SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The American Civil War marked the last time more soldiers died from disease than from enemy bullets and the beginning of medical science's movement beyond folklore and superstition. The wound management techniques described that were practiced just a little more than a century ago provide a dramatic and sharp counterpoint to current wound management procedures.
Main ways of perfection of methodical work of sanitary and epidemiologic institutions (SEI) are opened taking into account the modern sights on the given problem. The special attention is given to rendering the methodical help from the part of SEI experts to the troops medical service on the places, to development of science-reasonable recommendations for organization of sanitary and epidemiologic supervision and antiepidemic measures, to preparation of the methodical documents on questions of antiepidemic protection of the troops. Methods of organization of the garrison educational training (conferences) of the medical personnel, participation in their preparation and realization of the SEI experts are opened. The questions of organizations in SEE of one-monthly military epidemiology and military hygiene practice for the medical service chiefs of the units and institutions, and also preparation of the younger medical experts for antiepidemic protection of the troops are discussed. Estimation of organization of methodical work in SEI is given, the approaches and ways of its perfection are determined.
Lessons learned from environmental and occupational hazard risk management practices over the past 30 years have led the Department of Defense to explore alternative risk management approaches. Policies for cleanup of environmentally hazardous waste sites are undergoing examination and are being reframed. A Demonstration Risk Communication Program is described which incorporates principles that integrate risk-based scientific information as well as community values, perceptions, and needs in a democratic process that includes the public as an active participant from the earliest stages. A strong scientific foundation for assessment and characterization of risk is viewed as necessary but not sufficient; the public's values must be actively integrated into the negotiated criteria. The Demonstration Program uses a model to prepare the participants and to guide them through the process. A five-step process is presented: (1) create risk communications process action team including at least one member of the specific site audience; (2) professionally train participants on team dynamics including interpersonal communication skills; (3) train risk communicators to deliver a cogent presentation of the message to secure a decision acceptable to both the government and the public; (4) identify existing biases, perceptions, and values held by all participants; and (5) develop risk message incorporating science and values. The process action team approach assumes the participants enter into the effort with the goal of improved environment and safeguarded public health. The team approach avoids confrontational or adversarial interactions and focuses on a dialogue from which a negotiated team response develops. Central to the program is the recognition that communication is only effective when the dialogue is two-way.
Biological warfare (BW) threat assessments identify and prioritize BW threats to civilian and military populations. In an ideal world, they provide policymakers with clear and compelling guidance to prioritize biodefense research, development, testing, evaluation, and acquisition of countermeasures. Unfortunately, the biodefense community does not exist in an ideal world. National security professionals responsible for crafting BW threat assessments often are challenged by factors that limit the clarity and/or timeliness of those assessments. Moreover, the potential for life science advances to enhance threats enabled by state programs and the possibility that non-state actors may pursue crude but effective BW methodologies will drastically expand the scope of the perceived threat. Appropriate investment of federal biodefense funds will require some mechanism for validating and prioritizing present and future threats. Ideally, such a mechanism will incorporate empirical data targeted to elucidate actual hazards. In this regard, the Department of Homeland Security's creation of a Biological Threat Characterization Program for the technical validation of threat agents will be a valuable addition to the nation's overall biodefense strategy. This article articulates the need for a coordinated national biological threat characterization program, discusses some of the principal challenges associated with such research, and suggests a few options for their resolution.
BACKGROUND/AIMS: The Institute of Medicine (IOM) of the United States Academy of Sciences in 2000 encouraged the evaluation of active long-term monitoring studies of large populations to further evaluate the relative safety of anthrax vaccine. Anthrax is a deadly bacterial infectious disease that currently has been engineered as a biological warfare agent. The vaccine produced against anthrax is a cell-free crude culture of the various toxin components of the natural disease. The U.S. military current goal is to vaccinate its entire personnel by 2003. The purpose of this study was to evaluate anthrax vaccination and its association with arthritic, immunological and gastrointestinal adverse reactions based upon analysis of the Vaccine Adverse Events Reporting System (VAERS) database. METHODOLOGY: We analyzed the VAERS database from 15 December 1997 to 12 April 2000. We also compared the incidence of anthrax adverse reactions with the incidence of adverse reactions reported to VAERS after adult tetanus vaccination. RESULTS: Anthrax vaccine was one of the most reactogenic vaccines included in VAERS. The incidence of adverse reactions reported following anthrax vaccine was higher for every reaction analyzed in comparison to the adult vaccine control groups. CONCLUSIONS: The current anthrax vaccine may be acceptable in military populations in impending threat of anthrax exposure, the cost-benefits of vaccination in less high risk military populations may be more questionable. Civilian anthrax vaccination will require a less reactogenic vaccine. Civilian doctors should be aware of anthrax vaccine adverse reactions. Military and civilian doctors should also be diligent in their reporting to VAERS of cases of adverse reactions to anthrax vaccine.
BACKGROUND: Jet-lag commonly affects air travellers who cross several time zones. It results from the body's internal rhythms being out of step with the day-night cycle at the destination. Melatonin is a pineal hormone that plays a central part in regulating bodily rhythms and has been used as a drug to re-align them with the outside world. OBJECTIVES: To assess the effectiveness of oral melatonin taken in different dosage regimens for alleviating jet-lag after air travel across several time zones. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsychLit and Science Citation Index electronically, and the journals 'Aviation, Space and Environmental Medicine' and 'Sleep' by hand. We searched citation lists of relevant studies for other relevant trials. We asked principal authors of relevant studies to tell us about unpublished trials. Reports of adverse events linked to melatonin use outside randomised trials were searched for systematically in 'Side Effects of Drugs' (SED) and SED Annuals, 'Reactions Weekly', MEDLINE, and the adverse drug reactions databases of the WHO Uppsala Monitoring Centre (UMC) and the US Food & Drug Administration. SELECTION CRITERIA: Randomised trials in airline passengers, airline staff or military personnel given oral melatonin, compared with placebo or other medication. Outcome measures should consist of subjective rating of jet-lag or related components, such as subjective wellbeing, daytime tiredness, onset and quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms. DATA COLLECTION AND ANALYSIS: : Ten trials met the inclusion criteria. All compared melatonin with placebo; one in addition compared it with a hypnotic, zolpidem. Nine of the trials were of adequate quality to contribute to the assessment, one had a design fault and could not be used in the assessment. Reports of adverse events outside trials were found through MEDLINE, 'Reactions Weekly', and in the WHO UMC database. MAIN RESULTS: : Nine of the ten trials found that melatonin, taken close to the target bedtime at the destination (10pm to midnight), decreased jet-lag from flights crossing five or more time zones. Daily doses of melatonin between 0.5 and 5mg are similarly effective, except that people fall asleep faster and sleep better after 5mg than 0.5mg. Doses above 5mg appear to be no more effective. The relative ineffectiveness of 2mg slow-release melatonin suggests that a short-lived higher peak concentration of melatonin works better. Based on the review, the number needed to treat (NNT) is 2. The benefit is likely to be greater the more time zones are crossed, and less for westward flights. The timing of the melatonin dose is important: if it is taken at the wrong time, early in the day, it is liable to cause sleepiness and delay adaptation to local time. The incidence of other side effects is low. Case reports suggest that people with epilepsy, and patients taking warfarin may come to harm from melatonin. REVIEWER'S CONCLUSIONS: Melatonin is remarkably effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe. It should be recommended to adult travellers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet-lag on previous journeys. Travellers crossing 2-4 time zones can also use it if need be. The pharmacology and toxicology of melatonin needs systematic study, and routine pharmaceutical quality control of melatonin products must be established. The effects of melatonin in people with epilepsy, and a possible interaction with warfarin, need investigation.
Documents at the Australian Academy of Science and the United States National Academy of Sciences reveal that wartime research by the Australian Army at Cairns had a significant impact on United States malaria research programs, as well as providing a scientific basis for drug control of malaria.
Reflexology has been present throughout Spanish science since the last third of the nineteenth century and its importance can be seen in the works of authors such as Martín Salazar, Ramón y Cajal, Gómez Ocaña, Simarro and Turró. The most important research in Reflexology in Spain takes place a) at the Schools of Neurophysiology and Psychology in Barcelona and Madrid, b) with a group of authors specializing in pathological medicine and c) in the Military's Health Department, Pavlov's work was received in Spain with special interest. Fernández-España, who could be considered the "first Spanish Pavlovian," emphasized Pavlov's work in a series dedicated to the study of objective psychology which was published between 1914 and 1924. Planelles was the first investigator to develop a program in pavlovian experimentation, presenting his results in 1935. The Civil War (1936-1939) ended these and many other Spanish projects in psychology. After the war, interest in Reflexology and Pavlov's theories slowly rose again, first through psychosomatic medicine and then in the 60's because of the works of such authors as Monserrat-Esteve, Rof Carballo and Colodrón. The progressive inclusion of psychology in the Schools of Philosophy and Arts after 1968 marked the beginning of a new era.
Anthrax vaccination has become a 'hot' topic. On the one hand, fears that Iraq holds secret caches of anthrax-based weaponry, that other countries may be developing or may have developed similar devices, or that hard-line groups may make their own anthrax-based devices for bioterrorist attacks have focused official attention on the need for means of protection, principally, though, for the military. On the other hand, the unsolved issues of the Gulf War illnesses have left elements of doubt in the minds of some as to the possible role of anthrax (among other) vaccines in this syndrome, and have drawn attention to the shortage of pre-clinical, clinical, pharmacological and safety data on the existing UK and US anthrax vaccines. In the middle are those hotly debating the US and Canadian policies of mandatory anthrax immunization for military personnel or, in the case of the UK policy of voluntary immunization, simply voting with their feet. Compounding matters have been the publicized failures of the US vaccine production facility and the less publicized UK problems of supply. Meanwhile, those in genuine at-risk occupations are left unsure whether, if they can get the vaccine at all, they really want it. Despite two decades of elegant science aimed at formulating alternative vaccines to overcome all the problems of efficacy, safety and supply, such an alternative is at least five years away, and the current status is that we must live with the old vaccines or not vaccinate.
Symposium Topics and Presenters: 1. Education of tuberculosis in medial school: Kaoru SHIMOKATA (Department of Clinical Preventive Medicine, Nagoya University Daiko Medical Center) 2. From Medical University holding Tuberculous ward: Shosaku ABE (Third Department of Internal Medicine, Sapporo Medical University School of Medicine), et al. 3. Necessity and Significance of Sanatorium ward associated with University Hospital: Saburo SONE, et al. (Third Department of Internal Medicine, The University of Tokushima School of Medicine) 4. A proposal on education and training for tuberculosis in medical school from aspect of sanitariums: Takeshi OGURA (Toneyama National Hospital) 5. How to avoid infecting TB and to prevent contracting TB while medical and nursing practices: Keiichi NAGAO (Health Sciences, Center, Chiba University), et al. 6. Special speech: A review of the year since TB patient rooms were included in a common ward as a part of ministry of welfare's model project: Shuji KURANE (Fourth Department of Internal Medicine, Nippon Medical School) Tuberculosis began to rank first in mortality rate in Japan in the Meiji Era, and especially since it did not conform to the "national wealth and military strength" that was the national policy of the time due to the high mortality rates in the early decades of life, it was referred to as the "disease that was destroying the country" and the "pandemic disease." Even after entering the Showa Era, tuberculosis long occupied first place as the cause of death in Japan, and it raged unchecked for a period after World War II. However, the prognosis of tuberculosis as a whole improved considerably as a result of the development of antituberculosis agents, such as streptomycin, and the advent of rifampicin made it a curable disease. Its rank as a cause of death subsequently fell precipitously, and many of the TB wards that had been established in university hospitals were closed as the numbers of patients rapidly declined. At the present time, only 22 of the 80 university hospitals in the country have TB wards or TB beds, and 18 of the hospitals that had TB wards have closed them. Two of them closed them prior to 1964, 6 between 1965 and 1974, 4 between 1975 and 1984, 4 between 1985 and 1994, and 2 since 1995. Thus, it would be no exaggeration to say that there has been a steady decline in the TB wards of university hospitals. It is fairly easy to surmise that the result has been a decrease in the opportunities and time available for educating medical students about tuberculosis. Today, university hospitals not only accept medical students, but 80% of clinical residents as well, and they too have lost opportunities for education concerning tuberculosis. We would hope that the concern of Japanese physicians regarding tuberculosis has not diminished in proportion to the decrease in TB wards in our university hospitals. However, as is truly revealed by the expression "doctor's delay" in the diagnosis and treatment of tuberculosis, it is a fact that physicians no longer bear pulmonary tuberculosis in mind when diagnosing and treating patients with respiratory disease, and that as a result diagnosis is delayed, treatment is drawn out, and in the worst-case scenario, we see scattered instances of a tragic outcome. When we consider the recent conditions in society, as reported in recent newspapers, tuberculosis is not a disease that is on the decline at all in Japan today. However, as stated above, but if the concern of ordinary physicians has drifted away from tuberculosis, it is fair to say that it is not only a major problem medically, but socially as well. Consideration of the tuberculosis education in university medical schools seems to be opportune at this time. Professor Shimokata of Nagoya University, who is chairperson of the Japan Tuberculosis Education Committee, outlined the problems of tuberculosis education in his speech at this symposium. (ABSTRACT TRUNCATED)
OBJECTIVES: Mefloquine has now largely replaced earlier malaria prophylaxis drugs which are no longer considered to be effective against all Plasmodium species, due to parasite resistance. However mefloquine may be associated with neuropsychological harmful effects. The objective of this review was to assess the effects of mefloquine in adult travellers. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase, Lilacs, Science Citation Index and reference lists of articles. We contacted researchers in the subject of malaria chemoprophylaxis, and drug companies. SELECTION CRITERIA: Randomised trials comparing mefloquine with other standard prophylaxis or placebo in non-immune adult travellers. DATA COLLECTION AND ANALYSIS: The two reviewers independently assessed trial quality and extracted data. Study authors were also contacted. MAIN RESULTS: Ten trials involving 2750 non-immune adult travellers were included. One trial comparing mefloquine with placebo showed mefloquine prevented malaria episodes in an area of drug resistance (odds ratio 0.04, 95% confidence interval 0.02 to 0.08). Withdrawals in the mefloquine group were consistently higher in four placebo controlled trials (odds ratio 3. 56, 95% confidence interval 1.67 to 7.60). In five trials comparing mefloquine with other chemoprophylaxis, no difference in tolerability was detected. REVIEWER'S CONCLUSIONS: Mefloquine prevents malaria, but there is not enough evidence to evaluate its tolerability and toxicity, particularly for general travellers.
Attrition among medical students is a concern for the institution, the individual, and the profession. Disenrollment has an impact on the institution, in terms of academic reputation and resources expended, and the individual, in terms of self-esteem, personal finances, and opportunity costs. This study summarizes the results of an epidemiologic study of student attrition conducted at the only federal medical school in the United States--the Uniformed Services University of the Health Sciences in Bethesda, Maryland--and describes the association between demographic and selected quantitative variables for those students who graduated or remained enrolled and those who disenrolled. Both sex (female) and a decelerated curriculum were predictive of attrition in this medical student population. The records of the students who left Uniformed Services University of the Health Sciences without graduating were examined to ascertain the presence of noncognitive issues surrounding disenrollment; over one-half of the students who disenrolled left voluntarily and for nonacademic reasons.
OBJECTIVE: To investigate the current status of internet-based publication of biomedical journals and website construction in Guangdong province. METHODS: On the platform of the currently available databases for academic science journals (Wanfang Datebase, China Acdemic Journal Network, PubMed and SCI) with the assistance general searching engines, the websites of the medical journals in Guangdong province were evaluated and the editorial offices of the core medical journals in Guangdong province were interviewed. RESULTS: At present, the internet-based publication of the journals was executed predominantly by 3 means, namely utilization of the access to the websites of the direct sponsor, authoritative websites of science and technology, or independent websites. CONCLUSION: Relying on the database system of Wanfang and China Academic Journal Network, for instance, most of the journals can provide access to their full-text resources, but this internet-based publication is somehow delayed in comparison with the print publication. At present, only a few medical journals in Guangdong have built their independent websites, and among those which already have, Journal of First Military Medical University and Cancer are indexed by IM and PubMed, therefore they provide online abstracts of the papers ahead of the print copy publication.
In the last 15 years, the US and UK have fought two major wars in the Persian Gulf region. Controversy has arisen over the nature and causes of health problems among military veterans of these two wars. Toxic exposures have been hypothesised to cause the majority of the long-term health problems experienced by veterans of the 1991 Gulf War. The assessment of these toxic exposures and the resolution of controversy about their health effects provide a unique case study for understanding how toxicological disputes are settled in the US. Neither clinical examination of ill war veterans nor scientific research studies have been sufficient to answer contentious questions about toxic exposures. Numerous expert review panels have also been unable to resolve these controversies except for the US National Academy of Sciences Institute of Medicine (IOM). The IOM has conducted exhaustive and independent investigations based on peer-reviewed scientific literature related to potential health risks during the two Gulf Wars. In four recent studies, IOM committees identified a wide range of previously documented illnesses associated with common occupational and environmental exposures after considering thousands of relevant publications; however, they did not identify a new medical syndrome or a specific toxic exposure that caused widespread health problems among Gulf War veterans. These IOM studies have, therefore, added little to our basic knowledge of environmental hazards because most of the health effects were well known. Nevertheless, this expert review process, which is on-going, has been generally acceptable to a wide range of competing interests because the findings of the IOM have been perceived as scientifically credible and independent, and because none of the postulated toxicological risks have been completely ruled-out as possible causes of ill health among veterans.
BACKGROUND: From 1961-1971, The Air Development Test Center, Eglin Air Force Base (AFB), Florida, developed, tested, and calibrated the aerial spray systems used in support of Operation RANCH HAND and the US Army Chemical Corps in Vietnam. Twenty major test and evaluation projects of aerial spray equipment were conducted on four fully instrumented test grids, each uniquely arrayed to match the needs of fixed-wing, helicopter, or jet aircraft. Each of the grids was established within the boundary of Test Area 52A of the Eglin Reservation. METHODS: The tests, conducted under climatic and environmental conditions similar to those in Vietnam, included the use of the military herbicides (Agents) Orange, Purple, White, and Blue. Approximately 75,000 kg of 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) and 76,000 kg of 2,4-dichlorophenoxyacetic acid (2,4-D) were aerially disseminated on an area of less than 3 km2 during the period 1962-1970. Data from the analysis of archived samples suggested that an estimated 3.1 kg of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), present as a contaminant, were aerially released in the test area. Because most of the vegetation had been removed before establishing the test site in 1961, there was an opportunity to follow ground-based residues independent of canopy interception, and the resulting high solar exposure of initial residues. Studies of the soils, fauna, flora, and aquatic ecosystems of the test grids and associated perimeters of Test Area C-52A (an area totally more than 8 km2) were initiated in 1969 and concluded in 1984. RESULTS AND DISCUSSION: Data from soil samples collected from 1974 through 1984 suggested that less than one percent of the TCDD that was present in soil when sampling began persisted through the ten-year period of sampling. More than 340 species of organisms were observed and identified within the test area. More than 300 biological samples were analyzed for TCDD and detectable residues were found in 16 of 45 species examined. Examination of the ecological niches of the species containing TCDD residues suggested each was in close contact with contaminated soil. Indepth field studies, including anatomical, histological and ultrastructural examinations, spanning more than 50 generations of the Beachmouse, Peromyscus polionotus, demonstrated that continual exposure to soil concentrations of 0.1 to 1.5 parts-per-billion (ng/g) of TCDD, had minimal effects upon the health and reproduction of this species. CONCLUSIONS: Since Agent Orange with its associated TCDD contaminant was aerially disseminated on the test grids, Test Area C-52A provided a 'field laboratory' for what may have happened in Vietnam, had there been no intercepting forest cover. However, in Vietnam a 'typical' mission would have disseminated 14.8 kg of 2,4,5-T/ha, most of which was intercepted by the forest canopy, versus the 876 kg 2,4,5-T/ha on the test grid at Eglin. Moreover, each hectare on the Eglin test grid received at least 1,300 times more TCDD than a hectare sprayed with Agent Orange in Vietnam. The disappearance or persistence of TCDD is dependent upon how it enters the ecosystem. Spray equipment test and evaluations missions at Eglin were generally scheduled and conducted with environmental conditions that were optimal for spray operations. This suggests that conditions favorable for dissemination of herbicide were the same conditions favorable for photodegradation of TCDD. It was likely that 99 percent of the TCDD never persisted beyond the day of application. No long-term adverse ecological effects were documented in these studies despite the massive quantities of herbicides and TCDD that were applied to the site. Reviews by the US Environmental Protection Agency and the National Academy of Sciences' Institute of Medicine did not address the fate of Agent Orange and TCDD as described in these studies from Eglin AFB, Florida.
There are few more devastating injuries that afflict man than those associated with spinal cord injury (SCI). The economic, psychological, and social impact are encompassing and enormous to the individual and society. During the last several years, there has been a renewed interest in the study of SCI, with the hope of finding a cure. It is appropriate, then, to examine the efforts accomplished throughout medical history. With this retrospective view, potential avenues for future treatment become more apparent and clear. As in the past, the integration of basic science and clinical innovation will create the path toward progress for treatment of this disease.
Clinical medicine in the 18th century is devoted to Hippocratic tradition. Pathology is not a requisite in this concept. The viewpoint of the pathologists is obscured by traditional philosophy and hampered by insufficient methods. In the 19th century, concepts of correlation between clinical signs and local organ pathology occur. The catastrophic increase of traumatic injury of the nervous system during world war I results in better concepts of clinical localization. At the beginning of the 21st century, the traditional view of the neurological science has changed the image of the patient profoundly, by the emergence of new diseases, disappearance of others and an altered view of the traditional neurologist.
Academic, business, and government organizations are increasingly looking to distance education to meet workforce learning needs. This modality differs from classroom education, however, and simply transferring content from a traditional classroom to a distance learning application can result in poor outcomes. The Department of Veterans Affairs and the Uniformed Services University of the Health Sciences Graduate School of Nursing implemented a program preparing adult nurse practitioners solely through the medium of distance education, with no university "in-residence" requirement. Lessons learned from this success can prove useful to organizations that are planning distance education initiatives.