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Preventive health services: Sexually transmitted disease control.

Over 10 million cases of sexually transmitted diseases (STD) occur annually, 86 percent of them in 15- to 29-year-olds. The most common STDs are trichomoniasis, gonorrhea, non-gonococcal urethritis, genital herpes, and syphilis. In 1950 the reported syphilis rate was 146 per 100,000. The rate decreased to 30 per 100,000 by 1978, resulting in approximately 80,000 new cases of syphilis a year. During the same time span the gonorrhea rate increased from 192 cases per 100,000 to 468 cases per 100,000. In each year between 1967 and 1976, reported cases of gonorrhea increased between 10 and 15 percent. Between 1976 and 1978 the annual increase was less than 1 percent, but the total number of case of gonorrhea still exceeded 2.5 million. In addition to the large number of syphilis and gonorrhea cases, 3 million cases of trichomoniasis, 2.5 million cases of non-gonococcal urethritis, and 500,000 cases of genital herpes occur annually. The most serious complications caused by sexually transmitted agents are pelvic inflammatory disease, sterility, infant pneumonia, infant death, birth defects, and mental retardation. There is clear evidence that both the quality of the services and the attitudes with which they are delivered are important in attracting those who need STD services. While existing programs are interrupting the transmission of syphilis and gonorrhea, many vulnerable groups are not yet being served. To approach them effectively will require not only the efforts of STD clinics and investigators but also those of family planning clinics, private physicians, diagnostic and public health laboratories, and schools and other educational institutions.

Adolescent

Health protection: Toxic agent and radiation control.

It is estimated that of the four million chemical compounds which have been synthesized or isolated from natural materials, more than 55,000 are produced commercially. Approximately 1,000 new compounds are introduced annually; pesticide formulations alone contain about 1,500 active chemical ingredients. Diagnostic x-rays are used extensively in medicine and dentistry. Over 2,000 chemicals are suspected carcinogens in laboratory animals--epidemiologic evidence suggests that 26 of these chemicals and/or industrial processes are carcinogenic in humans. More than 20 agents are known to be associated with birth defects in humans; 47 atmospheric contaminants have been identified in animal studies as recognized carcinogens and 128 as mutagens; and, of the 765 contaminants identified in drinking water, 12 were recognized carcinogens, 31 suspected carcinogens, and 59 mutagens. Radiation has known carcinogenic and genetic effects at significant levels of exposure. Problems with toxic agents and radiation sources occur not only in industry, but also in medical and dental care (x-rays and drugs), agriculture (pesticides and herbicides), Government activities (biological and chemical agents), consumer products (incorrect use of consumer products which contain toxic substances), and natural sources (fungal products).

Adolescent

Preventive health services: High blood pressure control.

An estimated 60 million Americans have high blood pressure that increases their risk of illness and premature death. Of these persons approximately 35 million need some form of continuing treatment, while the remaining 25 million have borderline high blood pressure that requires medical surveillance. Untreated hypertension is the largest single contributor to stroke and a major contributor to heart disease and kidney failure. The National High Blood Pressure Education Program, started in 1972, has helped to improve hypertension control in the Nation. With providers and the public better informed about hypertension, patient visits and medication prescriptions for hypertension have increased, as has the number of persons whose hypertension is well controlled. Associated deaths, especially from stroke, have declined rapidly and dramatically. There is much room for improvement. Provider interest in and attention to long-term regimen adherence needs more emphasis. Large segments of the population, especially ethnic and racial minority groups, continue to face access problems. Awareness and attempted application of patient management technologies have improved, but stronger efforts are needed to address care delivery system management issues.

Adult

Health protection: Occupational safety and health.

Many of the Nation's approximately 100 million workers are exposed to some kind of occupational health hazard: carcinogenic agents, pulmonary or other physical disease incitant, physical agents or job-related pressures of noise, crowding, or stress. Exposure to toxic chemicals or physical hazards can produce chronic lung disease, cancer, degenerative disease in a number of vital organ systems, birth defects, and genetic changes. These exposures are estimated to result in 100,000 Americans dying each year from occupationally related illnesses, with an additional 400,000 cases of occupationally related disease. Yet many workers are inadequately protected from common hazards. Recent experience has demonstrated that occupational hazards can be controlled by modifying the work environment, patterns of job performance, or both. Among the health protection measures available are those which: alter the work environment to prevent exposures and injuries; provide workers with special protective equipment; specify design and maintenance of equipment; and provide employees with proper training. Some companies have ventured into the health promotion arena and offered their employees worksite programs for promoting health through health education, physical fitness activities, stress reduction activities, and preventive medicine including screening for high blood pressure, high cholesterol, and other factors related to heart disease.

Accidents, Occupational

Health protection: Fluoridation and dental health.

Tooth decay, which affects 95 percent of Americans, is our most common health problem, costing an estimated +2 billion yearly for treatment. By the time children reach 17 years of age, 94 percent have experienced caries and 36 percent have lost one or more permanent teeth due to caries. Dental disease prevention embodies the spectrum of many activities from the fluoridation of community and school water supplies to the dental health education of the child and adult. At this stage of our knowledge, the most effective and cost-beneficial intervention is fluoridation. Fluoridation can reduce the incidence of dental caries by about 65 percent, reduce the need for multiple surface fillings, crowns and extractions, and significantly increase the number of children who are completely free of cavities. No other public health measure is as effective in building a decay-resistant tooth while being available to all without regard to education or socio-economic background. The number of people served by fluoridated water systems has increased steadily since its introduction. Currently, however, less than half of all Americans have access to fluoridated water. In areas where community water supplies are not fluoridated, school drinking water is seldom fluoridated despite evidence supporting the efficacy of this procedure.

Child

Health protection: Surveillance and control of infectious diseases.

Although pneumonia and influenza are the only infectious diseases remaining among the 10 leading causes of death in this country, more than 290 million infectious illnesses occur annually--more than one for every person. These diseases have a significant impact on the population when measured in terms of increased social costs, including quality of life, decreased work productivity, and increased health care costs. During the next decade, no dramatic changes are anticipated in infectious disease trends; however, diseases may be newly recognized, epidemiologic patterns will be defined, antibiotic resistant patterns will change, and changing immigration patterns and refugee migrations may affect disease trends in the United States (e.g., tuberculosis). These factors will require the development and application of effective prevention methods, including disease surveillance, sanitation, casefinding and control, and development and use of vaccines and drugs. In addition, efforts to improve the rapidity and accuracy of diagnosis as well as the appropriateness of therapy are also important activities.

Communicable Disease Control

Health protection: Accident prevention and injury control.

More than 153,000 Americans die annually as a result of accidental injuries--nearly half of them from motor vehicle accidents, the rest from falls, burns, poisoning, and other causes. Injuries are the leading cause of death between ages 1 and 44, and account for approximately 55 percent of fatalities for those aged 15 to 24. Further, it is estimated that in 1979 70 million people suffered non-fatal accidental injuries requiring medical treatment. In 1980, the damage, injury, and lost productivity resulting from accidents cost the Nation an estimated +83.2 billion. Accident victims are not distributed evenly throughout the population. Teenagers and young adults have the highest motor vehicle death rate; fatal falls, which occur primarily in the home, disproportionately affect the population aged 75 and over; and children 10 years and younger are a high risk population for burns. Accident prevention programs should be based on epidemiological documentation of injury problem areas at the State and local levels. Prevention measures include public education, skill development, safety engineering, environmental modification, legislation, regulation, and enforcement.

Accident Prevention

A national sentinel surveillance network for the measurement of ill-health in South Africa. A prerequisite for epidemiological research and health planning.

Data on births, on deaths by cause and on morbidity are essential in planning appropriate health interventions, but the scarcity of these data in South Africa is striking. Some of the limitations of national mortality and morbidity data collection systems are reviewed. In order to improve the usefulness of vital statistical information, it is proposed that active disease monitoring be introduced in a number of surveillance sites where the population has been properly enumerated. A network of these sites would routinely gather information on births and deaths by cause and on a list of conditions that are: (i) easy to identify clinically; (ii) would bring most people to the attention of health personnel; and (iii) would indicate failure of health service provision, environmental control or resource allocation. The measurement of the geographical variation of a number of conditions, coupled with geographical information on health care indicators and risk and health promotive factors in each site, would facilitate the planning of interventions in a rational manner.

Female

Health services for refugees in countries of second asylum.

As successive groups of refugees reach countries of second asylum, refugee health care must be reinvented for each new group. But how can we bridge the one-to-two-year lag time between resettlement and publication of studies of specific cultures and thus render effective health services for refugees from the time of resettlement? Below, health problems common to refugees in countries of second asylum are identified and a community-based system for addressing their healthcare needs is proposed. The nursing process and principles of community health nursing are key concepts.

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