The Singapore Tuberculosis Elimination Programme: the first five years

The Singapore Tuberculosis Elimination Programme (STEP) was launched in 1997 because the incidence of the disease had remained between 49 and 56 per 100,000 resident population for the preceding 10 years. STEP involves the following key interventions: directly observed therapy (DOT) in public primary health care clinics; monitoring of treatment progress and outcome for all cases by means of a National Treatment Surveillance Registry; and preventive therapy for recently infected close contacts of infectious tuberculosis cases. Among other activities are the revamping of the National Tuberculosis Notification Registry, the discontinuation of BCG revaccination for schoolchildren, the tightening up of defaulter tracing, and the education of the medical community and the public. Future plans include an outreach programme for specific groups of patients who are unable to attend their nearest public primary care clinics for DOT, the detention of infectious recalcitrant defaulters for treatment under the Infectious Diseases Act, the molecular fingerprinting of tuberculosis isolates, and targeted screening of high-risk groups. The incidence of tuberculosis fell from 57 per 100,000 population in 1998 to 48 per 100,000 in 1999 and continued to decline to 44 per 100,000 in 2001. With political will and commitment and the support of the medical community and the public it is hoped that STEP will achieve further progress towards the elimination of tuberculosis in Singapore.     

Telemedicine in Greenland--the creation of an evaluation plan

Implementation of telemedicine in Greenland is a continuing process based on a plan of operation for the years 1999-2002. In this context, a plan of evaluation was designed as a health technology assessment in interdisciplinary cooperation between the Telemedicine Team of Greenland and the Norwegian Centre of Telemedicine in Troms?. The geography of Greenland, the financial situation and the shortage of medical staff influenced the way in which the evaluation was designed. This has implications for the extent to which the results may be generalized.     

Mortality among German vegetarians: first results after five years of follow-up

A prospective study of vegetarians recruited from all regions of the Federal Republic of Germany, including West Berlin, was started in 1978 after a preparatory phase of two years in which the cohort was established. The mortality of the 1,904 study participants was evaluated after a follow-up of five years, comparing observed deaths with expected rates based on the national mortality statistics. Of the 858 men and 1,046 women, 89% had followed their diet for at least five years at study entry, the majority of them as strict vegetarians (1,163). By the end of 1983, only 82 persons had died, whereas 219 deaths were expected. In both sexes, the mortality was lowest from cardiovascular diseases [standardized mortality ratio (SMR) for ischemic heart disease about 20] and from cancer (SMR 58 for men, 54 for women). Deaths from diseases of the respiratory and digestive system were also reduced. For individual cancer sites the observed numbers were extremely small, but the risk of dying from lung cancer was significantly reduced; however, deaths from cancers of the colon and rectum, prostate, and breast were rare or even absent. More deaths than expected were observed from stomach, pancreatic, testicular, and brain cancers. An internal comparison of mortality between strict and moderate vegetarians (741) suggests a higher mortality from all causes and malignant neoplasms among strict vegetarians in both sexes, although not statistically significant, and a lower mortality from circulatory system diseases for males. The possible influence of selection factors (e.g., "healthy participant effect," socioeconomic level, and body weight) on the findings of a decreased mortality is discussed together with the role of diet.     

Florida Epidemic Intelligence Service Program: the first five years, 2001-2006

The Florida Epidemic Intelligence Service Program was created in 2001 to increase epidemiologic capacity within the state. Patterned after applied epidemiology training programs such as the Centers for Disease Control and Prevention Epidemic Intelligence Service and the California Epidemiologic Investigation Service, the two-year postgraduate program is designed to train public leaders of the future. The long-term goal is to increase the capacity of the Florida Department of Health to respond to new challenges in disease control and prevention. Placement is with experienced epidemiologists in county health departments/consortia. Fellows participate in didactic and experiential components, and complete core activities for learning as evidence of competency. As evidenced by graduate employment, the program is successfully meeting its goal. As of 2006, three classes (n=18) have graduated. Among graduates, 83% are employed as epidemiologists, 67% in Florida. Training in local health departments and an emphasis on graduate retention may assist states in strengthening their epidemiologic capacity.     

Passive smoking, potential atopy and asthma in the first five years.

Evidence of prolonged exposure to cigarette smoke was sought in a group of 86 children aged five years and under with moderately severe asthma, and in 1199 infants from a mixed background population of Armed Service and civilian families. Asthmatics with a normal serum IgE (less than +1 s.d. for age) made up almost half of the cases and, compared with those with an elevated serum IgE (+1 s.d. for age or more), a greater proportion were male, had experienced prolonged exposure to cigarette smoke, were from Service families and already had fixed chest deformity. It is suggested that, in addition to facilitating the expression of asthma in young potential atopics, passive smoking may be an important contributory cause of the more severe disease reported in the so-called 'intrinsic' group. Perhaps the burden of illness and the extent of exposure noted in this survey will prompt renewed efforts to be made to discourage smoking in families, particularly two years before and for at least five years after the birth of a child.     

High prevalence of overweight children in Michigan primary care practices. An UPRNet study. Upper Peninsula Research Network

BACKGROUND: Our goal was to determine whether the prevalence of obesity in children who receive care in Michigan primary care practices is greater than national and state prevalences. METHODS: We compared prevalences of overweight children and adolescents in primary care practices with the results of the National Health Examination Survey (NHES), the National Health and Nutrition Examination surveys, and a contemporary survey of Michigan schoolchildren. We collected data from 19 rural family practice offices and 2 urban clinics. We measured the heights and weights of 993 consecutive patients aged 4 to 17 years who visited one of the participating practices during the spring of 1996. RESULTS: Obesity prevalences were the main outcome measure. Of the boys, 38% were above the 85th percentile of the NHES, and 16% were above the 95th percentile. Of the girls, 33% were above the 85th percentile, and 13% were above the 95th percentile. Prevalences of obesity were much higher among the primary care patients than in the results of the national surveys and the contemporary Michigan schoolchildren survey. CONCLUSIONS: The prevalences of obesity for children and adolescents presenting for care in Michigan primary care practices are higher than the prevalences documented in state and national surveys. A larger systematic study is needed to confirm or refute these findings. If this prevalence of obesity in primary care patients is confirmed, explanations for the differences should be explored.     

Concentrations and Hazard Assessment of Organochlorine Contaminants and Mercury in Smallmouth Bass from a Remote Lake in the Upper Peninsula of Michigan

Concentrations of PCBs, DDTs, toxaphene, chlordanes, dieldrin, and mercury were determined in smallmouth bass (Micropterus dolomieui) collected from Fumee Lake, a remote lake in the Upper Peninsula of Michigan. An ecological hazard assessment was conducted to determine potential impacts of contaminants on bald eagles and mink eating fish from this lake. Concentrations of organochlorines, except toxaphene, and mercury in smallmouth bass were similar to those found in fish from Lake Superior, where atmospheric inputs are the primary sources. Bioaccumulation was indicated by a positive correlation between fish weight and contaminant concentrations for organochlorines, while mercury concentrations did not appear to correspond predictably to body weight. Concentrations of mercury and PCBs in smallmouth bass were sufficiently great to be of concern regarding their consumption by eagles or mink. Received: 16 June 1997/Accepted: 11 August 1997     

A review of the first five years of the University of Arizona telepsychiatry programme

We performed a retrospective review of the first five years of activity in the University of Arizona Telepsychiatry Programme. The programme began in 1998 as part of a telemedicine service for underserved rural areas. Over the first five years, 1086 teleconsultations were carried out for a total of 206 patients. There were 159 adult (77%) and 47 paediatric patients (23%). During the study period, the racial/ethnic diversity of the paediatric patients increased, as did the number of follow-up visits for adult patients (average 5.3/patient). These trends suggested that telepsychiatry became an integral part of the mental health service system at the six referring sites. Adult patients completed 81 satisfaction surveys (51%) and psychiatrists completed 47 (23%). The responses showed that providers and patients found telepsychiatry services satisfactory, although in a minority of teleconsultations (18% for providers and 17% for patients) equipment problems were distracting. The continued use of the services suggests that the telepsychiatry programme fills a service gap in rural areas of the state.     

Managing quality: the next five years

Over the past five years, the principles and tools of quality management have gained a foothold in healthcare, but evaluated in terms of actual breakthroughs in results, the movement has not demonstrated its value as an antidote for America's troubled healthcare delivery system. By reemphasizing their investments in eight critical areas, healthcare leaders can accelerate the pace of improvement and set the stage for fundamental systemic change.