Implementing Integrated Disease Surveillance and Response: Four African countries' experience, 1998-2005.

The Integrated Disease Surveillance and Response (IDSR) strategy was developed by the Africa Regional Office (AFRO) of the World Health Organisation (WHO) and proposed for adoption by member states in 1998. The goal was to build WHO/AFRO countries' capacity to detect, report and effectively respond to priority infectious diseases. This evaluation focuses on the outcomes in four countries that implemented this strategy. Major successes included: integration of the surveillance function of most of the categorical disease control programmes; implementation of standard surveillance, laboratory and response guidelines; improved timeliness and completeness of surveillance data and increased national-level review and use of surveillance data for response. The most challenging aspects were: strengthening laboratory networks; providing regular feedback and supervision on surveillance and response activities; routine monitoring of IDSR activities and extending the strategy to sub-national levels.

The role of state public health agencies in genetics and disease prevention: results of a national survey.

OBJECTIVES: The onset and severity of the clinical expression of most diseases that are of public health importance are influenced by genetic predisposition. The ability to assess human genetic predisposition for many diseases is increasing rapidly. Therefore, state public health agencies should be incorporating new developments in genetics and disease prevention into their core functions of assessment, policy development, and assurance. The authors assessed the status of this process. METHODS: The Council of State and Territorial Epidemiologists (CSTE) surveyed states about projects and concerns related to genetics and public health activities. Respondents were the Health Officer, the Maternal and Child Health/Genetics Program Director, the Chronic Disease Program Director, and the Laboratory Director. Where applicable, responses were categorized into assessment, policy development, and assurance functions. RESULTS: Thirty-eight (76%) state health departments responded. Ongoing genetics activities were assurance (82%), assessment (17%), and policy development (2%). In contrast, Health Officers responded that future genetics activities would be distributed differently: assurance, 41%; assessment, 36%; and policy development, 23%. Future assurance activities would be largely educational. Topics of interest and recently initiated activities in genetics were primarily assessment functions. Funding was the greatest concern, followed by lack of proven disease prevention measures and outcomes data. CONCLUSIONS: State health departments recognize a need to realign their activities to meet future developments in genetics. Lack of adequate resources, proven disease prevention measures, and outcomes data are potential barriers. Public health agencies need to develop a strategic plan to meet the opportunities associated with the development and implementation of genetic tests and procedures.

Immediate outcomes of substance use treatment within a state psychiatric hospital.

Outcomes of an integrated inpatient treatment program for persons with serious mental illness and substance use disorders are examined in relationship to five stages of treatment--stabilization, engagement, persuasion/awareness, active treatment, and relapse prevention. The study used a randomized design with participants assigned to an integrated mental health and substance abuse treatment program or standard psychiatric hospital treatment. At discharge, participants in the integrated treatment program indicated more active engagement in treatment and greater awareness of mental health issues, substance use issues, and the 12-step program than those who received standard hospital treatment. Participants in the integrated treatment program also saw their treatment as being more effective and had more motivation to stay healthy and sober. The integrated treatment program was not equally effective at each treatment stage with all participants. The implications of the program's success overall and at each treatment stage are discussed.

Interrelationships between dietary protein level, energy intake, and nitrogen retention in pregnant gilts.

Two experiments were conducted to study the effects of dietary protein levels and DE intake on N retention in pregnant gilts. Thirty-two gilts were used in Exp. 1 to investigate the response to eight levels of dietary CP ranging from 50 to 235 g/kg (3.3 to 14.5 lysine/kg). Gilts were given 1,400 g of feed daily throughout pregnancy; diets contained similar balances of amino acids and similar amounts of DE (3.60 to 3.63 Mcal/kg). Thirty gilts in Exp. 2 were allocated during pregnancy to six levels of feeding ranging from 1.1 to 3.1 kg/d. The common diet given to gilts contained 3.49 Mcal of DE/kg, 155 g of CP/kg, and 10.7 g of lysine/kg and was considered adequate in protein. Nitrogen balance trials were conducted during early, mid-, and late pregnancy and collection periods of 5 d duration commenced on d 30, 58, and 86 in Exp. 1 and d 30, 58, and 93 in Exp. 2. The average live weights of pigs on all treatments within each collection period were similar and were 112.5, 123.3, and 136.6 kg and 120.7, 136.3, and 158.3 kg in Exp. 1 and 2, respectively. At each stage of pregnancy increments of dietary protein increased N retention up to an inflection point, after which N retention remained at a constant level. The maximum rates of N retention, 10.0, 12.1, and 16.5 g/d during early, mid-, and late pregnancy, occurred at 142, 133, and 162 g of CP/kg, respectively; the corresponding dietary lysine:DE values were 2.4, 2.3, and 2.7 g of lysine/Mcal of DE.(ABSTRACT TRUNCATED AT 250 WORDS)

The response of first-litter sows to dietary protein level during lactation.

Thirty-six sows were used to study responses of milk production, milk composition, and N balance to six concentrations of dietary CP ranging from 63 to 238 g/kg (4.4 to 15.1 g of lysine/kg) during the first lactation. Sows, on average, were 149.3 kg live weight and had 26.1 mm of back fat at P1 (which is 45 mm from the midline at the level of the last rib) immediately after parturition. During lactation, all sows suckled nine pigs each and were offered up to 4,000 g of feed daily; diets contained similar balances of amino acids and similar amounts of DE (3.56 to 3.63 Mcal/kg). Nitrogen balance trials were conducted during early and late lactation and 5-d collection periods commenced on d 10 and 24 of lactation, respectively. During both periods of lactation, there were significant positive linear relationships between the level of dietary protein and milk yield and contents of fat and total solids in milk. Milk yield increased from 7.79 to 9.91 kg/d and from 7.02 to 8.90 kg/d, whereas total solids in milk increased from 199 to 225 g/kg and from 202 to 228 g/kg during early and late lactation, respectively, in response to increasing level of dietary protein from 63 to 238 g of CP/kg. A two-phase linear regression model used to describe the relationship between N balance and dietary CP level established that sows required a diet containing > or = 202 g of CP/kg or 12.8 g of lysine/kg to maximize N balances during both stages of lactation.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged infection of human synovial cells with Ross River virus.

Primary cultures of human synovial cells shed infectious virus for 14 to 35 days following infection with isolates of Ross River virus which had been passaged in the C6/36 line of Aedes albopictus mosquito cells. No frank cytopathic effect was seen in infected synovial cells and they continued to replicate for the duration of the experiments.

Prediction of recidivism in young offenders after brief institutionalization.

Administered 100 delinquent adolescent boys a battery of tests that measured intelligence, mental control, self-concept and physical fitness. The battery of tests was administered at the beginning and at the end of short-term institutional placement (M = 6 months) and again 1 to 2 years after release from the institution. Significant prediction of prosocial behavior in the year after institutionalization was achieved by using tests that reflected mental control and academic achievement. Background variables such as race, socioeconomic status, family status, and previous criminal charges were not related significantly to presence or absence of antisocial behavior during the year after institutionalization. Implications for management and treatment are discussed.

Reticulate pigmented anomaly of the flexures. Case reports and genetic investigation.

Reticulate pigmented anomaly of the flexures is a pigmented macular disease characterized by punctate, hyperpigmented macules on the flexural areas. Histopathologic findings include acanthosis, keratinization of the follicular infundibulum, and filiform downgrowths of epidermal cells. Examination of a family has revealed the presence of the disease in six members. Analysis of these data suggests that reticulate pigmented anomaly of the flexures is an autosomal dominant genodermatosis with possibly variable penetrance, variable expressivity, and delayed onset.

Allergen skin-test reactivity in a community population sample: correlation with age, histamine skin reactions and total serum immunoglobulin E.

Allergen skin reactivity to 14 common local antigens was studied in a community population sample. Differences in the prevalence of positive reactions were related to both the specific antigen itself and the age of the subjects. For most allergens, peak prevalence occurred in the 20- to 34-yr age group, falling thereafter with increasing age. The frequency distribution of reactions revealed a bimodal curve, peaks occurring among nonreactors and those with eight positive reactions out of the 14 tests that were applied. The major contributor to this age--skin test relationship was the level of total serum IgE that was highest in young people and decreased progressively with age. Histamine skin reactions, which were smallest in younger subjects compared with all three older age groups, also contributed to the age-related prevalence of allergen skin-test reactions.

Reversibility of severe bleomycin-induced pneumonitis.

The use of bleomycin sulfate as an antineoplastic agent has been limited by its substantial pulmonary toxic effects. The exact incidence and prognosis of bleomycin-pneumonitis is unresolved. Although bleomycin pulmonary toxicity is thought to be dose-related, recent reports have emphasized severe reactions at low doses. Furthermore, severe pulmonary toxicity has been suggested to be progressive, irreversible, and ultimately, fatal. We report clinical, roentgenographic, and pathophysiologic recovery after severe, bleomycin-induced pneumonitis.