Pregnancy and infant health: progress toward the 1990 objectives

Assuring all infants a healthy start in life and enhancing the health of their mothers are goals of the Public Health Service's health promotion and disease prevention initiative. The 13 priority objectives selected for the pregnancy and infant health area of the initiative focus on lowering infant, neonatal, and perinatal mortality rates, reducing the number of low-birth-weight infants, improving the health care of pregnant women and infants through regionalized perinatal care systems and comprehensive primary care services, encouraging early prenatal care and healthy lifestyles in pregnancy, and targeting the factors and populations associated with health risk. Although considerable progress has been made in this century in lowering the infant mortality rate, infants continue to die at a higher rate than members of any other age category under 60 years, and black infants die at almost twice the rate of white infants. To lower these high mortality rates, the private, public, and voluntary sectors have cooperated in new approaches to perinatal and infant health that have already produced some encouraging results. Recent data, for example, indicate that the priority objective of universal screening of newborns for treatable metabolic disorders has already been achieved and that the target for neonatal and infant mortality rates could be reached earlier than 1990. Substantial challenges, however, lie ahead if the current racial and ethnic differentials evident in the rates for prenatal care registration, low-birth-weight babies, and maternal and infant mortality are to be eliminated.     

Toxic agent and radiation control: progress toward objectives for the nation for the year 1990

In 1980, the Department of Health and Human Services set national prevention objectives for 1990 in 15 health priority areas, 1 of which is the control of toxic agents and radiation. Ten objectives related to this area are priorities for the national control effort. Progress is reviewed on those priorities within the responsibilities of the Public Health Service. Six key program elements, or types of support activities, are deemed essential to preventing, identifying, and controlling toxic agent and radiation threats. Significant progress has been made toward achieving objectives for which all key program elements have been successfully implemented to provide the requisite know-how, manpower, and tools. Important advances have been made in reducing the blood lead levels of the population, reducing unnecessary exposure to medical X-rays, evaluating the toxicities of chemicals in toxic waste dumps, and improving the scientific and technical information base and its availability for prevention and control efforts. The most important priority for the forseeable future will be to expand our knowledge of potential health risks posed by toxic agents and radiation. Expanded surveillance systems and data bases are essential to determining the extent of the problems in terms of human health effects and for measuring the impact of prevention programs. Emphasis on the activities embodied in the key elements will encourage the expansion of the knowledge base and its effective application to prevention and control problems.     

Occupational safety and health: progress toward the 1990 objectives for the nation

Occupational safety and health is 1 of 15 areas addressed in the Public Health Service's Objectives for the Nation. This area represents 104 million working men and women and the deaths, diseases, and injuries that result from exposures to hazards in their work environment. Characteristics of public health practice are compared with characteristics of occupational safety and health practice. The National Institute for Occupational Safety and Health (NIOSH), created by the Occupational Safety and Health Act, is discussed. NIOSH has developed a list of 10 leading work-related diseases and injuries. The list is headed by occupational lung diseases. Twenty Objectives for the Nation in the area of occupational safety and health are reviewed, and the status of NIOSH efforts toward their attainment is discussed. Five categories of objectives are covered: (a) improved health status, (b) reduced risk factors, (c) improved public and professional awareness, (d) improved service and protection, and (e) improved surveillance and evaluation. The potential for achieving these objectives is discussed, with special attention given to the lack of a data base for monitoring progress. A major conclusion is that surveillance in occupational safety and health needs to be strengthened.     

Progress toward the 1990 objectives for sexually transmitted diseases: good news and bad

The problem of sexually transmitted diseases (STDs) in the United States has been growing, in both scope and complexity, at an alarming rate. As evidence of the emergence of these diseases as a primary national concern, the Surgeon General has designated them as 1 of 15 priority areas in which further actions are required to improve the health of the American people. The key targets for the 1990 objectives for the nation in the STD area include reducing the incidence of gonorrhea; gonococcal pelvic inflammatory disease; and primary, secondary, and congenital syphilis. This report updates progress toward these objectives. There is good news with respect to the continuing success of proven methods in preventing and controlling both gonorrhea and syphilis. However, the picture is less bright with respect to control of other STDs that have gained new prominence--Chlamydia, herpesvirus, human papillomavirus, and human T-cell lymphotropic virus type III infections. Escalating interest in STDs reflects more recent appreciation of their relation to reproductive outcomes. STD organisms clearly have a far-reaching effect on the nation's population, including the capacity to reproduce, the rate of perinatal infection, the incidence of genital cancers, and the occurrence of acquired immune deficiency syndrome (AIDS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Progress toward achieving the 1990 immunization objectives

Dramatic progress has been made in reducing morbidity due to infectious diseases of childhood through programs of universal immunization of children. This success has been achieved by a program that involves a remarkable integration of private and public endeavors and cooperation between official and voluntary agencies. Similar models of cooperation and integration have not yet been developed for selective use vaccines and new vaccines. As a consequence, although it seems likely that the childhood immunization objectives will be achieved by 1990, the ability to achieve objectives for selective use and new vaccines is in doubt. The National Institute of Allergy and Infectious Diseases has undertaken, as an initiative, the accelerated development of new vaccines. The goal is to expedite the availability of needed vaccines by selecting a few candidate vaccines for extra research and development efforts. Studies are in progress on more than 50 antigens for more than 30 different bacterial, viral, and parasitic diseases.     

The 1990 objectives for the nation for control of stress and violent behavior: progress report.

The control of stress and violent behavior is 1 of the 15 priority areas addressed in the Public Health Service''s Objectives for the Nation. The National Institute of Mental Health, which provides a national focus for the Federal effort to increase knowledge of, and promote effective strategies dealing with, issues associated with mental illness and mental health, has been designated the lead Federal agency in this priority area. The authors summarize progress achieved and further activities planned with respect to 10 objectives for control of stress and violent behavior that have been selected for Federal implementation. The objectives for control of stress include improved public and professional awareness of community agencies that can provide professional services, hotlines, and mutual support groups. The objectives for control of violent behavior address three major problems: deaths from homicide among young black males, suicide among the young, and child abuse. Achievement of several of the objectives is currently impeded by lack of a valid data base. Efforts have been initiated, both by individual agencies and through collaboration among the various participating Public Health Service components, to develop valid and reliable baseline data and surveillance procedures.     

Hypertension control: meeting the 1990 objectives for the nation.

Hypertension (high blood pressure) is 1 of 15 health priorities of the Public Health Service set forth in the report, "Promoting Health/Preventing Disease: Objectives for the Nation." The nine objectives for hypertension include improved health status, reduced risk factors, increased public-professional awareness, improved services and protection, and improved surveillance-evaluation systems. A number of Federal agencies, coordinated by the National Heart, Lung, and Blood Institute, are working to reach the hypertension objectives in cooperation with State, local, and voluntary agencies and organizations. A great deal of progress has been made toward the objectives, as reflected by a variety of indicators. By 1980, for example, 34.1 percent of the population with hypertension had their blood pressure controlled at less than 160/95 mm Hg, but in 1972 only 16.5 percent were so controlled. Since 1972, the age-adjusted death rate has dropped 42 percent for stroke and 27 percent for coronary heart disease. Data indicate that the national goal for sodium ingestion (3-6 grams daily) may already have been met. Fifty-one percent of the population understand that hypertension may lead to stroke, meeting another objective. Public knowledge about hypertension as a "major likely cause of heart trouble" almost doubled in the 6-year period for which data are available. In 1982, 30 percent of processed food in grocery stores had sodium content labeling and almost 50 percent had calorie labeling, according to studies conducted by the Bureau of Foods of the Food and Drug Administration. Efforts are underway to develop a methodology for assessing incidence of hypertension and categories of hypertension control, a need spelled out in another objective.     

Health objectives for the nation: moving toward the 1990s

The 1990 Objectives are an outgrowth of the 1979 Surgeon General's Report, Healthy People, which identified a set of five broad goals for improving the health of the American public through the decade of the 1980s. A year later, more than 500 health experts from the government and the private sector met to develop specific quantifiable objectives for each of the areas outlined in Healthy People. Fifteen topics, including improved nutrition, were used to formulate a framework for 227 objectives that give directions for a national program of health promotion and disease prevention. In 1980, the Public Health Service published the report Promoting Health/Preventing Disease: Objectives for the Nation. A mid-course review of the 1990 objectives has been conducted, and the results were published in 1986. In the nutrition area, it is apparent that some overall progress has been made, but data are insufficient to assess progress on several objectives, and others are unlikely of achievement by 1990. Ultimately, however, the success of the objectives depends on the recognition that they are national, not federal, goals that require commitment to their implementation by both the public and the private sector.     

实施传染病监测是预防控制传染病的有效途径

传染病监测是我国疾病预防控制工作的重要内容之一。建国以来,我国传染病监测和报告制度不断完善,技术手段不断革新,在控制传染病暴发流行中发挥了不可替代的作用。当前全球传染病形势仍然较为严峻,传染病监测仍将是防控传染病的有效途径。本期“传染病监测”栏目的论文,针对不同监测数据进行分析、解释,将成为我国传染病控制研究方面的重要信息,为传染病防控研究提供科学依据。     

Toxic agent and radiation control: meeting the 1990 objectives for the nation.

Toxic agent and radiation control is 1 of the 15 health priority areas addressed through the Public Health Service''s Objectives for the Nation. Several gains in moving toward the 1990 goals for toxic agent and radiation control have been recorded. Research and technical assistance, combined with legislation to reduce the amount of lead in gasoline, have contributed to a decrease in the mean blood lead level of the general population. New testing procedures have been developed to evaluate both reproductive and developmental toxicities of chemicals. Educational implementation of pelvimetry referral criteria in a multiyear study involving approximately 200 U.S. hospitals has resulted in a 50 percent reduction in the number of pelvimetries performed. Health-related responses have been given to environmental problems such as exposures to polychlorinated biphenyls (PCBs) in Massachusetts and Florida and exposures to dioxin in Missouri and New Jersey. Chemical records for some 1,000 compounds likely to occur in chemical dumps or in bulk transit are being either created or updated to enhance online data retrieval services. For the foreseeable future, however, improvement of knowledge of the potential health risk posed by toxic chemicals and radiation must remain one of the most important priorities. To control toxic agents, development of surveillance systems and data bases are equally important.     

Meeting the 1990 hypertension objectives for the nation--a progress report

The National High Blood Pressure Education Program (NHBPEP) effort got underway in 1972 following hypertension research findings and continues to be influenced and, when necessary, redirected, by further findings. Its coordinating committee is composed of representatives from 32 national organizations, and the program itself includes several Federal agencies, all State health departments, and more than 2,000 community-based programs. The goals of NHBPEP and the 1990 prevention objectives for the nation center around the same basic theme: high blood pressure is a serious condition leading to major diseases and premature death. It can be easily detected and effectively brought under control. In the summer of 1984, Admire and co-workers provided a general review and status report of the 1990 Hypertension Objectives and the progress made in meeting those objectives. In the remarkably short period of time since that review, there is even more progress to report. There is good evidence of progress in preventing disease and premature death from hypertension, in bringing hypertension under long term control, and in giving Americans a better understanding of the consequences of uncontrolled high blood pressure. There is also evidence in the fact that while visits to physicians generally have increased only slightly, hypertension visits have increased more markedly. And there is evidence that stroke mortality continues to decline in an almost linear fashion.     

New opportunities for enhancing oral health: moving toward the 1990 objectives for the nation

In July 1983, the Assistant Secretary for Health reviewed progress toward achievement of a dozen national objectives in fluoridation and dental health. These 12 objectives, classified under the categories of improved oral health status, reduced risk factors, increased public and professional awareness, improved services and protection, and improved surveillance-evaluation systems, hold promise for improved oral health in this country. It is noteworthy that the objective that 40 percent of 9-year-old children be caries-free in their permanent dentition has been accomplished (51 percent of 9-year-olds were caries-free according to a 1979-80 National Institute of Dental Research study). Still, dental caries is highly prevalent among teenaged children, and gingival and periodontal conditions are highly prevalent among children and adults. A number of highly effective methods are available for preventing dental decay in children as well as adults; they include community or school water fluoridation, the use of multiple forms of supplemental fluorides, avoidance of frequent consumption of foods that are high in sugar content, and the use of adhesive pit and fissure sealants. Personal use and professional provision of these methods in appropriate combinations can contribute significantly to future improvements in oral health. Meticulous personal oral hygiene practices combined with periodic professional care are the currently available means of protecting periodontal health. Through increased collaboration among various governmental, academic, and corporate entities, as well as active participation by individuals, the achievement of a number of these objectives becomes feasible to the benefit of national productivity, health care financing, and the quality of life for Americans.     

The 1990 objectives for the nation for injury prevention: a progress review

Unintentional injuries are the principal cause of preventable early death. Beyond terms of human suffering and death, injuries place enormous burdens on this country's economic and health care resources. Demographic, sociological, environmental, and behavioral factors that influence our society contribute to the complexity and scope of the injury problem. Progress in injury prevention will be achieved only through the combined efforts of individuals, organizations, and government at every level of our society. The Federal Government is an important contributor to this process through its role of leading, catalyzing, and providing strategic support. Within the Department of Health and Human Services, numerous agencies have major injury prevention components with a broad range of responsibilities, including the direct delivery of services, establishment of safety standards, sponsorship of education and information efforts, building of the capacity of other sectors, basic and applied research, and surveillance. The Centers for Disease Control, as the lead agency, assists State and local health departments in their injury prevention efforts and coordinates activities undertaken jointly by Federal agencies, State and local governments, and private-sector organizations. To meet the 1990 Objectives for the Nation with respect to injury prevention, both the public health and private-sector providers must recognize the injury problem of the 1980s. Without the support and involvement of the public health and provider communities and of the private sector, injuries and their costs will continue at their present alarming rates. The opportunity is great for promoting health, preventing injuries, and reducing associated costs to society. Making the best of this opportunity is our challenge during this decade.     

Toward the 1990 objectives for smoking: measuring the progress with 1985 NHIS data

The Health Promotion and Disease Prevention component of the 1985 National Health Interview Survey allowed us to measure the progress made toward achieving the 1990 objectives for the nation concerning cigarette smoking. The first smoking-related objective, namely, to reduce to below 25 percent the proportion of the U.S. population who smoke, has not been achieved. Today 31 percent of the population smoke. More than 85 percent are aware of the special risk of developing and worsening chronic obstructive lung disease, chronic bronchitis, and emphysema among smokers. More than 90 percent are aware that smoking is a major cause of lung cancer; however, awareness of the risk of laryngeal, esophageal, bladder, and other kinds of cancer from smoking is not so great. More than 85 percent are aware that cigarette smoking is one of the major risk factors for heart disease. In general, then, the 1990 objectives concerning the population's knowledge of the health consequences of cigarette smoking have been met.     

Surveillance of infectious diseases: principles and organisation in France in 2005

Surveillance is a continuous and systematic process of collection, analysis, and diffusion of health data to all those who contributed to the collection and all those who need this data in order to take action. Surveillance activities first target health problems for which effective prevention or control measures are available. Surveillance objectives include the following-up of trends and changes in disease characteristics, evaluation of public health actions, and early detection of infectious diseases threats and epidemic and their investigation. The data produced by surveillance systems allow prioritizing public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians and microbiologists have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals or services, and repeated surveys. The national surveillance is coordinated by a public health institute, "l'Institut de Veille Sanitaire", the missions of which are public health surveillance of the population, alerting health authorities in case of health threats, and identifying the determinants of changes in the population's health status.     

新出现传染病流行与传染病控制国际法规(连载一)

目的掌握目前新出现传染病的流行情况，研究传染病控制国际法规，依法、科学、有效开展新出现传染病控制。方法收集各新出现传染病的流行病学资料和各国传染病立法，分析新出现传染病的原因、流行情况及国际上防治传染病的法规措施的差异性。结果新出现传染病此起彼伏．遍及全球各地，控制突显重要，传染病的流行现状和医学科学的发展已超过人类传染病控制法规的发展。结论修改、补充、完善传染病法规，加强国际间合作，共同应对是良策，也提示各国在自扫门前雪的同时应加强对国外新出现传染病传入国内的防范。     

Surveillance in eradication and elimination of infectious diseases: a progression through the years

During the years since certification of smallpox eradication, the power of infectious disease surveillance has been greatly increased by new biotechnical and electronic technologies. These technologies have transformed the way that surveillance can be used to contribute to public health, and to infectious disease eradication and elimination. In addition to permitting precise geographical placement of infections by incorporating the most up to date geographical positioning systems, infectious disease surveillance can now also provide more comprehensive understanding of the spread and risks of infections because of genomic sequencing that leads to more meaningful epidemiological analysis. These new technologies have made infectious disease surveillance an even more powerful and timely tool than it was during the period of smallpox eradication. Future surveillance will continue to refine these technologies, and adapt newer ones such as rapid point of care diagnostics and hand held communication devices that will lead to more timely and accurate reporting from health facilities. These technologies will also lead to the possibility of direct participation in surveillance by individuals who will be able to report their own disease syndromes, those of their neighbors, or those of domestic and wild animals at the animal/human interface.