APPENDIX A

Glossary and Acronyms

This glossary is intended to define terms commonly encountered throughout this report as well as some terms that are commonly used in the public health arena. This glossary is not all inclusive. New terms and new usages of existing terms will emerge with time and with advances in technology. The definitions for the terms presented here were compiled from a multitude of sources, which are listed at the end of the glossary.

AAFP (American Academy of Family Physicians):

A national, nonprofit medical association founded to promote and maintain high-quality standards for family doctors who are providing continuing comprehensive health care to the public (www.aafp.org).

AAMC (Association of American Medical Colleges):

A nonprofit association whose purpose is to improve the nation's health (www.aamc.org).

AHCPR (Agency for Health Care Policy and Research):

An agency of the U.S. Department of Health and Human Services that is charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services (www.ahcpr.gov).

AHCs (Academic Health Centers):

Academic health centers, or AHCs, consist of health care institutions that are owned by or closely affiliated with a university or medical school. AHCs also have at least one additional health professional program and are engaged in undergraduate and graduate medical education, biomedical research, and delivery of patient care.

Antibiotic:

Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g.,



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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections APPENDIX A Glossary and Acronyms This glossary is intended to define terms commonly encountered throughout this report as well as some terms that are commonly used in the public health arena. This glossary is not all inclusive. New terms and new usages of existing terms will emerge with time and with advances in technology. The definitions for the terms presented here were compiled from a multitude of sources, which are listed at the end of the glossary. AAFP (American Academy of Family Physicians): A national, nonprofit medical association founded to promote and maintain high-quality standards for family doctors who are providing continuing comprehensive health care to the public (www.aafp.org). AAMC (Association of American Medical Colleges): A nonprofit association whose purpose is to improve the nation's health (www.aamc.org). AHCPR (Agency for Health Care Policy and Research): An agency of the U.S. Department of Health and Human Services that is charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services (www.ahcpr.gov). AHCs (Academic Health Centers): Academic health centers, or AHCs, consist of health care institutions that are owned by or closely affiliated with a university or medical school. AHCs also have at least one additional health professional program and are engaged in undergraduate and graduate medical education, biomedical research, and delivery of patient care. Antibiotic: Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g.,

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections penicillin was derived from molds), but many currently used antibiotics are semisynthetic and are modified by the addition of artificial chemical components. Antibiotic resistance: Property of bacteria that confers the capacity to inactivate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics. Antimicrobial agents: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi. ASM (American Society for Microbiology): The oldest and largest membership organization in the world devoted to a single life science. ASM represents 24 disciplines of microbiological specializations plus a division for microbiology educators (www.asmusa.org). Bacteria: Microscopic, single-celled organisms that have some biochemical and structural features different from those of animal and plant cells. Basic research: Fundamental, theoretical, or experimental investigation to advance scientific knowledge, with immediate practical application not being a direct objective. Benchmark: For a particular indicator or performance goal, the industry measure of best performance. The benchmarking process identifies the best performance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance. Breteau Index: A derived measurement of the density of larval populations of Aedes aegypti mosquitoes used in vector-borne disease epidemiology (such as dengue and yellow fever). Generally, the higher the value of the Breteau Index the greater the relative abundance of A. aegypti, which results in an increased risk of vector-borne disease transmission in an area during a specified period of time. Broad-spectrum antibiotic: An antibiotic effective against a large number of bacterial species. It generally describes antibiotics effective against both gram-positive and gram-negative classes of bacteria. CDC (Centers for Disease Control and Prevention): A public health agency of the U.S. Department of Health and Human Services whose mission is to promote health and quality of life by preventing and controlling disease, injury, and disability (www.cdc.gov). Clinical practice guidelines: Systematically developed statements that assist practitioners and patients with decision making about appropriate health care for specific clinical circumstances. Clinical research: Investigations aimed at translating basic, fundamental science into medical practice.

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections Clinical trials: As used in this report, research with human volunteers to establish the safety and efficacy of a drug, such as an antibiotic or a vaccine. Clinicians: One qualified or engaged in the clinical practice of medicine, psychiatry, or psychology, as distinguished from one specializing in laboratory or research techniques in the same fields. DHHS (U.S. Department of Health and Human Services): The U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves (www.os.dhhs.gov). Directly Observed Treatment Short-course (DOTS): A short-course chemotherapy regimen for the treatment of tuberculosis (TB) that lasts 6 to 8 months and uses a combination of powerful anti-TB drugs under the direct observation by someone who is willing, trained, responsible, acceptable to the patient, and accountable to the TB control services. Disease: The condition in which the functioning of the body or a part of the body is interfered with or damaged. In a person with an infectious disease, the infectious agent that has entered the body causes it to function abnormally in some way or ways. The type of abnormal functioning that occurs is the disease. Usually the body will show some signs and symptoms of the problems that it is having with functioning. Disease should not be confused with infection. Emerging infections: Any infectious disease that has come to medical attention within the last two decades or for which there is a threat that its prevalence will increase in the near future (IOM, 1992). Many times, such diseases exist in nature as zoonoses and emerge as human pathogens only when humans come into contact with a formerly isolated animal population, such as monkeys in a rain forest that are no longer isolated because of deforestation. Drugresistant organisms could also be included as the cause of emerging infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human immunodeficiency virus, Ebola virus, and multidrug-resistant Mycobacterium tuberculosis. Encephalitis: An acute inflammatory disease of the brain due to direct viral invasion or to hypersensitivity initiated by a virus or other foreign protein. Endemic: Disease that is present in a community or common among a group of people; said of a disease continually prevailing in a region. Enzootic: A disease of low morbidity that is constantly present in an animal community. EPED: Epidemiologist's Editor as a general word processor. EPIAIDS: A programmable word processing program within the Epidemiologist's Editor (EPED) word processor. EPIAIDS programs are provided to guide one through tutorials on the use of EPED and other programs and to

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections assist in constructing memoranda, questionnaires, and epidemiological study designs. Epizootic: A disease of high morbidity that is only occasionally present in an animal community. Etiology: Science and study of the causes of diseases and their mode of operation. FDA (U.S. Food and Drug Administration): A public health agency of the U.S. Department of Health and Human Services charged with protecting American consumers by enforcing the Federal Food, Drug, and Cosmetic Act and several related health laws (www.fda.gov). FIC (Fogarty International Center): is a component of the international research effort of the National Institutes of Health (NIH). The FIC is responsible for advancing health through international scientific cooperation. FIC assumed a leadership role in formulating and implementing NIH biomedical research and policy in priority global health areas and in developing human capital and building research capacity in the poorest nations of the world, where the need is the greatest. FoodNet: A set of activities designed to determine and monitor the burden of foodborne diseases and improve understanding of the proportion of foodborne diseases attributable to various pathogens. It is an example of population-based surveillance in the emerging infections programs. Formulary: List of drugs approved for the treatment of various medical indications. It was originally created as a cost-control measure, but it has been used more recently to guide the use of antibiotics on the basis of information about resistance patterns. HMO (health maintenance organization): A health care service plan that requires its subscriber members, except in a medical emergency, to use the services of designated physicians, hospitals, or other providers of medical care. HMOs typically use a capitation payment system that rewards providers for cost-effective management of patients. Immunogenicity: The property that endows a substance with the capacity to provoke an immune response or the degree to which a substance possesses this property. Incidence: The frequency of new occurrences of disease within a defined time interval. Incidence rate is the number of new cases of a specified disease divided by the number of people in a population over a specified period of time, usually 1 year. Infection: The invasion of the body or a part of the body by a pathogenic agent, such as a microoganism or virus. Under favorable conditions the agent develops or multiplies, the results of which may produce injurious effects. Infection should not be confused with disease.

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections Invasive isolates: A genetically homologous culture of a microorganism or virus that is capable of invading or penetrating the body or a part of the body. MCO (managed care organization): An organization that arranges for health care delivery and financing and that is designed to provide appropriate, effective, and efficient health care through organized relationships with providers. Includes formal programs for ongoing quality assurance and utilization review, financial incentives for covered members to use the plan's providers, and financial incentives for providers to contain costs. Managed care plans vary greatly in the degree to which benefit coverage is offered, and monitored and also the degree to which benefits are conditioned on the basis of the meeting of certain criteria by the subscriber member and the member's primary care physician. Meningitis: Inflammation of the membranes of the spinal cord or brain as a result of an infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. Sometimes referred to as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. MIC (minimum inhibitory concentration): The lowest antibiotic concentration that prevents bacterial growth. MRSA (methicillin-resistant Staphylococcus aureus): In strict terms, a Staphylococcus aureus strain resistant to the antibiotic methicillin. In practice, MRSA strains are generally resistant to many antibiotics, and some are resistant to all antibiotics except vancomycin, such that the acronym is now generally used to mean “multidrug-resistant S. aureus.” NCID (National Center for Infectious Diseases): The division of the Centers for Disease Control and Prevention whose mission is to prevent illness, disability, and death caused by infectious diseases in the United States and around the world. NCID accomplishes its mission by conducting surveillance, epidemic investigations, epidemiological and laboratory research, training, and public education programs to develop, evaluate, and promote prevention and control strategies for infectious diseases (www.cdc.gov/ncidod/ncid.htm). NIAID (National Institute of Allergy and Infectious Diseases): A division of the National Institutes of Health that provides the major support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunological, and allergenic diseases that afflict people worldwide (www.niaid.nih.gov). NIH (National Institutes of Health): A public health agency of the U.S. Department of Health and Human Services whose goal is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold (www.nih.gov).

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections Nosocomial infection: An infection that is acquired during hospitalization but that was neither present nor incubating at the time of hospital admission, unless it is related to a prior hospitalization, and that may become clinically manifest after discharge from the hospital. Outpatient services: Medical and other health care services not requiring hospitalization. These services may be provided by a hospital or other qualified facility or supplier, such as mental health clinics, rural health clinics, mobile X-ray units, or freestanding dialysis units. Such services include outpatient physical therapy services, diagnostic X-ray and laboratory tests, and radiation therapy. PA (Program Announcement): A public announcement describing the goals and scope of a proposed scientific project awaiting approval from a specific scientific organization. Primary care: Basic or general health care, traditionally provided by family practice, pediatric, and internal medicine physicians. Prophylactic antibiotics: Antibiotics that are administered before evidence of infection with the intention of warding off disease. Public Health Service Act of 1944: An act to consolidate and revise the laws relating to the U.S. Public Health Service. Sepsis: The pathological condition that results from the presence of pathogenic microorganisms or their toxins in blood or other tissues. SSS (Sentinel Surveillance Systems): A type of surveillance that relies on reports of cases of disease whose occurrence suggests that the quality of preventive or therapeutic medical care needs to be improved. Surveillance systems: Used in this report to refer to data collection and record-keeping to track the emergence and spread of disease-causing organisms such as antibiotic-resistant bacteria. Sylvatic disease: An infectious disease spread among wild animals living in forests. Vaccine: A preparation of living, attenuated, or killed bacteria or viruses, fractions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organisms that is administered to raise immunity to a particular microorganism. Zoonotic disease or infection: An infection or infectious disease that may be transmitted from vertebrate animals (e.g., a rodent) to humans. Definitions for this glossary were compiled from the following sources:

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections American Academy of Family Physicians, Federal Advocacy Sites (date of last update: January 17, 2000). Available at: www.aafp.org/fpnet/guide/append_d.html American Academy of Pediatrics (date of last update: March 26, 1999). Available at: www.aap.org/advocacy/washing/fedinfo.htm . American Association of Health Plans, Network-Based Health Plans Definitions (date of last update: July 19, 1998). Available at: www.aahp.org/menus/index1.cfm . American College of Obstetricians and Gynecologists: Women's Health Care Physicians. Available at: www.acog.com . American Medical Association. Manual of Style, 9th ed. Chicago: American Medical Association, 1998. Association of American Medical Colleges (date of last update: December 7, 1999). Available at: www.aamc.org . Centers for Disease Control and Prevention. Available at: www.cdc.gov . Dorland's Illustrated Medical Dictionary, 28th ed. Philadelphia: The W. B. Saunders Co., 1994. Health Care Quality Glossary (date of last update: February 8, 2000) Overview. The Russia-United States of America Joint Commission on Economic and Technological Cooperation, The Health Committee, Access to Quality Health Care, 1999. Agency for Health Care Policy and Research, Rockville, Md. Available at: www.ahrq.gov/ qual/hcqgloss.htm . Institute of Medicine. Orphans and Incentives: Developing Technologies to Address Emerging Infections. Workshop Report. Washington, D.C.: National Academy Press, 1997. Institute of Medicine. Antimicrobial Resistance: Issues and Options. Workshop Report. Washington, D.C.: National Academy Press, 1998. Institute of Medicine. Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention. Workshop Summary. Washington, D.C.: National Academy Press, 2000. McGraw-Hill Dictionary of Scientific and Technical Terms, 5th ed. Washington, D.C.: McGraw-Hill, Inc., 1994. Medline Plus (date of last update: May 3, 2000). Available at: www.nlm.nih.gov/medlineplus . National Cancer Institute. Available at: www.nci.nih.gov . National Center for Infectious Diseases (date of last update: May 3, 2000). Available at: www.cdc.gov/ncidod/index.htm . National Human Genome Research Institute, Glossary of Genetic Terms (date of last update: December 29, 1999). Available at: www.nhgri.nih.gov/DIR/VIP/Glossary . National Institute of Allergy and Infectious Diseases (date of last update: March 10, 1999). Available at: www.niaid.nih.gov . National Institutes of Health. Available at: www.nih.gov .

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EMERGING INFECTIOUS DISEASES FROM THE GLOBAL TO THE LOCAL PERSPECTIVE: A Summary of a Workshop of the Forum on Emerging Infections OneLook Dictionaries. Available at: www.onelook.com . U.S. Department of Health and Human Services. Available at: www.os.dhhs.gov . U.S. Food and Drug Administration. Available at: www.fda.gov . Webster's Third New International Dictionary. Springfield, Mass.: Merriam-Webster, Inc., 1986.