An International Conference for the Seventh Revision of the International Lists of Diseases and Causes of Death was held in Paris in February 1955. Only minor changes were recommended. The new revision becomes effective January 1, 1958. The NOVS produces the official life tables for the United States. Essentially, these tables are a mathematical device for summarizing the age-specific mortality rates for the population. They are used extensively for many fields of interest: e. g., population, insurance, public health, medicine, and social security. They are also used widely as comparable measures of longevity for various population groups over specific periods. The most recent tables in the decennial life-table series, which have been published since 1900, were completed in 1954, and are based on population enumerated in the 1950 Census and on mortality data for the 3-year period, 1949-51. ARCTIC HEALTH RESEARCH CENTER One of the significant achievements in the Arctic Health Research Center program during the year was the development of the home. treatment (chemotherapy) program for tuberculous Eskimos, Indians and Aleuts in central, western and interior Alaska. In the 9 months since the program was initiated (October 1954) X-ray surveys were completed in 20 villages; 3,233 X-ray films were processed and read; and 456 individuals are now participating in the home treatment program. Results of the first 9 months of the tuberculosis chemotherapy program, which is conducted in cooperation with the Alaska Native Service, and the Alaska Department of Health, are: (1) Treatment of Alaskan natives in their homes with oral chemotherapeutic agents is practical and worthwhile. (2) The Eskimo, Indian and Aleut patients are extremely receptive, cooperative, and willing not only to accept the recommended treatment but also to carry it on faithfully over a period of time. (3) Considerable field work is needed to keep the treatment program operating smoothly, but the interest maintained by the field nurses and the patients has facilitated progress despite the obstacles encountered in launching a new operation of this type. The redirection and expansion of the environmental sanitation program was another major development during the past year. Heretofore emphasis has been given primarily to consideration of problems of water supplies, sewage and waste disposal in the larger Alaskan communities. Under a cooperative plan with the Alaska Department of Health and the Alaska Native Service, the Center is now concentrating on the improvement of sanitary conditions in small isolated villages. A third major development at the Center was the beginning of operations in the new Infectious Disease Laboratory. Virus isolation procedures have been established, and work on poliomyelitis, upper respiratory infections, and "flu-like" diseases is now underway, utilizing specimens submitted to the laboratory by local public health and medical groups and private physicians. Specimens from local cases of non-bacterial enteritis are being studied to determine their etiology. PUBLIC HEALTH NURSING SERVICES On June 30, 1955, there were 134 public health nurses in the Public Health Service. Their primary responsibilities include: (1) giving consultation and assistance to State and local health agencies, to other Federal agencies, and to universities on public health nursing service or education; (2) conducting studies on public health nursing practice, and participating in field studies and demonstrations; (3) giving leadership in the development of public health nursing policies and plans through nursing and public health organizations; (4) rendering public health nursing services to medical beneficiaries of the Public Health Service. Today, every State and Territorial health department has a well qualified group of public health nurses on its professional staff. Twenty years ago, at least 17 State and Territorial health departments lacked nursing units, and less than one-third of those employed were fully qualified public health nursing supervisors. Some of the problems still facing public health nursing are: (1) developing resources which will increase the supply of public health nurses, especially in rural and suburban areas; (2) furnishing satisfactory field practice in public health to the increasing number of students in collegiate schools of nursing; (3) securing additional training for approximately 60 percent of the nurses now employed in public health who are not fully qualified; (4) developing plans for more adequate clerical and auxiliary help for public health nurses so that their skilled services will be utilized most effectively; and (5) determining the most effective and economical methods for providing nursing service to children of school age. HEALTH EDUCATION SERVICES The aim of public health education services is to assist health officials in developing sound educational opportunities in public health practice. This is carried out in two ways: (1) by providing technical assistance to all parts of the Public Health Service, the States, schools of public health, and other educational institutions; and (2) by conducting a program of studies in education and social psychology. An exploratory study of the ways in which health services by union. health centers and industrial health plans can be integrated with the preventive services provided by health departments was initiated in cooperation with the health department of the City of New York. The health education staff cooperated with the National Tuberculosis Association and the tuberculosis program of the Public Health Service in a study to identify factors which influence participation in tuberculosis control programs. The analysis of extensive interviews with 1200 randomly selected adults in three cities is now under way. Preliminary findings suggest that a willingness or desire on the part of people to obtain screening X-rays is highly associated with: a concern that they themselves might contract tuberculosis; a real belief that they could have tuberculosis for an extended period of time without being aware of it; and a real belief that the problems and worries they anticipate, should they contract the disease, would be greatly reduced if the disease were detected at an early stage. The staff is cooperating with the Division of Nursing Resources in the study of methods for use by administrators in assessing job satisfaction of nursing personnel as related to turnover and in identifying means of improvement. During the year, pilot investigations were carried out in two hospitals in Washington, D. C., and three hospitals in Syracuse, New York. In cooperation with the heart program, a new study was initiated to identify the social and psychological aspects associated with coronary disease and rehabilitation following a coronary attack. Special Health Services The Division of Special Health Services assists States in putting to work as speedily as possible the results of research in disease control and health conservation. The services to State include grants, assignment of skilled personnel upon request, consultation, and evaluation and analysis of field study data. The Division administers five health program activities; Chronic Disease, Heart Disease, Occupational Health, Venereal Disease, and Tuberculosis. During the year a new program activity, the Community Air Pollution Medical Program, was established in the Office of the Chief. CHRONIC DISEASE PROGRAM In the study of abnormal carbohydrate metabolism in pregnancy begun in April 1954, 3,430 women were screened for possible abnormal glucose tolerance on the basis of blood sugar level one hour after drinking a glucose preparation. Women with a history of previous abnormal pregnancies or a family history of diabetes were also selected. Approximately 1,200 women (35.3 percent) screened positive to at least one screening criterion. Of these, 58 were considered 368636-56 -9 to have abnormal carbohydrate metabolism and were selected for study of the effectiveness of insulin treatment. Selection of women for followup is expected to continue for another 4 years, and followup of those selected will go on for at least 15 years. The diabetes test validation study continued. Preliminary findings indicate that different screening levels for various hours after eating can be established to maximize sensitivity and specificity. Blood sugar screening tests appear both more sensitive and more specific than urine tests, an observation of considerable value in diabetes detection programs. Protocols and forms were prepared for the study of diabetes casefinding among parents of large babies. A pilot study is under way in Oxford, Massachusetts, where hospital birth records since 1935 were checked. Of 1,416 babies, 292 weighed 8 or more pounds, and 96 weighed 9 or more pounds. Activity is continuing to attempt to locate the parents and examine them to determine their prevalence of diabetes by weight groups of offspring. Preliminary investigations of screening techniques and studies were made in glaucoma, obesity, and nephritis. Preliminary exploration was also undertaken with regard to studies of methods of patient education in the hospital and public education in the community. Orientation courses in diabetes control were given to 60 health workers: 8 physicians, 29 nurses, 18 nutritionists, 1 social worker, 2 health educators, 1 laboratory technician, and 1 statistician. HEART DISEASE CONTROL PROGRAM During the year progress was made in both operational research and professional service activities. Consultation to States, in cooperation with regional consultants, was continued in specific aspects of heart disease control programs. One research study revealed that chest X-rays compare favorably with other screening devices for heart disease, when reading criteria are properly selected. Retrospective studies in Los Angeles and Dallas were carried on to determine the beneficial effects to individuals with cardiovascular disease of casefinding by X-ray. Film reading was completed and plans were made for refereeing disagreements for followup to determine subsequent mortality experience. Initial steps were taken for the establishment of a Training Center in Cardiovascular Disease for Nurses at the University of Minnesota. OCCUPATIONAL HEALTH PROGRAM Operational research activities included completion of the field epidemiologic survey of the diatomaceous earth industry and preparation of a draft report. The long-term study of the effect of indus trial noise on hearing loss was continued in cooperation with four Federal penitentiaries. Efforts to develop satisfactory ventilation systems for small-scale uranium mines were continued. Tentative agreement was reached on an acceptable long-term exposure level for radon and its decay products. Laboratory investigations were completed on the possible dermatologic effects of waterless handcleaners and silicone protective creams. Employee health conservation studies completed during the year included development of methods whereby employers can estimate the costs due to sickness and injury of their workers, and the costs of providing employee health services. Design of a survey to determine the attitudes and understanding of management concerning employee health services was completed and an extensive survey is scheduled in five cities and four industries for fiscal year 1956. Program services included comprehensive occupational health surveys conducted in the States of Florida, Washington, Kentucky, and South Dakota, and detailed environmental surveys of working conditions made for the Library of Congress, the U. S. Government Printing Office, and the Bureau of Mines oilshale demonstration plant at Rifle, Colorado. The industrial nursing consultative services of the occupational program were reactivated during the year. TUBERCULOSIS CONTROL PROGRAM During the year, emphasis in tuberculosis control was placed on projects designed to answer urgent epidemiological questions, to evaluate tuberculosis control practices, and to assist in the improvement of services. Recent developments in tuberculosis therapy have placed increased responsibilities upon State and local health departments in the provision of services for case supervision and treatment. To obtain information regarding characteristics of patients and the care and services provided them, the tuberculosis staff conducted a nationwide study of the current status of nonhospitalized tuberculosis patients. An experimental study of the use of isoniazid in the prevention of tuberculosis shows that in guinea pigs tuberculosis can be prevented by giving the drug at the time of infection. When isoniazid is withdrawn, protection is provided against a second infection. To determine whether isoniazid will prevent the development of tuberculosis meningitis and other complications in children, the staff is carrying on a national study in which more than a thousand children with recently diagnosed primary tuberculosis are participating. A cooperative clinical investigation on the antimicrobial treatment of tuberculosis has demonstrated the effect of chemotherapy in preventing relapses, the value of changing chemotherapy for patients |