Developing case definitions for symptom-based conditions: the problem of specificity.
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Fatigue Syndrome, Chronic↗
Biomedical subjects
K C Hyams
Publications and source records attributed to K C Hyams.
A survey of women's health care needs on U.S. Navy ships.
A total of 628 female and 526 male U.S. military personnel completed a health survey questionnaire at the completion of four shipboard deployments lasting 10 to 180 days (mean, 57 days). During deployment, women visited clinic (sick call) at significantly higher rates than men: 189 versus 117 visits per week per 1,000 personnel. Except for generally minor gynecological conditions, women and men had similar medical problems. Upper respiratory complaints and requests for contraceptive pills were the most common reasons for clinic visits among women. The majority of sailors felt that they had received appropriate medical care, although fewer women (66%) than men (78%) were satisfied. Levels of cigarette and alcohol use and sexual activity were comparable among women and men and corresponded to those of the general U.S. population of young adults. Because of high levels of health, most medical needs of women sailors can be managed readily by providing routine gynecological care and by minor additions to the shipboard pharmacy.
Adolescent↗
Identification of Gulf War syndrome: methodological issues and medical illnesses.
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Humans↗
Oropouche virus transmission in the Amazon River basin of Peru.
Seroepidemiologic studies were conducted to determine the prevalence of Oropouche (ORO) viral antibody, risk factors, and the incidence of infection among residents of the Amazon region of Peru. Blood samples, as well as demographic, cultural, and medical history data, were collected from residents in a sector of the city of Iquitos and in an adjacent rural and three neotropical rain forest communities. Blood specimens were obtained approximately one year later from a cohort of the same study subjects who were negative for ORO antibody on the initial cross-sectional survey. Sera were tested for ORO IgG antibody by an enzyme-linked immunosorbent assay. Antibody prevalences were 35% for residents of the urban population, 24-46% for the forest communities, and 18% for the rural community. Antibody prevalence increased with age, and subjects who were seropositive were significantly (P = 0.001) older (mean = 33 years) than the seronegative subjects (mean = 15 years). Multivariate analysis revealed that only age, urban and forest residence, and occupation as a farmer or housekeeper remained significantly associated with seropositivity. Seroconversion data for the same populations one year later demonstrated evidence of ORO viral infection among 28% of the residents in the rural community and 2% or less in the forest and urban communities. Oropouche virus infection was significantly associated with older age (P = 0.04) in the rural community (P < 0.001). These data support prior evidence of ORO viral infection among residents of Iquitos and surrounding villages and suggest that transmission of this virus occurs continuously in the population of this area of the Amazon basin.
Adolescent↗
Immunogenicity of recombinant hepatitis B vaccine among infants of mothers with active schistosomiasis.
A study of the immunogenicity of a recombinant hepatitis B vaccine was conducted among 385 Egyptian infants, 191 (49.6%) of whom were born to mothers with moderately active Schistosoma mansoni infection (mean egg count = 224 eggs/g of feces). All mothers were seronegative for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen. Infants were vaccinated with a 2.5-microg dose of this vaccine, given along with diphtheria, tetanus, and pertussis (DTP) vaccine, at the ages of two, four, and six months. Serum samples taken from each infant at nine months of age were tested for HBsAg, antibody to hepatitis B core antigen, and quantitatively for antibody to hepatitis B surface antigen (anti-HBs). There was no significant difference (P = 0.1) between anti-HBs titers in infants of S. mansoni-infected mothers (mean = 539 mIU/ml) and in infants of noninfected mothers (mean = 377 mIU/ml). This study shows that there was no apparent effect of maternal schistosomiasis infection on the immune response of these infants to vaccination.
Adult↗
Short report: evidence of worldwide transmission of hepatitis G virus.
Hepatitis G virus (HGV) has been recently documented in the Americas, Europe, and Australia. Distinct risk populations from North Africa, South America, and Southeast Asia were screened for HGV, in addition to hepatitis B and C viruses. First time recognition of HGV is described from Egypt and Indonesia. Notable is the high proportion of HGV positive individuals among multiply transfused children, ranging from 24% of those sampled from Egypt to 32% in Indonesia. Also, data from Peru suggest the likely association of HGV infection with progressive liver disease. Hepatitis G virus should be considered a world-wide health concern.
Flaviviridae↗
Epidemic and sporadic hepatitis E virus transmission in West Kalimantan (Borneo), Indonesia.
A cross-sectional survey was conducted in West Kalimantan (Borneo), Indonesia to geographically profile hepatitis E virus (HEV) prevalence in the riverine areas recognized as the foci of epidemic HEV transmission in 1987. Additionally, a contiguous, although distinct, population with no identifiable historical exposure to epidemic HEV was surveyed downstream for comparative purposes. Eight hundred eighty-five sera were assayed by enzyme immunoabsorbent assay for anti-HEV IgG and anti-hepatitis A virus (HAV) IgG markers. A very high percent (90%) of both the outbreak and comparison populations was anti-HAV IgG positive by the age of nine years. In contrast, the prevalence of anti-HEV IgG in the outbreak area (50%) was significantly higher than in the comparison area (23%) (P < 0.0001). In both the outbreak and comparison areas, anti-HEV IgG prevalence increased with age ( < 0.0001), except for the group > or = 50 years of age. The prevalence (53%) of antibody to HEV in the population > or = seven years of age from the outbreak area (alive during the actual 1987 outbreak) was significantly (P < 0.0001) greater than among the children < seven years of age (born after the outbreak) (15%). However, anti-HEV IgG prevalence among the population from the comparison area did not differ significantly between the > or = seven- (23%) and < seven- (20%) year-old age groups. The percentage of anti-HEV IgG-positive individuals among males (47%) from the outbreak area was lower (P < 0.05) compared with females (55%). While overall usage of river water for drinking purposes was not universal, dependence on river water as a primary source was significantly higher (P < 0.001) in households from the outbreak area (60%) compared with the comparison area (30%). This study indicates persistence of an anti-HEV IgG response in a large percentage of the population seven years after an epidemic of HEV infections. Also, the relatively high prevalence (15%) of anti-HEV in children < seven years of age from the outbreak area reflects continuing, sporadic infections.
Adolescent↗
A survey of outpatient visits in a United States Army forward unit during Operation Desert Shield.
Reports suggest that deployed soldiers during Operations Desert Shield and Desert Storm remained healthy, but primary care data are limited. We reviewed the outpatient visit surveillance data from the 3d Armored Cavalry Regiment to obtain information regarding soldiers' health in the field. Nontraumatic orthopedic problems accounted for the highest incidence of primary health care visits, followed by unintended injuries, gastrointestinal, respiratory, and dermatologic conditions. Visits for heat injuries, sexually transmitted diseases, unexplained fever, and psychiatric problems were low, probably due to preventive measures. These results suggest that increased prevention to decrease orthopedic problems and unintended injuries may substantially reduce outpatient visits during future deployments. Medical surveillance during future deployments can be improved by taking advantage of current advances in technology to facilitate patient data retrieval and provide timely information to first- and second-echelon medical personnel.
Ambulatory Care↗
Women in the Persian Gulf War: health care implications for active duty troops and veterans.
The health of women who participated in Operations Desert Shield/Storm was evaluated to better understand the medical requirements of deployed military women and women veterans of the Persian Gulf War. Women's health care needs during the Persian Gulf War were reported to be very similar to those of men, with the exception of gynecologic problems, which generally were not serious and did not require hospitalization. However, insufficient data were obtained to identify specific health care needs among deployed women troops. During the 5 years since the end of the Persian Gulf War, no unique health problems have been identified among women veterans. Whether there will be any exceptional long-term health care requirements currently is unknown. Nevertheless, important medical problems of all women-reproductive issues, menopause, osteoporosis, joint disease, breast cancer, heart disease, and stroke-inevitably will be major considerations when caring for this population of war veterans.
Adult↗
War syndromes and their evaluation: from the U.S. Civil War to the Persian Gulf War.
PURPOSE: To better understand the health problems of veterans of the Persian Gulf War by analyzing previous war-related illnesses and identifying possible unifying factors. DATA SOURCE: English-language articles and books on war-related illnesses published since 1863 that were located primarily through a manual search of bibliographies. DATA EXTRACTION: Publications were assessed for information on the clinical characteristics of war-related illnesses and the research methods used to evaluate such illnesses. DATA SYNTHESIS: Poorly understood war syndromes have been associated with armed conflicts at least since the U.S. Civil War. Although these syndromes have been characterized by similar symptoms (fatigue, shortness of breath, headache, sleep disturbance, forgetfulness, and impaired concentration), no single recurring illness that is unrelated to psychological stress is apparent. However, many types of illness were found among evaluated veterans, including well-defined medical and psychiatric conditions, acute combat stress reaction, post-traumatic stress disorder, and possibly the chronic fatigue syndrome. No single disease is apparent, but one unifying factor stands out: A unique population was intensely scrutinized after experiencing an exceptional, life-threatening set of exposures. As a result, research efforts to date have been unable to conclusively show causality, have been subject to reporting bias, and have lacked similar control populations. In addition to research limitations, war syndromes have involved fundamental, unanswered questions about the importance of chronic somatic symptoms and the factors that create a personal sense of ill health. CONCLUSION: Until we can better understand what constitutes health and illness in all adult populations, we risk repeated occurrences of unexplained symptoms among veterans after each war.
Adult↗
Molecular cloning and disease association of hepatitis G virus: a transfusion-transmissible agent.
An RNA virus, designated hepatitis G virus (HGV), was identified from the plasma of a patient with chronic hepatitis. Extension from an immunoreactive complementary DNA clone yielded the entire genome (9392 nucleotides) encoding a polyprotein of 2873 amino acids. The virus is closely related to GB virus C (GBV-C) and distantly related to hepatitis C virus, GBV-A, and GBV-B. HGV was associated with acute and chronic hepatitis. Persistent viremia was detected for up to 9 years in patients with hepatitis. The virus is transfusion-transmissible. It has a global distribution and is present within the volunteer blood donor population in the United States.
Acute Disease↗
Hepatitis E virus infection in Peru.
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Adolescent↗
Sporadic acute hepatitis caused by hepatitis E virus in Egyptian adults.
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Acute Disease↗
Hepatitis B virus (HBV)/hepatitis D virus (HDV) coinfection in outbreaks of acute hepatitis in the Peruvian Amazon basin: the roles of HDV genotype III and HBV genotype F.
Recurring outbreaks of acute hepatitis have been a significant cause of morbidity and mortality among Peruvian military personnel stationed in the Amazon Basin region of Peru. The role of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection was investigated as the possible cause of acute hepatitis among 88 military patients stationed at four different jungle outposts during 1992-1993. Analysis of serum markers indicated that 95% (84/88) had evidence of acute HBV infection; 64% (54/84) were also infected with HDV. Genetic analysis of PCR-amplified HDV and HBV fragments showed exclusively HDV genotype III and HBV genotype F. Furthermore, HDV RNA sequences were similar among patients from the same outpost but different from those at other jungle locations. The data suggested focal sources of HDV infection in the jungle environment of the outposts and, further, confirmed the unique association of HDV genotype III with severe cases of human disease in northern South America.
Acute Disease↗
The potential effect of global warming on the geographic and seasonal distribution of Phlebotomus papatasi in southwest Asia.
The distribution of Phlebotomus papatasi in Southwest Asia is thought to be highly dependent on temperature and relative humidity. A discriminant analysis model based on weather data and reported vector surveys was developed to predict the seasonal and geographic distribution of P. papatasi in this region. To simulate global warming, temperature values for 115 weather stations were increased by 1 degree C, 3 degrees C, and 5 degrees C, and the outcome variable coded as unknown in the model. Probability of occurrence values were then predicted for each location with a weather station. Stations with positive probability of occurrence values for May, June, July, and August were considered locations where two or more life cycles of P. papatasi could occur and which could support endemic transmission of leishmaniasis and sandfly fever. Among 115 weather stations, 71 (62%) would be considered endemic with current temperature conditions; 14 (12%) additional stations could become endemic with an increase of 1 degree C; 17 (15%) more with a 3 degrees C increase; and 12 (10%) more (all but one station) with a 5 degrees C increase. In addition to increased geographic distribution, seasonality of disease transmission could be extended throughout 12 months of the year in 7 (6%) locations with at least a 3 degrees C rise in temperature and in 29 (25%) locations with a 5 degrees C rise.
Animals↗
Short-term IgM and IgG antibody responses to hepatitis E virus infection.
53 adult patients with acute hepatitis caused by hepatitis E virus were identified by the presence of IgM antibody to hepatitis E virus, and followed for 12 months to evaluate the kinetics of anti-HEV antibodies. All but 1 female Kuwaiti patient were expatriate workers from the Indian subcontinent, temporarily working in Kuwait. Follow-up samples obtained at 1, 3, 6 and 12 months were evaluated for IgM and IgG antibodies to hepatitis E virus. IgM-class antibodies to hepatitis E virus were detectable in 12/27 (44%) patients at 1 months, in 0/26 at 3 months, in 0/8 at 6 months and 0/6 at 12 months. IgG antibodies to hepatitis E virus were detectable in 46/47 (98%) at onset, 26/27 (96%) at 1 month, in 26/29 (90%) at 3 months, 16/16 (100%) at 6 months and 8/8 (100%) at 12 months of follow-up. This study suggests that IgM antibodies to hepatitis E virus decline rapidly after an acute infection but IgG antibodies to hepatitis E virus persists for at least 1 year in many patients.
Acute Disease↗
Assessment of arthropod vectors of infectious diseases in areas of U.S. troop deployment in the Persian Gulf.
Beginning in August 1990, approximately 800,000 coalition troops were deployed to the Persian Gulf during Operations Desert Shield and Desert Storm. There was substantial concern about arthropod-borne diseases, particularly sand fly fever and cutaneous leishmaniasis, because of high morbidity rates in the Persian Gulf during World War II (WWII). In sharp contrast to WWII, there was no report of sand fly fever among coalition forces and only 31 cases of leishmaniasis among 697,000 U.S. troops. To further evaluate the risk of arthropod-borne diseases, an entomologic survey was conducted in 12 areas of Kuwait and Saudi Arabia. A total of 1,556 arthropods was collected during four survey periods in 1992. The suspected vectors of cutaneous Leishmania major infection, sand fly fever, West Nile fever, Rift Valley fever, and Crimean-Congo hemorrhagic fever were identified; however, there was no evidence of arboviruses or Leishmania among collected specimens nor from 51 trapped rodents. There are several possible reasons for the low risk of arthropod-borne infectious diseases among Desert Shield/Storm troops in an area where suspected vectors frequently were found: the use of insecticides and repellents, and the deployment of most ground troops to the open desert during the cooler, winter period--conditions least favorable for the transmission of arthropod-borne diseases.
Animals↗