Revisions to chronic disease surveillance indicators, United States, 2004

To allow public health officials to uniformly define, collect, and report chronic disease data, Indicators for Chronic Disease Surveillance was released by the Council of State and Territorial Epidemiologists in 1999. This publication provided standard definitions for 73 indicators developed by epidemiologists and chronic disease program directors at the state and federal levels. The indicators were selected because of their importance to public health and the availability of state-level data. This report describes the latest revisions to the chronic disease indicators published in 2004. The revised set of 92 indicators includes 24 for cancer; 15 for cardiovascular disease; 11 for diabetes; 7 for alcohol; 5 each for nutrition and tobacco; 3 each for oral health, physical activity, and renal disease; and 2 each for asthma, osteoporosis, and immunizations. The remaining 10 indicators cover such overarching conditions as poverty, education, and life expectancy. Although multiple states have used the indicators, wider adoption depends on increased epidemiology capacity at the state level and improved access to surveillance data.     

Usefulness of renal scinitigraphic scanning in the prognosis of acute renal failure (author's transl)]

The authors present their first results concerning the use of renal scintigraphic scanning using hippuran in acute renal failure (A.R.F.). The tubular stages of hippuran, extraction and secretion then excretion correspond to phenomena which are normally apparent within the first 10 minutes following the injection of hippuran, also it seemed interesting to study the changes which occur in A.R.F. 18 hospital in-patients with A.R.F. were studied, 10 of them suffering from tubulointerstitial nephropathy (T.I.N.) 4 with acute glomerulonephritis (A.G.N.), 2 with obstruction of the urinary pathways and 2 with tubular necrosis on underlying chronic renal failure. In the 10 cases of T.I.N. the phenomenon of extraction was evident without any sign of secretion appearing during the 24 minutes of the investigation. No relationship could be found between the scintigram and the rapidity of recovery from A.R.F., but 8/10 recovered satisfactory renal function, the two others died from their disease, the A.R.F. being only secondary. Two of the 4 cases of A.G.N. had normal or slightly lowered extraction and minimal or absent secretion, and they recovered, in the 2 others no image of extraction appeared within 24 mn. and in these 2 cases the course was unfavorable. Finally, the last four had evident extraction and for 3 of them the course was favorable, the death of the fourth being consecutive to the primary disease. It therefore seems that the presence of an extraction phenomenon, whatever the aetiology of the A.R.F., is a parameter which authorizes the prognosis of a favorable course whereas its absence during the 24 mn. of the investigation permits one to envisage an unfavorable course.     

Pain control: Mastery through group experience

This paper describes a group program which is part of the therapeutic management of out-patinets with chronic pain at the multidisciplinary Pain Clinic in Hamilton, Ontario (McMaster Division, Chedoke-McMaster Hospital).The programme seeks to assist chronic pain sufferers in developing more adaptive coping styles.Groups of 12–14 patients meet for 9 weeks, 3 h/week, under the co-leadership of a physiotherapist and an occupational therapist with backgrounds in psychology and psychiatry.Seventy-five patients with diverse aetiologies of chronic pain have completed these “pain control classes”. Outcome was assessed on the basis of several parameters. Results indicate a considerable reduction in depression, pain perception and analgesic intake. Conversely, employment figures increased from 20 to 48% after completion of the program. 21% were considered failures. Significant variables differentiating successes from failures were sex, marital status, work incentive, employment and absence of litigation or Workmen's Compensation claims.     

Enhanced surveillance for acute and likely acute hepatitis B in Canada: 1999 to 2002.

OBJECTIVE: To assess the incidence of clinically identified hepatitis B cases, as well as the demographic and risk behaviour profiles of these cases in a defined Canadian population. METHODS: An enhanced hepatitis surveillance system was established in October 1998 to identify acute hepatitis B and C cases in Canada. Acute and likely acute cases, as determined by laboratory testing, collectively defined incident clinical hepatitis B cases. Data from 1999 to 2002 on incidence, demographic characteristics and risk behaviour characteristics were collected and analyzed. RESULTS: During the 1999 to 2002 surveillance period, 379 cases were identified in a target population ranging from 3,128,179 to 8,576,071 individuals. The observed hepatitis B incidence rate was 1.93/100,000 person-years in the surveillance area. The incidence rate was 2.74 times higher in men. The observed incidence rates decreased for all age groups over the surveillance period but remained high in the 20- to 29-year-old and 30- to 39-year-old age groups, as well as in men. Of the incident cases, 55.9% self-identified as being born in Canada and 18.5% as being born in Asia, while 18.7% did not identify a birth area. Of the Canadian-born cases, 61.3% identified themselves as Caucasian, 11.3% as Aboriginal and 23.6% as no ethnic category. Injection drug use was the most reported risk behaviour (19.1%), followed closely by sex-associated risk behaviours. A large proportion, 24%, indicated none of the known risk behaviours. CONCLUSIONS: The hepatitis B incidence rate has shown some decrease in the surveillance population from 1999 to 2002 and this may be due, in part, to past intervention programs (eg, vaccination programs and health promotion campaigns). The authors' results identify some high-risk groups that would benefit from additional prevention and control programs, and further targeted research and intervention.     

Myocarditis in Patients With Antisynthetase Syndrome: Prevalence,Presentation, and Outcomes

Antisynthetase syndrome (aSS) corresponds to an overlapping inflammatory myopathy identified by various myositis-specific autoantibodies (directed against tRNA-synthetases). Myocardial involvement in this condition is poorly described.From a registry of 352 aSS patients, 12 cases of myocarditis were retrospectively identified on the basis of an unexplained increase in troponin T/I levels associated with either suggestive cardiac magnetic resonance imaging (MRI) findings, nonsignificant coronary artery abnormalities or positive endomyocardial biopsy.The prevalence of myocarditis in aSS is 3.4% and was not linked to any autoantibody specificity: anti-Jo1 (n = 8), anti-PL7 (n = 3), and anti-PL12 (n = 1). Myocarditis was a part of the first aSS manifestations in 42% of the cases and was asymptomatic (n = 2) or revealed by an acute (n = 4) or a subacute (n = 6) cardiac failure. It should be noted that myocarditis was always associated with an active myositis. When performed (n = 11), cardiac MRI revealed a late hypersignal in the T1-images in 73% of the cases (n = 8). Half of the patients required intensive care. Ten patients (83%) received dedicated cardiotropic drugs. Steroids and at least 1 immunosuppressive drug were given in all cases. After a median follow-up of 11 months (range 0–84) 9 (75%) patients recovered whereas 3 (25%) developed a chronic cardiac insufficiency. No patient died.The prevalence of myocarditis in aSS is similar to that of other inflammatory myopathies. Although the prognosis is relatively good, myocarditis is a severe condition and should be carefully considered as a possible manifestation in active aSS patients.