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PubMed2004

Hepatitis C prevalence--a nationwide serosurvey.

Hepatitis C is the most commonly notified disease in Australia. In 1998 the Hepatitis C Virus Projections Working Group (HCPWG) estimated that there were approximately 210,000 people who had been infected by hepatitis C virus (HCV) in Australia by 2001. Population-based serosurveys are required to validate this estimate. Here we estimate HCV prevalence on the basis of HCV antibody seroprevalence in the Australian national serosurvey. Between 1996 and 1998, 2,800 sera opportunistically collected from pathology laboratories throughout Australia were tested for HCV antibody. National HCV notifications reported from 1991 through 1998 were also assessed. Eighty-one sera were HCV antibody positive, giving an age standardised prevalence of 2.3 per cent (95% CI 1.8%-2.9%). The 20-24 year age group had the highest HCV prevalence, 5.3 per cent (95% CI 3.3%-8.1%) and the male to female ratio was 1.8:1.0. Approximately 111,000 HCV notifications were received from 1991 through 1998. HCV prevalence estimated by the serosurvey is approximately three times higher than cumulative HCV notifications. Age and sex distributions of seroprevalence are broadly consistent with cumulative notification data. These distributions are consistent with the majority of HCV infections in Australia being transmitted by injecting drug use. Very low age specific seroprevalence estimates in the over 50 years age group indicate that there is not a large pool of undiagnosed infection in this age group. The serosurvey provides an estimate of Australian HCV prevalence and baseline data to determine incidence trends, both of which are required for health-care planning.

Adolescent↗
PubMed2006

Rotavirus gastroenteritis in the Northern Territory, 1995-2004.

OBJECTIVE: To present data on rotavirus notifications in the Northern Territory to provide knowledge about the local epidemiology of rotavirus gastroenteritis that can be used to inform the use and funding of rotavirus vaccines. DESIGN: Retrospective analysis of data from the Northern Territory Notifiable Diseases Database. PARTICIPANTS AND SETTING: Patients with cases of rotavirus infection notified to the NT Centre for Disease Control from 1 January 1995 to 31 December 2004. MAIN OUTCOME MEASURES: Patterns of rotavirus notifications over time; infection rates in Indigenous versus non-Indigenous children aged 0-5 years; age groups infected with rotavirus. RESULTS: Numbers of rotavirus notifications over the period 1995-2004 show annual, monthly and regional variability. The rotavirus notification rate for Indigenous children aged 0-5 years was 2.75 per 100 per year, compared with 0.98 for non-Indigenous children, with a relative risk for Indigenous children of 2.17 (95% CI, 1.97-2.39) over the 10 years. Indigenous children infected with rotavirus were younger than non-Indigenous children, with median ages of 11 months and 16 months, respectively. Rotavirus gastroenteritis occurred in outbreaks, transmitted over months throughout the NT. CONCLUSION: Large numbers of cases of rotavirus gastroenteritis affecting Indigenous and non-Indigenous children in the NT are notified every year. The rate in Indigenous children may be decreasing relative to non-Indigenous children. An effective rotavirus vaccine could prevent significant morbidity.

Age Distribution↗
PubMed1999

[Incidence of measles in Italy in the 1985-1994 period].

Measles notifications in Italy underestimate the actual incidence by a factor of ten, as it is ascertained by seroepidemiological investigation. In the decade 1980-89, 45,000 measles cases were notified, on average, per year. Since 1988 mass vaccination campaigns were implemented in several Italian regions. The strategy aimed to offer the prophylaxis actively to all children aged 13 months to 8-12 year for whom a sure recollection of measles was absent. The study has aimed to evaluate the impact of the strategy that worked in the period 1989-91, on the standardised average annual incidence of measles notification, comparing the periods 1985-89 and 1990-94. A reduction of 45% resulted all over Italy. On the contrary the incidence of chickenpox notifications has increased, indicating that the notification system did not worse.

Adolescent↗
PubMedDate not supplied

[General practitioners and mandatory surveillance of communicable diseases: a descriptive study in Puglia (South Italy)].

Public health passive surveillance systems are often affected by low sensitivity level. Enhancement of the reporting by general practitioners is important to improve the sensitivity of notification system. The aim of this work was to evaluate the mandatory notification activities of communicable diseases by general practitioners (GPs) and family pediatricians (FPs) in the Local Health Unit Bari/4, during the years 1999-2000. This study shows that GPs and FPs notified only 39% and 28% of notifiable diseases respectively in 1999 and 2000, although some of these diseases have a very low hospitalization rate. The majority of doctors never notified any case of infectious disease during the period. The study shows also that the doctors who was older and who had larger list of patients had a greater compliance regarding notification. Therefore, a specific training of family doctors and a better facility in the notification procedures (for example, by phone or e-mail) should be very important to improve the sensitivity of surveillance system.

Communicable Diseases↗
PubMed2005

High sensitivity for tuberculosis in a national integrated surveillance system in Finland.

Little is known about the sensitivity of surveillance for tuberculosis after integration of formerly dedicated tuberculosis surveillance and control into the general health care system, an integration which took place in Finland in 1987. We compared routine laboratory notifications to the National Infectious Disease Register (NIDR) for Mycobacterium tuberculosis from January 1, 1995, to December 31, 1996, with data collected independently from all laboratories offering M. tuberculosis culture, and with data from patient records. 1059 culture-positive cases were found. The overall sensitivity of the NIDR was 93 % (984/1059). The positive predictive value of a culture-positive case in the NIDR to be a true culture-confirmed case was 99%. For the culture-confirmed cases in the NIDR, one or more physician notification forms had been submitted for 89%. A highly sensitive notification system for culture-positive tuberculosis can be achieved in an integrated national infectious disease surveillance system based on laboratory notification.

Clinical Laboratory Information Systems↗
PubMed2006

[Research results on sensitivity of surveillance on the infectious diseases of PSSE Zwoleń].

The aim of the paper was to evaluate sensitivity of surveillance of infectious diseases in 2005, in comparison to 2000-2004 (i.e. after taking the measures to improve notification of infectious diseases). In the first half of 2005 significant improvement was noticed, mainly in the group of diseases, which had been to be reported obligatorily since 2002 (e.g. helminthiasis). The improvement of notification and registration was short-lasting. In the second half of the year the drop of notification and registration was reported. There is a need of active and permanent monitoring of notification and registration of infectious diseases and renewed consideration of the list of diseases which are subjected to be obligatorily notified.

Communicable Disease Control↗
PubMed1994

The incidence of meningococcal illness in the East Anglian Regional Health Authority: 1990-1991.

The rate at which notifications of meningococcal meningitis were reported by districts of the East Anglian Regional Health Authority to the Office of Population Censuses and Surveys (OPCS) varied between 6.8 and 28.0 cases per million resident population per year between 1987 and 1991. A study was conducted to find out whether this variation represented differences in incidence, completeness of notification, or reporting practices. One hundred and one cases of meningococcal illness with onset between 1 January 1990 and 31 December 1991 were identified retrospectively in residents of the East Anglian region (population 2.06 million). The ascertained incidence of meningococcal illness was 24.5 cases/million/year with a range between districts of 13.1 to 35.7 cases/million/year, similar to that expected from national data. Most of the variation in the rates of reporting to OPCS was explained by the practices of two consultants in communicable disease control (CCDCs), who reported all cases of which they were aware, irrespective of statutory notification. The study showed that communication to CCDCs was sometimes inadequate, and that control measures were not instituted in a small proportion of cases. The recommendations resulting from this study are, firstly, that OPCS should produce clear guidelines for notification and reporting. In the meantime proper officers should make their reporting practice explicit. Secondly, a sensitive case definition for meningococcal illness is needed for local monitoring of prophylactic coverage. Thirdly, CCDCs, microbiologists, clinicians, and environmental health officers should review arrangements for data exchange.

Adolescent↗
PubMed1995

A computer-based surveillance system for human immunodeficiency virus infection in Singapore.

The first case of the human immunodeficiency virus (HIV) infection was detected in Singapore in 1985 and the first case of the acquired immunodeficiency syndrome (AIDS) in 1986. Since then, the number of infections had increased. By the end of 1993, there were 222 residents with HIV infection, including 75 cases of AIDS. In view of the rapidly increasing magnitude of HIV infection, a microcomputer-based surveillance system was designed and developed in 1992 to better monitor epidemiological trends of HIV infection in Singapore. OBJECTIVE--The objective was to define a composite model of a successful HIV and AIDS registry that included: (a) patient data forms, (b) patient's contact data forms, (c) data analysis, and (d) report generation. METHODOLOGY--An IBM-compatible desk-top microcomputer was used for the project. The main software used for computer programming and data analysis were DBase IV (Version 1.5) and Epi Info (Version 5.0), respectively. Security features were incorporated into the programme to ensure confidentiality of information and that only authorized personnel could gain access to the programme. MAIN FINDINGS--The system functioned as the National HIV Notification Registry and was able to track notifications, analyse data and enabled prompt dissemination of information. The system was also linked to another database system for tuberculosis to enhance surveillance of both HIV infection and tuberculosis. CONCLUSION--The authors believe that this system would enhance surveillance and provide timely information for national AIDS control programmes. However, the effectiveness of this computer-based surveillance system is dependent on an established notification structure with notifications of sufficient completeness for both HIV infection and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Undernotification of tuberculosis in Otago: national implications.

AIM: To ascertain the reliability of notification of tuberculosis in Otago; to establish a more accurate incidence rate for cases of tuberculosis in Otago. METHODS: Official notification information 1985-93 was cross checked against other record systems. RESULTS: In the 1985-90 period the official notifications were underestimated by 33% (28/84) and during 1991-2 by 48.5% (17/35). The crude annual incidence rates for all cases were 7.3 per 100,000 for the 1985-90 period and 9.1 per 100,000 for the 1991-3. CONCLUSION: The average annual crude incidence rates for tuberculosis were considerably higher than the official rates. Tuberculosis remains an important clinical and public health issue. Improvements in notification locally and nationally are required if the impact of the projected increase in tuberculosis is to be minimised.

Adolescent↗
PubMed1997

Occupational asthma and other nonasbestos occupational respiratory diseases notified between 1993 and 1996.

AIM: To review notifications to the Occupational Safety and Health Service of the Department of Labour Notifiable Occupational Disease System since its inception until June 1996. METHODS: All notifications received for non asbestos related occupational respiratory disease were reviewed to evaluate the outcome of the notification and to identify the causative agent where possible. RESULTS: There were 277 cases notified and investigated including worksite investigations. Of these 73 cases were confirmed as having occupational asthma, 35 by the asthma validation panel. Nineteen cases of other occupational respiratory disease were notified of which 11 were reviewed by the panel. Extrinsic allergic alveolitis secondary to organic dusts was the most common such notification. CONCLUSIONS: Isocyanates are well recognised as a cause of occupational asthma in New Zealand. It is suspected that occupational asthma and other occupational respiratory diseases are poorly notified to this system. Better mechanisms are needed to identify occupational causes of respiratory (and other) disease.

Asthma↗
PubMed1997

Notifying patients exposed to blood products associated with Creutzfeldt-Jakob disease: integrating science, legal duties and ethical mandates.

The issue of notifying people who have been exposed to blood products that have been associated with Creutzfeldt-Jakob disease (CJD) has arisen at a time when the Canadian blood system is under intense scrutiny. As a result, the Canadian Red Cross Society issued a recommendation to health care institutions that recipients of CJD-associated blood products be identified, notified and counselled. Although Canadian jurisprudence in the realm of informed consent may support a policy of individual notification, a review of the scientific evidence and the applicable ethical principles arguably favours a policy of a more general public notification. Indeed, situations such as this require a unique approach to the formation of legal and ethical duties, one that effectively integrates all relevant factors. As such, the authors argue that individual notification is currently not justified. Nevertheless, if a system of general notification is implemented (e.g., through a series of public health announcements), it should provide, for people who wish to know, the opportunity to find out whether they were given CJD-associated products.

Beneficence↗
PubMed1998

Is food poisoning a clinical or a laboratory diagnosis? A survey of local authority practices in the south Thames region.

An audit of South Thames infectious disease surveillance systems in 1995 revealed large inconsistencies between the numbers of food poisoning records held on local databases and the numbers of food poisoning notifications reported to the Office for National Statistics (ONS), then called the Office of Population Censuses and Surveys. In March 1996 a questionnaire sent to each local authority in South Thames asked what action was usually taken when a laboratory report of cryptosporidium, campylobacter, salmonella, or giardia was received unsupported by a notification of food poisoning. All 51 local authorities responded to the questionnaire. Forty-eight reported salmonella to ONS, 38 reported cryptosporidium, 38 campylobacter, and 37 giardia. Some local authorities considered whether a food or water source was evident or suspected before reporting. Patterns of notification varied between geographical areas. Differences between local authorities' interpretations of the requirement to report to ONS the isolations of food poisoning organisms from patients make it difficult to analyse food poisoning statistics. We would recommend the adoption of a simple approach, in which laboratory reports and notifications are reconciled locally. A case should be reported to ONS only if the doctor who notified or arranged for an examination of stool suspected food or waterborne transmission initially.

Disease Notification↗
PubMed1998

Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines.

BACKGROUND: Hyperkalemia is a common, potentially life-threatening disorder. Electrocardiograms are considered to be sensitive indicators of the presence of hyperkalemia. Since the treatment of hyperkalemia involves relatively few maneuvers and because its success can be objectively scored, we investigated how physicians manage this disorder and how successful their prescribed therapy is. We also sought to determine whether treatment could be improved by providing the treating physicians with therapy guidelines on a real-time basis. METHODS: Consecutive patients with hyperkalemia were identified by review of laboratory records. During the observation-only phase of the study, demographic data, contributing causes, electrocardiogram findings, treatments used, compliance with prescribing guidelines, and patient outcome were recorded. During the subsequent notification phase of the study, treatment recommendations were sent to the patient's ward when the elevated potassium value was noted. The same outcome data were collected. RESULTS: There were 127 episodes of hyperkalemia during the observation-only phase and 115 during the notification phase. No patients died or had life-threatening cardiac arrhythmias. Electrocardiographic abnormalities consistent with hyperkalemia were observed in only 14% of episodes. Renal failure (77%), drugs (63%), and hyperglycemia (49%) contributed to most episodes. Treatments used were exchange resin (51%), insulin (46%), calcium (36%), bicarbonate (34%), and albuterol (4%). The agents were equally efficacious. The time to first treatment was shorter in patients with potassium levels of 6.5 mmol/L or more than in patients with lower values (2.1 +/- 2.2 vs 2.8 +/- 2.4 hours; P<.05). Treatment was better in the intensive care unit than on regular wards. Only 39% of episodes during the observation-only period met the predetermined criteria for monitoring and diagnosis, initial treatment, and follow-up. During the notification period, physician performance was no better; only 42% of episodes met all criteria. The laboratory transmitted a copy of the guidelines to the patient's ward only 38% of the time. In a separate analysis of these episodes, there was no improvement in treatment. Physicians who did not receive the notification fulfilled all treatment criteria more often than physicians who did (50% vs 30%; P<.05). CONCLUSIONS: Although treatment of hyperkalemia was frequently suboptimal, no serious arrhythmias and no deaths complicated management of 242 episodes of severe hyperkalemia. A narrowly targeted effort to improve physician management of a disorder with discrete treatment options did not improve therapy.

Adolescent↗
PubMedDate not supplied

Reduction of polypharmacy by feedback to clinicians.

OBJECTIVE: To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center. DESIGN: 292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104). SETTING: Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center. PATIENTS/PARTICIPANTS: All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male. INTERVENTIONS: The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention. MEASUREMENTS AND MAIN RESULTS: Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant. CONCLUSIONS: A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.

Colorado↗
PubMed1996

Feel good legislation: prevention or calamity.

The following paper was prepared by the Safer Society Foundation regarding the issue of public notification of convicted sex offender release to the community. It does not represent the views or opinions of any other organization or group, professional or otherwise. The Safer Society advocates for community safety, victim restitution and treatment, and quality comprehensive sex offender treatment. While the Safer Society supports adult sex offender registration laws in general, it is totally opposed to public notification laws. This document is designed to assist states considering public notification to explore related issues and the impact of public notification on the greater community, including citizens, families, victims, and offenders. Numbers preceding the following points do NOT indicate relative importance, but are used for ease of reference.

Adolescent↗
PubMed2005

Using the WTO/TBT enquiry point to monitor tendencies in the regulation of environment, health, and safety issues affecting the chemical industry.

The growing importance of technical regulation affecting the use and sale of chemical products is a topic of interest not only for the chemical industry, but also for governments, nongovernmental organizations, consumers, and interested communities. The results of such regulation on behalf of the environment, health and safety of individuals, as well as its economic effects on industrial activity, are well understood in the United States and recently in the European Union. In less developed countries, however, the general level of public understanding of these issues is still minimal. It is common knowledge that the so-called "regulatory asymmetry" between countries at different levels of development contributes to the establishment of technical barriers to trade. Such asymmetries, however, also have other impacts: the displacement of polluting industrial sectors to countries which have less demanding regulations, the concentration of unsafe and harmful environmental conditions in certain parts of the globe, and the competitive disadvantage for industries located in countries where control is more rigid. This study analyses information on a wide range of technical regulations issued by World Trade Organization (WTO) members, and focuses on those regulations that affect the chemical industry. This information is available through the WTO Enquiry Points, organizations created in each country to administrate the Technical Barriers to Trade Agreement (TBT). This article consists of an analysis of 4,301 notifications of technical regulations by WTO member states in the 7-year period following the establishment of the WTO in 1995. Starting from this mass of information, 585 notifications that affect the circulation or use of chemical products were isolated. Of this group, 71% refer to only 15 countries. This group of notifications was further classified according to their motivation (the environment, health, safety), by the type of product affected (medications, fuels, hazardous products, etc.), by the type of country where it was established (developed, emerging or developing) and the existing conformity assessment mechanism (prohibition, licenses, certification, labeling, etc.). Beyond identifying tendencies in specific industrial sectors, the notifications studied here reach more than 100 chemical products, substances, preparations and other materials, which are subject to various levels of restrictions in different parts of the globe because of their composition or adverse reactions during their life cycles.

Chemical Industry↗
PubMed2004

Epidemiology of tuberculosis and leprosy, Sabah, Malaysia.

The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.

Adolescent↗
PubMed1999

The potential impact of rural mayday systems on vehicular crash fatalities.

Rural mayday systems can reduce the time between the occurrence of an accident and the notification of emergency medical services--called the accident notification time. Reductions in this time, in turn, may affect the numbers of fatalities. A statistical analysis is used to estimate the quantitative relationship between fatalities and the accident notification time. The elasticity of rural fatalities with respect to the accident notification time was found to be 0.14. If a rural mayday system were fully implemented (i.e. a 100% market penetration) and the service availability were 100%, then we would expect monetary benefits of about $1.83 billion per year and comprehensive benefits (which includes the monetary value attached to the lost quality of life) of $6.37 billion per year.

Accidents, Traffic↗