (464 dyn.s.cm-5 and 86 dyn.s.cm-5 respectively), alpha and beta mimetics were used: 1 microgram.kg-1.min-1 noradrenaline and 15 micrograms.kg-1.min-1 dobutamine. After 7 h of this treatment, spontaneous sinus rhythm returned abruptly. Noradrenaline and dobutamine were replaced thereafter with adrenaline (0.25 microgram.kg-1.min-1), which was stopped 24 h later. There was a marked respiratory and haemodynamic improvement, the patient leaving the intensive care unit on the fourth day and returning home one week after the overdose. The relationships between cellular calcium movements and the adrenergic system are discussed, as well as the possible mechanism of cardiac failure.

Adrenergic alpha-Agonists↗
PubMed1989

Public attitudes toward Social Security.

In the early years of the Social Security program, public support for old-age pensions was high but knowledge and understanding about benefits and taxes were low. Understanding has greatly increased, even though the program has expanded, and support for Social Security has remained high. Data from the surveys and polls examined in this article indicate that support for Social Security was strong even during the late 1970's and early 1980's, when a fiscal crisis generated a crisis of confidence in the public's perception of the system's ability to pay benefits in the future. The proportion of the American public declaring confidence in the program declined sharply from a large majority with confidence (63 percent) in 1975 to a minority with confidence (39 percent) in 1978. Following the restoration of program financing through the provisions in the 1983 amendments, the trend has reversed. By 1988, nearly one-half of the public expressed confidence in the future of the Social Security program. For the most part, other aspects of public opinion regarding Social Security have shown great stability over the years. The program is popular and has been well-supported. Support for the Government to spend more for Social Security has been consistently high, as has support for benefits to increase with inflation and for benefits to increase even if it means higher taxes. Many individuals rely on income from Social Security or expect to rely on it when they retire. It is clear that the public wants the program to continue. If participation were optional, about three-fourths of the population would stay in the program.

Health Surveys↗
PubMed1995

First Federal Appeals Court finds anti-violence law constitutional.

In a unanimous decision issued on February 13, (1995) a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit upheld the dismissal of two anti-choice challenges to the Freedom of Access to Clinic Entrances Act (FACE). The first mid-level federal bench to rule on FACE's validity, the appeals court held that the law "strikes a balance among competing rights holders. It protects those who seek or provide reproductive health services without suppressing robust debate about abortion. Those opposed to abortion or any other reproductive health service retain the freedom to express their deeply-held moral or religious views in a peaceful, non-obstructive way." In mid-June of last year in American Life League v. Reno, U.S. District Court Judge Leonie Brinkema in Alexandria, Virginia, found that FACE did not violate abortion opponents' First Amendment rights. In open court the next month, Judge Brinkema dismissed Woodall v. Reno, which was filed by an abortion opponent in concert with Concerned Women for America. The cases were consolidated on appeal. Attorneys for the plaintiffs have indicated that they will seek U.S. Supreme Court review. Every other federal court to rule on FACE since its May 1994 enactment has also found the measure constitutional.

Abortion, Induced↗
PubMedDate not supplied

An improved approach to the patient with metabolic acidosis: a need for four amendments.

Clinicians should identify life-threatening issues in patients with metabolic acidosis. These threats may be present before therapy begins and/or anticipated after therapy commences. By adding four amendments, short-comings in the commonly used clinical approaches for the diagnosis of metabolic acidosis can be overcome. First, a definition of metabolic acidosis should consider not only the concentration of bicarbonate but also the content of bicarbonate in the extra cellular fluid compartment. The latter requires a quantitative estimate of the ECF volume, which can be obtained using the hematocrit and/or the total protein concentration in plasma. Second, to determine if the basis for metabolic acidosis was the addition of acids or the loss of NaHCO 3 , one must hunt for new anions, not only in plasma, but also in the urine. Third, it is important to measure the venous as well as the arterial PCO2 to assess the capacity to buffer H+ while minimizing H + binding to intracellular proteins. Fourth, to assess the role of the kidney in a patient with metabolic acidosis, the urine osmolal gap and the concentration of creatinine in the urine should be measured to provide an estimate of the rate of excretion of ammonium.

Acid-Base Equilibrium↗
PubMed2005

Metformin extended release: metformin gastric retention, metformin GR, metformin XR.

Metformin extended release [Glumetza, metformin hydrochloride, metformin gastric retention, metformin GR] is a proprietary once-a-day formulation of metformin hydrochloride under development with Depomed for the treatment of diabetes mellitus. In May 2002, Depomed licensed manufacturing and marketing rights for its proprietary formulation of metformin extended release (500mg dose) to Biovail Corporation for the US (including Puerto Rico) and Canada. Under the terms of the agreement, Biovail will pay DepoMed a 25 million dollars milestone fee upon approval of the 500mg dosage and also customary royalties on the net sales in the US and Canada. Biovail also agreed to acquire approximately 2.4 million of additionally issued Depomed shares for 12.3 million dollars. Biovail has subsequently developed a 1000mg dose of metformin extended release [metformin XR] using its proprietary Smartcoat delivery technology allowing a graduated release of the active drug from the tablet. In April 2004, Depomed and Biovail amended their original license agreement of May 2002. Under the terms of the amended agreement, Depomed will receive royalties on sales of Biovail's 1000mg tablet in the US and Canada. In turn, Biovail acquired access to Depomed's clinical data for the metformin 500mg tablet that will be used to accelerate regulatory filings for Biovail's 1000mg tablet and establish equivalence between the two dosages. Biovail is seeking marketing partners for metformin extended release (Glumetza) in the US. The company anticipates signing an agreement for the US during the second half of 2005. In Canada, Biovail Corporation will market Glumetzatrade mark through its Canadian division, Bioval Pharmaceuticals Canada. Depomed has an agreement with LG Life Sciences for the commercialisation and distribution of metformin extended release in Korea. Metformin GR is available for partnership in Europe and Asia. Biovail Corporation and Depomed announced in June 2005 that the US FDA has approved metformin extended release (Glumetza) 500mg and 1000mg tablets for the treatment of type 2 diabetes mellitus. Biovail plans launching the product in the fourth quarter of 2005. In July 2005, Biovail paid Depomed a 25 million dollars milestone payment following approval of metformin extended release in the US for type 2 diabetes. In March 2005, Biovail Corporation and Depomed announced that they have received an approvable letter from the FDA for the once-daily, extended-release formulation of metformin extended release (Glumetza) 500mg and 1000mg tablets. The letter specified an issue related to finalising one manufacturing specification. There were no clinical labeling issues identified in the letter. Both companies filed a response to a specified issue at the FDA on 8 April 2005. The companies believed that the response will be classified as a Class I response with a 60-day review period. The 500mg dosage was developed by Depomed using its patented drug delivery GR technology, while Biovail developed metformin 1000mg dose using its proprietary Smartcoat delivery technology. Biovail's NDA for a once-daily, extended-release formulation of metformin HCl for the treatment of type II diabetes was filed in April 2004 and accepted for review in June 2004 by the FDA. Depomed completed two double-blind, pivotal, phase III clinical trials with metformin extended release 500mg at 60 sites in the US in more than 1000 patients with type 2 diabetes. In three different dosing regimens, metformin extended release significantly decreased the glycosylated haemoglobin level similarly to that of metformin immediate-release. Biovail successfully compared metformin extended release 1000mg dose with Depomed's 500mg dose in multiple equivalence studies. In these studies, metformin extended release was well tolerated and demonstrated an excellent safety profile in terms of gastrointestinal adverse events. On 1 June 2005, Depomed and Biovail Comporation, the licensee, announced that the Therapeutic Products Directorate in Canada issued a Notice of Compliance for metformin extended release (Glumetza) 500mg and 1000mg for the treatment of type 2 diabetes. Biovail Pharmaceuticals Canada plans to launch the product in the fourth quarter of 2005. Biovail has submitted an application for metformin extended release with the Therapeutic Products Directorate in Canada. and received notification of acceptance for review in August 2004. Bristol-Myers Squibb is marketing a proprietary, once-daily extended-release formulation of metformin (Glucophage XR). Several companies are developing controlled-release and extended-release formulations of metformin.

Clinical Trials as Topic↗
PubMed2001

What are the contributing factors for insomnia in the general population?

Lack of a systematic assessment of insomnia has led to large variations in its reported prevalence in the general population. This study aims to provide new guidelines to assess insomnia prevalence. A cross-sectional telephone survey using the Sleep-EVAL system was done with 24,600 general population-based subjects 15 years and older representative of general populations (France, the UK, Germany, Italy, Portugal, and Spain) consisting of 251,405,391 inhabitants. The overall participation rate was 81.0%. Within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptomatology for insomnia, 27.2% (95% confidence interval: 26.6-27.8%) of the sample reported difficulty initiating sleep (DIS) (10.1%) or maintaining sleep (DMS) (disrupted sleep (DS): 18.0%; early morning awakening (EMA): 10.9%) or nonrestorative sleep (NRS) (8.9%) at least three times per week; 48.5% of them were concomitantly suffering of a DSM-IV sleep/mental disorder. A factor analysis identified several variables strongly related to each of the major factors of insomnia allowing: (1) The narrowing of the definition of insomnia: the prevalence of insomnia decreased to 16.8% with 64.5% of insomnia subjects having a DSM-IV sleep/mental disorder; (2) The identification of a sleep-deprived (voluntary or not) group without insomnia symptoms, representing 2.1% (1.9-2.3%) of the sample. Interestingly, the latter group closely matched the definition of insufficient sleep syndrome as described by the International Classification of Sleep Disorders (ICSD). Using more delineated criteria to assess insomnia increases the recognition of subjects complaining about sleep. Classifications should be amended to improve the correct identification of insomnia. Sleep-deprived subjects should also not be neglected.

Adolescent↗
PubMed2001

Interventions for preventing obesity in childhood. A systematic review.

BACKGROUND: The prevalence of obesity and overweight is increasing worldwide. Obesity in children impacts on their health in both short- and long-term. Obesity prevention strategies are poorly understood. OBJECTIVE: To assess the effectiveness of interventions designed to prevent obesity in childhood. SEARCH STRATEGY: Electronic databases were searched from January 1985 to October 1999. SELECTION CRITERIA: Data from randomized control trials and non-randomized trials with concurrent control group were included. A priori, studies with follow up of 1 year minimum were selected however, this was subsequently amended to include studies with a minimum follow up of three months. DATA COLLECTION & ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Seven studies were included, three long-term (> 1 years) and four short-term (> 3 months and < 1 years). The studies included were diverse in terms of study design and quality, target population, theoretical underpinning of intervention approach, and outcome measures. As such, it was not appropriate to combine study findings using statistical methods. CONCLUSIONS: Two of the long-term studies (one focused on dietary education and physical activity vs. control, and the other only on dietary education vs. control), resulted in a reduction in the prevalence on obesity, but the third, which focused on dietary education and physical activity, found no effect. Of the four short-term studies, three focused simply on physical activity/reduction of sedentary behavious vs. control. Two of these studies resulted in a reduction in the prevalence of obesity in intervention groups compared with control groups, and another study found a non-significant reduction. The fourth study focused on dietary education and physical activity, and did not find an effect on obesity, but did report a reduction in fat intake. Overall, the findings of the review suggest that currently there is limited quality data on the effectiveness of obesity prevention programmes and as such no generalizable conclusions can be drawn. The need for well-designed studies that examine a range of interventions remains a priority.

Child↗
PubMed2006

[The new Tuberculosis Control Program of Japan].

The 1951 Tuberculosis Control Law of Japan was amended extensively and has been in effect since April, 2005. The revision of the National Tuberculosis Program (NTP) is to respond to the tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. In this review, the main points and framework of the revisions were summarized and the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation is discussed. Also, challenges of Japan's NTP in the recent future are discussed, including the controversies over the proposed abolishment of the Tuberculosis Control Law. 1. IMMUNIZATION: In the revision of NTP, the BCG vaccination of elementary school and junior-high school entrants was discontinued. In order to strengthen the early primary vaccination for infants, the new Law has adopted the direct vaccination scheme omitting tuberculin testing prior to immunization. This program is implemented to young babies, i.e., less than six months old, as defined by the decree. It is a heavy responsibility for the municipalities to ensure the high coverage of immunization when the period of legal vaccination is rather strictly limited practically to the fourth to sixth months after birth. The safe direct vaccination is another new challenge where appropriate management of the Koch's phenomenon or similar reactions should be warranted. 2. CHEMOPROPHYLAXIS: Though unfortunately suspended for some legal reason currently, the expansion and improvement of chemoprophylaxis, or treatment of latent tuberculosis infection, to cover anyone with higher risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. The technical innovations in diagnosis of TB infection such as QuantiFERON will be very helpful. Development of new drugs or drug regimens for this purpose is also expected. 3. CASE DETECTION: The "indiscriminate" screening scheme in the periodic mass health examination has been replaced with a selective one. Only subjects aged 65 or older are eligible for the screening, supplemented with selected occupational groups who are considered to become source of infection, should they develop tuberculosis, such as health-care providers and school teachers. Local autonomies are also responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses, as decided by the autonomies at their disposal. Another important mode of active case-finding, i.e., contact investigation has been legally enforced so that anybody cannot refuse to be examined by the Health Center. This investigation service will be greatly enhanced by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection. Regarding the clinical service of the symptomatic patients that detect 75% of new cases currently will be improved in its quality by introducing an external quality assurance system of commercial bacteriological laboratory services. 4. TREATMENT AND PATIENT SUPPORT: The revised NTP clearly states the government's responsibility for treating TB patients in close cooperation with a doctor, in the framework of the DOTS Japan version. While the development of new anti-tuberculosis drugs will be realized in the near future, Japan still has to overcome the issues of improper practice of treatment, as well as the government's slow process for approving drugs to be used for multi-drug resistant TB and non-tuberculous mycobacterioses, such as quinolones, macrolides and others. 5. PREFECTURAL TB CONTROL PLAN: In order to respond to the specific issues of tuberculosis problem in the respective prefectures in terms of epidemiology or in available resources, the Law requests every prefecture to develop and implement its own TB control plan. The rather abruptly proposed argument of abolishing Tuberculosis Control Law and merging the NTP to Infectious Disease Control Law threatens us with the government's premature departure from active commitment in the tuberculosis control. This reminds us of the United States' remarkable experience of the tuberculosis resurgence in the late 1980's and early 1990's, after 15 years of abandonment of the governmental efforts during 1970s.

Government Programs↗