WHO meeting on the standardization of HPV assays and the role of the WHO HPV Laboratory Network in supporting vaccine introduction held on 24–25 January 2008, Geneva,Switzerland

In anticipation of the implementation of new prophylactic HPV vaccines, the WHO is supporting the establishment of a global WHO HPV Laboratory Network whose mission is to “contribute to improving the quality of laboratory services for effective surveillance and monitoring of HPV vaccination impact through enhanced, state-of-the-art laboratory support”. WHO convened a meeting at its headquarters, 24–25 January 2008 which placed particular emphasis on the harmonization of HPV Laboratory Network practices and standardization of HPV assays as these are crucial for the success of the HPV Laboratory Network in conducting studies measuring HPV disease burden and vaccine impact. To assist the HPV Laboratory Network in fulfilling its mission, the meeting was attended by all members of the HPV Laboratory Network, representatives of WHO Headquarters and Regional Offices, WHO Collaborating Centres involved in HPV-related work as well as experts from additional HPV laboratories around the world, representatives of national regulatory and control authorities, non-profit organizations and the vaccine industry.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites, United States, 2001

An estimated 76 million persons contract foodborne illnesses each year in the United States. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data about 10 foodborne diseases in nine U.S. sites to quantify and monitor foodborne illnesses. This report describes preliminary surveillance data for 2001 and compares them with 1996-2000 data. The data show a decrease in the major bacterial foodborne illnesses, indicating progress toward meeting the national health objectives of reducing the incidence of foodborne diseases by 2010. However, the data do not show a sustained decline in some infections, indicating that increased efforts are needed to reduce further the incidence of foodborne illnesses.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites,United States, 2002

In the United States, an estimated 76 million persons contract foodborne illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on 10 foodborne diseases in nine U.S. sites. FoodNet follows trends in foodborne infections by using laboratory-based surveillance for culture-confirmed illness caused by several enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2002 and compares them with 1996-2001 data. The data indicate a sustained decrease in major bacterial foodborne illnesses such as Campylobacter and Listeria, indicating progress toward meeting the national health objectives of reducing the incidence of foodborne infections by 2010 (objectives 10-1a to 10-1d). However, the data do not indicate a sustained decline in other major foodborne infections such as Escherichia coli O157 and Salmonella, indicating that increased efforts are needed to reduce further the incidence of foodborne illnesses.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003

In the United States, an estimated 76 million persons contract foodborne and other acute diarrheal illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on diseases caused by enteric pathogens transmitted commonly through food in nine U.S. sites. FoodNet quantifies and monitors the incidence of these infections by conducting active surveillance for laboratory-diagnosed illness. This report describes preliminary surveillance data for 2003 and compares them with 1996-2002 data. The data indicate substantial declines in the incidence of infections caused by Campylobacter, Cryptosporidium parvum, Escherichia coli O157, Salmonella, and Yersinia enterocolitica. These data represent progress toward meeting the 2010 national health objectives of reducing the incidence of foodborne infections (objective nos. 10.1a, 10.1b, and 10.1d). However, increased efforts are needed to reduce further the incidence of foodborne illnesses, particularly among children.     

全国实验室生活饮用水中汞检测的能力验证结果分析

目的通过能力验证计划,对全国实验室的生活饮用水中汞含量检测能力进行分析和评价。方法能力验证计划中使用的被测样品参考二级标准物质制备方法制备,采用单因子方差分析法和线性拟合趋势分析法分别对其进行均匀性检验和稳定性检验。将全国多个行业系统所属的434家实验室提交的结果进行迭代稳健统计分析,采用Z比分数评定各参加实验室的测试结果。结果获得满意结果的实验室390家,结果满意率为89.9%;可疑结果的有13家,结果可疑率为3.0%;离群结果的有31家,结果离群率为7.1%。结论能力验证统计结果表明,国内实验室的生活饮用水中汞检测能力总体较好,少部分实验室的检测能力有待改进提高。     

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.     

Laboratory capacity to detect antimicrobial resistance, 1998

Emerging mechanisms of antimicrobial resistance have clinical, microbiologic, and infection-control implications for health-care providers. Antimicrobial resistant organisms include Staphylococcus aureus with reduced susceptibility to vancomycin (minimum inhibitory concentration [MIC] > or = 4 microg/mL), including vancomycin intermediate S. aureus (VISA; vancomycin MIC = 8-16 microg/mL) and Enterobacteriaceae that produce extended spectrum beta-lactamases (ESBLS), which result in resistance to a broad range of beta-lactam antibiotics. Detecting VISA and ESBLs-producing gram-negative pathogens can be difficult for clinical microbiology laboratories. Although CDC and the National Committee for Clinical Laboratory Standards (NCCLS) have published screening and confirmatory methods for these pathogens (Tables 1 and 2), the extent of use of these methods is unknown. This report summarizes results from a survey of microbiology laboratories that participate in the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program (EIP) Network to assess the capacity of clinical microbiology laboratories to detect VISA and ESBL-producing pathogens; findings indicate that despite adequate capacity for proper testing, many laboratories do not have appropriate methodology to detect these resistant pathogens.     

全国实验室生活饮用水中硝酸盐氮测定的能力验证研究

目的通过能力验证计划,对全国实验室的生活饮用水中硝酸盐氮含量检测能力进行分析和评价。方法能力验证计划中使用的被测样品参考二级标准物质制备方法制备,采用单因子方差分析法和t检验法分别对其进行均匀性检验和稳定性检验。将全国多个行业系统所属的608家实验室提交的结果进行迭代稳健统计分析,采用Z比分数评定各参加实验室的测试结果。结果获得满意结果的实验室541家,结果满意率为89.0%;可疑结果的有20家,结果可疑率为3.3%;离群结果的有47家,结果离群率为7.7%。结论能力验证统计结果表明,国内实验室的生活饮用水中硝酸盐氮检测能力总体较好,少部分实验室的检测能力有待改进提高。     

Reducing the rate of teen pregnancy in Canada: a framework for action

In partnership with the Young/Single Parent Support Network of Ottawa-Carleton and Timmin's Native Friendship Centre, the Canadian Institute of Child Health has completed a framework to reduce the rate of teen pregnancy in Canada. The final document is called Pro-Action, Postponement, and Preparation/Support: A Framework for Action to Reduce the Rate of Teen Pregnancy in Canada. The objectives were to learn what is currently being done and what needs to be done on this issue across the country, and to explore the potential role of projects funded by the federal Canada Action Program for Children (CAPC) and Canada Prenatal Nutrition Program (CPNP) in reducing the rate of teen pregnancy. Being an extremely complex and sensitive issue, the report was a culmination of a number of research methods: over 40 key informants from diverse backgrounds and expertise were interviewed to determine the scope of the problem and potential solutions; a detailed literature review identified existing date and documentation on the topic, using both Canadian and international studies; youth surveys and focus groups were conducted in both on-reserve Aboriginal communities and non-Aboriginal communities.     

Performance of asbestos fiber counting laboratories in the NIOSH proficiency analytical testing (PAT) program

Asbestos fiber counting data reported in the NIOSH Proficiency Analytical Testing (PAT) Program are used in this study to evaluate the analytical performance of participating laboratories and to determine if overall performance has improved during a ten-year period. PAT laboratories have achieved intralaboratory precision of 0.18 to 0.28 relative standard deviation (RSD), and interlaboratory precision of 0.33 to 0.44 RSD. In addition, there was higher variability between PAT laboratories from 1974 to 1978, when the program underwent considerable change and growth than the variability found during previous or subsequent time periods. The improvements in interlaboratory precision by approximately one-third since 1974 and the tendency of laboratories with little PAT experience to have poorer interlaboratory precision than more experienced laboratories raises a concern that interlaboratory precision may deteriorate as large numbers of new laboratories start to enroll in the PAT Program with the increased emphasis on asbestos removal in public buildings.     

全国实验室生活饮用水中三氯甲烷的测定能力验证研究

目的通过能力验证计划,对全国实验室的生活饮用水中三氯甲烷含量检测能力进行分析和评价。方法能力验证计划中使用的被测样品参考二级标准物质制备方法制备,采用单因子方差分析法和t检验法分别对其进行均匀性检验和稳定性检验。将全国多个行业系统所属的329家实验室提交的结果进行迭代稳健统计分析,采用z比分数评定各参加实验室的测试结果。结果获得满意结果的实验室299家,结果满意率为90.9%;可疑结果的有14家,结果可疑率为4.3%;离群结果的有16家,结果离群率为4.9%。结论能力验证统计结果表明,国内实验室的生活饮用水中三氯甲烷检测能力总体较好,少部分实验室的检测能力有待改进提高。     

Laboratory practices for prenatal group B streptococcal screening--seven states, 2003

In the United States, group B streptococcus (GBS) is the leading cause of serious bacterial infections in newborns. In 1996, consensus guidelines for use of intrapartum antibiotic prophylaxis (IAP) to prevent perinatal GBS disease recommended either of two methods for identifying candidates for chemoprophylaxis: 1) late prenatal culture-based screening for GBS colonization or 2) monitoring of women intrapartum for particular risk factors associated with early-onset GBS disease. Evidence that culture-based screening was substantially more effective than the risk-based approach led to revised guidelines in 2002 recommending late prenatal GBS screening for all pregnant women. Although methods for isolation and identification of GBS from prenatal specimens remained the same as those recommended in 1996, the 2002 guidelines recommended that laboratories perform antimicrobial susceptibility testing on prenatal GBS isolates from women at high risk for penicillin anaphylaxis and clarified that laboratories should report the presence of any GBS in urine specimens from pregnant women. To assess laboratory adherence to recommendations in the 2002 guidelines, CDC's Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network surveyed clinical laboratories about prenatal culture-processing practices in 2003. This report summarizes the results of that survey, which indicated that, although adherence to GBS isolation procedures was high, opportunities exist to improve implementation of recommendations related to antimicrobial susceptibility testing and GBS bacteriuria.     

Monitoring the performance of occupational health laboratories.

To monitor the performance of occupational health laboratories analyzing workplace air, the American Industrial Hygiene Association (AIHA), with assistance from the National Institute for Occupational Safety and Health, has established four national quality assurance programs. They are the Proficiency Analytical Testing (PAT) Program, the AIHA Laboratory Accreditation Program, the Asbestos Analysts Registry, and the Bulk Quality Assurance Program. This paper focuses on the PAT program, a quality audit program that provides samples of asbestos, silica, metals, and solvents to laboratories quarterly. PAT data for asbestos, silica, and lead were examined for trends in precision. Simple graphs of coefficient of variation during the 18-yr history of the program provide evidence of improved agreement among laboratories performing these analyses. The improvement took place in spite of growth in the number of laboratories and decreases in the levels being analyzed. The improvement is attributed to several factors, including improved analytical methods and the very existence of the PAT and AIHA Laboratory Accreditation Programs.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 sites, United States, 2004

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. sites on diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-diagnosed illness. This report describes preliminary surveillance data for 2004 and compares them with baseline data from the period 1996-1998. The 2004 data indicate declines in the incidence of infections caused by Campylobacter, Cryptosporidium, Shiga toxin-producing Escherichia coli (STEC) O157, Listeria, Salmonella, and Yersinia. Declines in Campylobacter and Listeria incidence are approaching national health objectives (objectives 10-1a through 1d); for the first time, the incidence of STEC O157 infections in FoodNet is below the 2010 target. However, further efforts are needed to sustain these declines and to improve prevention of foodborne infections; efforts should be enhanced to reduce pathogens in food animal reservoirs and to prevent contamination of produce.     

Implementation of the Project P.A.T.H.S. in Hong Kong: observations based on the Co-Walker Scheme

The implementation quality of the Tier 1 Program (Secondary 1 Program) of the Project P.A.T.H.S. in the third year of the Full Implementation Phase was examined in this study, with classroom observations of 233 units in 157 schools. Results demonstrated that the overall level of program adherence was generally high with an average of 72.96%. A total of 13 aspects regarding program delivery were significantly correlated. Multiple regression analyses indicated that overall implementation quality was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, degree of achievement of the objectives, and time management. Student participation and involvement, classroom control, degree of achievement of the objectives, and time management were significant predictors of success of implementation.     

Measuring the impact of a Web-based data query system: the logic model as a tool in the evaluation process.

A review of program evaluation perspectives, including the concept of a logic model and its applicability to the evaluation of Web-based data query systems (WDQSs), is presented. A logic model is used to flesh out evaluation components of a WDQS, including inputs, constraints, program activities, program outputs, and outcomes. For each component, a list of potential items is presented for inclusion in the model, along with examples of initial, intermediate, and ultimate outcomes for a WDQS. Program evaluation is a process that is important to conduct both early in WDQS development to promote clarity of its vision and objectives and throughout the course of the WDQS implementation and maintenance to ensure that its objectives are being met. Should the WDQS not be producing desirable results, the logic model provides a road map for understanding which activities are not meeting the WDQS's objectives so that the course of WDQS development, implementation, and maintenance may be altered to improve the probability of reaching desirable outcomes.     

A laboratory intercomparison of radon in water measurements in Maine

Naturally occurring radon exists in ground water and drinking water supplies. Many water testing laboratories provide measurements of radon in water for the public. No known national intercomparison program exists to verify the accuracy of the laboratories measuring radon in water in Maine or the Northeast. In recognition of this situation, the State of Maine Radiation Control Program sanctioned an intercomparison study for laboratories registered in Maine to measure radon in water. The University of Maine supplied each laboratory with water samples of various radon concentrations, served as the reference laboratory, and analyzed the results. Of the nine participating laboratories, eight use the liquid scintillation method while the ninth uses the E-PERM method to measure radon in water. Presented here are the results of this intercomparison study with a tabulation of the materials and methods used by the laboratories. The results from five of the nine testing laboratories showed significant discrepancies with those of the reference laboratory, typically due to low measurements.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 States, United States, 2005

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illness. This report describes preliminary surveillance data for 2005 and compares them with baseline data from the period 1996-1998. Incidence of infections caused by Campylobacter, Listeria, Salmonella, Shiga toxin-producing Escherichia coli O157 (STEC O157), Shigella, and Yersinia has declined, and Campylobacter and Listeria incidence are approaching levels targeted by national health objectives. However, most of those declines occurred before 2005, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2006

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illnesses. This report describes preliminary surveillance data for 2006 and compares them with baseline data from the period 1996-1998. Incidence of infections caused by Campylobacter, Listeria, Shigella, and Yersinia has declined since the baseline period. Incidence of infections caused by Shiga toxin-producing Escherichia coli O157 (STEC O157) and Salmonella, however, did not decrease significantly, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness and achieve national health objectives.     

How small business health exchanges can offer value to their future customers--and why they must

The success of the Small Business Health Options Program (SHOP)-health insurance exchanges targeted at the small-group market and opening for business in January 2014-will depend in large part on persuading small employers and qualified health plans to participate. The most important objective will be offering employers lower-cost health plans than they have now. Other critical objectives will be offering small firms administrative efficiencies and access to choices among high-value plans that are not offered elsewhere. This article frames the challenges that exchanges will encounter in meeting these objectives. In particular, it discusses the advisability of small-business exchanges' offering an "employee choice" model (which the article describes in detail); of combining the small-business and individual exchanges to broaden product offerings and gain operational efficiencies; and of encouraging low-cost plans to enter the exchange market, perhaps by enabling Medicaid managed care plans to offer comparable commercial products, and in turn affording health plans access to a uniquely motivated market of small firms and their workers who want affordable coverage.