Tuberculosis transmission among five school bus drives and students in two New York countries

OBJECTIVE: Between November 1994 and April 1995, more than 3300 students in 49 schools in two countries in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students. METHODS: Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as >/=10 mm induration, and a converter was an individual with an increase in reaction size of >/=10 mm in the past 2 years. RESULTS: The rates of positive skin tests were 0.8 percent, 0.3 percent, 9.9 percent, 1.1 percent and 0.7 percent among US-born student exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for student expose to driver 3 and the only secondary case identified among students was exposed to driver 3. The DNA fingerprinting patterns of isolates from drivers 3 and 4 matched. CONCLUSION: There was no clear evidence of transmission of M tuberculosis to students from driver 1, 2, 4, or 5. However, evidence suggests the driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures(AU)

Geographic spread of measles on the island of Dominica, West Indies

Because of the short incubation period of most acute infectious diseases, short-term and daily mobility are more important than permanent and seasonal migration for the spread of these diseases. Yet most studies of population mobility focus on permanent or semipermanent change of residence. Here, we describe the results from a field study conducted on the island of Dominica, West Indies, during the summers of 1989 and 1990 and the winter of 1991. The study was designed to collect data on short-term mobility rather than migration. These mobility data are linked with data on pattern of measles transmission during a 1984 epidemic. Three-hundred five individuals from all parts of the island were interviewed about their daily travel patterns, their travel off the island, and the travel of members of their immediate family. In addition to these respondents, interviews were conducted with representatives of most of the major occupations that involve travel in the course of a workday. Data were also collected on the number and type of motor vehicles traveling along various routes on the island and on travel of native residents to the capital city, Roseau, to buy or sell at the major weekly market. Analysis of the interviews shows that travel within the island is clearly nonrandom. For example, almost everyone interviewed traveled to Roseau at least once a month, but 40 percent of the respondents had never been to any of the major villages in the Grand Bay Health District, which is only about a half-hour from Roseau. Patterns of disease transmission have been directly affected by these mobility patterns. The measles epidemic in 1984 apparently did not reach the Grand Bay Health District, even though all other areas of the island experienced significant rates of infection. Analysis of reasons for the relative isolation of the Grand Bay Health District indicates the importance of transportation patterns, as well as social, cultural, and geographic factors, to the disease transmission patterns throughout the island. (AU)

Spatial patterns of use of health services in the Kingston metropolitan area, Jamaica

This study focuses on the influence of distance, transport and accessibility on the use of health services in Kingston, Jamaica. It reviews various factors affecting the use of health care with particular reference to third world cities and presents results from a case study of utilization in the Kingston Metroploitan Area. Three pairs of sites of constrasting social status were selected and 50 respondents questioned in each about spatial patterns of primary health care (PHC) attendance. Types of facility attended, mode of transport, travel times, distance and frequency of utilization were discussed. Some distinctive differences appeared between low and high status site respondents with regard to distances to facilities and travel times, which were almost always higher for the low status respondents. Most respondents were not using their nearest facilities, for varying reasons which included, for poorer respondents, need to attend frequently distant public facilities and, for wealthier respondents, loyalty to old family doctors and use of company-related doctors. The mobility of higher status respondents afforded them considerable choice of locations used for health care and their attendance was much more convenient than that of lower status respondents. Utilization rates were somewhat higher in the high status sites although not to the extent found by some earlier studies in similar settings.(AU)

Management of the transport fleet of the Ministry of Health

Focuses on the transport fleet of the Ministry of Health in order to formulate proposals for upgrading its management. Lists the number of vehicles assigned to the Ministry of Health, the specific persons to which these are assigned and the major activities which make up the daily routine of the fleet. Presents the guidelines as set out by the Procedures Manual within which the transport fleet operates. Contends that the procedures were meant to ensure: inventory control, operating cost control, utilization control, control of servicing and preventive maintenance ans cost benefit analysis via the vehicle history summary. Discusses the five major management processes - planning, organizing, co-ordinating, directing, and control evaluation. Contends that, from discussions and interviews held with persons involved in the management of the fleet, the problems identified originate in the planning exercise which was prior to the development of the procedure manual. Comments on the weakness in the present filing system, the inability of the transport officer to undertake all the prescribed duties of his office because he has to undertake clerical duties, was largely through under-utilization of vehicles and on the misuse and abuse of vehicles. Presents a summary of proposals for upgrading the transport fleet(AU)

Environmental impact assessment - an important tool for decision makers

The use of Environmental Impact Assessment, EIA, as a tool for decision makers is described. EIA can be used for identifying, predicting and assessing impacts arising from proposed activities such as major development projects like industrial complexes, highways and water-related projects. Implementation of EIAs is usually for projects for which a number of alternatives may be assessed. The methods used at each stage of the EIA process are identified. The matrix method is used to illustrate an EIA of the development of an industrial complex, port and urban development. The alternatives of continuing with the traditional uses, that is, agriculture (sugar cane), fisheries and recreation are also assessed. Additionally, the impact of a third alternative of changing the monocrop agriculture to diversified agriculture is considered. It is recommended that EIAs are formally integrated into the planning process in Trinidad and Tobago. (AU)

The meat trade in Portland with special emphasis on the public health aspect

Some of the features stated which make a private slaughter place unsatisfactory are :- 1) Broken up concrete slab 2) Overgrown vegetation 3) Stagnant water in drains 4) Dirty concrete surface 5) Inadequate water supply 6) Dirty and unsightly surroundings 7) Insanitary toilet facilities . In respect of the survey carried out to determine the extent to which the public is exposed to disease through the meat trade, from the purchasing of the animals through to the consumption of the meat, the researcher has decided to make the following recommendations for further improvements. (AU)