Tuberculosis out-of-pocket expenditure study Lesotho: Final study report

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Improvement of a national public health surveillance system through use of a quality circle.

Surveillance systems for infectious diseases build the basis for effective public health measures in the prevention and control of infectious diseases. Assessing and improving the quality of such national surveillance systems is a challenge, as many different administrations and professions contribute to a complex system in which sensitive information must be exchanged in a reliable and timely fashion. We conducted a multidisciplinary quality circle on the national public health surveillance system in Germany which included clinicians, laboratory physicians, and staff from local and state health departments as well as from the Robert Koch-Institut. The recommendations resulting from the quality circle included proposals to change the federal law for the control of infectious diseases as well as practical activities such as the change of notification forms and the mailing of faxed information letters to clinicians. A number of recommendations have since been implemented, and some have resulted in measurable improvements. This demonstrates that the applied method of quality circle is a useful tool to improve the quality of national public health surveillance systems.

Yellow jacket allergy. Comparison of skin prick tests and intradermal tests with three different yellow jacket venom extracts.

The aim of the present study was to compare yellow jacket venom extracts from two different companies and to compare skin prick test (SPT) with intradermal test (IDT). IDT and SPT with yellow jacket venom (ALK and Pharmacia Reless) were performed on 54 yellow jacket allergic patients and 44 symptom-free volunteers. Venom was diluted to 300, 100, 10 and 1 microgram/ml for SPT and 10(0), 10(-1), 10(-2), 10(-3) and 10(-4) micrograms/ml for IDT, according to the manufacturers' instructions. Skin tests were performed on both forearms. Both extracts showed approximately the same relationship between sensitivity and specificity, but the Pharmacia Reless yellow jacket venom extract showed a 5-10 fold higher biological activity in both SPT and IDT. Thus yellow jacket venoms of ALK and Pharmacia Reless are not comparable in allergen activity at the same venom concentrations. Using extracts from the same company, SPT and IDT were comparable with regard to sensitivity and specificity at an allergen concentration 1000 times higher for SPT than for IDT.