Improvement of a national public health surveillance system through use of a quality circle.

Surveillance systems for infectious diseases build the basis for effective public health measures in the prevention and control of infectious diseases. Assessing and improving the quality of such national surveillance systems is a challenge, as many different administrations and professions contribute to a complex system in which sensitive information must be exchanged in a reliable and timely fashion. We conducted a multidisciplinary quality circle on the national public health surveillance system in Germany which included clinicians, laboratory physicians, and staff from local and state health departments as well as from the Robert Koch-Institut. The recommendations resulting from the quality circle included proposals to change the federal law for the control of infectious diseases as well as practical activities such as the change of notification forms and the mailing of faxed information letters to clinicians. A number of recommendations have since been implemented, and some have resulted in measurable improvements. This demonstrates that the applied method of quality circle is a useful tool to improve the quality of national public health surveillance systems.

Between fear and relief: how rural pregnant women experience foetal ultrasound in a Botswana district hospital.

Ultrasound technology has achieved almost universal coverage in industrialised countries with particular importance in antenatal surveillance. Its routine use has, however, been viewed critically from medical as well as from sociological perspectives. Studies on women's perception of ultrasound underline the crucial role of client provider communication supporting the technical procedure. Ultrasound is now increasingly available in developing countries. Little is known about how clients in these settings perceive the technology. This study was concerned with women's experience of ultrasound scanning in an African district hospital setting and how their experience concurs with the health professionals' views about the new technology. The study was qualitative and used semi-structured in-depth interviews with 41 clients and structured non-participant observation of the examination process, as well as semistructured interviews with health staff. Most women viewed ultrasound as being beneficial. Some expressed considerable fear. The quality of client-provider interaction played a decisive role in how the procedure was perceived. Many statements, however, reflect women's overestimation of the diagnostic power of ultrasound and prenatal therapeutic possibilities. Technology and its often expatriate providers tend to be mystified and at the same time non-technological procedures provided by local staff in the context of normal history taking and antenatal care undervalued. Health staff expressed very positive views of ultrasound. They admitted, however, that since the availability of ultrasound they were tempted to take histories and physical examinations less thoroughly than before. Irrational expectations from the clients' side and unindicated overuse of ultrasound by health professionals may in the long run interact in a way that possibly undermines the quality and rational utilisation of antenatal care and respective referral guidelines. Indications for the use of ultrasound must be clearly specified within specific societal contexts and mechanism of ensuring adherence to these criteria be established. Communication with patients and appropriate information about the benefits and limitations of ultrasound are essential to alleviate fear, and to discourage irrational expectations and demand.

Problems related to schoolgirl pregnancies in Burkina Faso.

A qualitative study of pregnancy among schoolgirls in a small town in Burkina Faso was conducted that described the situation of pregnant students and their motherhood, their social environment, and the situation of their children. The analysis of findings revealed four main factors that influenced students' pregnancies: lack of contraceptive knowledge, ambiguous feelings about pregnancy and contraception, conflicting messages concerning the reproductive role of young women, and the girls' low self-esteem in their interaction with older, experienced male partners. The study revealed that existing family planning programs fail to address the needs of the sexually active school-age population. Recommendations are made concerning sex education and service delivery.

Tratamento da bexiga nao-inibida com diciclomina. / Treatment of uninhibited bladder with dicyclomine

O tratamento sistematico da bexiga nao-inibida, sem lesao neurologica, se constitui em preocupacao constante do clinico pela falta de um farmaco que tenha acao eficaz com pouco efeito colateral. O cloridrato de diciclomina, um relaxante da musculatura lisa, foi testado em 16 pacientes na dose de 20mg 3 vezes ao dia e produziu significativa melhora em 14. Os sintomas que melhor responderam ao tratamento foram a urgencia, a incontinencia de urgencia e a dor com a bexiga distendida. Houve grande melhora tambem na polaciuria e nocturia Em 8 pacientes que tiveram sua capacidade vesical testada, houve um aumento medio de 90% na mesma em 4 semanas. A quase ausencia de efeitos colaterais em relacao aos anticolinergicos puros, foi notavel