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PubMed2002

National disease management plans for key chronic non-communicable diseases in Singapore.

In Singapore, chronic, non-communicable diseases, namely coronary heart disease, stroke and cancer, account for more than 60% of all deaths and a high burden of disability and healthcare expenditure. The burden of these diseases is likely to rise with our rapidly ageing population and changing lifestyles, and will present profound challenges to our healthcare delivery and financing systems over the next 20 to 30 years. The containment and optimal management of these conditions require a strong emphasis on patient education and the development of integrated models of healthcare delivery in place of the present uncoordinated, compartmentalised way of delivering healthcare. To meet these challenges, the Ministry of Health's major thrusts are disease control measures which focus mainly on primary prevention; and disease management, which coordinates the national effort to reduce the incidence of these key diseases and their predisposing factors and to ameliorate their long-term impact by optimising control to reduce mortality, morbidity and complications, and improving functional status through rehabilitation. The key initiatives include restructuring of the public sector healthcare institutions into two clusters, each comprising a network of primary health care polyclinics, regional hospitals and tertiary institutions. The functional integration of these healthcare elements within each cluster under a common senior administrative and professional management, and the development of common clinical IT systems will greatly facilitate the implementation of disease management programmes. Secondly, the Ministry is establishing National Disease Registries in coronary heart disease, cancer, stroke, myopia and kidney failure, which will be valuable sources of clinical and outcomes data. Thirdly, in partnership with expert groups, national committees and professional agencies, the Ministry will produce clinical practice guidelines which will assist doctors and healthcare professionals to better manage important aspects of the key diseases. Finally, the Ministry has committed funds to support selected National Disease Management programmes, illustrated by the disease management plan for asthma.

Chronic Disease↗
PubMed2005

Operationalisation of surveillance of communicable diseases in Chandigarh.

Weekly reports of listed communicable diseases from various departments and centres of Government Medical College, Chandigarh, involved in clinical care and laboratory diagnosis, compiled and forwarded by Department of Community Medicine, sub-nodal centre under National Surveillance Programme for Communicable Diseases (NSPCD), to Anti- Malaria-cum-Nodal Officer, NSPCD were analysed for a period of one year Out of 14,082 cases of various communicable diseases 9166 (64.62%) were of Acute Respiratory Infections (ARI), 3586 (25.78%) of Acute Diarrhoeal Diseases (ADDs) and 576 (4.10%) of Pulmonary Tuberculosis. The proportion of ARI appeared higher among females while that of other diseases was higher among males. Most cases of ARI (76.5%) and Pneumonia (3.09%) reported in winter, ADDs (38.89%) and Pulmonary Tuberculosis (4.68%) in summer and Typhoid (1.57%) and Viral Hepatitis (1.23%) in monsoon season. No significant gender predilection was seen. Overall reporting of communicable diseases seen to be significantly more during winter and summer compared to monsoon season, with specific seasonal trends demonstrated by various morbidities.

Communicable Disease Control↗
PubMed1992

Communicable disease in New Zealand.

Communicable diseases remain a major problem in New Zealand; one which often only comes to the attention of management when an outbreak occurs and health care dollars are required for disease control. Hepatitis B and rheumatic fever remain the two diseases that place New Zealand in the developing nation league. Overall, the impact on mortality is low (only 5% in the 1-14 year age group) as is the impact on potential years of life lost. Morbidity figures are not known with any degree of accuracy as they are dependent on a notification system acknowledged to be deficient and hospital discharge data which include only a fraction of cases for a few serious diseases. The main preventive action hinges on the childhood immunisation programme which has undergone recent change. The true impact of environmental hygiene measures, health promotion and education has not been evaluated.

Adolescent↗
PubMed1984

Imported communicable diseases in Singapore.

Most communicable diseases in Singapore have been brought under control and some eliminated. In recent years, an increasing proportion of the reported cases turned out to be imported. Between the period 1977 and 1982, 96% of malaria, 44% of paratyphoid, 32% of typhoid, 20% of leprosy, 11% of acute viral hepatitis, 7% of dengue fever/dengue haemorrhagic fever and 7% of cholera were imported. About 10% of the notified tuberculosis cases were non-residents while all the sporadic cases of poliomyelitis (except in 1977) and diphtheria (except in 1982) were contracted outside Singapore. The majority of the infections originated from Southeast Asia and the Indian subcontinent. The main groups of population with imported infections were local residents who travelled to the endemic areas without taking adequate preventive measures, foreign contract workers, and foreign seeking medical treatment in Singapore. Whether or not these imported cases would spread the infection to others in the community and cause epidemics depend on the virulence of the pathogen introduced, the susceptibility of the population and the environmental conditions which favour transmission of infection. Measures taken to reduce the risk of transmission include provision of a high standard of environmental sanitation, epidemiological surveillance to detect and eliminate the focus of infection; maintenance of a high level of herd immunity through immunisation; health education of the medical practitioners and of the public on the need for personal prophylaxis when travelling overseas; and screening of foreign contract workers and returning residents in special situations.

Adolescent↗
PubMed1999

Public health physicians who contribute to on-call communicable disease control duties: national comparative clinical audit by questionnaire survey.

BACKGROUND: In most health authorities in the UK, general public health physicians provide out-of-hours cover for specialists in communicable disease control. Although communicable disease control was part of their specialist training, there is no current formal mechanism to enable these doctors to keep up to date. The Faculty of Public Health Medicine has an active Continuing Professional Development Programme. A new initiative aimed to assess the knowledge of general public health physicians who take part in on-call communicable disease control rotas, or may do so in the future, by means of an educational clinical audit exercise. METHODS: Experts in communicable disease control developed a questionnaire containing a selection of scenarios, covering six different situations that might arise on-call. This was circulated to all members of the Faculty, but participation was voluntary. Answers were marked against model answers agreed by the experts. Results were analysed by positions held by participants. RESULTS: Response was unacceptably low. Overall scores ranged from 15 per cent to 89 per cent with a mean of 63 per cent. There was a trend of improvement in marks from those not normally involved in on-call (mean score 56.1 per cent (95 per cent confidence interval 51.6-60.7 per cent)) through Directors of Public Health (58.4 (54.9-62.0) per cent), Consultants (62.8 (60-65.6) per cent), and specialist registrars (67.9 (65.2-70.6) per cent), to Consultants in Communicable Disease Control (70.9 (68.1-73.6) per cent). CONCLUSION: The public health physicians who took part in this audit appear to be competent in their knowledge of communicable disease control, and particularly good at dealing with meningitis and salmonella, which are frequently encountered out of hours.

Clinical Competence↗
PubMed2005

[Changing patterns of communicable diseases in Korea].

Before twentieth centuries and during early twentieth centuries, communicable diseases were the major cause of morbidity and mortality in Korea. But reliable data are not available. After 1975, the overall morbidity and mortality from communicable diseases, rapidly declined. Recently many new pathogenic microbes were recognized: L. monocytogenes, Hantaan virus, Y. pseudotuberculosis, P. multocida, L. pneumophilia, Human immunodeficiency virus (HIV), G. seoi, H. capsulatum, C. burnetii, V. cholerae 0139, C. parvum, F. tularensis, E. coli 0157:H7, B. burgdorferi, S. Typhimurium DT104, Rotavirus, hepatitis C virus and so on. Since the first HIV infection recognized in 1985, the reported cases of infection and deaths from HIV/AIDS have been steady increased each year. Legionnaire's disease, E. coli 0157:H7 colitis, listeriosis and crytosporidiasis have been occurring just sporadically among immunocompromized cases. Many re-emerging communicable diseases were occurred in Korea: leptospirosis, malaria, endemic typhus, cholera, tsutsugamushi disease, salmonellosis, hepatitis A, shigellosis, mumps, measles, acute hemorrhagic conjunctivitis, brucellosis and so on. Leptospirosis and tsutsugamushi diseases have been noticed as major public health problems since 1980s. The malaria that had been virtually disappeared for a decade has reappeared from 1993 with striking increase of patients in recent 3-4 years. The distributions of salmonella and shigella serotypes have been changed a lot in recent few decades. Furthermore rapid emergence of antibiotic-resistant bacterial strains induces more difficult and complex problems in control of communicable diseases. We must recognize on the importance of environment and ecosystem conservation and careful prescription of anti-microbial agent in order to prevent communicable diseases.

Communicable Diseases, Emerging↗
PubMed2000

Evaluation of the SIMI system, an experimental computerised network for the surveillance of communicable diseases in Italy.

In Italy, the current communicable disease notification system is organised as follows: in each region, Local Health Units (LHU) fill in and forward case report forms (CRF) to the Regional Health Authority, which send aggregated and individual notifications to several central-level institutions. In most regions, all data are recorded manually on hardcopy. Although most relevant data from CRFs are eventually entered into a computerised database at the National Institute of Statistics (ISTAT), the national database is only available 3-4 years later and no data-quality control is performed at that time. To improve the quality and timeliness of notification, in 1994, the Istituto Superiore di Sanità (the National Institute of Health) began to develop an experimental computerised surveillance network for communicable diseases (referred to as 'SIMI'). Specifically, a software was created and distributed to the LHUs and the Regional Health Authorities; staff training was performed; and feedback and analyses of collected data was promoted. SIMI was evaluated in the 13 regions that were participating in 1997 (out of a total of 20 regions in Italy), using criteria commonly used for surveillance systems (i.e., completeness and coherence of data, case definitions, costs, timeliness, and feedback). SIMI was implemented at a limited cost and the data collected were observed to have had a high degree of completeness and internal consistency. The SIMI system has since been adopted for the routine notification of communicable diseases in nearly all regions. Similar evaluations will be necessary for assessing the performance of the various notification systems used across Europe and to include them in a European network.

Communicable Disease Control↗
PubMed1978

[Imported diseases, the epidemiological challenge of communicable diseases (author's transl)].

Imported infectious diseases being seen more often in consequence of intensive human contacts with developing countries through labourers and tourists, but also in consequence of immigration and of import of exotic diseases and of food, favoured by the quick air traffic, can be divided into 5 groups: 1. Imported diseases from the tropics (exotic diseases) 2. Imported agents from the tropics with human infection in the native country 3. Re-importation of diseases which were eliminated in the homelands 4. Diseases which are as well imported as also native 5. Single disease importations from neighboured countries. The imported infections are discussed systematically, caused by viruses, rickettsias, bacteries, protozoes, fungi, and followed by references to statistics, laboratory infection reports, questions of insurance. Imported diseases of the future are especially mentioned. Knowledge of the tropical infections as a main danger for our "civilized" world should be part of the medical training, since imported infectious diseases cause an epidemiologic challenge in the modern picture of communicable infections.

Bacterial Infections↗
PubMed2002

Responding to the challenge of communicable disease in Europe.

In the 1960s and 1970s, communicable disease seemed a minor threat, but since then the emergence of new infections and the reemergence of old diseases has provoked a renewed focus on European communicable disease surveillance and control. A "network approach" among European countries has been successful in detecting some international outbreaks, but management and funding aspects remain unresolved. Surveillance outside the European Union has faced new challenges as a result of economic and political change following the collapse of communism. Subsequently, innovative international surveillance schemes are currently being implemented in the countries of Central and Eastern Europe and the former Soviet Union. The challenge for surveillance in Europe is to ensure that it has the capacity to meet both the needs of today and the diseases of the future.

Communicable Disease Control↗