Restricted isotype, distinct variable gene usage, and high rate of gp120 specificity of HIV-1 envelope-specific B cells in colostrum compared with those in blood of HIV-1-infected, lactating African women.

A successful HIV-1 vaccine must elicit immune responses that impede mucosal virus transmission, though functional roles of protective HIV-1 Envelope (Env)-specific mucosal antibodies remain unclear. Colostrum is a rich source of readily accessible mucosal B cells that may help define the mucosal antibody response contributing to prevention of postnatal HIV-1 transmission. To examine the HIV-1 Env-specific colostrum B-cell repertoire, single B cells were isolated from 17 chronically HIV-infected, lactating women, producing 51 blood and 39 colostrum HIV-1 Env-specific B-cell antibodies. All HIV-1 Env-specific colostrum-derived antibodies were immunoglobulin (Ig)G1 isotype and had mean heavy chain complementarity-determining region 3 (CDR3) lengths and mutation frequencies similar to those isolated from blood. However, variable heavy chain (VH) gene subfamily 1(∼)69 usage was higher among colostrum than blood HIV-1 Env-reactive antibodies (49% vs. 20%, P=0.006, Fisher's exact test). Additionally, more HIV-1 Env-specific colostrum antibodies were gp120 specific than those isolated from blood (44% vs. 16%, P=0.005, Fisher's exact test). One cross-compartment HIV-1 Env-specific clonal B-cell lineage was identified. These unique characteristics of colostrum B-cell antibodies suggest selective homing of HIV-1-specific IgG1-secreting memory B cells to the mammary gland and have implications for targeting mucosal B-cell populations by vaccination.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

[Preoperational study for the improvement of hygiene conditions in long-term care facilities]. / Modellprojekt zur Verbesserung der Hygiene in stationären Pflegeeinrichtungen.

Hygiene is becoming more and more important in long-term care facilities. Long-term care facilities are subject to monitoring by the Public Health Service (PHS) and other authorities. For the PHS in Bavaria the Bavarian Health and Food Safety Authority (Landesamt für Gesundheit und Lebensmittelsicherheit, LGL) published a hygiene monitoring concept and there exists an inspection guide developed by a specialist department for nursing homes and institutions for the handicapped (Fachstelle für Pflege und Behinderteneinrichtungen, FQA). Because inspections are performed in multiprofessional teams, it makes sense to use a coordinated inspection catalog. The aim was to integrate hygienic requirements specified in the Bavarian guidelines for hygiene by the LGL into the inspection guide published by the FQA to obtain a quality assured surveillance. The involved parties were questioned about the inspection guide and their hygiene management and then the hygiene criteria of the LGL were implemented into the inspection guide. Questions dealing with hygiene requirements concerning intensive care, management of multidrug resistant bacteria and interviews with the person responsible for infection control in the facility itself were developed for the first time and were integrated into the inspection guide. The revised inspection guide was tested for its applicability. With the revised inspection guide there now exists a tool which allows not only comprehensive inspections of the facilities including hygiene issues but also a good cooperation of the various parties involved. There are many actions which have to be conveyed into the future, especially programs to train staff to apply the inspection guide and to enhance the ability of all participants to act in cooperation. The guide will also allow the facilities to cooperate more easily and more closely, as the guide takes the respective problems and challenges of the different facilities into consideration. Additionally the development of legal guidelines regarding hygiene can support general healthcare of residents.

[Infection control management and practice in home care - analysis of structure quality]. / Infektionshygiene in der ambulanten Pflege - Eine Untersuchung zur Strukturqualität.

BACKGROUND: Surveillance of infection control management and practices in home care is an important task of the public health service. While infection control aspects in residential homes for the aged and nursing are increasingly being discussed this subject has been poorly recognised in home care. AIM: The aim of this study was to identify problems in hygiene regarding the transmission of infectious diseases as well as quality assessment in home care. Based on the results of this study implications for infection control in home care facilities for public health services should be developed. METHOD: Statistical analyses were performed on the primary quality assessment data of home care facilities collected by the medical service of health insurances via computer-assisted personal interviews between March 2006 and March 2009. Structure quality in 194 home care facilities was analysed as well as human resources and organisational conditions. Analyses were also done in the context of the clients' risk factor load. All analyses were performed by stratifying for the size of the home care services. To assess how the involved characteristics vary according to the size of the home care services chi-square tests and non-parametric tests were calculated. RESULTS: About 80% of the assessed home care services disposed of an infection control management plan. Compared to larger services smaller home care services, especially services with less than 10 clients had a poor structure in infection control management and practice. They also carried a higher load of risk factors in clients. The larger services had significantly less human resources. CONCLUSIONS: Surveillance of infection control management and practices by the public health services should focus on the structure of the smaller home care services. At the same time smaller home care services should be supported by offering training for the staff or counselling regarding hygiene-related aspects. Furthermore, the outcome quality of the larger home care services with poorer human resources (one full-time nurse cares for more than 10 dependants) should also be assessed in the frame of infection surveillance.

[Universal newborn hearing screening (UNHS): is it possible to successfully implement it nationwide?]. / Universelles Neugeborenen-Hörscreening (UNHS) - Ist eine erfolgreiche Umsetzung flächendeckend möglich?

BACKGROUND: Since 01.01.2009 in Germany a newborn hearing screening (UNHS) is obligatory for every child. The UNHS is part of the guidelines for the prevention of diseases for children up to 6 years of age (Kinder-Richtlinien). 2 years after its introduction in Bavaria, we now evaluate whether the UNHS has been implemented successfully,and if the quality criteria of the guidelines have been met. METHODS: In the guidelines details for the procedure and screening quality are given. The UNHS data from the screening facilities in Bavaria were evaluated for process quality criteria like screening coverage, screening method, REFER rate (rate of failed tests) and child age at diagnosis. RESULTS: More than 96 % of all newborns were screened. The REFER rate for 2010 was 4.5 %. Only 18 % of the controls were done by a paediatric audiologist.In 38.5 % of the newborns an intervention of the screening centre was necessary to assure controlling of a failed screening test. In 2009 the median age at diagnosis for a bilateral hearing loss was 5.5 months, and the start of therapy was 6.2 months. CONCLUSION: In Bavaria the UNHS was implemented successfully. A tracking system for all children who failed the hearing screening test is pivotal for the early diagnosis of children with bilateral hearing deficiency.

[H1N1 pandemic. Measures and experiences on the state level]. / H1N1-Pandemie. Maßnahmen und Erfahrungen auf Landesebene.

In order to establish a joint pandemic strategy, the German states ("Länder") together with the German federal government ("Bund") agreed on joint preparations for pandemic scenarios. This included the description of procedures, such as infection control measures, stockpiling of antiviral drugs, and contracts with vaccine manufacturers to ensure supply of vaccines in the event of a pandemic. The situation during the influenza H1N1 pandemic differed from that planned so that many short-term adjustments were required. It highlighted the need to make pandemic planning more flexible. In spite of several obstacles which had to be overcome during the situation, the states managed to achieve a relatively coordinated procedure and provided the availability of vaccines. In the course of the pandemic, gaps and shortcoming in existing surveillance systems were identified, which should lead to further improvements. A key point for future pandemic events is successful communication between all interested parties, especially with the medical profession, to increase the acceptance of public policies.

Dissection of biochemical borderline phenotypes in carriers and genetic variants of medium-chain acyl-CoA dehyrogenase deficiency: implications for newborn screening [corrected].

Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) represents a potentially fatal fatty acid beta-oxidation disorder. Newborn screening (NBS) by tandem mass spectrometry (MS/MS) has been implemented worldwide, but is associated with unresolved questions regarding population heterogeneity, burden on healthy carriers, cut-off policies, false-positive and negative rates. In a retrospective case-control study, 333 NBS samples showing borderline acylcarnitine patterns but not reaching recall criteria were genotyped for the two most common mutations (c.985A>G/c.199C>T) and compared with genotypes and acylcarnitines of 333 controls, 68 false-positives, and 34 patients. c.985A>G was more frequently identified in the study group and false-positives compared to controls (1:4.3/1:2.3 vs. 1:42), whereas c.199C>T was found more frequently only within the false-positives (1:23). Biochemical criteria were devised to differentiate homozygous (c.985A>G), compound heterozygous (c.985A>G/c.199C>T), and heterozygous individuals. Four false-negatives were identified because our initial algorithm required an elevation of octanoylcarnitine (C(8)) and three secondary markers in the initial and follow-up sample. The new approach allowed a reduction of false-positives (by defining high cut-offs: 1.4 micromol/l for C(8); 7 for C(8)/C(12)) and false-negatives (by sequencing the ACADM gene of few suspicious samples). Our validation strategy is able to differentiate healthy carriers from patients doubling the positive predictive value (42-->88%) and to target NBS to MCADD-subsets with potentially higher risk of adverse outcome. It remains controversial, if NBS programs should aim at identifying all subsets of all diseases included. Because the natural course of milder variants cannot be assessed by observational studies, our strategy could serve as a general model for evaluation of MS/MS-based NBS.

[Dietary intake of non-dioxin-like polychlorinated biphenyls (PCB) in Bavaria, Germany. Results from the Integrated Exposure Assessment Survey (INES)]. / Nahrungsbedingte Zufuhr von nicht-dioxinähnlichen polychlorierten Biphenylen (PCB) in Bayern. Ergebnisse von INES (Integrated Exposure Assessment Survey).

Polychlorinated biphenyls (PCB) were widely used in numerous industrial and commercial applications in high quantities in the past. Based on their persistence in the environment, their tendency to accumulate in the organism and their specific health effects, PCBs have to be assessed as critical substances. Because the dietary intake was assumed to be the main intake route, the Integrated Exposure Assessment Survey (INES) aimed to measure the recent exposure to PCBs in Germany. The study consisted of 10 female and 10 male participants living in Munich and surroundings. The participants collected dietary duplicates of all food consumed and prepared as for consumption over 7 consecutive days. Altogether the 6 non-dioxin-like PCB congeners 28, 52, 101, 138, 153 and 180 ndl-PCB or, respectively, indicator PCB and furthermore the congener 118 were detected using a gas chromatographic method. Dietary intake was calculated using the amount of food eaten daily and the results from the duplicates. Using the sum of PCB 138, 153 and 180 multiplied by 4, the daily intake ranged from 4.0 to 24.1 ng/kg b.w. (median: 9.5 ng/kg b.w.). On the contrary, the daily intake was 2.9 to 20.6 ng/kg b.w. (median: 11.2 ng/kg b.w.) if the sum of the 6 indicator PCBs multiplied by factor 2 was used for quantification. No sex-related difference of the dietary intake was observable. Overall, it can be concluded that the dietary PCB intake has further decreased in the last years in Germany. At present, the toxicological database is not suitable to assess the risks coming solely from the non-dioxin-like PCBs because it is not possible to differentiate between non dioxin-like and dioxin-like effects in toxicological studies. Nevertheless, a further reduction of PCB exposure via food by searching for possible sources is needed.

[Evaluation of a pilot study on measles vaccination in Bavarian preschool children]. / Evaluation einer Pilotstudie zu Masern-Impfraten in bayerischen Kindergärten.

Several areas of Bavaria show measles vaccination coverage in preschool children below 95%. Repeated outbreaks could be attributed to this situation. A recollection model in nurseries was tested in order to document the vaccination rate in this age group and to measure the percentage of vaccinations due to intervention. Parents of new entrants to nurseries in a randomly selected rural district were asked to provide measles vaccination records of their kids and to fill in a questionnaire. 121 out of 144 vaccination records (85%) documented a complete immunisation status for measles. 12 children had not been vaccinated against measles, 10 children had received one vaccination. Eight out of these 22 children obtained supplementary measles immunisation at the time of ascertainment. The results provided are of limited statistical significance due to the small sample size. Further intervention studies have to be conducted and should even include measures supported by legal regulations.

[An interventional study to improve breast-feeding conditions in obstetric clinics of a model region in Bavaria]. / Eine Interventionsstudie zur Verbesserung von Stillbedingungen in Geburtskliniken einer Modellregion in Bayern.

Breastfeeding is influenced amongst other aspects by the support of the medical staff in clinics. Therefore WHO and UNICEF have implemented the programme "ten steps to successful breastfeeding" and the certificate "Baby friendly hospital" to promote breastfeeding in clinics. When the study "Breastfeeding in Bavaria" was started only two clinics in Bavaria were certified as baby friendly. In a Bavarian region where breastfeeding rates were significantly lower than in other regions an intervention study will be conducted. The aim of the study is to educate the clinic staff in the support of breastfeeding mothers. This paper describes the aims and methods of this intervention study.

[A concept to improve vaccination coverage in Bavaria]. / Konzept zur Verbesserung der Impfraten in Bayern.

The aim of the Bavarian immunisation concept is the effective implementation of national vaccination recommendations taking into account known characteristics in Bavaria and social groups with limited access to vaccinations. Furthermore, it intends to coordinate the various players in the field of vaccine-prevention of disease. Key points of this concept are, among others, improvement of the available data, definition of vaccination aims, implementation of vaccination recall systems during the regular examination on entering primary and secondary school, coordination and enforcement of vaccination campaigns in schools as well as steps for the qualification and motivation of the physicians involved in vaccination. In addition, an independent committee for the coordination of professionals and institutions participating in vaccine prevention in Bavaria was created. This "Bayerische Landesarbeitsgemeinschaft Impfen (LAGI)", which was established at the end of 2006 includes representatives from medical associations and corporations, health insurance companies and public health agencies and is the key for the realisation and further development of this concept.

[Health monitoring units in Bavaria. Concept, aims and thematic focus of the first survey on children's environment and health]. / Gesundheits-Monitoring-Einheiten (GME) in Bayern. Konzept, Ziele und thematische Schwerpunkte des 1. Surveys zu Umwelt und Gesundheit von Kindern.

Starting in 2004, health monitoring units (GME) were established in three rural and three urban regions of the federal state Bavaria, Germany. The GME s aim is to gain current and relevant health data especially of children in Bavaria and to evaluate health promotion and prevention strategies. The first survey 2004/2005 was a cross-sectional study of the environmental health of children aged 5 to 7 years. There are data available from 3030 girls and 3319 boys (response rate 78%). This paper describes the study regions and the sociodemographic characteristics of the study population which differed substantially between urban and rural regions. The thematic focus of the survey was: (1) Social disparities in housing conditions, related environmental exposures, and children's health, (2) accidents and injuries, (3) environmental tobacco smoke exposure of children and precautionary measures of their parents, (4) nutrition, physical activity and obesity, and (5) temporal trends of the prevalence of asthma and allergies. The insights gained within the health monitoring units will contribute to the identification and quantification of health risks as well as to the establishment of intervention strategies with special focus on the needs of the public health service.

Occurrence of perfluorinated substances in an adult German population in southern Bavaria.

OBJECTIVES: Perfluorinated compounds (PFCs) are a large group of chemicals produced for several decades and widely used for many industrial and consumer applications. Because of their global occurrence in different environmental media, their persistence, and their potential to bioaccumulate in organisms they are of toxicological and public concern. METHODS: In the present study, the internal exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) in 356 human plasma samples collected from an adult population in Germany in 2005 is quantified. RESULTS: We were able to detect the target analytes in all plasma samples and observed a significant correlation between the PFOS and PFOA concentrations. In female participants, the levels of PFOS and PFOA ranged between 2.5-30.7 (median: 10.9 microg/l) and 1.5-16.2 microg/l (median: 4.8 microg/l), respectively. In males we observed concentrations from 2.1 to 55.0 microg/l (median: 13.7 microg/l) for PFOS and from 0.5 to 19.1 microg/l (median: 5.7 microg/l) for PFOA. A significant correlation between both PFOS and PFOA concentrations and gender was observed. We also found increased levels of the PFCs with increasing age of the participants, but this association reached statistical significance among females only. CONCLUSIONS: Our data agree well with results of other recent studies in Europe and suggest that the current exposure of the adult German population is lower than the exposure of the US and Canadian population. The sources of human exposure are currently not well understood. Toxicological implications are restricted to animal studies and occupational investigations not adequate for quantitative risk assessment in humans. Overall, more scientific research is necessary to characterize the body burden of PFCs (especially for relevant subsets of the population) and the main sources and routes, which are responsible for human exposure and possible health implications of these compounds.

Supervised machine learning techniques for the classification of metabolic disorders in newborns.

MOTIVATION: During the Bavarian newborn screening programme all newborns have been tested for about 20 inherited metabolic disorders. Owing to the amount and complexity of the generated experimental data, machine learning techniques provide a promising approach to investigate novel patterns in high-dimensional metabolic data which form the source for constructing classification rules with high discriminatory power. RESULTS: Six machine learning techniques have been investigated for their classification accuracy focusing on two metabolic disorders, phenylketo nuria (PKU) and medium-chain acyl-CoA dehydrogenase deficiency (MCADD). Logistic regression analysis led to superior classification rules (sensitivity >96.8%, specificity >99.98%) compared to all investigated algorithms. Including novel constellations of metabolites into the models, the positive predictive value could be strongly increased (PKU 71.9% versus 16.2%, MCADD 88.4% versus 54.6% compared to the established diagnostic markers). Our results clearly prove that the mined data confirm the known and indicate some novel metabolic patterns which may contribute to a better understanding of newborn metabolism.

[New challenges to the Screening Center in the Bavarian State office for Health Care and Safe Quality of Foods]. / Neue Herausforderungen für das Screeningzentrum im Bayerischen Landesamt für Gesundheit und Lebensmittelsicherheit.

UNLABELLED: AIM of the newborn screening model programme implemented in Bavaria, Germany, in 1999 was earliest possible and complete detection of all children with treatable severe inborn errors of metabolism. This was to be achieved by the introduction of new laboratory methods (expanded disease coverage, earlier blood take) and of a tracking system to ensure complete access for all newborns and complete requested repeat testing. Long-term prognosis of the newly screened disorders is to be investigated. The model programme "newborn hearing screening in Bavaria" started in 2003 in the administrative district Oberpfalz aims at testing, whether tracking is also suitable to achieve early detection of all children with inborn severe hearing defects. METHODS: To attain these goals a central state screening centre was established. Demographic tracking coordinated by this centre is achieved by matching screening notifications with all birth notifications on name on a regional basis and individual contacts with parents of children with missing screening notification. In addition, all pending recalls are consequently tracked by case-specific contacts. This system was initially introduced for metabolism screening and is currently being implemented also for hearing screening of newborns. Both screening programmes are being scientifically evaluated. Children with disorders detected by screening are followed up in a long-term study by the screening centre. Written consent by the parents is requested yearly at the childs birthday regarding medical care, knowledge of the disease und health development of the child. RESULTS: 470,247 newborns were tested for treatable inborn errors of metabolism from 1999 to 2002. With the introduction of tracking, the documented participation rate increased from previously < 80 to 98.5 %. Due to tracking 99.2 % of requested recalls could be achieved. In 14 cases diagnosis was made, respectively therapy was initiated first after intervention by the screening centre. Altogether 368 children affected by the target disorders of the programme were detected. 332 children could be included in the long-term follow up study. Besides encouraging results, this study reveals deficits in parental information, provision with emergency cards, expert medical consultation, and sometimes treatment not according to the guidelines. Corresponding data from the hearing screening programme are not yet available. CONCLUSION: The establishment of an independent state screening centre has proved very valuable. It enables comprehensive state-wide demographic tracking despite several laboratories engaged in screening for inborn errors of metabolism. A long-term follow-up study has proved to be effective in this setting.

[Prevention and early detection of cancer of the skin]. / Prävention und Früherkennung von Hautkrebs.

The article demonstrates the importance of prevention and early detection of skin cancer as a consequence of the increasing morbidity and mortality of these tumours. Epidemiology, clinical appearance, diagnosis and therapy of the three most important and also most frequent malignant tumours of the skin, i.e. malignant melanoma, squamous cell carcinoma and basal cell carcinoma, are summarised. Subsequently the resulting means for primary and secondary prevention of these tumours are discussed. Finally the possibilities of the public health service for the prevention and early detection of skin cancer in Germany are shown with emphasis on the Bavarian prevention campaign "Sonne(n) mit Verstand" ("Sun with Sense").

[PCB in interiors - a relevant health risk?]. / PCB in Innenräumen - ein relevantes Gesundheitsrisiko?

Polychlorinated biphenyls (PCB) were manufactured between 1929 and 1989. Due to their great chemical persistence, these substances have been used for many different purposes. These chemical properties, however, caused PCB to accumulate in the food chain and resulted in background exposure of the general population. PCB has also been used as plasticizer for sealants in prefabricated buildings, thus causing problems to the present date. At the end of the 90-ties in a school in Nuremberg, Germany, elevated PCB concentrations were measured in indoor air. Some of these results were higher than 3,000 ng/m(3) which means decontamination according to the German "PCB directive". Press coverage made these results a matter of public debate, so that teachers, school children and parents were highly worried because of possible health effects. The Bavarian Minister for Health, Nutrition and Consumer Protection asked us to examine school children and teachers with regard to their internal PCB exposure and health complaints. A group of school children from a non-contaminated school served as controls. For the determination of PCB levels the plasma samples were blinded before analysis. Lower chlorinated PCB (PCB 28, 52, 101) were detected more often and in higher concentrations in plasma samples of school children of the contaminated school compared to the controls. The plasma levels of the higher chlorinated PCBs (PCB 138, 153, 180) did not show similar differences between exposed and non-exposed school children. The relative PCB doses additionally taken up in the contaminated school were less then 5 % of the background exposure of the children. That is why it could finally be concluded that no appreciable additional health risk may result from inhalation of PCB contaminated indoor air in this school. Due to the design, performance and interpretation of this study, including representatives of parents and teachers, these results were widely accepted by most of the parents who initially had been very concerned about possible health effects.

[Model project for reorganising of newborn screening]. / Modellprojekt zur Neuordnung des Neugeborenen-Screenings in Bayern.

OBJECTIVE: To establish a newborn screening programme for congenital metabolic or endocrine defects which meets the national requirements in Germany: documentation of complete and early diagnosis. METHODS: The main new components of the programme consist of the introduction of a new method for detection of congenital metabolic defects (MS-Ms and 17 alpha-OHP), extension of the programme to a number of new conditions such as, fatty acid oxidation defects, aminoacidopathies, organoacidurias and AGS (adrenogenital syndrome) and the establishment of a follow-up unit of the public health service (screening centre) to allow tracking of completeness of participation rates and follow-up testing of screening positives or inconclusive screening results. RESULTS: 350 393 children were screened during 1999 to 2001. Documented participation with the screening programme could be increased from 80 % before the introduction of the new programme to at present > 98 %. The required follow-up testing for 99.1 % of the children with positive or inconclusive screening results could be achieved. In 16.5 % (1926) of the children in need of replicate testing an intervention of the screening centre was required. 271 children with congenital metabolic or endocrine defects could be identified during the 3-year period. The mean age of blood taken for screening was 3.1 days. The new screening programmes met with high acceptance from the different participants in the health care system and from parents. CONCLUSIONS: The tracking system worked excellently although the number of conditions included in the programme was high. Such a tracking system is a prerequisite for the expansion of neonatal screening programmes since many of the new conditions require early onset of treatment.