Biomedical subjects
R A Goodman
Publications and source records attributed to R A Goodman.
Immunization programs.
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Morbidity and mortality associated with influenza B in the United States, 1979-1980. A report from the Center for Disease Control.
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Indochinese refugees and infectious disease.
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Tuberculosis in Indochinese refugees.
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Influenza and influenza vaccination.
The hemagglutinin and neuraminidase surface antigens of the influenza virus periodically undergo major or minor structural changes. These influence epidemiologic patterns and the composition of vaccine. Annual vaccination is recommended for individuals at increased risk of complications from lower respiratory tract infections. Vaccine for 1979-80 contains antigens representative of three viruses and is closely related to the vaccine of 1978-79. Amantadine is approved for prophylaxis and treatment.
Nosocomial influenza A (H1N1) infection.
In late February 1979, 21 days after admission to the hospital for a diagnostic evaluation of weight loss and abdominal pain, a 25-year-old female developed nosocomial influenza. The case was presumed to be associated with an outbreak of influenza involving nursing students at the same hospital. Viral cultures obtained from the patient and two of the nursing students yielded influenza A/Brazil/11/78 (H1N)-likelike viruses. A retrospective study of the 136 nursing students indicated that 58 (43 percent) had experienced an influenza-like illness during the period mid-December 1978 to mid-March 1979 with a peak of 50 (37 percent) illnesses occurring the month of February. To the authors' knowledge, the illness involving this patient represents the first reported nosocomial case of influenza A/Brazil/78 in literature.
Norwalk gastroenteritis associated with a water system in a rural Georgia community.
An outbreak of acute gastroenteritis occurred during January 4-9, 1982, in a rural community in north Georgia. A systematic telephone survey revealed that 63% of persons living in homes served by the community water system had symptoms of acute gastroenteritis in contrast to 9% of persons in homes served by private wells or other sources (P less than .001). A fourfold rise in antibody titer to the Norwalk virus occurred in 20 of 22 serum pairs obtained from ill persons. Fecal coliforms (greater than 16 MPN/100 ml) were detected in a spring which served as one water source for the community system. Surface runoff from a heavy rainfall, which preceded the outbreak, may have contaminated the system. Outbreaks of gastroenteritis should be promptly reported and investigated to facilitate corrective measures and to identify causative agents such as Norwalk virus.
A role for the infection control specialist in child day care?
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.
Relationship between day care and health care providers.
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.
Improved applicator-patient coupling in microwave-induced hyperthermia.
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.
The prevention of ankle sprains in sports. A systematic review of the literature.
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.
Quantifying the disease impact of alcohol with ARDI software.
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.
Training and service in public health practice, 1951-90--CDC's Epidemic Intelligence Service.
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.
Epidemiologic field investigations by the Centers for Disease control and Epidemic Intelligence Service, 1946-87.
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.
Alcohol and fatal injuries: temporal patterns.
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.
Methodological alternatives for measuring premature mortality.
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.