An analysis of factors influencing nurse anesthesia educational program director turnover. 1996-1997 AANA Education Committee.
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Adult↗
Biomedical subjects
G C Gray
Publications and source records attributed to G C Gray.
The postwar hospitalization experience of U.S. veterans of the Persian Gulf War.
BACKGROUND: Since the Persian Gulf War ended in 1991, many veterans of that conflict have reported diverse, unexplained symptoms. To evaluate the health of Gulf War veterans, we studied their postwar hospitalization experience and compared it with that of other military personnel serving at the same time who did not go to the Persian Gulf. METHODS: Using a retrospective cohort approach and data from Department of Defense hospitals, we studied hospitalizations of 547,076 veterans of the Gulf War who were serving in the Army, Navy, Marine Corps, and Air Force and 618,335 other veterans from the same era who did not serve in the Persian Gulf. Using multivariate logistic-regression models, we analyzed risk factors for hospitalization both overall and in 14 broad diagnostic categories during three periods from August 1991 through September 1993 (a total of 45 specific comparisons). RESULTS: After the war, the overall odds ratio for hospitalization of the Gulf War veterans was not higher than that of the other veterans, even after adjustment for selection effects related to deployment. In 16 of the 42 comparisons involving specific diagnoses, the risk of hospitalization among Gulf War veterans differed significantly from that among other veterans. Among these 16 comparisons, Gulf War veterans were at higher risk in 5: neoplasms (largely benign) during 1991, diseases of the genitourinary system during 1991, diseases of the blood and blood-forming organs (mostly forms of anemia) during 1992, and mental disorders during both 1992 and 1993. The differences were not consistent over time and could be accounted for by deferred care, postwar pregnancies, and postwar stress. CONCLUSIONS: During the two years after the Persian Gulf War, there was no excess of unexplained hospitalization among Americans who remained on active duty after serving in that conflict.
Adult↗
Pro-oxidant activity of flavonoids: effects on glutathione and glutathione S-transferase in isolated rat liver nuclei.
The effects of three representative flavonoids, quercetin, myricetin and kaempferol, on the nuclear antioxidant defense glutathione (GSH) and glutathione S-transferase (GST) were investigated in a model system of isolated rat liver nuclei. The three flavonoids induced a concentration-dependent decrease of both the nuclear GSH content and GST activity. Myricetin, which has the maximum number of hydroxyl groups, was the most active. The results demonstrate the pro-oxidant activity of these polyphenolic flavonoids. The impairment of the nuclear antioxidant defense GSH and GST by the polyphenolic flavonoids can lead to oxidative DNA damage, which may be responsible for their mutagenicity.
Animals↗
Decreasing rates of hospitalization for varicella among young adults.
Hospitalizations for varicella-zoster virus infection (n = 13,018) among active-duty Navy and Marine Corps personnel were studied retrospectively for the years 1981-1994. A large increase in hospitalization rates occurred during the 1980s, peaking in 1987 with 2025 total hospitalizations and a crude rate of 258/100,000 persons. Since that time, hospitalization rates have decreased markedly, with only 473 hospitalizations in 1994 (rate, 74/100,000 persons). In unconditional logistic regression risk factor modeling for varicella hospitalization, personnel at highest risk of hospitalization had foreign homes of record, were most junior in rank, had < or = 2 years of military service, were Filipino or black, were male, and served in the Navy. Adjusted risk of hospitalization fell > 2-fold from 1987-1988 to 1993-1994. These finding may assist military public health officials in developing strategies to prevent varicella morbidity.
Adolescent↗
The risk of Helicobacter pylori infection among U.S. military personnel deployed outside the United States.
To determine whether military personnel deployed outside the United States are at increased risk of Helicobacter pylori infection, 1,000 male U.S. Navy and Marine Corps personnel (mean age 22 years) were evaluated. Study subjects included 200 recruits, 500 shipboard personnel deployed for six months to South America, West Africa, and the Mediterranean, and 300 ground troops deployed for five months to Saudi Arabia. Among all 1,000 subjects, 247 (25%) were seropositive for H. pylori IgG antibody by an enzyme-linked immunosorbent assay; 24% of new recruits and 25% of troops who had been on active duty for a mean of four years. The prevalence of H. pylori antibody was higher among subjects who were older, nonwhite, foreign-born, and seropositive for antibody to hepatitis A virus. Among the 601 initially seronegative subjects evaluated before and after a 5-6 month deployment outside the United States, five seroconverted, for a rate of infection of 1.9% per person-year of exposure. As found in other populations in developed countries, these data indicate that among U.S. military personnel a large proportion of H. pylori infections occur before adulthood and infection is related to demographic factors. These preliminary findings also suggest that deployed U.S. military personnel may be at increased risk of H. pylori infection compared with adult populations in developed countries either from exposure in developing countries or from crowding.
Adolescent↗
Serologic evidence of respiratory and rickettsial infections among Somali refugees.
Somali refugees living in a camp located in Djibouti were studied in October 1991 and May 1992. The refugees had been living at the camp for about two years. The median age of volunteers was 25 years, of whom 69% were female. Paired sera obtained seven months apart were evaluated by complement fixation, microimmunofluorescence, indirect fluorescent antibody, streptococcal antibody, and enzyme-linked immunosorbent assay techniques for evidence of pathogen infection. Fifty-two percent, 31.3%, 8.0%, 5.9%, and 25.4% of the volunteers had serologic evidence for pre-enrollment infection with Chlamydia pneumoniae, Mycoplasma pneumoniae, Rickettsia typhi, R. conorii, and Coxiella burnetti, respectively. Similarly, 43.5%, 5.2%, 6.1%, 10.7%, 15.8%, and 11.9% of the volunteers studied had serologic evidence for new infection with Streptococcus pyogenes, C. pneumoniae, M. pneumoniae, R. typhi, R. conorii, and Cox. burnetii, respectively. These data suggest that the studied pathogens may be endemic in displaced populations living in the Horn of Africa.
Adolescent↗
Kaempferol-induced nuclear DNA damage and lipid peroxidation.
The extent of DNA damage and lipid peroxidation induced by kaempferol, a polyphenolic flavonoid with a molecular structure similar to quercetin, was studied under aerobic conditions in isolated rat-liver nuclei. Kaempferol induced significant (P < 0.05) concentration-dependent nuclear DNA degradation concurrent with lipid peroxidation; these effects were enhanced by iron(III) or copper(II). Catalase, superoxide dismutase (SOD), mannitol, and sodium azide did not show any inhibitory effect on the kaempferol-induced nuclear DNA damage in the presence of iron(III) or copper(II). On the other hand, all stimulated the kaempferol-induced DNA damage in the presence of iron(III); in the presence of copper(II) only SOD and mannitol showed statistically significant stimulatory effects. The kaempferol induced lipid peroxidation was significantly stimulated by catalase and sodium azide in the presence of iron(III). These results demonstrate the pro-oxidant properties of polyphenolic flavonoids, which are generally considered as antioxidants and anticarcinogens, suggesting their possible dual role in mutagenesis and carcinogenesis.
Animals↗
Pneumonia hospitalizations in the US Navy and Marine Corps: rates and risk factors for 6,522 admissions, 1981-1991.
The authors identified hospitalizations for pneumonia (n = 6,522) in active-duty Navy and Marine Corps personnel during 1981-1991 from computerized inpatient records. The crude mean annual rate of pneumonia hospitalization was 77.6 per 100,000 active-duty personnel; 65% of pneumonia hospitalizations had no etiologic agent identified. The most commonly reported agents to cause pneumonia hospitalization were Streptococcus pneumoniae (12.3%), Mycoplasma pneumoniae (10.8%), other streptococcal species (2.1%), and Haemophilus influenzae (1.9%). The median age at hospitalization was 22 years. The median duration of hospital stay was 4 days and the case fatality rate was 0.4%. The authors used a 2% sample of the entire population and by means of stepwise unconditional multivariate logistic regression modeling for pneumonia found that, independent of age, the most junior Navy and Marine Corps personnel were at highest risk. Whites were at higher risk than blacks, Hispanics, or Filipinos. These results indicate that among this generally healthy US young adult military population, pneumonia hospitalization is common, often brief, and frequently without specifically identified pathogens.
Adolescent↗
Prevaccination screening for citizens of the United States living abroad who are at risk for hepatitis A.
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Adolescent↗
Interactions of flavonoids, trace metals, and oxygen: nuclear DNA damage and lipid peroxidation induced by myricetin.
The extent of DNA damage and lipid peroxidation induced by myricetin, a polyphenolic flavonoid, were studied in isolated rat liver nuclei under aerobic conditions. Myricetin induced significant (P < 0.05) concentration-dependent nuclear DNA degradation concurrent with lipid peroxidation; these effects were enhanced by iron (III) or copper (II). Catalase, superoxide dismutase (SOD), mannitol and sodium azide did not inhibit myricetin-induced nuclear DNA damage in the presence of iron (III) or copper (II). However, all of these antioxidants stimulated myricetin-induced DNA damage in the presence of copper (II). Lipid peroxidation induced by myricetin was significantly inhibited only by SOD in the presence of copper (II), whereas it was enhanced by catalase and sodium azide in the presence of iron (III). These results demonstrate the pro-oxidant properties of polyphenolic flavonoids, which are generally considered to be antioxidants and anticarcinogens, and suggest a dual role for these flavonoids in mutagenesis and carcinogenesis.
Animals↗
Interpreting a single antistreptolysin O test: a comparison of the "upper limit of normal" and likelihood ratio methods.
Single serologic tests may occasionally influence clinicians in making diagnoses. The antistreptolysin O (ASO) test is a frequently used tool for detecting recent Streptococcus pyogenes infection and is helpful in the diagnosis of diseases like rheumatic fever. Using data from a 1989 prospective study of 600 healthy male military recruits, in which 43% experienced S. pyogenes upper respiratory tract infection (2-dilution rise in ASO), this report compared two methods of interpreting a single ASO titer. Using the "upper limit of normal" (80 percentile) method, recruits with an ASO titer of greater than 400 showed evidence of recent S. pyogenes infection. This method had a sensitivity and specificity of only 65.9 and 81.9% respectively. In contrast to the "yes-no" dichotomy of the "upper limit of normal" method, the likelihood ratio method statistics were ASO value specific, more consistent with clinical judgment, and better emphasized the caution clinicians must use in interpreting a single ASO test.
Antistreptolysin↗
The endemic infectious diseases of Somalia.
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Communicable Diseases↗
The risk of measles, mumps, and varicella among young adults: a serosurvey of US Navy and Marine Corps recruits.
OBJECTIVES: To assess the risk of epidemic transmission and to guide immunization policy, the seroprevalence of antibody to measles, mumps, and varicella was determined in a group of young adults. METHODS: A cross-sectional study of 1533 US Navy and Marine Corps recruits was conducted in June 1989. Antibody status was determined with commercially available enzyme-linked immunosorbent assays. RESULTS: Direct sex and race adjustment to the 15- to 29-year-old US population resulted in seronegativity rates of 17.8% for measles, 12.3% for mumps, and 6.7% for varicella. Measles and mumps seronegativity rates were higher among Whites whereas varicella seronegativity was higher among non-Whites. Recruits enlisting from outside the 50 US states, especially those from island territories, were more likely to lack varicella antibody. The sensitivity of a positive history of vaccination or disease in predicting antibody status was less than 90% for all diseases. CONCLUSIONS: These results suggest a continued potential for epidemics, especially of measles, and the need for mandatory immunization policies. Immigrants to the United States, especially those from island territories, may be a high-risk group that could benefit from varicella vaccination.
Adolescent↗
Trends of human immunodeficiency virus type-1 infection in female prostitutes and males diagnosed with a sexually transmitted disease in Djibouti, east Africa.
A cross-sectional serosurvey for human immunodeficiency virus type 1 (HIV-1) was conducted during the first quarter of 1991 among high risk groups in Djibouti, East Africa, and compared with previous surveys in 1987, 1988, and 1990. The survey demonstrated evidence of HIV-1 infection in 36.0% (n = 292) of street prostitutes, 15.3% (n = 360) of prostitutes working as bar hostesses, and 10.4% (n = 193) of males diagnosed with a sexually transmitted disease. By multivariate modeling, HIV-1 seropositivity in prostitutes was associated with Ethiopian nationality, working as a street prostitute, and residing in Djibouti for two years or less. We suggest that prostitution, particularly street prostitution, is a major route of HIV-1 transmission in Djibouti.
Adolescent↗
Late results of operation for ventricular tachycardia.
We have analyzed results in 54 consecutive patients with recurrent ventricular tachycardia and coronary artery disease in whom we used an aggressive surgical approach involving map-directed ventricular tachycardia ablation, scar excision and left ventricular remodeling, and coronary artery bypass grafting, as well as staged mitral valve replacement when necessary. We have previously shown age greater than 65 years to be an independent predictor of mortality and have excluded such patients from this series. Average age was 56 +/- 7 years. All patients had a previous myocardial infarction; 24% of the infarctions (13/54) were posterior in location. Symptoms included syncope or presyncope in 83% of the patients (45/54), angina in 54% (29/54), and congestive heart failure in 52% (28/54). Extensive coronary artery disease was found in 78% (42/54), and 89% (48/54) had serious compromise of left ventricular function (ejection fraction < 0.40; average ejection fraction, 0.28 +/- 0.12). Only 63% (34/54) appeared to have a resectable left ventricular aneurysm on the preoperative angiogram. Ablation techniques included endocardial excision in 82% (44/54), with the addition of cryoablation in 60% (32/54), and balloon electric shock ablation in 22% (12/54); coronary artery bypass grafting was performed in 85% (46/54). There were four hospital deaths (7%). The surgical cure rate (no inducible VT at postoperative electrophysiologic study was 72% (39/54). During follow-up (mean, 50 +/- 31 months) there have been six late deaths (1 sudden death, 1 stroke, 4 congestive heart failures with or without mitral regurgitation). Four patients with progressive congestive heart failure and serious mitral regurgitation have undergone repeat operation for mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Oral erythromycin prophylaxis against Streptococcus pyogenes infection in penicillin-allergic military recruits: a randomized clinical trial.
Historically, military recruits have required benzathine penicillin G to prevent epidemics of Streptococcus pyogenes. In this randomized clinical trial, low-dose oral erythromycin was evaluated as an alternative for prophylaxis against group A beta-hemolytic streptococci in penicillin-allergic recruits. US Marine Corps recruits (186) reporting penicillin allergy were randomly given either oral erythromycin (250 mg twice a day) or a vitamin (one tablet daily) for 60 days. Evidence of infection was defined as a two-dilution rise in anti-streptolysin O titer. The erythromycin group had a significantly lower risk of S. pyogenes infection than did the vitamin group (relative risk 0.44; 95% confidence interval, 0.22-0.89). There was no significant difference among the treatment groups in isolation of group A beta-hemolytic streptococci from throat cultures. Low-dose oral erythromycin appears as effective as benzanthine penicillin G in preventing S. pyogenes infection.
Administration, Oral↗
Seroprevalence of hepatitis A, B, and C in a United States military recruit population.
One thousand five hundred thirty-eight U.S. Navy and Marine Corps enlisted recruits were tested for hepatitis A, B, and C serologic markers. The recruit population (mean age, 19 years) was 91% male, 69% white, 17% black, 9% Hispanic, 2% Filipino, and 2% "other" racial/ethnic group. Anti-HAV was found in 129 (8.4%) recruits, anti-HBc in 35 (2.3%), HBsAg in 5 (0.3%), and anti-HCV in 4 (0.3%). For recruits born in the U.S., the prevalence of anti-HAV and anti-HBc was 5.5% and 1.3%, respectively; for the 7% of recruits born outside the U.S., the prevalence was 44.9% and 14.0%, respectively. By logistic regression analysis, seropositivity for hepatitis A and B was independently associated with age, nonwhite racial/ethnic groups, and birth outside of the U.S. This study indicates that there is a relatively low risk of hepatitis A, B, and C infection among Navy and Marine Corps recruits.
Adolescent↗
Hyperendemic Streptococcus pyogenes infection despite prophylaxis with penicillin G benzathine.
BACKGROUND: In closely confined populations, in which epidemics of Streptococcus pyogenes infection are common, penicillin G benzathine has long been used prophylactically to reduce morbidity from this pathogen. We report on our investigations of the effectiveness of penicillin G benzathine prophylaxis at a military recruit camp. METHODS: We prospectively studied the rates of pharyngeal colonization and infection by S. pyogenes among 736 male U.S. Marine Corps recruits from January through March 1989. Throat swabs for culture, clinical data, and questionnaire data were obtained during six examinations at intervals of two weeks. Serum samples obtained before training, after training, and from acutely ill recruits were analyzed with use of an antistreptolysin O microtitration technique. RESULTS: Although 93 percent of the recruits received prophylaxis with two intramuscular injections of 1.2 million units of penicillin G benzathine each (administered 30 to 39 days apart), 33 percent of the recruits were colonized by S. pyogenes, and 42 percent had infection (as defined by a two-dilution increase in the antistreptolysin O titer). Thirty-seven percent of 265 recruits who reported a sore throat and were infected with S. pyogenes did not seek medical attention. The recruits who were allergic to penicillin (7 percent of the total), who received no prophylaxis, were more likely to be colonized; an increased risk of colonization and infection among the nonallergic recruits was associated with the presence of a higher percentage of allergic recruits in the platoon. After the study was completed, all recruits who were allergic to penicillin were prescribed 250 mg of oral erythromycin twice daily (a total daily dose of 500 mg) for 60 days. Subsequently, the average weekly rate of clinically evident S. pyogenes pharyngitis fell by more than 75 percent. CONCLUSIONS: If the prevention of S. pyogenes infection is to be effective in closely confined populations such as military recruits, prophylactic antibiotics must be administered to all members of the population. Exempting those who are allergic to penicillin may create a bacterial reservoir from which infection can be transmitted to nonallergic members of the population.
Drug Hypersensitivity↗