1
|
Abstract
AbstractNosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.
Collapse
|
2
|
Thacker SB, Stroup DF, Branche CM, Gilchrist J, Goodman RA, Porter Kelling E. Prevention of knee injuries in sports. A systematic review of the literature. J Sports Med Phys Fitness 2003; 43:165-79. [PMID: 12853898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
AIM We reviewed evidence regarding risk factors associated with incidence of knee injuries both to assess the effectiveness of prevention strategies, and to offer evidence-based recommendations to physicians, coaches, trainers, athletes, and researchers. METHODS We searched electronic data bases without language restriction for the years 1966 - September 1, 2001, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 328 citations identified, we emphasized the results from the 13 reports that compared alternative methods to prevent knee injury and assessed the methodologic quality of these reports using a standardized instrument. RESULTS Five studies addressed the effectiveness of bracing in football players; these studies showed no consistent evidence of benefit. Two studies comparing alternative cleat designs and a controlled study testing the effects of adjustments in the ski boot/binding system were difficult to interpret because of inadequate reporting of methodology. Six prospective studies that addressed the impact of conditioning and training showed promise of proprioception and neuromuscular training for protection against knee injury. We identified serious flaws in study design, control of bias, and statistical methods; the median quality scores ranged from 11 to 56 (out of 100). CONCLUSION Structured training programs that emphasize neuromuscular and proprioceptive training offer encouraging evidence for the prevention of knee injuries. However, flaws in study design and implementation have limited the effectiveness of work in this field. A rigorously implemented research program is needed to address this critically important sports medicine problem.
Collapse
Affiliation(s)
- S B Thacker
- Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | |
Collapse
|
3
|
Abstract
A case of PI in a 57-year-old patient with colonic inertia treated with lactulose for PSE secondary to cirrhosis is described. The colonic inertia led to longer transit time. Retained lactulose and a build-up of carbon dioxide and hydrogen gas occurred in the setting of altered bacterial flora deficient in hydrogen metabolism. The increased gas pressure caused extravasation of air into the intestine, causing PI with pneumoperitoneum. They both resolved with discontinuation of lactulose.
Collapse
Affiliation(s)
- R A Goodman
- Department of Medicine, The Hershey Medical Center, Pennsylvania State University, College of Medicine, 17033, USA
| | | |
Collapse
|
4
|
Affiliation(s)
- R A Goodman
- Centers for Disease Control, Atlanta, Georgia, USA
| | | | | |
Collapse
|
5
|
Abstract
OBJECTIVE To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs). DESIGN Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. PARTICIPANTS Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs. INTERVENTION Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals. MAIN OUTCOME MEASURES Delivery of and receipt of preventive services and perceived access to care. RESULTS CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews. CONCLUSION Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.
Collapse
Affiliation(s)
- J D Klein
- Division of Adolescent Medicine, Strong Children's Research Center and Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York 14642, USA.
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.
Collapse
Affiliation(s)
- S B Thacker
- Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
A variety of infectious diseases can be transmitted during competitive sports. Modes of transmission in athletic settings include person-to-person contact, common-source exposures and airborne/droplet spread. This paper reviews the most commonly reported infectious diseases among athletes and discusses the potential for transmission of bloodborne diseases in sports. Guidelines are provided regarding measures to prevent transmission of infectious diseases in athletic settings, including hygiene and infection control practices, vaccination, and education of officials, coaches, trainers and sports participants.
Collapse
Affiliation(s)
- E E Mast
- Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | | |
Collapse
|
8
|
Abstract
Interactions of interstitial fibroblasts with nearby epithelial cells are thought to play a role in lung growth and development. The present studies support this premise. Medium conditioned by second-passage lung fibroblasts (FCM) stimulated both DNA synthesis and accumulation in low-density (2 x 10(4)/cm2) cultures of type II alveolar epithelial cells. FCM effects did not require serum; they were time- and dose dependent, with half-maximal FCM activity at 1:8 dilution. A maximal response to FCM required 30 h of exposure. FCM activity was reduced in medium from fibroblasts treated with dexamethasone, suggesting physiological regulation. Type II cells subjected to cyclic mechanical stress demonstrated an increased response to FCM compared with static cultures. FCM activity did not appear to be accounted for by hepatocyte growth factor, keratinocyte growth factor, acidic fibroblast growth factor, or fibronectin. These results suggest that early passage lung fibroblasts release, by regulated pathways, one or more factors that stimulate DNA synthesis by type II cells. Sensitivity to FCM appears to be elevated in type II cell cultures subjected to cyclic mechanical stress.
Collapse
Affiliation(s)
- M Pasternack
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey 17033, USA
| | | | | | | |
Collapse
|
9
|
Zaki SR, Khan AS, Goodman RA, Armstrong LR, Greer PW, Coffield LM, Ksiazek TG, Rollin PE, Peters CJ, Khabbaz RF. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978-1993: implications for emerging infectious diseases. Arch Pathol Lab Med 1996; 120:134-9. [PMID: 8712893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the occurrence of unrecognized cases of hantavirus pulmonary syndrome preceding the detection of the 1993 outbreak in the southwestern United States and the initial description of the syndrome. DESIGN Retrospective clinicopathologic and immunohistologic study. PATIENTS Eighty-two patients who died prior to April 1993 with histologically unexplained noncardiogenic pulmonary edema. METHODS Clinicopathologic review and immunohistochemical evaluation of autopsy tissues for evidence of hantaviral infection. RESULTS Twelve retrospective fatal cases of hantavirus pulmonary syndrome were identified through clinicopathologic review and immunohistochemical testing of tissues. Patients' ages ranged from 16 to 49 years. The earliest identified case occurred in 1978, 15 years prior to the outbreak of hantavirus pulmonary syndrome in the southwestern United States. Immunohistochemical testing showed widespread deposition of hantaviral antigens, primarily within endothelial cells, similar to the pattern observed with current hantavirus pulmonary syndrome cases. CONCLUSIONS Although hantavirus pulmonary syndrome was first recognized in 1993, the findings from this study document the earlier existence of this disease. These findings underscore the need for systematic archiving and analysis of clinical information and specimens from patients with diseases of unknown etiology to facilitate the study of new clinical entities and their associated etiologic agents.
Collapse
Affiliation(s)
- S R Zaki
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Dunsmore SE, Martinez-Williams C, Goodman RA, Rannels DE. Composition of extracellular matrix of type II pulmonary epithelial cells in primary culture. Am J Physiol 1995; 269:L754-65. [PMID: 8572237 DOI: 10.1152/ajplung.1995.269.6.l754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Type II pulmonary epithelial cells in primary culture synthesize and deposit an extracellular matrix which has reciprocal biological effects on cellular differentiation. The present work establishes conditions for metabolic labeling of matrix constituents and for separation of cells from the associated matrix; it also defines matrix composition, which does not appear to change qualitatively between days 2 and 6 of primary culture. Type II cells synthesize and deposit a spectrum of radiolabeled components on the culture surface. These include fibronectin, laminin, type IV collagen, and plasminogen activator inhibitor-1, along with additional unidentified proteins. Few radiolabeled proteins in medium conditioned by type II cells bind nonspecifically to the culture surface in the absence of cells. Fibroblasts and macrophages, which may contaminate the primary cultures, do not appear to contribute substantially to the type II cell matrix. These results demonstrate that type II cells synthesize and deposit a complex multicomponent extracellular matrix. The work provides a basis for further investigations of bidirectional interactions between type II cells and the extracellular matrix.
Collapse
Affiliation(s)
- S E Dunsmore
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey 17033, USA
| | | | | | | |
Collapse
|
11
|
Abstract
Type II pulmonary epithelial cells in primary culture synthesize and assemble a multicomponent extracellular matrix which exhibits biological activity in vitro. Simultaneously, the pneumocytes degrade components of the underlying matrix, such that matrix composition may be determined by the balance of synthesis and turnover. The present work defines turnover of the specific matrix glycoproteins, fibronectin and laminin, both in the type II cell and in its extracellular matrix. Pulse-chase experiments demonstrate that both fibronectin and laminin, identified by immunoprecipitation, turn over rapidly in the cell and extracellular matrix compartments, with half-lives < 10 h. In the cell compartment, initial rates of laminin turnover are more rapid than those of fibronectin on culture day 2, but these rates are similar on day 6. Matrix fibronectin also turns over rapidly, with similar rates on day 2 and day 6. During the chase interval, small but increasing amounts of immunoprecipitable fibronectin are detected in the medium, suggesting that a portion of the glycoprotein may be released to the extracellular compartment, rather than degraded. Alternatively, release of immunoreactive glycoprotein may involve ongoing processing and secretion of residual radiolabeled fibronectin by the cells. The results suggest that matrix composition may be determined by turnover, as well as synthesis, of its components.
Collapse
Affiliation(s)
- S E Dunsmore
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey 17033, USA
| | | | | | | |
Collapse
|
12
|
Goodman RA, Remington PL, Howard RJ. [How to communicate information for public health action]. Bol Oficina Sanit Panam 1995; 119:43-9. [PMID: 7654297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R A Goodman
- Centros para el Control y la Prevención de Enfermedades (CDC), Programa de Epidemiología, Atlanta, Georgia 30341, USA
| | | | | |
Collapse
|
13
|
Abstract
Publicity about human immunodeficiency virus (HIV) infection in athletes has focused attention on the potential for transmission of blood-borne pathogens during sports and athletic competitions. Existing information suggests that the potential risk for such transmission is extremely low and that the principal risks athletes have for acquiring HIV and hepatitis B virus are related to off-the-field activities. Therefore, efforts to prevent transmission of blood-borne pathogens among athletes should emphasize prevention in off-the-field settings. We summarize technical and other information about this issue, and provide recommendations for the education of sports participants, for infection control in athletic settings, and for training of coaches and officials.
Collapse
Affiliation(s)
- E E Mast
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | |
Collapse
|
14
|
Goodman RA, Jenkins EL, Mercy JA. Workplace-related homicide among health care workers in the United States, 1980 through 1990. JAMA 1994; 272:1686-8. [PMID: 7966897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To improve understanding of the epidemiology of fatal violence directed toward physicians and other health care workers (HCWs) in health care settings. DESIGN Analyses of data for 1980 through 1990 from the National Traumatic Occupational Fatalities surveillance system. MAIN OUTCOME MEASURES Overall occurrence of occupational injury deaths and occurrence of workplace-related homicides among HCWs. RESULTS From 1980 through 1990, a total of 522 HCWs died from injuries sustained while working. The most common causes of death were motor vehicle crashes (122 [23.4%]), homicide (106 [20.3%]), and suicide (88 [16.9%]). Firearms were used in the greatest number (78 [73.6%]) of workplace-related homicides among HCWs. CONCLUSIONS These findings highlight the need for strengthened surveillance and more accurate estimates of the risks of workplace-related violent injury for HCWs in the United States.
Collapse
Affiliation(s)
- R A Goodman
- Division of Safety Research, Centers for Disease Control and Prevention, Atlanta, Ga 30333
| | | | | |
Collapse
|
15
|
Goodman RA, Sacks JJ, Aronson SS, Addiss DG, Kendrick AS, Osterholm M. Child day-care health: themes, issues, and future directions. Pediatrics 1994; 94:1118-20. [PMID: 7971084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA
| | | | | | | | | | | |
Collapse
|
16
|
Straub I, Goodman RA, Wilbanks CR. Public health information in Hungary. Lancet 1994; 343:1421. [PMID: 7910894 DOI: 10.1016/s0140-6736(94)92541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
17
|
Goodman RA, Thacker SB, Solomon SL, Osterholm MT, Hughes JM. Infectious diseases in competitive sports. JAMA 1994; 271:862-7. [PMID: 8114242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Participation in competitive sports is popular and widely encouraged throughout the United States. Reports of infectious disease outbreaks among competitive athletes and recent publicity regarding infectious disease concerns in sports underscore the need to better characterize the occurrence of these problems. DATA SOURCES To identify reports of infectious diseases in sports, we performed a comprehensive search of the medical literature (MEDLINE) and newspaper databases in two on-line services (NEXIS and DIALOG PAPERS). STUDY SELECTION Articles selected from the literature review included those describing cases or outbreaks of disease in which exposure to an infectious agent was likely to have occurred during training for competitive sports or during actual competition. Articles from the newspaper review included reports of outbreaks, exposures, or preventive measures that directly or indirectly involved teams or spectators. DATA SYNTHESIS The literature review identified 38 reports of infectious disease outbreaks or other instances of transmission through person-to-person (24 reports), common-source (nine reports), or airborne (five reports) routes; the newspaper search identified 28 reports. Infectious agents included predominantly viruses but also a variety of fungi and gram-positive and gram-negative bacteria. CONCLUSIONS Our findings indicate that strategies to prevent transmission of infectious diseases in sports must recognize risks at three levels: the individual athlete, the team, and spectators or others who may become exposed to infectious diseases as a result of sports-related activities. Team physicians and others who are responsible for the health of athletes should be especially familiar with the features of infectious diseases that occur in sports and measures for the prevention of these problems.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga 30333
| | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- D M Dwyer
- Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, Baltimore
| | | | | | | |
Collapse
|
19
|
Abstract
The dissolution of the Soviet Union created many problems for the health care systems of the New Independent States (NIS). To address these problems, the U.S. Secretary of State convened a coordinating conference in Washington, D.C., on 22-23 January 1992 at which more than 50 nations and organizations were represented. After this conference, an expert medical working group visited 10 republics of the NIS during February and March 1992. Hospitals, public health facilities, and pharmaceutical plants and distribution sites were visited to assess the health care needs of a large population in a vast geographic area. It was concluded that the massive health care system of the Soviet Union remains largely intact but has major economic and supply deficiencies. The assessment process and findings in one republic, Ukraine, are presented. Ukraine was chosen because of its size, location, and representativeness.
Collapse
Affiliation(s)
- R G Farmer
- U.S. Agency for International Development, Washington, DC
| | | | | |
Collapse
|
20
|
Goodman RA, Remington PL, Howard RJ. Communicating information for action. MMWR Morb Mortal Wkly Rep 1992; 41 Suppl:143-7. [PMID: 1344249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
|
21
|
Thacker SB, Addiss DG, Goodman RA, Holloway BR, Spencer HC. Infectious diseases and injuries in child day care. Opportunities for healthier children. JAMA 1992; 268:1720-6. [PMID: 1527882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs. DESIGN We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles. SETTING Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs. PATIENTS OR OTHER PARTICIPANTS Primarily children in a variety of day-care settings, often compared with children cared for at home. MAIN OUTCOMES The occurrence of outbreaks and illness related to infectious disease and injury. RESULTS Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home. CONCLUSIONS Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion.
Collapse
Affiliation(s)
- S B Thacker
- Epidemiology Program Office, Center for Disease Control, Atlanta, GA 30333
| | | | | | | | | |
Collapse
|
22
|
Goodman RA, Solomon SL. Transmission of infectious diseases in outpatient health care settings. JAMA 1991; 265:2377-81. [PMID: 2016835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333
| | | |
Collapse
|
23
|
Abstract
To assess the usefulness of medical examiner data in describing the relationship between alcohol use and fatal injuries, 1978-84 data from the Office of the Chief Medical Examiner (ME), State of Oklahoma, was examined. In each year in the study period, approximately 1,500 deaths resulted from unintentional injuries (UI) and 800 deaths resulted from intentional injuries (i.e., suicides and homicides). For persons who died on the same day they were injured, testing for blood alcohol ranged from 90% of homicide victims, to 73% of suicide victims and to 66% of UI victims. Alcohol was associated with 52% of homicides, 49% of UI and 40% of suicides. Alcohol was detected most often in samples from Hispanic men and from Native Americans of both sexes. This study suggests that state public health agencies and researchers should consider the use of ME data for epidemiologic information on the relationship between alcohol and injury-related mortality and for surveillance of these problems.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, Georgia 30333
| | | | | | | | | |
Collapse
|
24
|
Shultz JM, Rice DP, Parker DL, Goodman RA, Stroh G, Chalmers N. Quantifying the disease impact of alcohol with ARDI software. Public Health Rep 1991; 106:443-50. [PMID: 1652146 PMCID: PMC1580257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alcohol-Related Disease Impact (ARDI) Software has been developed for the Centers for Disease Control (CDC) to allow States to calculate mortality, years of potential life lost (YPLL), direct health-care costs, indirect morbidity and mortality costs, and nonhealth-sector costs associated with alcohol use and misuse. The mortality related measures--mortality, YPLL, and indirect mortality costs--are computed for 35 diagnoses related to alcohol use and misuse. A review of clinical research studies and injury surveillance studies was conducted to produce estimates of the alcohol-attributable fraction (AAF) for each diagnosis. For these measures, age-specific and age-adjusted rates are also calculated. Health care costs, morbidity costs, and nonhealth-sector costs are prorated from national studies to the State or locality. This multiple-measure approach to quantifying a health problem is termed "disease impact estimation." National estimates of the disease impact of alcohol use and misuse have been produced using ARDI software and State-specific estimates are in preparation. Designed to CDC specifications, ARDI is completely menu-driven and operates within Lotus 1-2-3 software as a set of linked spreadsheets. ARDI adapts national epidemiologic and health economics methods for use by State and local health agencies. ARDI produces data on the health consequences of alcohol use and misuse for use by locally based policymakers, public health professionals, and researchers, while permitting comparison and compilation of these data across jurisdictions.
Collapse
Affiliation(s)
- J M Shultz
- Department of Epidemiology and Public Health, University of Miami School of Medicine, FL
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
Epidemiologic field investigations are often done in response to acute public health problems. When outbreaks of disease occur, there usually is an urgent need to identify the source and/or cause of the problem as a basis for control. Alternatively, the identification of environmental or occupational hazards frequently demands evaluation of exposed persons and assessment of the risks of disease. In this commentary, the authors present a perspective on the public-sector practice of epidemiology by considering the factors that influence epidemiologic prospectively planned studies; and examining the complexities of the relations between epidemiology and public health practice.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA
| | | | | |
Collapse
|
26
|
Goodman RA, Bauman CF, Gregg MB, Videtto JF, Stroup DF, Chalmers NP. Epidemiologic field investigations by the Centers for Disease control and Epidemic Intelligence Service, 1946-87. Public Health Rep 1990; 105:604-10. [PMID: 2175440 PMCID: PMC1580185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The epidemiologic field investigation is an important tool used by the Centers for Disease Control (CDC) to provide assistance to State, local, and international public health agencies. The Epidemic Intelligence Service (EIS) of the CDC is an ongoing program that gives physicians and other health professionals opportunities to learn and practice epidemiology. In the period 1946-87, EIS Officers and other professional staff based at CDC headquarters participated in 2,900 epidemiologic field investigations requested by State, local, and international public health agencies. Nearly two-thirds of the investigations involved infectious disease problems, while 13 percent involved noninfectious conditions; for 21.1 percent, the etiology of the problem was unknown when the investigation was initiated. Among the specific subcategories, bacterial causes were the most common, accounting for 864 (29.8 percent) of all investigations. During this 41-year period, an increasing proportion of the field epidemiologic investigations involved public health problems of noninfectious etiology. Trends in the types of investigations done probably represent the influence of such factors as CDC's priorities, organizational structure, and budget; the size of the EIS Program; national health initiatives; and the States' needs and programs.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333
| | | | | | | | | | | |
Collapse
|
27
|
Thacker SB, Goodman RA, Dicker RC. Training and service in public health practice, 1951-90--CDC's Epidemic Intelligence Service. Public Health Rep 1990; 105:599-604. [PMID: 2175439 PMCID: PMC1580174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The Epidemic Intelligence Service (EIS) was created at the Centers for Disease Control (CDC) in 1951 as a combined training and service program in the practice of applied epidemiology. Since 1951, more than 1,700 professional have served in this 2-year program of the Public Health Service. In the decade of the 1980s, EIS underwent dramatic changes in response to the increased breadth of the CDC mission and the rapid expansion of epidemiologic methods. Modifications in the experience of an EIS Officer have resulted from the increased need for more sophisticated analytic methods and the use of microcomputers, as well as CDC's expanded mission into chronic diseases, environmental health, occupational health, and injury control. Officers who have entered the EIS in the past decade tend to be older than their predecessors, tend to enter the program with more experience and training in epidemiology, and are more likely to stay in public health either at the Federal level or in State and local health departments. The EIS Program continues to be a critical source for men and women to respond to the need and demand for epidemiologic services both domestically and internationally.
Collapse
Affiliation(s)
- S B Thacker
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333
| | | | | |
Collapse
|
28
|
Smith SM, Goodman RA, Thacker SB, Burton AH, Parsons JE, Hudson P. Alcohol and fatal injuries: temporal patterns. Am J Prev Med 1989; 5:296-302. [PMID: 2789850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although alcohol use has been established as a risk factor for injuries associated with motor vehicle crashes, the role of alcohol for other unintentional and intentional injuries is less defined. A review of 102,401 deaths investigated by North Carolina medical examiners in the period 1973-1983 characterized the temporal patterns of ethyl alcohol in unintentional injury fatalities, suicides, homicides, and persons who died of natural or unknown causes. Victims of homicides (85.9%) and suicides (77.7%) were tested for alcohol more frequently than were fatalities resulting from unintentional injury (67.5%) or natural causes (61.6%). Alcohol was present in 62.8% of homicide victims, 48.6% of unintentional injury fatalities, 35.3% of suicides, and 14.4% of deaths from natural causes. The percentage of alcohol-associated deaths for each manner of death showed little yearly or seasonal variation. Alcohol was most frequently detected in persons fatally injured on the weekend and from 6 PM to 6 AM. This study highlights the magnitude of alcohol's role in intentional and unintentional injuries, especially for persons injured at night and on weekends.
Collapse
Affiliation(s)
- S M Smith
- Division of Surveillance and Epidemiologic Studies, Centers for Disease Control, Alanta, GA 30333
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
To characterize mortality associated with injuries and other health problems in Oklahoma, we examined data from the Office of the Chief Medical Examiner of the State of Oklahoma for the years 1978 through 1984. Each year, approximately 1,500 and 800 deaths resulted from unintentional injury (UI) and intentional injury (ie, suicide and homicide), respectively. The medical examiner (ME) data differed substantially from the state's vital statistics (VS); over the seven years, the ME records showed 2,021 (16%) fewer UI deaths than did the VS, as well as 24 (1%) more cases of suicide and 499 (23%) more cases of homicide. Rates for UI and suicide were highest for young adults and for the elderly; in contrast, rates for homicide were highest for young adults, and then decreased with age. For each of the three categories of injury-related deaths, rates for male subjects were approximately three times those for female subjects; rates also varied by race-ethnic group. Deaths due to UI and homicide occurred more often in the summer and on weekends, though suicides did not vary by month and were slightly more common on weekdays. This study indicates that ME data represent an important source of epidemiologic information for the surveillance and study of injury-related mortality.
Collapse
Affiliation(s)
- R A Goodman
- Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333
| | | | | | | | | |
Collapse
|
30
|
Goodman RA, Baker DB, Powell KE, Sayre JW. Estimating the prevalence of leisure-time physical activity. J Sports Med Phys Fitness 1988; 28:360-6. [PMID: 3230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
31
|
Wise RP, Livengood JR, Berkelman RL, Goodman RA. Methodological alternatives for measuring premature mortality. Am J Prev Med 1988; 4:268-73. [PMID: 3224004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although crude and age-adjusted mortality statistics are frequently used to quantify public health problems, they are heavily influenced by the underlying disease processes of the elderly. Alternative measures have been developed to reflect the mortality experience of younger age groups (i.e., premature mortality). We evaluated four different methods for tabulating premature mortality, one method weighted by the remaining life expectancy at death and three methods with constant end points using age spans from birth to 65 years, birth to 75 years, and 1 to 65 years. These alternatives provide dramatically different descriptions of premature mortality in the United States in 1984. In general, the constant end-point methods emphasize the different pattern of mortality among younger persons, while premature mortality computed by the remaining life expectancy method more closely resembles the pattern of crude mortality. Although no single method is preferable for all purposes, the constant end-point method best differentiates the leading causes of premature death.
Collapse
Affiliation(s)
- R P Wise
- Division of Surveillance and Epidemiologic Studies, Centers for Disease Control, Atlanta, Georgia 30333
| | | | | | | |
Collapse
|
32
|
Patriarca PA, Arden NH, Koplan JP, Goodman RA. Prevention and control of type A influenza infections in nursing homes. Benefits and costs of four approaches using vaccination and amantadine. Ann Intern Med 1987; 107:732-40. [PMID: 3116900 DOI: 10.7326/0003-4819-107-5-732] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We developed a model to project morbidity, mortality, and costs attributable to type A influenza virus infections in nursing homes and to evaluate the relative benefits and costs of programs for prevention and control. Influenza vaccination was the most cost-effective intervention under various simulations in the model but usually allowed for higher rates of morbidity and mortality compared with other alternatives. The combined use of previous vaccination and chemoprophylaxis during outbreaks in the nursing home was associated with significantly fewer cases than use of vaccination alone, with only modest increases in net program costs. The use of chemoprophylaxis throughout the influenza season (without vaccination) resulted in the fewest number of illnesses, hospitalizations, and deaths but would cost at least 650% more than alternatives involving vaccination. Regardless of which strategy is chosen, our model suggests that influenza control programs in nursing homes are both beneficial and cost-effective and should be considered a part of standard care.
Collapse
Affiliation(s)
- P A Patriarca
- Division of Immunization, Center for Infectious Diseases, Atlanta, Georgia
| | | | | | | |
Collapse
|
33
|
Graitcer PL, Williams WW, Finton RJ, Goodman RA, Thacker SB, Hanzlick R. An evaluation of the use of medical examiner data for epidemiologic surveillance. Am J Public Health 1987; 77:1212-4. [PMID: 3618857 PMCID: PMC1647010 DOI: 10.2105/ajph.77.9.1212] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To assess the value of medical examiner (ME) data bases for use in epidemiologic surveillance, we compared data from non-injury deaths that became ME cases to all non-injury deaths occurring in 1984 among Fulton County, Georgia residents. The decedents in the ME series were younger and included a large proportion of Black males. Although not representative of all deaths in a community, ME data bases include demographic and medical information that is often difficult to collect in community studies and in other surveillance systems.
Collapse
|
34
|
Goodman RA, Berkelman RL. Physicians, vital statistics, and disease reporting. JAMA 1987; 258:379-81. [PMID: 3599334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
35
|
McCloskey M, Sokol SM, Goodman RA. Cognitive processes in verbal-number production: inferences from the performance of brain-damaged subjects. J Exp Psychol Gen 1986. [PMID: 2949043 DOI: 10.1037//0096-3445.115.4.307] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article presents a model of the cognitive processes involved in the spoken production of verbal numbers (e.g., thirteen thousand four hundred two). On the basis of single-case studies of two brain-damaged subjects with number production deficits, we argue that verbal-number production involves the generation of a syntactic frame that constitutes a plan for the production of the appropriate sequence of words. The syntactic frame specifies each to-be-retrieved word in terms of a number-lexical class (i.e., ones, teens, or tens) and a position within that class. These class/position-within-class specifications guide the retrieval of lexical representations from a production lexicon that is partitioned into functionally distinct ones, teens, and tens classes. We conclude with a brief discussion of the rationale for, and advantages of, using patterns of impaired performance as a basis for drawing inferences about normal cognition.
Collapse
|
36
|
Abstract
To characterize patterns of barbiturate use in homicide victims, we used data from the Los Angeles City Police Department and the Medical Examiner-Coroner's Office to study 4,950 victims of criminal homicide committed in that city in 1970-1979. Barbiturates were detected in 323 (7.9 per cent) of the 4,063 victims who were tested. Detectable levels were present most often in black victims (10.4 per cent), in equal proportions of Anglos and Hispanics (6 per cent), and least often among victims in other race-ethnic groups (4.1 per cent). Among specific subgroups, barbiturate use was greatest in black female victims (15.1 per cent). The detection of barbiturates more commonly among certain subgroups and in specific types of homicidal encounters suggests that barbiturate use may be linked to specific behaviors that precede homicide.
Collapse
|
37
|
Abstract
Infection control services for child care are currently provided through the cooperative efforts of physicians, nurses, and other providers in the private health care sector; public health agencies; and academic-based infectious disease experts. However, the effectiveness of infection control practices is not uniform and varies considerably by locality. One approach to ameliorating these differences may be through the development of an "infection control specialist for child day care". Possible responsibilities for and uses of the infection control specialist in child day care include disease surveillance, outbreak control activities, implementation of primary prevention measures, and facilitation of communication among parents and day care and health providers. There are potential impediments to the development of this role, such as conflicts of interest and difficulties in obtaining adequate funding.
Collapse
|
38
|
Abstract
Effective control and prevention of infectious diseases in child day care depend on affirmative relationships between parents, day care providers, public health authorities, and primary health care providers (especially pediatricians). The role played by each of these groups varies in accordance with the specific infectious disease problems, legal requirements, and voluntary relationships that exist in a given locality, but each of these roles is important. Major barriers to productive working relationships between day care and health providers are inadequacy of communication channels, uncertainty in role definition, and overlap in function of different health providers. Public health authorities can play a major role in improving the relationship between day care and health providers, largely by disseminating information regarding disease-reporting laws and other legal requirements, prescribed measures for control and prevention of diseases, and resources that are available for these activities.
Collapse
|
39
|
Mercy JA, Goodman RA, Rosenberg ML, Allen NH, Loya F, Smith JC, Vargas LA. Patterns of homicide victimization in the city of Los Angeles, 1970-79. Bull N Y Acad Med 1986; 62:427-45. [PMID: 3488785 PMCID: PMC1629258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
40
|
Abstract
In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent of motorcycle-associated fatalities did not involve another vehicle, and head injuries alone or in combination with other injuries were responsible for death in approximately half. Helmet use, an effective measure for preventing motorcycle-associated fatalities, is required in Georgia; additional injury prevention strategies are discussed.
Collapse
|
41
|
Goodman RA, Mercy JA, Loya F, Rosenberg ML, Smith JC, Allen NH, Vargas L, Kolts R. Alcohol use and interpersonal violence: alcohol detected in homicide victims. Am J Public Health 1986; 76:144-9. [PMID: 3946695 PMCID: PMC1646489 DOI: 10.2105/ajph.76.2.144] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To characterize the relationship between alcohol use and homicide victimization, we used data from the Los Angeles City Police Department and the Los Angeles Medical Examiner's Office to study 4,950 victims of criminal homicides in Los Angeles in the period 1970-79. Alcohol was detected in the blood of 1,883 (46 per cent) of the 4,092 victims who were tested. In 30 per cent of those tested, the blood alcohol level was greater than or equal to 100 mg/100 ml, the level of legal intoxication in most states. Blood alcohol was present most commonly in victims who were male, young, and Latino, categories where rates have been increasing at an alarming pace. Alcohol was also detected most commonly in victims killed during weekends, when homicides occurred in bars or restaurants, when homicides resulted from physical fights or verbal arguments, when victims were friends or acquaintances of offenders, and when homicides resulted from stabbings. The evidence for alcohol use by homicide victims focuses attention on the need for controlled epidemiologic studies of the role played by alcohol as a risk factor in homicide and on the importance of considering situational variables in developing approaches to homicide prevention.
Collapse
|
42
|
McCloskey M, Sokol SM, Goodman RA. Cognitive processes in verbal-number production: Inferences from the performance of brain-damaged subjects. ACTA ACUST UNITED AC 1986; 115:307-30. [PMID: 2949043 DOI: 10.1037/0096-3445.115.4.307] [Citation(s) in RCA: 156] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a model of the cognitive processes involved in the spoken production of verbal numbers (e.g., thirteen thousand four hundred two). On the basis of single-case studies of two brain-damaged subjects with number production deficits, we argue that verbal-number production involves the generation of a syntactic frame that constitutes a plan for the production of the appropriate sequence of words. The syntactic frame specifies each to-be-retrieved word in terms of a number-lexical class (i.e., ones, teens, or tens) and a position within that class. These class/position-within-class specifications guide the retrieval of lexical representations from a production lexicon that is partitioned into functionally distinct ones, teens, and tens classes. We conclude with a brief discussion of the rationale for, and advantages of, using patterns of impaired performance as a basis for drawing inferences about normal cognition.
Collapse
|
43
|
|
44
|
Goodman RA, Smith JD, Sikes RK, Rogers DL, Mickey JL. Fatalities associated with farm tractor injuries: an epidemiologic study. Public Health Rep 1985; 100:329-33. [PMID: 3923543 PMCID: PMC1424762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Death certificates were used as a source of information to characterize fatalities associated with farm tractor injuries in Georgia for the period 1971-81. In this period, 202 tractor-associated fatalities occurred among residents of Georgia; 198 of these persons were males. The annual tractor-associated fatality rate for males based on the population of male farm residents was 23.6 per 100,000; rates of fatal injury increased with age for this population. Persons whose primary occupation was other than farming accounted for more than half of all tractor-associated deaths. Fatal injuries occurred throughout the year but predominantly during the planting and harvesting months. Injuries occurred throughout the day (7 a.m. to midnight), with a peak at 4 p.m. to 5 p.m. Most fatal injuries, 76 percent, resulted when tractors overturned. Fatalities were attributed to crushed chest, exsanguination, strangulation or asphyxia, drowning, and other injuries. Current safety standards for the operation of farm tractors are limited; rollover protective canopies are not required for farm owners or their family members. Descriptive epidemiologic information obtained from death certificates can be used to define injury determinants and to suggest approaches for the further study and prevention of specific types of injuries.
Collapse
|
45
|
Buehler JW, Finton RJ, Goodman RA, Choi K, Hierholzer JC, Sikes RK, Elsea WR. Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention. Infect Control 1984; 5:390-4. [PMID: 6090333 DOI: 10.1017/s0195941700062238] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.
Collapse
|
46
|
Goodman RA, Osterholm MT, Granoff DM, Pickering LK. Infectious diseases and child day care. Pediatrics 1984; 74:134-9. [PMID: 6330662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The number of day care centers and home care facilities has steadily increased in the United States. Recent interest has focused on the possible relationship between attendance at child day care facilities and the occurrence of certain infectious diseases. A variety of infectious agents have been reported as causes of illness among children and staff in day care programs. In general, however, concurrent risks for these infections among children attending and those not attending day care programs have not been established by prospective studies. A review is made of the pathogens that have been associated with infections in day care settings, patterns of occurrence of infectious diseases in day care facilities, aspects of control and prevention of these diseases, and controversies related to infectious diseases in child day care facilities. Aspects of this problem that warrant further research are outlined.
Collapse
|
47
|
|
48
|
Newman PE, Goodman RA, Waring GO, Finton RJ, Wilson LA, Wright J, Cavanagh HD. A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures. Am J Ophthalmol 1984; 97:344-8. [PMID: 6702973 DOI: 10.1016/0002-9394(84)90634-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We studied three cases of keratitis caused by Mycobacterium chelonei, a nontuberculous mycobacterial species. The cases occurred in two women, 76 and 80 years old, and one man, 67 years old, treated as outpatients in the same office. One case followed suture removal and the other two occurred after posterior capsulotomy. Corneal lesions appeared within two to three weeks of trauma and were white, round infiltrates with indistinct margins and radiating projections. The lesions were found at all levels of the stroma and were associated with an epithelial defect. Anterior chamber reaction varied from a minimal response to a hypopyon. One patient responded to topical therapy with amikacin and erythromycin, but the other two patients required penetrating keratoplasties because of deep abscesses, which progressed toward the sclera despite therapy. These cases emphasized the possibility of rapidly growing nontuberculous mycobacteria producing serious ocular infections.
Collapse
|
49
|
Abstract
The effect on the efficiency of power transfer and microwave leakage of different applicator-load coupling schemes is examined. For a 915-mHz applicator and musclelike phantom separated by 4 cm, it is found that by filling the air gap with dielectric powder or deionized water, the efficiency of power transfer from applicator to load can be raised to levels comparable to that obtained for direct applicator-load contact. For these coupling conditions, it is also found that microwave leakage intensities in the immediate vicinity of the applicator-phantom interface can be reduced to direct contact levels. Employment of such materials and techniques in our clinic, for coupling applicators to patient surfaces in the administration of local hyperthermia to head and neck tumors, has facilitated the reduction of average microwave leakage intensities from more than 15 MW/cm2 to less than 3 MW/cm2 in most cases.
Collapse
|
50
|
Buehler JW, Holloway JT, Goodman RA, Sikes RK. Gnat sore eyes: seasonal, acute conjunctivitis in a southern state. South Med J 1983; 76:587-9. [PMID: 6844965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In late summer 1981, a widespread outbreak of acute bacterial conjunctivitis occurred in southeast Georgia, affecting primarily grade-school children. This outbreak was similar to previously described seasonal conjunctivitis in the South. As suggested in previous studies, the eye gnat, Hippelates pusio, may serve as a mechanical vehicle in the transmission of the suspected causative agent, a possible Haemophilus species. The 1981 Georgia outbreak illustrates that "gnat sore eyes" is not obsolete and apparently can occur unpredictably during warm months in the southern states. Physicians and other health-care workers should be aware of the unique clinical and epidemiologic features of acute seasonal conjunctivitis.
Collapse
|