survey is no longer a statistical freak.Born of necessity, it is perhaps the only inexpensive short-term and relatively accurate tool that countries without functional vital registration systems can use to estimate birth, death, and migration rates.Implementation of fertility surveys is now worldwide.Brazil (1), India, (2, 3), Morocco (4), Pakistan (5), Senegal (6), Thailand (7), Turkey (8), and the United Arab Republic (9), to name a few, have used these surveys to provide basic information on population growth.Currently, Liberia (10) and Ghana (11) are carrying out fertility studies, and there is evidence that several other African States will soon follow. Chandrasekar-Deming TechniqueAlthough fertility surveys are relatively new on the statistical scene, most have adopted a similar pattern which is based on the Chan- drasekar-Deming(C-D) technique (12).Ba- Mr. Rumford, with the U.S. Bureau of the Census
years ago studies by Ciocco and co- workers (1, 2) concerning physical meas- urements of children in relation to subsequent results of medical examinations in the Seleotive Service System pointed to the possibility of identifying children very early in life who were likely to have adult health problems.He con- cluded that school health programs had not sufficiently appreciated that the roots of many adult diseases were already present in the child population being served.If the indicators could be located and remedial measures taken, he sug- gested, school health programs could have con- siderable impact on the health status of future adults as well as on the current health of school children.This study was undertaken to determine which characteristics, if any, among those noted on academic and health records of New York City school children could serve as pointers to physical or behavioral disabilities in the early adult ages.The index of adult health status, as in the studies of Ciocco and co-workers, was the classification of registrants after selective
T HE large number of calls for help reaching suicide prevention agencies each year and the growing number 'of these agencies suggests that they fill urgent needs. They appear to offer a valuable service not only to the suicidal persons who call upon them, but also to the public service agencies of the community. Yet few sociological investigations have been conducted of suicide prevention agencies. Therefore, to obtain information on how they function, we undertook an exploratory study in 1966 of such agencies, all located in urban areas. Our purpose was to learn the specific activities of the agencies that were directed at crisis intervention, the relationship of these activities to the prevention of suicide, how the emergency telephone service operated, what initial procedures were used in crisis intervention, and the kinds of resources to which clients were referred.
M UCH emphasis has been given to the team approach in providing health services, and to the need for students of the health sciences to receive part of their educational experience outside the professional school or medical center (1-3). These concepts are being tested at the University of Kentucky. The University of Kentucky College of Medicine has always considered the community as a laboratory. Its philosophy embraces the idea that the student must learn to look at the health of a community and make appropriate diagnoses-just as he must learn to look at the health problems of one patient and make a diagnosis. The college's department of community medicine sends students into a community to live and to study its health status during a required 6-week senior clerkship. The experiences of these students have been described elsewhere (4-6), and the pertinent aspects of the clerkship are discussed later in this report. The faculty of the new department of community health in the university's School of Allied Health Professions has more recently developed a course that is designed to focus the students' attention beyond the individual patient to his family and the community. At the culmination of the course, the allied health students team with medical students in fieldwork in communities. Thus all the students receive a much broader experience than they can possibly receive at the medical center alone.
Levitt, L. P.; Case, G. E.; Neill, J. S.; Casey, Helen L.; Adler, Picilip; Ferreri, Sam; Witte, J. J.
A 1968 Planned Parenthood Association Chicago Area follow-up study of an unbiased sample of 100 women (90% under 30 years 65% married 82% Negro) who had accepted a family planning method immediately post partum at Cook County Hospital was performed using sequential follow-up techniques: referral slips telephone contacts mailings and home visits. Results of the follow-up (2 to 3 months post partum) revealed that 89.6% of the 77 contacted were using a reliable method of birth control. Continuance rates were higher for oral contraceptives than for foam; referrals for intrauterine devices were least often completed. 1 pregnancy was reported. High mobility was the main factor causing failure to contact the 23 others whose rate of birth control continuation is assumed to be lower than that of those contacted. The high rate of acceptance immediately post partum (consistently greater than 90%) indicates that this is an opportune time to reach women in need of family planning services. Recommendations include more thorough follow-up attempt after 1 year in depth study of women discontinuing contraception and increased use of the telephone in follow-up activities.
T HE NEED to analyze critically the delivery of health services, as well as the use of those services, is well documented-for example, in a report by the National Commission on Community Health Services (1).Community health aides have been able to assist organizations in planning, implementing, and evaluating their services.In many communities, they have helped improve communications between orga- nizations and their clients (2).Having grown up in the community, the aides understand the environment and the beliefs of the people about health.They are also aware of the barriers to communication which have interfered pre- viously with the delivery of health services.Nevertheless, the employment of community health aides has brought a variety of reactions from staff members of health agencies, and the several interdisciplinary working relationships with these aides need to be carefully assessed.To clarify these relationslhips, we lhave tllere- fore attempted to view the functions of the community lhealth aides as perceived by the aides themselves and other health personnel.
EPIDEMIC INFLUENZA in a large urban population is of great public health concern. Practically all.levels ofhuman activity are affeeted, and the urban community may for a short period be seriously disabled. The heavy absenteeism and morbidity which are characteristic of epidemic influenza can drain vital community resources, both public and private. Major medical facilities rapidly become overloaded. The efficiency of fire, police, and health department services are seriously impaired. Edartational activities are interrupted or halted completely. Our report is an account of a major epidemic of influenza which occurred in Milwaukee, Wis., during the winter of 1968-69. The first cases of Hong Kong virus infections in the United States were reported in a civilian population in California during late October 1968. Influenza was reported at the same time in New Jersey, Colorado, Utah, and Illinois. By mid-December it was evident that the entire country was experiencing a major outbreak (1, 2), with 47 of 50 States reporting either spo-
service qualifying examinations. The need to consider the whole range of information in school records, behavioral and scholastic as well as physical, and its relationship to draft status was made apparent by previous findings that more than one-fifth (21.3 percent) of the 29,000 young men undergoing preinduction examinations in New York City in 1960 were disqualified for medical reasons; and in a, 2-year period, October 1962 through September 1964, more than one-third (37.7 percent) of those disqualified for medical reasons were rejected for psychiatric reasons(3). Clearly, one must look beyond the results of physical exa,minations in school to identify the early signs of behavioral disorders.
A CCIDENTS are the leading cause of death among the Navajo Indians of the Southwestern United States and are considered to be one of the most important public health probtems of all American Indians. Despite the importance of accidents as a leading cause of morbidity and mortality on the reservation, no epidemiologic investigation of their occurrence among this population has been reported. Our study was conducted in an attempt to define the nature and extent of accidents among the Navajos.
HOW consistently do people answer questions about their health when a survey is repeated after a short interval? How closely does the information collected by survey agree with that obtained from clinical records? This paper evaluates survey data on physical health from these two points of view. The two methodological studies discussed are part of a research program conducted by the Human Population Laboratory of the California State Department of Public Health and supported by grants from the Public Health Service. In 1965 health data were collected by selfadministered questionnaires from a large probability sample of adults in Alameda County, Calif. Known as the Survey of Health and Ways of Living, this baseline survey is the first of a projected series in a longitudinal study of physical, mental, and social health in the county. The study's purpose is to assess the relation between health, understood in a broad generic sense, and a wide range of demographic, economic, familial, cultural, and environmental factors and personal habits, which for convenience are referred to collectively as "ways of living." A primary hypothesis in this study is that in
THE FIRST ATTEMPT to characterize aseptic meningitis as a distinct entity was made by 'Wallgren (1) in 1925. Although his criteria are still useful today, improved laboratory diagnostic techniques now make it possible to demonstrate that what he originally assumed to be a single disease may occur in the course of infection due to a number of different etiological agents. The enteroviruses, other than the poliovirus, which have been associated with the aseptic meningitis syndrome in epidemic form include ECHO 4,6,9,11,16, and 30 (2), as well as Coxsackie A2, 4, 7, 9, 10, 16, and B1-B6 (3). The other types most frequently implicated, in addition to ECHO 9, are ECHO 4 and Coxsackie B5. The first reported outbreak of aseptic meningitis associated with ECHO 4 occurred in Marshalltown, Iowa, in 1955 (4, 5); the first reported epidemic of aseptic meningitis associated with Coxsackie B5 was in Cerro Gordo County, Iowa, in 1956(6). In a search of the U.S. literature, however, we found no reports of a well-defined epidemic of aseptic meningitis in which two enteroviruses, excluding poliovirus, played major etiological roles. Such an epidemic did occur in Baltimore, Md., in 1967. Baltimoire, in central Maryland, is surrounded by, but is politically distinct from, Baltimore County. According to estimates by the bureau of vital statistics of the Baltimore City Health Department, the population as of July 1, 1966, was 914,000. Approximately 41 percent of the population is nonwhite. Thirty-nine percent of the inhabitants are less than 20 years old. In 1967, epidemiologists of the Maryland State Department of Health, after being notified of an increased number of cases of aseptic meningitis in one Baltimore hospital, undertook a telephone survey of hospitals and offices olf selected pediatricians to assess the possibility of an outbreak in the city. When an increased incidence was confirmed by a number of these sources, letters were sent to all Maryland physicians alerting them to the pattern of symptoms and the laboratory results. Specimens of blood and spinal fluid, stool or rectal swabs, and throat swabs or washings were requested for laboratory study. Most of the reported cases were among the Dr. Garber, Dr. Glick, and Dr. Dupont are epidemic intelligence service officers with the National Communicable Disease Center, Public Health Service. Dr. Garber is assigned to the Maryland State Department of Health in Baltimore, Dr. Glick to NCDC in Atlanta, Ga., and Dr. Dupont to the University of Maryland School of Medicine in Baltimore. Dr. Joseph is assistant director, bureau of laboratories, Maryland State Department of Health, and Mr. Eichler is head of the virus isolation laboratory of that bureau.
ADVANCES in automation and instrumenta- tion have brought medicine and allied disci- plines to the brink of a new era in health care.It is now feasible to screen total populations or selected subgroups for asymptomatic disease at reasonable cost and with minimal use of phy- sician time.Medical personnel and facilities will be pro- gressively incapable of delivering health serv- ices if the population born after World War II in the United States is allowed to enter middle age with undetected and unaltered disease.Be- cause of this population boom the portion of the population aged 25 to 45, for example, will in- crease by 69 percent by 1990 (1).
in May 1967, released the prelim- inary results of a study carried out by the Committee on Safety of Drugs, comparing the use of oral contraceptives by women who died in 1966 of pulmonary embolism or infarction, coro- nary thrombosis, or cerebral thrombosis with that by control women selected from the prac- tices of the same physicians (1).The council found no relationship between use of oral contraceptives and death from coronary thrombosis.But a relationship was found with death from pulmonary embolism or infarction and possibly also with death from cerebral thrombosis.The estimated number of deaths in the United Kingdom from these conditions that were attributed to the use of oral contraceptives by married women aged 15 to 44 years was about three per 100,000 users per year.The results of the Medical Research Council study were subsequently amplified by Inman and Vessey (2).We used an entirely different method to esti- mate the upper limits of the annual excess mor- tality from thromboembolism among users of oral contraceptives in the United States.
DURING the summer of 1968, a major anti- genic change in the A2 influenza virus was documented through isolations of virus during epidemics in the Far East.In a special session in September 1968, the Public Health Service Advisory Committee on Immunization Prac- tices indicated that the change in the influenza virus increased the probability of a significant outbreak of influenza during the winter of 1968-69 and noted that the true impact of the disease could be determined only by extensive surveillance (1).Consequently, the division of communicable diseases, Pennsylvania Department of Health, set up a statewide influenza surveillance system to delineate the extent of the outbreak in Pennsylvania, to facilitate early laboratory confirmation of suspected cases, and to elucidate the clinical and epidemiologic characteristics of in- fluenza infections.The surveillance system was designed to monitor daily absenteeism in repre- sentative schools and industrial plants and to make such information readily available to laboratories and clinical institutions.This re- port deals primarily with the design and opera- Dr.
THE NEED for allied and paramedical per- sonnel to assume responsibility for health- related functions previously limited to the phy- sician and nurse has been receiving increasing emphasis (1, 2).In view of ithe ever-widening ratio of patients to professional health person- nel and the rising costs of professional staff, exploration of new approaches to traditional public health functions is imperative.In Den- ver, Colo., this exploration took the form of an investigation by the city's department of health and hospitals to determine the productivity of nurses' visits in bringing untreated patients with streptococcal infections and their sympto- matic contacts to treatment. Streptococcal Control ProgramThe division of disease control of the Denver Department of Health and Hospitals initiated a program for the control of streptococcal throat infections in 1957.This program oper- ated on the assumption that the department's responsibility to the individual citizen and the community at large necessitated home visits by the public health nurse to all persons with docu- mented positive beta hemolytic streptococcalThe authors are with the Denver Department of Health and Hospitals.
