Requirements for laboratory animals in health programmes

Laboratory animals are essential for the successful execution of many health programmes. A wide variety of animal models is used in the worldwide efforts to improve the control of various diseases, and in the basic research needed to improve health care. Biomedical programmes require specially-bred animals reared under controlled conditions, with close attention given to such factors as physical environment, nutrition, microbiological status, and genetic background. The need for a regular supply of appropriate animals has led to the development of a field of study known as laboratory animal science, and a speciality within veterinary medicine known as laboratory animal medicine. The importance of laboratory animals is recognized by the World Health Organization, which, in cooperation with other organizations, provides training, technical information, and consultative support in this field.     

The role of reference laboratories in animal health programmes in South America

The contribution of the Panamerican Foot and Mouth Disease (FMD) Centre (PANAFTOSA), as an OIE (World organisation for animal health) regional reference laboratory for the diagnosis of FMD and vesicular stomatitis, and for the control of the FMD vaccine, has been of fundamental importance to the development, implementation and harmonisation of modern laboratory procedures in South America. The significance of the work conducted by PANAFTOSA is particularly obvious when one considers the two pillars on which eradication programmes are based, namely: a well-structured regional laboratory network, and the creation of a system which allows technology and new developments to be transferred to Member Countries as quickly and efficiently as possible. Over the past decade, PANAFTOSA has kept pace with the changing epidemiological situation on the continent, and with developments in the international political and economical situation. This has involved the strengthening of quality policies, and the elaboration and implementation of diagnostic tools that make for more thorough epidemiological analyses. The integration of PANAFTOSA into the network of national laboratories and its cooperation with technical and scientific institutes, universities and the private sector means that local needs can be met, thanks to the design and rapid implementation of methodological tools which are validated using internationally accepted criteria. This collaboration, which ensures harmonisation of laboratory tests and enhances the quality of national Veterinary Services, serves to promote greater equity, a prerequisite for regional eradication strategies and this in turn, helps to increase competitiveness in the region.     

Drug acceptability in domiciliary tuberculosis control programmes

The extent to which the self-administration of drugs is achieved under the conditions of treatment supervision available in economically under-developed countries is of crucial importance in tuberculosis control. This is a problem not only in regard to the treatment of patients suffering from active disease; it is one that is relevant, too, to the whole question of the prophylactic administration of drugs to tuberculosis contacts and to tuberculosis suspects.     

Epidemiological model and cost-effectiveness analysis of tuberculosis treatment programmes in Indonesia

An epidemiological model of tuberculosis, based on the natural history of tuberculosis and the control programmes in Indonesia, was constructed. This model was used for estimating future tuberculosis-prevented cases and costs for three treatment strategies--the 100% standard course, the 100% short course, and the existing strategy (a combination of 65% standard course and 35% short course)--in accordance with the master plan of the Indonesian Government's tuberculosis control programme. A cost-effectiveness analysis of the three strategies confirmed that the short-course strategy was the most cost-effective. Sensitivity analysis, which applied a broad range of parameters, continued to confirm the short-course strategy as the most cost-effective. If the short-course strategy had been applied in 1980 instead of the existing strategy (using the most likely parameters), the short-course strategy would prevent 1.8 million sputum-positive cases and would save 61.0 million dollars by the year 2000.     

Incidence of tuberculosis among drug addicts in Amsterdam methadone programmes

The objective was to determine the tuberculosis incidence andrelated factors among drug users in 3 methadone maintenanceprogrammes in Amsterdam to see whether the present screeningprocedures are adequate. The study population was selected fromthe Central Methadone Register (CMR). Cases were identifiedduring hospitalization and during routine screening of ambulatorymethadone clients. The data were generated by the drug and tuberculosisdepartments of the Amsterdam Municipal Health Service (MHS).From 5,044 clients, 43 new cases were identified. The incidenceof tuberculosis was 386 per 100,000 person years (py) and increasedwith age and period of registration with the CMR. After correctionfor age, sex and period of registration, the incidence amongclients of general practitioners (GP) was the lowest. The incidenceamong the general MHS clients is 9 times this and in the MHSprogramme for prostitutes and illegal foreigners 27 times higherthan in the GP population. The increased risk for drug userstreated at the MHS indicates lifestyle as a risk factor; MHSclients are more involved in the drugscene than GP clients.On the basis of this study, periodic screening limited to clientsof the MHS would seem to be adequate for the present.     

The design and implementation of effective epidemiological surveillance programmes in Sub-Saharan Africa

Livestock is one of the main sources of wealth in developing countries. The improvement of national herds and of their productivity through controlling the main diseases and preventing epizootics is a major objective in these countries. The organisation of surveillance systems is indispensable to proper animal health management, both nationally and internationally. Therefore, thanks to foreign assistance, developing countries have gradually established epidemiological surveillance networks, despite unfavourable contexts (poverty, lack of resources or infrastructure...). To date, many networks are operating in satisfactory manner and produce tangible results. However, further efforts must be made to improve the quality of sanitary information produced, its performance and sustainability. This article discusses the context and motivations for the establishment of epidemiological surveillance networks in developing countries, especially in Africa, by describing some of their operational specificities and some results. Finally, it presents the example of a Mauritanian animal disease epidemiological surveillance network and its role in managing a health crisis.     

Smoking cessation in pregnancy: do effective programmes exist?

Smoking has been described as the most important cause of poorpregnancy outcome in Western countries. None the less, evidenceindicates that health care providers do not routinely providesmoking cessation interventions to pregnant women. The US SurgeonGeneral has recommended that programmes to reduce smoking duringpregnancy should be expanded in the public and private sectors.A review of the literature located 20 controlled evaluationsof smoking cessation interventions in pregnancy. The studieswere rated using the methodological criteria outlined by Windsorand Orleans (1986). Twelve of the studies were judged methodologicallyinadequate and excluded from the review. The remaining studieswere found to support the efficacy of cognitive behaviouralsmoking cessation programmes in pregnancy. There was insufficientevidence to determine whether advice, feedback or nurse home-visitationprogrammes increased smoking cessation rates in pregnancy underideal conditions. None of the methodologically adequate cognitivebehavioural studies fulfilled the criteria necessary for a smokingcessation programme to be incorporated into routine antenatalcare. Importantly, in only two studies were the smoking cessationinterventions delivered by usual care doctors or midwives. Thefindings indicate that it is unsurprising that health care providersdo not routinely deliver smoking cessation programmes to pregnantsmokers. Future research and programme needs are discussed.     

结核病实验室诊断研究进展

结核病(tuberculosis, TB)是我国重点控制的重大传染性疾病之一。潜伏性结核分枝杆菌(Mycobacterium tuberculosis, MTB)感染和耐药结核病的非典型临床表现,导致TB的防治难度增加。早期准确诊断是TB正确有效治疗的基础和前提,也是降低TB传播的有效措施。随着分子生物学和免疫学的迅速发展,MTB病原学检查和药物敏感试验的时间极大地缩短。现对MTB的实验室诊断及新兴诊断技术进展阐述如下。     

结核分枝杆菌的临床和实验室诊断

结核病是危及我国人民健康的重大传染病之一,由于临床表现不典型,加之潜伏性结核感染以及结核耐药问题,导致我国结核病疫情防控形势依然严峻。对结核病及时准确的早期诊断是降低结核病发病率的有效措施。近年来,随着生物技术、分子生物学和免疫学的快速发展,极大地缩短了细菌学检查和结核菌药敏试验的时间,在此,阐述结核分枝杆菌的临床和实验室诊断最新研究进展,以提高临床诊断的敏感度和特异度,以更大范围地确定统一的诊断标准。     

Statewide survey of laboratories performing Mycobacterium tuberculosis testing in Minnesota.

Rapid and accurate laboratory detection and identification of Mycobacterium tuberculosis, particularly multidrug-resistant strains, is critical to both public health control measures and patient management. The authors surveyed microbiology laboratories to evaluate whether their methods met national guidelines. As needed, laboratories received individualized recommendations for improvement. The laboratories were resurveyed a year later to assess changes in methods. Current guidelines recommend fluorochrome acid-fast smears, broth cultures, identification by nucleic acid probe or BACTEC-NAP, and BACTEC primary susceptibility panels, which should include pyrazinamide. Of 27 laboratories performing acid-fast smears, 15 used fluorochrome methods. Six of 16 laboratories performing mycobacterial cultures used broth media. Of six laboratories performing species identification, five used nucleic acid probes or BACTEC-NAP. Of five laboratories evaluating drug sensitivity, two used BACTEC and two included pyrazinamide in their protocols. Overall, 24 (89%) laboratories needed improvements; a year later, 16 (67%) of those had altered their methods or made definite plans to do so. Survey results suggest that health departments can facilitate improvements in laboratory testing for pathogens of public health importance.     

澳大利亚医学实验室检验流程借鉴

总结了澳大利亚检验记录和检验报告的特点,探讨了该院检验科的借鉴应用体会,提出重视检验过程记录、注意检验报告信息的完整性和结果的正确性、加强检验报告备注功能以增加报告附加值;培养有临床意识的检验人员以加强检验与临床交流;重视标本与检验资料的保存等检验科管理建议,旨在为国内检验科检验记录和检验报告的规范化管理提供一些有益的启示.

Abstract：

It summaried the characteristics of Australian laboratory records and laboratory reports, explored the application of clinical laboratory. In order to provide some useful inspiration for domestic laboratory standardized management of the laboratory records and laboratory reports, it proposed laboratory management recommendations, including emphasizing on the laboratory process records, the integrity of laboratory reports and the correctness of laboratory results, strengthening the laboratory report Remarks functions to increase the added value, cultivating clinical awareness of the clinical tests to enhance communication, and staff attached to the specimen and test data preservation     

A framework and toolkit for capturing the communicable disease programmes within health systems: tuberculosis control as an illustrative example

The frameworks and methods used for analysis, monitoring and evaluation of communicable disease control vary greatly. Although a number of manuals exist instruments for a detailed analysis of wider health system context are lacking. This is surprising given that the success of vertical programmes is often determined by the constraints of health systems. The importance of the context and the health system in determining the successful implementation of national tuberculosis programmes is well recognized by the WHO, which recommends analysis of national tuberculosis programmes within the context of health care system, health reform and the economic status of the country. However, current approaches inadequately capture intelligence on the health systems variables impacting on programme efficacy, limiting the ability of policy makers to draw lessons for wider use. A recent WHO report highlights the major systemic constraints to DOTS implementation and recommends a comprehensive and multi-sectoral approach to tuberculosis control. This obviates the need for tools that take into account health systems issues as well as focusing on a particular vertical programme but no such comprehensive tool exists. This paper outlines the conceptual basis for a model and a toolkit for rapid assessment, monitoring, and evaluation of the context, the elements of the health system and vertical communicable disease programme. It describes the framework, the potential strengths and weaknesses, approach and piloting of the toolkit and its two elements: first for 'horizontal assessment' of the health system within which the programme is embedded and second for 'vertical assessment' of the infectious disease-specific programme.     

Diagnosis of pulmonary tuberculosis in a microbiological laboratory

The positive diagnosis of pulmonary tuberculosis still relies on the direct detection of Mycobacterium tuberculosis complex strains after isolation, culture, and identification, or on the detection of specific DNA sequences. Clinical specimens for the direct diagnosis include respiratory tract and stool specimens, which can all be collected with a “tuberculosis kit” to simplify and standardize clinical and laboratory tasks. Gastric juice and other specimens are no longer useful. The association of new decontamination technics, new liquid and solid Middlebrook blood-enriched culture media allow for the isolation of tuberculous mycobacteria in 10 days. The microscopic-observation drug susceptibility and thin layer agar assays allow for rapid detection of M. tuberculosis including drug-resistant tuberculosis. “Closed molecular tests” adapted to “point-of-care” use allow for the detection of tuberculous mycobacteria in Ziehl-positive samples and the detection of rifampicin resistance in three hours. Rapid identification can be achieved with protein spectrum analysis by mass spectrometry. Finally, genotyping by various technics of profile analysis (spoligotyping, VNTR-MIRU) or by sequence analysis (multispacer sequence typing) allows for the identification of isolates among the six Mycobacterium tuberculosis complex species, and for the detection of laboratory cross-contaminations. It also allows diagnosing cross-transmission between patients including nosocomial cases, discriminating between reactivation and new infection, and determining the geographical origin of strains (geotyping). The ongoing search for new culture media is a priority to improve the speed of direct diagnosis of pulmonary tuberculosis.