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At least 217 records · Page 12Linked to original sources
PubMed1984

Waterborne giardiasis at a mountain resort: evidence for acquired immunity.

In November 1981, an outbreak of waterborne giardiasis occurred at a popular ski resort in Colorado. Stratification of illness by consumption of municipal tap water showed a striking dose-response, with an attack rate of 42 per cent among persons who drank six or more glasses of water per day. Filtered water samples revealed Giardia cysts in specimens both before and after treatment, and several deficiencies were found in the water treatment facility. Residents who had lived in the area greater than 2 years had a lower attack rate for illness than short-term residents.

Animals↗
PubMed1999

An outbreak of Campylobacter enteritis on an island resort, north Queensland.

An outbreak of Campylobacter enteritis among staff on a resort island in north Queensland is reported. Untreated rainwater and food from the staff dining room were initially suspected as possible sources of infection but Campylobacter species were not isolated from any environmental samples. Faecal contamination was detected in four rainwater tanks. A case control study involved a total of 23 cases (7 confirmed and 16 probable), 3 of whom required hospitalisation. There was a strong association between gastrointestinal illness and consumption of water from a dispenser in the staff restaurant that had probably been filled from one of the contaminated tanks. We conclude that this was probably a waterborne outbreak and postulate that Campylobacter species were introduced into one or more of the tanks by contamination with the faeces of wild animals.

Adolescent↗
PubMed1986

Hypothermia among resort skiers: 19 cases from the Snowy Mountains.

Even in relatively temperate environments, accidental hypothermia is a potentially lethal complication of exposure. We have reviewed our experience of accidental hypothermia among recreational alpine skiers at an Australian resort during the 1983 and 1984 seasons. There were 19 cases of accidental hypothermia, which occurred in 10 men and nine women who were aged between six and 47 years (mean age, 15.9 years) and who had rectal temperatures that ranged from less than 35 degrees C to 36 degrees C. The temperature at presentation to the Ski Injury Clinic was less than 35 degrees C in seven cases. One patient presented to the Clinic with a gastrointestinal haemorrhage in addition to hypothermia, and one was initially thought to be suffering from alcohol intoxication. Two patients were lost in the snow overnight. All patients were removed from the snow, changed into warm dry clothes where necessary, and their body temperatures allowed to return to normal spontaneously (17 patients), or were exposed to heat actively by means of inhaled, heated, humidified air (two severely obtunded patients). All patients responded satisfactorily. There were no deaths and no sequelae. We conclude that all skiers should be advised to wear effective thermal insulation, and to ski with a partner to ensure that adequate care is taken to prevent accidental hypothermia. Inhalational "warming" is effective in the treatment of hypothermia in obtunded patients.

Accidents↗
PubMed2000

Palliative treatments of last resort: choosing the least harmful alternative. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel.

Comprehensive palliative care, as exemplified by many state-of-the-art hospice programs, is the standard of care for the dying. Although palliative care is very effective, physicians, nurses, patients, families, and loved ones regularly face clinically, ethically, legally, and morally challenging decisions throughout the dying process. This is especially true when terminally ill patients are ready to die in the face of complex, difficult-to-treat suffering and request assistance from their health care providers. Although physician-assisted suicide has received the most attention as a potential last-resort response, this practice remains illegal in the United States except in Oregon, and even there it is relatively infrequent. More commonly, decisions are made about accelerating opioid therapy for pain, foregoing life-sustaining therapy, voluntarily stopping eating and drinking, and administering terminal sedation in response to unacceptable suffering. The moral distinctions between these practices are critical to some but relatively inconsequential to others. This paper illustrates, through summaries of real clinical cases, how each of these practices might be used in response to patients in particular clinical circumstances, keeping in focus the patient's values as well as those of families, other loved ones, and health care providers. The challenge is to find the least harmful solution to the patient's problem without abandoning patients and their loved ones to unacceptable suffering or to acting in a more deleterious way on their own.

Adult↗
PubMed1995

Tourist health services at tropical island resorts.

An unfamiliar holiday environment may give rise to a range of common and unique medical conditions and injuries. Based on a six-month retrospective analysis of clinic records, the present study reports a detailed profile of health services provided for guests at three tropical island tourist resorts. A total of 1183 clinic visits were analysed; 735 (62 per cent) concerned medical conditions, while 448 (38 per cent) were related to injuries. The most common medical conditions treated were respiratory, digestive, skin problems, eye disorders, and genito-urinary complaints. Injuries included lacerations, bites and stings, sprains and fractures. Health services consisted mainly of medication, specialist nursing care and first aid. Study findings highlight the advantages of using an internationally accepted classification system for primary health research, and the critical role of the nurse in tourist health services.

Australia↗
PubMed2005

Transmission of malaria in resort areas--Dominican Republic, 2004.

Malaria is caused by any of four Plasmodium parasites carried by Anopheles mosquitoes and usually is transmitted by the bite of an infective female Anopheles. In rural areas of the Dominican Republic, P. falciparum malaria is endemic, with the highest risk in the far western region of the country, and prophylactic medication with chloroquine is recommended for incoming travelers. Conversely, urban and resort areas in the Dominican Republic have been considered nonmalarious, and prophylactic medication has not been recommended for persons traveling to these areas. However, since November 2004, CDC has received reports of three malaria cases in U.S. travelers returning from areas in La Altagracia and Duarte provinces previously considered nonmalarious. An additional 14 cases of malaria in La Altagracia Province, in the far eastern region of the country, have been reported in European and Canadian travelers. This report describes three of these 17 malaria cases and summarizes the overall investigation, which led to expansion of CDC recommendations for chloroquine prophylaxis to include all of La Altagracia and Duarte provinces.

Adult↗
PubMedDate not supplied

[Obtaining informed consent and resorting to ethical committee in clinical and epidemiological research in Italy. A survey].

OBJECTIVES: To describe how informed consent (CIn) and ethical review (CEt) are obtained in the Italian clinical and health research. DESIGN: survey SETTING: 6 Italian and 7 foreigner journals in the years 2001 and 2002. SAMPLE: 157 original or short articles, letters and case reports for which a member of an Italian institution was the corresponding author. MAIN OUTCOME: Mention in the text of CIn and CEt procedures. RESULTS: In 42% of such studies (95% CI: 35-50%), informed consent was obtained; in 30% (95% CI: 23-37%), ethical committee approval was obtained, in 27% (95% CI: 21-35%) both had been obtained. The probability of informed consent and ethical review varied with type of data used (primary or secondary source). No significant differences, however, were noted based on the type of study population (vulnerable or non-vulnerable), the year, or the country in which the article was published (Italy or elsewhere). Keywords search in the articles text showed that ethical aspects of the study were not debated. Ethical procedures were synthetically reported as a rule, yet there were differences in their formulation. CONCLUSIONS: The limited resorting to CIn and CEt procedures and the concision and variability of their description might depend on the plethora of the ethical, legal, editorial guidelines available for Italian researchers that partially overlap and partially present specific aspects whose interpretation is not free of niceties.

Epidemiology↗
PubMed2005

Bortezomib: new drug. A last resort in myeloma: modest efficacy, major risks.

(1) First-line treatment of multiple myeloma depends first and foremost on the patient's age. There is no standard treatment for relapses and the median survival time after the first relapse is only 12 to 15 months. (2) Bortezomib, a cytotoxic agent, inhibits the 26S proteasome involved in protein breakdown in mammalian cells. It is licensed for use in myeloma after multiple treatment failure. (3) Three dose-finding studies showed some effects of 1 mg/m2 and 1.3 mg/m2 bortezomib administered twice a week for two weeks, with each course followed by a 10-day treatment-free period. It is not known whether 1.3 mg/m2 is more effective than 1 mg/m2. (4) In a non comparative trial that included 202 patients with multidrug-resistant myeloma, progression-free survival time increased to a median of 6.6 months (compared to 3.3 months after previous relapses), and the median overall survival time was 7 months in the 75% of patients who did not respond and more than 15 months in the 25% of responders. However, given the heterogeneous nature of the study population the evidence from this trial is rather weak. (5) An unblinded comparative trial including 54 patients failed to show whether bortezomib 1.3 mg/m2 was more effective than bortezomib 1 mg/m2 in terms of clinical outcome. Another comparative trial including 669 patients indicated that bortezomib was more effective than dexamethasone in terms of the median time to disease progression (5.7 months versus 3.6 months). (6) Animal studies indicate that bortezomib is cardiotoxic and neurotoxic, and that the interval between the maximal tolerated dose and the fatal dose is very small. Experience with bortezomib use is too limited to know the possible clinical repercussions of these experimental findings. (7) Adverse effects were frequent and varied in clinical trials. They included fatigue, nausea and vomiting, diarrhea, anemia, thrombocytopenia and peripheral neuropathies. They affected 30% to 60% of patients overall, and were severe in about 10% to 20% of patients. Other adverse effects included hypotension, fever, headache, pain and dehydration. (8) Bortezomib is metabolised by cytochrome P 450 isoenzyme 3A4, and this implies a high risk of drug-drug interactions. (9) Each vial of bortezomib contains more of the drug than is needed for one injection. This is not only wasteful, but also carries a risk of overdosing, with potentially serious consequences, should the entire contents be injected by mistake. (10) Bortezomib may be used as a last resort in some patients with multiple myeloma, but the individual risk-benefit balance must be carefully weighed in each case.

Antineoplastic Agents↗
PubMed2006

Tipranavir: new drug. HIV protease inhibitor. A last resort.

(1) Despite the availability of multidrug antiretroviral therapies, about 3% to 4% of HIV-infected patients exhaust nearly all available treatment options. (2) Tipranavir, an HIV protease inhibitor, is marketed in France for patients with multidrug resistance. (3) Two randomised unblinded trials are currently comparing the tipranavir + ritonavir combination with other protease inhibitors as adjuncts to optimised antiretroviral treatment in 1159 patients selected on the basis of laboratory criteria. Interim results at 48 weeks show that significantly more patients have an undetectable viral load with tipranavir + ritonavir than with other protease inhibitors (22.8% versus 10.2%). Enfuvirtide co-administration seems to reinforce the effect of tipranavir + ritonavir. In contrast, tipranavir does not seem to be more effective than other HIV protease inhibitors to which a given patient's viral population remains sensitive. (4) Tipranavir seems to be associated with higher risks of hepatic disorders, hypertriglyceridaemia, hypercholesterolaemia, and potentially severe bleeding than other protease inhibitors. (5) Tipranavir inhibits the activity of most cytochrome P450 isoenzymes. This creates a strong potential for drug interactions, but clinical experience is limited. (6) Patients on tipranavir must take 2 capsules twice a day. (7) In practice, tipranavir should be saved as a last-resort HIV protease inhibitor.

Cost-Benefit Analysis↗
PubMed1991

Bolus administration of 5 mg epinephrine as a treatment of last resort for cardiac arrest.

There is some evidence that the dose of epinephrine currently recommended for resuscitation is low. This study examines the effect of bolus administration of 5 mg of epinephrine when given as an agent of last resort for cardiac arrest. The experimental design called for the administration of high-dose epinephrine at the point where resuscitative efforts would have ordinarily been stopped. Resuscitation was then continued for a minimum of five minutes so that any changes in rhythm or return of spontaneous circulation could be noted. Eighty-five consecutive patients undergoing resuscitation in our Emergency Department were enrolled in this study. Twenty-eight (33 percent) exhibited a change in cardiac rhythm. Of these 28 patients, seven (8 percent) developed pulses. Of these seven patients, four expired in the Emergency Department, one survived to admission but expired two days later, and two patients survived to discharge. We conclude that bolus administration of 5 mg of epinephrine may be useful in treating cardiac arrest refractory to conventional therapy.

Adult↗
PubMed1990

[Percutaneous aortic valvuloplasty as a last resort in patients with critical aortic valve stenosis].

Emergency aortic valvuloplasty was performed as a last resort in 34 patients with an average age of 76 years with critical aortic stenosis in the terminal stages with congestive cardiac failure or cardiogenic shock. Emergency aortic valve replacement was considered to be too risky in these cases. The valve was dilated in all patients, resulting in a fall in mean peak-to-peak pressure gradients from 59 mmHg to 21 mmHg and an increase in valve surface area from 0.42 cm2 to 0.85 cm2. Significant improvement in myocardial function was observed immediately after the procedure with an increase of the cardiac index from 1.77 l/min/m2 to 2.07 l/min/m2 and of the ejection fraction from 28% to 35%. Complications were rare. There were no deaths or cerebrovascular accidents during the valvuloplasty procedure. Two patients died in hospital (6%) after the dilatation and two other patients who had persistent pulmonary oedema, underwent surgery; one died and the other had a good surgical result. A clear cut clinical improvement was obtained in the other 30 patients. The patients were followed up for an average of 15 +/- 7 months during which 15 died (50%), 6 +/- 5 months after dilatation. The other 15 survivors have a significant and unhoped for functional improvement. Three young patients later underwent surgical valve replacement in good clinical conditions with the same operative risk as that of standard candidates for aortic valve surgery. One other patient was operated on successfully during another relapse of cardiac failure. These results show that aortic valvuloplasty may be undertaken with a low risk even in the most critical clinical situations and that the procedure rapidly relieves the invalidating symptoms. It may be used as a bridge to surgery in patients with an unacceptable operative risk. The indications should be very flexible in young patients in terminal cardiac failure with cardiogenic shock or refractory pulmonary oedema.

Aged↗
PubMed1989

Calculation of crystalline lens radii without resort to phakometry.

A computing scheme was developed in 1988 to determine the equivalent powers of the eye and its crystalline lens without resort to phakometry. An adaptation to this scheme is described which allows calculation of the crystalline lens radii using an assumed average value for Q. The values obtained for lens radii using this method compare well with phakometric measurements made on 36 eyes (ocular refraction range -9.37 D to + 3.14 D) which suggests that the variations in Q for a large proportion of the population are small.

Accommodation, Ocular↗
PubMed1989

Thoracic outlet syndrome: resectioning the first rib as a last resort.

1. Thoracic outlet syndrome is a general term referring to compression neuropathies of the brachial plexus and subclavian vessels. 2. The symptoms result from compression of the brachial plexus or the subclavian vessels; the most common are pain and paresthesia but these may be accompanied by complaints of muscle weakness and easy fatigability of the extremity. 3. First rib resection has been proven valuable; however, because of the possibility of severe and irreversible complications, surgery should be used as a last resort.

Humans↗
PubMed1985

Legionnaires' disease in the Caribbean. An outbreak associated with a resort hotel.

Outbreaks of legionnaires' disease (LD) in tourists visiting Italian and Spanish resorts have been recently reported. An unusual number of reports of LD in tourists visiting the US Virgin Islands prompted an investigation of risk factors for development of LD in this area. Twenty-seven cases of LD were identified between 1979 and 1982 through press reports, personal communication, the national LD surveillance system, a review of hospital records, and a mail survey. Twenty-four of 27 persons with the disease had visited St Croix and 12 of them had stayed at a single hotel in 1981. Available evidence suggested that infection was due to Legionella pneumophila serogroup 1; L pneumophila serogroups 1 and 3 and several new Legionella species were isolated from the potable water system at the hotel. Following hyperchlorination of the potable water system, no further cases of LD in hotel visitors have been identified to date.

Disease Outbreaks↗
PubMed1981

[Changes in the phospholipid content of blood in diabetes mellitus before and after complex treatment at the Dzhermuk health resort].

The studies were carried out at Dzhermuk clinical sanatorium in 53 patients with moderate and severe diabetes mellitus. Qualitative and quantitative phospholipid content of the whole blood and total cholesterol and beta-lipoproteins of the blood serum were determined. The patients show the constant qualitative content of the blood phospholipids and marked quantitative variations in several phospholipid fractions along with a relatively stable condition of other lipid metabolism indices. The degree of phospholipid fraction quantitative disorders is dependent on the patient's age and diabetes mellitus severity, lipid-lipoid ratio tending to decrease in the neutral phospholipid per cent content of the total phospholipid sum. The treatment at the health resort is accompanied by normalization or a tendency to normalize the blood phospholipid quantitative content and lipid-lipoid ratio. The treatment efficiency is directly dependent on the patient's age, duration and severity of the disease.

Adult↗
PubMed1994

The management of health and safety hazards in tourist resorts. World Tourism Organization.

The enjoyment of a holiday has to do with landscape, buildings, people, and their activities. For truly sustainable development, these components need to become better integrated. Ways of achieving this were discussed at the IVth World Health Organization International Conference on Tourist Health, Rimini, Italy, in May 1994. It was agreed that attention to the health enhancing aspects of each component in the built environment is essential. Risks to health from man-made hazards in tourist resorts therefore need to be eliminated where possible, or otherwise minimised, contained or controlled. A systematic approach is outlined here in which owners, managers, operators, workers and users all have responsibilities and in which occupational physicians can contribute.

Accident Prevention↗