Trauma Systems: Origins, Evolution, and Current Challenges.

Trauma is the leading cause of death among patients 46 years or younger, and having a system in place for the care of the injured is of paramount importance to the health of a community. The growth and development of civilian trauma systems has not been an easy process. The concept of regionalized health care that the trauma system models has been emulated by other specialized and time-sensitive areas of medicine, notably stroke and acute cardiac events. Continued process improvement, public education, support and involvement, a sound infrastructure, and integrated technology should remain our focus.

Historia del Programa de Control de la Tuberculosis de Chile / History of the Program of Control of Tuberculosis in Chile

A book on the history of the Program of Control of Tuberculosis in Chile, recently published by the Ministry of Health as a landmark of the Public Health of the country, is commented. His author, the distinguished historian Marcelo López Campillay goes over the different stages of the tuberculosis epidemic in Chile and the successive attempts to control it. First with a modern control program and later with a program aimed at the elimination of tuberculosis as a public health problem, with a target of less than 5 cases per 100,000 inhabitants by 2020. The successes and difficulties of the program through its different stages are explained by the testimonies from its main protagonists and conductors. Complementary contributions about this exciting history are given.

Se comenta la publicación del Ministerio de Salud sobre la historia del Programa de Control de la Tuberculosis, como un hito dentro de la Salud Pública de Chile. Su autor, el distinguido historiador Marcelo López Campillay, recorre las distintas etapas vividas por la epidemia de tuberculosis en Chile y los sucesivos intentos de controlarla a través de un Programa de Control de la Tuberculosis moderno, que ha ido evolucionando a un programa cuya meta es la eliminación de la enfermedad como problema de salud pública, con una meta de menos de 5 casos por 100.000 habitantes para el año 2020. Se detallan los éxitos y dificultades que ha tenido que enfrentar el programa en sus distintas etapas, basados en los testimonios de sus principales protagonistas y se agregan aportes complementarios sobre esta interesante historia.

A ten-year history: the Cancer Quality Council of Ontario.

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO.

History of the radiological health program of the Pan American Health Organization

The radiological health program of the Pan American Health Organization (PAHO) was established in 1960. Although the program has undergone various organizational changes, it continues to operate to this date. It has been operational through the administrations of five of the Directors of the Pan American Sanitary Bureau (PASB), which is PAHO's Secretariat, and has been located in various PAHO divisions or areas of work. Its program emphasis has evolved with the requirements of the Member States of PAHO. However, the program has essentially remained a unit with activities in research, training, radiation protection, and services in the areas of public health and clinical medicine. (AU)

[Local and regional veterinary history]. / Lokale en regionale veterinaire geschiedenis.

Continuing a review, written in 1992, an overview is given of the five recent studies on local themes. The author emphasizes that telling a story of local traditions and usages, of striking personalities or personal experiences can illuminate the problems of a broader national or even international context. He points to the fact that the local archives contain many materials of veterinary historical relevance waiting for exploitation.

Partnerships in international applied epidemiology training and service, 1975-2001.

In 1951 the Centers for Disease Control and Prevention created the Epidemic Intelligence Service to provide training and epidemiologic service on the model of a clinical residency program. By January 2001, an additional 28 applied epidemiology and training programs (AETPs) had been implemented around the globe (with over 945 graduates and 420 persons currently in training). Field Epidemiology Training Programs and Public Health Schools Without Walls are the most common models. Applied epidemiologists, or field epidemiologists, use science as the basis for intervention programs designed to improve public health. AETPs train people by providing them with health competencies through providing service to public health intervention programs and strengthening health systems. AETPs are relatively expensive to create and maintain, but they are highly sustainable and can produce immediate benefits. Of the 19 programs that began before 1997, 18 (95%) continue to produce graduates. The Training Programs in Epidemiology for Public Health Interventions Network was organized in 1997 to provide support, peer review, and quality assurance for AETPs. In 2001, new programs are planned or in development in India, Argentina, China, and Russia.

[National socialist "children's euthanasia" program in the province of Westphalia (1940-1945)]. / Die NS-"Kinder-Euthanasie"-Aktion in der Provinz Westfalen (1940-1945).

As part of the organization structure of the "Reich committee for scientifically registering genetic and inherent serious illnesses" "childrens' special wards" were established in the province Westphalia in the child-psychiatry St. Johannesstift in Niedermarsberg (end of 1940), and then in the Provinzialheilanstalt Aplerbeck (end of 1941). The establishment thereof and personnel recruiting were done in close operation with provincial authorities. In Niedermarsberg external nurses were also employed. When the activities in the Marsberger ward became public despite efforts to keep them secret, the provincial association felt forced to establish a replacement ward in Dortmund-Aplerbeck. This ward was integrated stronger into the hospital-internal and regional care structures regarding personnel and institutional aspects than the previous ward. The actions of "child euthanasia" were based on a combination of hierarchical decision-making structures, limited responsibility, and scientific justification. The people performing these activities were provided action options withdrawal possibilities. For the affected parents the events were shifted into a psychological grey area which did not force decisions in principle. The internal conditions of the "childrens' special wards", the procedures and the "treatments" of the children were clearly regulated; the "euthanasia" activities themselves can be comprehended only in fragments from testimonies. By analyzing the reception books in connection with the medical files it is possible to make statements regarding the number of deaths, the death rate and cause, and also several social characteristics of the children. The fate of the children in the Westphalian "childrens' special wards" shows that the work in these regional "Reich committee wards" was limited to caring, observing, selecting and killing. The attempts of scientific justification are exposed as cover-ups.

A historical perspective of trauma system development in the United States.

The concept of a trauma system as public health policy has developed substantially during the 30 years since publication of Accidental Death and Disability: The Neglected Disease of Modern Society. The military experience with casualties established the public expectation that grievously injured citizens should be expected to survive if a system enables a team of experts to work smoothly together. The federal government has invested hundreds of millions of dollars in support of development of an infrastructure of emergency medical systems throughout the country, and trauma systems have benefited from timely prehospital care provided by trained professionals. State or regional metropolitan governments have initiated establishment of trauma systems as fusions of health care and the politics of health care policy. Trauma systems can be considered an experiment in health care policy because they have characteristics uncommon with other areas of medical practice. Hospitals have been categorized by means of outside review based on their capabilities to provide trauma care, which has led to designation, whereby individuals are transported to trauma centers after serious injury rather than the hospitals they might normally choose. The performance of hospitals and health providers in a trauma system is subjected to outside review and some form of public accountability. All of the effort, money, and work committed to trauma systems requires careful scrutiny to determine whether trauma systems are indeed beneficial. Have trauma systems reduced death, ameliorated disability, and successfully prevented the problems these public health policies intend to manage?

Prematurity as a public health problem: US policy from the 1920s to the 1960s.

During the 1920s and 1930s, a number of physicians created model premature infant stations in select hospitals, arguing that medicine could successfully treat premature infants, most of whom could be expected to live normal lives. Most hospitals and doctors, however, remained indifferent to the special medical needs of premature infants. Subsequently, public health officials, beginning in Chicago, took up the cause of the medical management of newborn premature infants, defining the problem and finding the resources for a community-wide solution. The latter included multiple, high-quality premature nurseries, infant transport, regionalization, and public financing. The "Chicago model" was adapted by many state and municipal departments of health, particularly after World War II, to create community-based programs, the largest of which was in New York City. As premature infant care became of greater interest to pediatricians and hospitals, in part because of the success achieved by public health officials, the earlier, prominent role of the latter was increasingly diminished and historically forgotten.

Alabama Regional Medical Program.

The story that follows attempts to chronicle the history of one state's involvement with the Heart Disease, Cancer and Stroke Amendments of 1965, subsequently known as Regional Medical Programs. It is a history of an enterprise fraught with problems, but energized by the will, skill and imagination of scores of public officials and citizens who, over the decade of the program's formal existence, bent every effort to insure the realization of its fundamental purpose: putting the best, most advanced medical knowledge within the reach of the greatest number of citizens. The following is a chronicle of the Alabama Regional Medical Program.