Quantitative guidelines for communicable disease control programs.
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It is in the interest of developing countries to have combined vaccines in veterinary medicine, not so much because they reduce production costs, but rather because they increase convenience and efficacy concerning the logistics of prophylactic projects in the field, thus lowering the cost of these projects. Their drawbacks are basically due to the biological compatibility of immunogens (possible immunosuppression by some viruses) and to the interaction of the various components when mixed, or when lyophilization is carried out. Some examples of such associations of vaccines are: (1) cattle plague + pleuropneumonia and possibly anthrax, (2) anthrax + blackleg, (3) sheeppox + anthrax, (4) pleuropneumonia + blackleg, (5) Newcastle disease + fowlpox + fowl typhoid, (6) fowl typhoid + chicken pasteurellosis. Practical results have been most positive and include the eradication of cattle plague - a major scourge of almost all of the African continent - and control over peripneumonia as a first step towards its eradication.
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Reference is made to the third edition of a handbook published 1800 in which experience in preventing and controlling animal diseases is given in the form of standards together with conclusions, the latter being related primarily to the incidence of cattle plague in the second half of the 18th century. The points made in the handbook are related to the history of veterinary medicine, with particular emphasis being laid on today's national veterinary services and the legal provisions which are now in effect for the prevention and control of high risk. Since production relations and productive forces were on a different level then, both the consequences of high-risk animal diseases and action for protection often had deterimental impact upon agricultural production and led to the ruin of many poorer farmers and dependent peasants. The substance of the prevention and control principles was not only adequate, but to some extent is valid even today, notwithstanding the much higher scientific basis on which many problems are tackled in our days. A set of strict rules had been established, and offenders had to expert severe punishment. Yet, in the class society of that time penalty rules differed for 'masters' and 'inferiors'. The handbook is of enlightening importance as a basisfor deliberate application of codes and standards.
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The importance of individual responsibility in many aspects of preventive medicine is emphasised in the introduction. A section on infectious disease as applied to Western society today follows with special mention of particular conditions such as turberculosis, influenza, rubella, gastro-intestinal diseases and Legionaire's Disease. The section on non-communicable disease is subdivided into coronary heart disease, malignant neoplasms and chronic bronchitis. It includes some discussion of screening. Short sections on prevention in the elderly, pregnancy and early life, dental health, accidents, alcoholism and drug misuse follow. In the conclusions the difficulty of determining priorities for different societies and the importance of establishing cost effectiveness of preventive measures are covered. The relative importance of societal, governmental and individual preventive measures are described and the authors emphasise that any expensive screening programme must adhere to established criteria.
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Different preventive approaches of mental and neurological disorders are discussed. Special emphasis has been put on the advances of biological research in the elucidation of aetiological and pathogenic mechanisms of major psychoses, such as schizophrenia and affective disorders. Perspectives of genetic and psychopharmacological research are emphasized. Multidisciplinary efforts are needed for the improvement of existing preventive measures.
36 patients with agranulocytosis among them 29 cancer patients were treated in a Life Island (LI) during totally 990 days and were studied for their psychological reactions. Another group of 9 patients among them 6 leukemia patients were treated in reverse isolation (RI) during 578 days. The psychological reactions of these patients were equally studied and were compared with those of the first group. Main reactions to the isolation in the LI were signs of deprivation, specially movement deprivation, as well as aggressive and regressive behaviour. The patients in RI showed on the other hand sensations of loneliness and boredom. To enter and to leave the LI was more important for the patients than the beginning and the end of RI. The isolation was never terminated for psychological reasons. The following factors are important for coping with the isolation; human bindings to doctors, nurses and relations, activities, music, religion as well as adequate information and an attitude of the patient himself which allows him to support the fact of the illness.
Herd infections, especially in children, are strongly influenced epidemiologically by social and demographic factors which have contributed favorably to a general decline in incidence and mortality during the past 50 years or more. Intervention procedures such as immunization cannot be evaluated or planned realistically except against these background factors. Assessed in this way, immunization against diphtheria and poliomyelitis was unequivocally effective in reducing incidence and morbidity of these diseases. By comparison, pertussis vaccine has a very limited protective effect, the value of which, as morbidity decreases, may be offset by the intrinsic toxicity of the vaccine and by the possibility of infrequent but severe brain damage in some children.