Health Department Officials Research Articles

Current tuberculosis screening practices.

Health department officials in all 50 states and 14 major cities responded to a survey questionnaire designed to obtain information about current tuberculosis screening practices. Persons being screened fell into the groups designated as high risk by the American Thoracic Society (ATS) and the Centers for Disease Control (CDC). The methods used for screening were generally those advocated by ATS, CDC, and the Food and Drug Administration (FDA), although chest radiographs continue to be overused. Screening in about one-half of the groups is mandated by law or regulation. There appears to be some confusion about the circumstances in which "two-step" tuberculin testing should be used. Data on the productivity and costs of screening activities were very limited. We encourage those responsible for tuberculosis screening programs to evaluate them, discontinue those which are unproductive, and intensify those which are productive.

Haemophilus influenzae type b disease after rifampin prophylaxis in a day care center: possible reasons for its failure.

Five infants enrolled in a day care center (DCC) developed invasive disease due to Haemophilus influenzae type b during a 25-week period. The isolates from four patients had identical outer membrane proteins and were biotype 1. Although rifampin prophylaxis was recommended on two different occasions, retrospective surveys demonstrated that 39 and 60%, respectively, of infants failed to receive the agent for various reasons. Pharyngeal cultures were obtained from infants, their families and DCC staff after prophylaxis was given the second time. Forty-seven % of DCC infants had positive cultures, and 59% of their households had at least one carrier of the invasive strain. Rifampin prophylaxis administered a third time to infants and members of their households was unsuccessful in eradicating the invasive Haemophilus influenzae type b strain from DCC infants. The possible reasons for failure of rifampin in this DCC outbreak included incomplete understanding by physicians and health department officials of the factors affecting a DCC outbreak of Haemophilus influenzae type b disease and failure properly to implement rifampin prophylaxis to all contacts and the index cases.

Childhood gonorrhea—but no sexual abuse

ABSTRACT When Neisseria gonorrhoeae appeared in a culture from the vaginal discharge of a 4-year-old clinic patient, health department and children's protective services officials were notified. Then another 4-year-old girl, brought to an emergency department, was found to have gonococcal vaginitis, and she was a playmate and resident of the same housing project as the first girl.The obvious concern: sexual abuse by adults. Investigation, however, indicated quite different circumstances.At the recent joint meeting of the American Pediatric Society and the Society for Pediatric Research in San Antonio, Tex, two investigators from the Michigan State University College of Human Medicine, East Lansing, reported the results.Screening of all 91 families in the housing project showed nine more presumptive cases of gonorrhea in children 4 months to 6 years of age, said Margaret M. Bailey, PhD, and Susan L. Scheurer, MD. Five of these were confirmed through culturing. A sixth child,

PCBs in Breast Milk

Publicity has raised concern about the presence of polychlorinated biphenyls (PCBs) in breast milk. There are no known effects in children at levels found in people in the United States. In Kyushu, Japan, pregnant women who ingested cooking oil that was heavily contaminated with PCBs and other chemicals had small-for-gestational-age infants who had transient darkening of the skin. PCBs are stored in body fat and are not readily excreted, except in the fat of breast milk. In the past, PCBs have entered the body through a variety of foods. More recently, contaminated game fish and occupational exposures have been the main sources. The only women in the United States who may have been heavily exposed are those who worked with PCBs or who have eaten large amounts of sports fish from PCB-contaminated waters such as the Saint Lawrence Seaway. Unless women have a history of exposure to PCBs, they should be encouraged to breast-feed their infants as usual. When a well-documented history of exposure to PCBs is obtained and the mother wants to breast-feed her infant, the mother's PCB level could be measured in about three weeks' time. The advice of state health department officials should be sought in the rare instances when a high PCB level is found.

Design of sanitary sewage collection system by electronic computer

The tedious and time consuming task of designing a municipal sewage collection system has been automated by a series of integrated computer programs resulting in a simultaneous network solution of sanitary sewers for a large area. The computer approach to the problem allows a sanitary engineer the opportunity of studying several solutions and iterating each to a minimum cost for a project.A collection system in Nassau County previously designed by conventional methods was used as a check model for the computer design technique. The computer techniques developed, which include estimation of design flows, design of sewers, computation of partial flow characteristics and estimate of costs were then applied to the design of the proposed Merrick Harbor Collection District in Nassau County.This Collection District includes an area of approximately 5 square miles, with an ultimate population of 39,500 persons. The topography is typical of the Long Island south shore area containing only minor relief. The sewage collection system as designed contains approximately 80 miles of sewer lines ranging from 8 in. to 36 in. dia. and two pumping stations.The project had two primary objectives: (1) to produce a computer-oriented design procedure which would do at least as much as the engineer would or could do with conventional procedures but in less time, with less cost and with a higher level of precision; and, (2) to utilize the memory and speed capability of the computer for an improved sewer design by using iterative computer techniques which allow an opportunity for redesign with continuous monitoring of cost implications.There are also several useful by-products accompanying the application of computer techniques including an increased insight into the problems involved which gained by the detailed systemization of procedures, the improvement of both the quantity and the quality of output produced, and the release of engineering staff from the tedium associated with the repetitive compilation of data, the design of individual lines, and the estimation of costs.The automated procedure, with two main computer programs (written in FORTRAN IV) and two stages of input, covers all details of the sanitary sewer design, including: computation of contributing flows; design elements such as diameter, slope, length and invert elevations of pipe sections; identification of manholes; and finally cost estimates with quantities and unit prices. The second stage of input can make modifications for additional field data and for changes in layout or design parameters.Important features of the computerized system include general applicability to any collection system, contributing flow which can be inputted in terms of dwelling units or otherwise, capacity factors which can be applied automatically, based upon contributing population and capacity-population curves, critical control lines can be identified by a tree search technique and the design altered, manholes may be renumbered, and information on interferences may be applied and adjustments made.This paper summarizes several advantages of this computer technique for design, presents statistics relating to computer execution time and input preparation time for the several phases of execution of the program, and includes program exhibits. The acceptance of the output from the computer for this application by county and health department officials has paved the way for more efficient and rapid design and review of sanitary sewer systems.

OB DEPARTMENT: Organization and Results of a Regional Maternal-Mortality Study

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsAnthony RuppersbergThe AuthorsDr. Ruppersberg received his M.D. degree from Jefferson Medical College, Philadelphia. He is a clinical assistant professor of obstetrics and gynecology, College of Medicine, Ohio State University; chairman, maternal division, committee of maternal and perinatal health, District V, American College of Obstetricians and Gynecologists; and chairman and co-founder of the Franklin County Maternal Mortality Study (Columbus, Ohio) and the Ohio State Maternal Mortality Study.The author of many published articles, Dr. Ruppersberg acknowledges with appreciation the assistance of committee members, attending physicians, county medical society representatives, coroners, health department officials and numerous other individuals and agencies in preparing the material for this survey.

Home management of pulmonary tuberculosis and other forms

The home management of tuberculosis is discussed by illustrating experiences with eighty-six patients cared for by office practice. Treatment has been integrated with sanatorium or hospital programs in most instances. Since large numbers of tuberculous patients must of necessity be observed outside of hospital or sanatorium, it seems highly practical that physicians interested in this disease should take an active part in the therapy of an increasing number of persons as antimicrobial indications are broadened. Close liaison with health department officials is highly desirable. The inclusion of surgical procedures in many cases may be health restoring. It is suggested that long-continued use of drugs may sharply reduce the recurrence rate.