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At least 739 records · Page 41Linked to original sources
PubMed1998

Acalculous cholecystitis and septicemia caused by non-O1 Vibrio cholerae: first reported case and review of biliary infections with Vibrio cholerae.

The first case of septicemic acute acalculous cholecystitis caused by non-O1 Vibrio cholerae is described in a healthy traveler, and biliary tract infections from V. cholerae are reviewed. Immediately after a vacation in Cancun, Mexico, a 55-year-old man developed acute cholecystitis. Blood and bile cultures grew non-O1 V. cholerae. At surgery, the gallbladder was acalculous, inflamed, distended, and nearly ruptured. Pathogenetic factors may have included diarrhea prophylaxis with bismuth subsalicylate, distension of the gallbladder from illness-induced fasting, and bacterial toxins in the gallbladder. The patient received i.v. cephapirin, followed by oral cephradine for a total of 10 days, and he made a quick and complete recovery. V. cholerae should be considered in the differential diagnosis of persons from endemic areas who present with cholecystitis or acute jaundice.

Bacteremia↗
PubMedDate not supplied

Phytophotodermatitis: the other "lime" disease.

Phytophotodermatitis is a skin eruption that occurs after contact with photosensitizing compounds in plants and exposure to UV light. There are two common presentations of phytophotodermatitis. Acutely, erythema and vesiculation similar to a severe sunburn are noted. After resolution of the inflammation, the involved skin has marked hyperpigmentation. Many plants have been identified that contain furocoumarins (psoralens), including limes, lemons, and celery. We present a patient with an acute phototoxic eruption and hyperpigmentation after contact with limes during a beach vacation.

Adult↗
PubMed2006

[Visceral leishmaniasis in an immunocompetent subject, acquired in the Pyrenees region].

INTRODUCTION: Visceral leishmaniasis can develop in immunocompetent subjects exposed to a risk of infestation during physical activities outdoors. CASE: A 35-year-old woman was hospitalized for impaired health status with fever, hepatomegaly, splenomegaly, and pancytopenia, which worsened during her stay. Leishmaniasis was finally diagnosed, based on serologic testing and the finding of Leishmania infantum in the sternal aspiration. Eight months earlier, she had spent two weeks at a lake in the Pyrenees. Treatment with meglumine antimoniate was efficacious. COMMENTS: This case is original because of the extent of the organomegaly and its onset after vacation in an area far from those where it is thought to be endemic.

Adult↗
PubMed1989

Characteristics of established group practices in Ontario.

Established group practices in Ontario were surveyed to determine their structure, characteristics and attitudes toward government assistance in the development of group practice. The degree of organization of the groups surveyed was related to size and less than that reported in surveys of United States group practices. Group size and years of operation were strongly associated. Night, weekend and vacation coverage, the use of a unit patient record and the employment of non-physician administrators were reported frequently, and were more common in older and larger groups. As well, fringe benefits, except for professional organization dues, were not commonly provided.

Attitude of Health Personnel↗
PubMed2004

Tick paralysis presenting in an urban environment.

We report the case of a 17-month-old female with tick paralysis presenting to an urban Los Angeles emergency department. The tick was later identified as the North American wood tick, Dermacentor andersoni, and was likely obtained while the family was vacationing on a dude ranch in Montana. We discuss the epidemiology of tick paralysis, a differential diagnosis for health care providers, and methods of detection and removal. Given the increasing popularity of outdoor activities and ease of travel, tick paralysis should be considered in cases of acute or subacute weakness, even in an urban setting.

Female↗
PubMed1998

Travelers' diarrhea. Epidemiology, prevention, and self-treatment.

Risk factors for travelers' diarrhea include adventurous behavior, consumption of unclean water or food, and special hosts like those taking long acting H2 blockers. Approaches to prevention include education about risk factors, which often fails to lead to modification of risky behavior, and chemoprophylaxis with bismuth subsalicylate-containing compounds or antimicrobial agents. Chemoprophylaxis is generally discouraged except in special circumstances and in high-risk hosts. Self-treatment of travelers' diarrhea is successful in limiting the course of diarrhea and minimizing losses of vacation and business time. Current therapeutic options, in order of increasing effectiveness, include attapulgite, BSS-containing compounds, loperamide, antimicrobial agents such as the fluoroquinolones, and the combination of loperamide and an antimicrobial agent. Under study are a nonabsorbed antimicrobial agent, rifaximin, and a novel calmodulin inhibitor, zaldaride. Development and evaluation of vaccines against enterotoxigenic Escherichia coli and Shigella are proceeding apace but are not yet available for routine use.

Antidiarrheals↗
PubMed2002

Lifestyle and diet as risk factors for overanticoagulation.

The risk of hemorrhage when using coumarin anticoagulants sharply increases when the International Normalized Ratio (INR) is > or =6.0. We performed a case-control study among outpatients of an anticoagulation clinic to identify sociodemographic-, lifestyle-, and dietary factors related to overanticoagulation. Three hundred cases with an INR > or =6.0 were compared with 302 randomly selected matched controls with an INR within the target zone. Age, sex, and level of education were not associated with overanticoagulation. Body mass index was negatively related to overanticoagulation, a beneath-average level of physical activity was positively related to overanticoagulation and never-smokers were more likely to have an INR > or =6.0 compared with smokers. Habitual alcohol consumption, even heavy drinking, was not related to overanticoagulation. However, a recent decrease of alcohol intake increased the risk of an INR > or =6.0. In addition, weight loss and a vacation were risk factors for overanticoagulation. Dietary factors were not associated with overanticoaguation. If risk factors can not be avoided, increased monitoring of INR values could prevent overanticoagulation and potential bleeding complications.

Aged↗
PubMed2003

The flip side of synapse elimination.

The fine tuning of synaptic circuits often requires an activity-dependent phase in which appropriate connections are strengthened and inappropriate connections are eliminated. In this issue of Neuron, Walsh and Lichtman propose a novel "synaptic takeover" mechanism for synapse elimination at the vertebrate NMJ, where withdrawal of one axon is accompanied by expansion of a competing axon into the newly vacated territory.

Animals↗
PubMed1995

Land mines: the suffering of a nation.

For two nursing students, a long summer vacation provided an opportunity to gain some first hand experience of nursing in a developing country. The Kingdom of Cambodia, a country of approximately 9.3 million people in South East Asia, was the chosen destination. Here not only was a different culture encountered but also a hazard to public health which one would not usually encounter in the UK: the land mine.

Blast Injuries↗
PubMed1993

Emergency air medical transport of U.S.-citizen tourists: 1988 to 1990.

STUDY OBJECTIVE: To study the epidemiology of U.S. citizens who become ill or injured while on vacation outside the United States and are transported back to the United States by emergency air medical transports. DESIGN: A retrospective self-reported survey covering a study period of three years (1988-1990) of air medical transport services in the United States. SETTING AND TYPE OF PARTICIPANTS: All members of the Association of Air Medical Services (AAMS) who operate either rotorcraft within range of non-U.S. territories (excluding Canada) or who operate fixed-wing aircraft in the United States. INTERVENTIONS: None. RESULTS: There were a total of 796 cases reported by AAMS members during the study period. Males comprised 61% of the cases. Unintentional injury accounted for 44% (n = 351) of the patients transported. Acute myocardial infarctions, angina and post-cardiac arrest cases comprised 15% (n = 141) of the total cases. Infectious diseases other than pneumonia comprised slightly more than 1% (n = 11) of the total cases. There were 12 gunshot wounds and one stab wound, comprising 1.6% (n = 13) of the total cases. Mexico, the Virgin Islands, and the Bahamas were the top three sites of transport origin, accounting for 59% of the cases. Fixed-wing transport accounted for 90% of the reported flights. CONCLUSIONS: This survey reveals a previously undescribed portion of travel-related morbidity and mortality. Injury prevention needs greater emphasis when travel advice is given by physicians and other travel medical services. Air medical transport is an important aspect of the care of acutely injured or ill U.S.-citizen tourists.

Age Distribution↗
PubMed1999

Moving out of the red zone: addressing staff allocation to improve patient satisfaction.

BACKGROUND: Each summer, Hermann Hospital (Houston), like virtually all health care organizations, faces staffing challenges because of employee vacations, increased patient load, and staff turnover. A "zone" system was developed to address staff allocation, which was identified as a factor in deterioration of the hospital's patient satisfaction performance. ZONE SYSTEM: Every day, each unit or department designated the zone most appropriate based on factors identified in root cause analysis--high patient census, high patient acuity, emergent activity, and the number of float, agency, or unfamiliar staff members. A green zone defines conditions where the staff is very comfortable; yellow reflects increased activity; and red indicates that staff members are stressed and overwhelmed with patient needs. ACTION STEPS: Management's action steps included decreasing the nursing vacancy rate to minimize reliance on agency and float staff members and securing longer-term commitments from temporary staff members. Individual units also generated contingency plans, such as identifying a "partner unit" to provide shared staff members, supplies, and other assistance. RESULTS: The percentage of patients rating their overall experience at Hermann Hospital as "good" or "excellent" increased from 83% in August 1997 to 89% in August 1998, despite increases in admissions, patient days, operating room cases, and emergency department visits. DISCUSSION: The zone system provides a rapid way to quantify contributing factors to patient dissatisfaction and respond to them. Hermann Hospital is currently developing a broader zone system to include staff vacancy rates by departments, areas of increased patient census for prolonged periods, and balancing episodic zones with prolonged zones.

Hospitals, General↗
PubMed2003

Occupational asthma due to exposure to iroko wood dust.

BACKGROUND: Occupational asthma (OA) from iroko wood has been reported primarily in case reports. OBJECTIVE: To improve understanding of the pathogenesis of OA induced by iroko wood dust. METHODS: Three groups of woodworkers were included in this study: 9 workers who had clinically proven OA from iroko; 10 asymptomatic woodworkers; and 10 woodworkers with asthma. All patients underwent the following tests: a skin test with an iroko aqueous extract, specific IgE determination, and an iroko bronchial provocation test (IBPT). An eosinophil count was determined before and after the IBPT, and a methacholine inhalation test was performed after avoidance of exposure to iroko. Patients were asked to monitor their peak expiratory flow rates during a week at work followed by a week's vacation. RESULTS: In all patients with a personal history predictive of OA from iroko, a reduction of the peak expiratory flow rate and positivity to the IBPT while working with iroko were present. The latter test result showed a dual response, with a decrease in forced expiratory volume in 1 second from 25% to 32% at 10 minutes and a further decrease from 35% to 43% at 8 hours; at 24 hours, the eosinophil count was higher (P = .046). In 4 patients, the intradermal test results with iroko extract were positive, whereas the skin prick test result and the specific IgE determination were negative in all patients. The methacholine test result was also positive. In the control groups, all the test results with iroko extract were negative. CONCLUSIONS: Our data suggest that OA due to iroko wood may be induced by immunologic mechanisms other than IgE-mediated immediate hypersensitivity reactions.

Adult↗
PubMed2005

Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia.

BACKGROUND: A "bundle" of ventilator care processes (peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, elevation of the head of the bed, and a sedation vacation), which may also reduce ventilator-associated pneumonia (VAP) rates, can serve as a focus for improvement strategies in intensive care units (ICUs). Between July 2002 and January 2004, teams of critical care clinicians from 61 health care organizations participated in a collaborative on improving care in the ICU. METHODS: ICU team members posted data monthly on a Web-based extranet and submitted narrative descriptions describing the changes tested and the strategies implemented. RESULTS: For the 35 units that consistently collected data on ventilator bundle element adherence and VAP rates, an average 44.5% reduction of VAP was observed. DISCUSSION: The goal-oriented nature of the bundle appears to demand development of the teamwork necessary to improve reliability. The observations seem sufficiently robust to support implementing the ventilator bundles to provide a focus for additional change in ICUs.

Canada↗
PubMed1998

Seasonality of induced abortion in North Carolina.

This paper examines the seasonality of induced abortion in North Carolina between 1980 and 1993. Distinct seasonal patterns are found, with a peak in February and a valley in September. These patterns correspond to the implicit seasonality of conceptions associated with the seasonality of birth pattern. One notable difference from the general pattern is among unmarried women aged 18 and younger. They have the February peak and an additional peak in August that may be associated with the summer vacation from school.

Abortion, Induced↗
PubMed1973

Salmonella javiana infection in an infant associated with a marsupial, the quokka, Setonix brachyurus, in Western Australia.

Salmonella javiana, a serotype rarely isolated in Australia, has been recovered from the faeces of a 14-month-old infant with symptoms of enteritis.The child had been closely associated with a marsupial species, the quokka, during a vacation on Rottnest Island in Western Australia, and S. javiana was isolated from faecal pellets from adult quokkas, and also from a snake collected on the island.Sampling revealed a high incidence of Salmonella infection in the quokkas. In all, 62 out of 87 animals (71%) were found to be infected, and 17 Salmonella and 3 Arizona serotypes were identified from 100 isolations comprising 92 salmonellas and 8 arizonas. Multiple infections were frequently detected and up to four serotypes were recovered from individual animals. S. javiana was isolated from four quokkas.A close parallel was observed between the serotypes isolated from quokkas and sea-gulls on the island, and abattoir effluents, lake waters, bird droppings and reptiles sampled on the adjacent mainland.The epidemiological significance of Salmonella and Arizona infections in the quokka population and their possible association with the seasonal decline in condition and numbers of animals on Rottnest Island is discussed.

Animals↗
PubMed1995

Epidemiology of measles in Taiwan: dynamics of transmission and timeliness of reporting during an epidemic in 1988-9.

We analysed nation-wide reported measles cases during the 1988-9 epidemic and found that longer duration and wider spread were two major characteristics of the outbreak. All the 22 county/city index cases were reported with a delay of > 4 days and 64% were aged 5-14 years. This epidemic occurred mainly among 5-14-year-old school-children (59%), infants under 1 year (19%), and pre-school children (18%). The overall attack rate was 0.63 cases per 10,000 population, with the highest attack rate (7.4 cases per 10,000 population) occurring in infants. Among 280 confirmed cases < 15 months of age, 9-month-old infants (42 cases) had a higher risk of measles and peaked at 10 months (49 cases). This epidemic started in March 1988 among 5-9-year-old children in the northern suburban area, then spread to Taipei City and neighbouring counties or cities. It continued to spread from the northern to southern and western areas during the summer vacation and New Year holidays. Multiple logistic regression analysis showed that the delay of measles reporting was strongly associated with the cases infected early in the epidemic (OR = 6.9, P < 0.001) and reported from teaching hospitals (OR = 2.6, P < 0.001). The reappearance of high attack rates among 5-9-year-old children in the 1985 and 1988-9 measles epidemics in Taiwan indicated the persistence of pockets of susceptible individuals even after mass immunization.

Adolescent↗
PubMed2003

A large outbreak of influenza A and B on a cruise ship causing widespread morbidity.

In September 2000 an outbreak of influenza-like illness was reported on a cruise ship sailing between Sydney and Noumea with over 1,100 passengers and 400 crew on board. Laboratory testing of passengers and crew indicated that both influenza A and B had been circulating on the ship. The cruise coincided with the peak influenza period in Sydney. Morbidity was high with 40 passengers hospitalized, two of whom died. A questionnaire was sent to passengers 3 weeks after the cruise and 836 of 1,119 (75%) responded. A total of 310 passengers (37%) reported suffering from an influenza-like illness (defined as cough, fever, myalgia and weakness) and 528 (63%) had seen a doctor for illness related to the cruise. One-third of passengers reported receipt of influenza vaccination in 2000; however neither their rates of influenza-like illness nor hospitalization were significantly different from those in unvaccinated passengers. A case-control study also found no significant protective effect of influenza vaccination. With the increasing popularity of cruise vacations, such outbreaks are likely to affect increasing numbers of people. Whilst influenza vaccination of passengers and crew may afford some protection, uptake and effectiveness may not be sufficient to prevent outbreaks. Surveillance systems and early intervention measures, such as antiviral therapies, should be considered to detect and control such outbreaks.

Adult↗
PubMed2005

A pilot examination of the impact of cancer patients' fatigue on their spousal caregivers.

OBJECTIVE: In this pilot project we examined the quality of life of spouses of cancer patients who had significant fatigue. METHODS: We assessed both the spouses of cancer patients and the patients who presented with chemotherapy-induced fatigue and anemia. Study endpoints included the impact that cancer patients' fatigue had on their spouses' quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment. We examined the extent to which changes in patients' fatigue from baseline to one month follow-up were associated with changes in spouses' quality of life indices. RESULTS: 25 couples completed the study. Seven (28%) spousal caregivers reported handling fewer responsibilities at work, 8 (32%) had reduced their work hours, and 8 (32%) felt that they were less effective overall at work. Spousal caregivers also missed a significant amount of time at work during the month long study, missing an average of 2.7 (SD = 2.95) days, with an additional 1.29 (SD = 2.97) sick days and 1.76 (SD = 2.63) vacation days during that time. Spouses reporting greater levels of caregiver strain were more likely to have increased fatigue at baseline (F1,23 = 8.11, p < .01), and worse dyadic adjustment at both time points (baseline: F1,23 = 7.80, p < .01; follow-up: F1,21 = 9.24, p < .01). Also, those with more caregiver strain were less likely to engage in social activity at baseline (F1,23 = 6.11, p < .05) and more likely to engage in less work by the one month follow-up (F1,20 = 8.36, p < .01). SIGNIFICANCE OF RESULTS: Spouses who were identified as having elevated burden experienced more personal fatigue, had worse dyadic adjustment, reported poor energy levels, and tended to engage in fewer work and social activities; the impact of patient's fatigue level on these parameters was highly variable in this small pilot study.

Absenteeism↗