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PubMed2004

Should dentistry be part of the National Health Information Infrastructure?

BACKGROUND: The National Health Information Infrastructure, or NHII, proposes to improve the effectiveness, efficiency and overall quality of health in the United States by establishing a national, electronic information network for health care. To date, dentistry's integration into this network has not been discussed widely. METHODS: The author reviews the NHII and its goals and structure through published reports and background literature. The author evaluates the advantages and disadvantages of the NHII regarding their implications for the dental care system. RESULTS: The NHII proposes to implement computer-based patient records, or CPRs, for most Americans by 2014, connect personal health information with other clinical and public health information, and enable different types of care providers to access CPRs. Advantages of the NHII include transparency of health information across health care providers, potentially increased involvement of patients in their care, better clinical decision making through connecting patient-specific information with the best clinical evidence, increased efficiency, enhanced bioterrorism defense and potential cost savings. Challenges in the implementation of the NHII in dentistry include limited use of CPRs, required investments in information technology, limited availability and adoption of standards, and perceived threats to privacy and confidentiality. CONCLUSIONS: The implementation of the NHII is making rapid strides. Dentistry should become an active participant in the NHII and work to ensure that the needs of dental patients and the profession are met. Practice Implications. The NHII has far-reaching implications on dental practice by making it easier to access relevant patient information and by helping to improve clinical decision making.

Artificial Intelligence↗
PubMed2005

18th International Conference on Antiviral Research.

The 18th International Conference on Antiviral Research (ICAR) was held at the Princess Sofia Hotel in Barcelona, Spain, from 11th-14th April, 2005. This is a yearly international meeting sponsored by the International Society for Antiviral Research (ISAR). The current president of ISAR is John A Secrest 3rd of the Southern Research Institute. The scientific programme committee was chaired by John C Drach from the University of Michigan. ISAR was founded in 1987 to exchange prepublication basic, applied and clinical information on the development of antiviral, chemical and biological agents as well as to promote collaborative research. The ISAR has had a major role in the significant advances of the past decade in the reduction of the societal burdens of viral diseases by the focus of ICAR on the discovery and clinical application of antiviral agents. The 18th ICAR was organised as a series of focus presentations on specific viral groups consisting of oral and poster presentations of original research findings. In addition, the conference included plenary speakers, award presentations, a minisymposium on bioterrorism, and a satellite symposium on clinical antiviral drug developments. The size of the conference (> 50 oral and 250 poster presentations) necessitates limitation to the most noteworthy in the judgment of this reviewer. The current membership of the ISAR is approximately 700 with approximately 50% the membership in attendance.

Antiviral Agents↗
PubMed2002

The situation on antimicrobial agents and chemotherapy in 2002: highlights of the 42nd ICAAC.

The 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy took place in San Diego on 27-30 September 2002. The meeting was held in the light of current events. Bioterrorism, malaria, issues of surveillance and multiple resistance were discussed in depth. Few truly new drugs or potential targets were presented. Peptide deformylase inhibitors and several other metalloenzymes as new targets were among the most promising results.

Adult↗
PubMed2003

Advances in the development of bacterial vector technology.

The demand for new and improved vaccines against human diseases has continued unabated over the past century. While the need continues for traditional vaccines in areas such as infectious diseases, there is an increasing demand for new therapies in nontraditional areas, such as cancer treatment, bioterrorism and food safety. Prompted by these changes, there has been a renewed interest in the application and development of live, attenuated bacteria expressing foreign antigens as vaccines. The application of bacterial vector vaccines to human maladies has been studied most extensively in attenuted strains of Salmonella. Live, attenuated strains of Shigella, Listeria monocytogenes, Mycobacterium bovis-BCG and Vibrio cholerae provide unique alternatives in terms of antigen delivery and immune presentation, however and also show promise as potentially useful bacterial vectors.

Antigen Presentation↗
PubMed2004

Vaccines against Francisella tularensis--past, present and future.

Francisella tularensis is a facultative intracellular bacterial pathogen capable of causing a spectrum of human diseases collectively called tularemia. The pathogen is highly infectious and some strains can cause rapidly lethal infection especially when inhaled. The latter were developed as biological weapons in the past and nowadays cause concern as potential bioterrorism agents. A live attenuated strain of the pathogen was developed more that 40 years ago and remains the sole prophylactic measure against the pathogen. Research to develop better live and subunit vaccines is under way. The former will require an understanding of the virulence factors of F. tularensis and a facile means of mutating them and the latter will require identification of the protective antigens of the pathogen. The current vaccine and its potential replacements are the focus of this review.

Bacterial Vaccines↗
PubMed2006

Toxins of concern to animals and people.

Historically veterinarians have diagnosed accidental poisonings and identified possible terrorist events before they have come to the attention of public health authorities. There are many toxins that pose a threat to both humans and animals and the authors examine several of them here, namely, anthrax, tricothecenes, staphylococcal enterotoxin B, botulinum toxins, ricin, saxitoxin and dinoflagellate toxins. By discussing exposure routes, clinical signs and differential diagnoses the authors demonstrate how veterinarians are in a unique position to recognise zoonotic diseases, toxin exposure, and acts of bioterrorism. The work of veterinarians protects the food supply and contributes to human health and this article highlights the importance of coordination and communication between veterinarians and physicians. Sharing information is critical in confirming diagnoses and, in the case of intentional toxin attacks, could also be beneficial in identifying the perpetrators of the crime.

Animal Diseases↗
PubMed2006

Factors impacting the acceptance of traceability in the food supply chain in the United States of America.

Global demands for increased food safety and quality assurance programmes, increased global competition, changing government rules and regulations, political and trade barriers, bioterrorism, and identity preservation requirements in global markets are affecting the world's food supply chain. To satisfy changing market demands, all suppliers in the food supply chain must adaptto these global issues. Total asset visibility must be maintained in production, in process, in storage, and in transit.

Animal Identification Systems↗
PubMed2005

In their own words: lessons learned from those exposed to anthrax.

OBJECTIVES: We evaluated perceptions of workers at the US Postal Service Brentwood Processing and Distribution Center and US Senate employees regarding public health responses to the anthrax mailings of October 2001. We generated recommendations for improving responses to bioterrorism on the basis of the perceptions we recorded. METHODS: Transcripts from focus groups conducted with Brentwood and US Senate employees were examined, and qualitative analysis identified common domains. RESULTS: Brentwood focus groups consisted of 36 participants (97% African American and 19% hearing impaired). US Senate focus groups consisted of 7 participants (71% White and 0% hearing impaired). The focus groups revealed that participants' trust in public health agencies had eroded and that this erosion could threaten the effectiveness of communication during future public health emergencies. Among Brentwood participants, lack of trust involved the perception that unfair treatment on the basis of race/ethnicity and socioeconomic status had occurred; among US Senate participants, it derived from perceptions of inconsistent and disorganized messages. CONCLUSIONS: Effective communication during a public health emergency depends on the provision of clear messages and close involvement of the affected community. Diverse populations may require individualized approaches to ensure that messages are delivered appropriately. Special attention should be given to those who face barriers to traditional modes of communication.

Black or African American↗
PubMed2001

Preemptive biopreparedness: can we learn anything from history?

The treat of bioterrorism is in the public eye again, and major public health agencies are urging preparedness efforts and special federal funding. In a sense, we have seen this all before. The Centers for Disease Control and Prevention grew substantially during the Cold War era in large part because Alexander Langmuir, Chief Epidemiologist of the CDC, used an earlier generation's anxieties to revitalize the CDC, create an Epidemic Intelligence Service, and promote epidemiologic "surveillance" as part of the nation's defense. Retrospective investigation suggests that, while Langmuir contributed to efforts promoted by the Department of Defense and the Federal Civil Defense Administration, the United States did not have real cause to fear Communist biological warfare aggression. Given clear historical parallels, it is appropriate to ask, What was gained and what was lost by Langmuir's central role in that first instance of American biopreparedness? Among the conclusions drawn is that biopreparedness efforts fed the Cold War climate, narrowed the scope of public health activities, and failed to achieve sustained benefits for public health programs across the country.

Biological Warfare↗
PubMed2004

Predictors of help seeking among Connecticut adults after September 11, 2001.

OBJECTIVES: We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001. METHODS: Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11. RESULTS: Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help. CONCLUSIONS: Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters.

Adult↗
PubMed2003

Nucleic acid approaches for detection and identification of biological warfare and infectious disease agents.

Biological warfare agents are the most problematic of the weapons of mass destruction and terror. Both civilian and military sources predict that over the next decade the threat from proliferation of these agents will increase significantly. In this review we summarize the state of the art in detection and identification of biological threat agents based on PCR technology with emphasis on the new technology of microarrays. The advantages and limitations of real-time PCR technology and a review of the literature as it applies to pathogen and virus detection are presented. The paper covers a number of issues related to the challenges facing biological threat agent detection technologies and identifies critical components that must be overcome for the emergence of reliable PCR-based DNA technologies as bioterrorism countermeasures and for environmental applications. The review evaluates various system components developed for an integrated DNA microchip and the potential applications of the next generation of fully automated DNA analyzers with integrated sample preparation and biosensing elements. The article also reviews promising devices and technologies that are near to being, or have been, commercialized.

Biological Warfare↗
PubMed2004

Mass spectrometry provides accurate characterization of two genetic marker types in Bacillus anthracis.

Epidemiological and forensic analyses of bioterrorism events involving Bacillus anthracis could be improved if both variable number tandem repeats (VNTRs) and single nucleotide polymorphisms (SNPs) could be combined on a single analysis platform. Here we present the use of electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICR-MS) to characterize 24 alleles from 6 VNTR loci and 11 alleles from 7 SNP loci in B. anthracis. The results obtained with ESI-FTICR-MS were consistent with independent results obtained from traditional approaches using electrophoretic detection of fluorescent products. However, ESI-FTICR-MS improves on the traditional approaches because it does not require fluorescent labeling of PCR products, minimizes post-PCR processing, obviates electrophoresis, and provides unambiguous base composition of both SNP and VNTR PCR products. In addition, ESI-FTICR-MS allows both marker types to be examined simultaneously and at a rate of approximately 1 sample per min. This technology represents a significant advance in our ability to rapidly characterize B. anthracis isolates using VNTR and SNP loci.

Alleles↗
PubMed2005

Internal dissension grows as CDC faces big threats to public health.

According to current and former CDC officials and several outside experts, the Centers for Disease Control and Prevention is being roiled by internal dissension as it faces such unprecedented threats as bioterrorism, a potential flu pandemic, and the obesity epidemic. The agency has been thrown into turmoil by a combination of factors, including a drawn-out restructuring, the departure of dozens of its most respected scientists, concerns about political interference, and a pending budget cut of nearly dollar 500 million. The impact remains a matter of debate, but the uproar is causing widespread alarm among public health authorities.

Bioterrorism↗
PubMed2004

Anthrax versus the flu.

As state governments in the United States slash their public health budgets, federal money is pouring in for bioterror preparedness.

Anthrax↗
PubMed2001

Deliberate releases of biological agents: initial lessons for Europe from events in the United States.

The experience of autumn 2001, when anthrax spores were released in the postal system, had considerable consequences in the United States and in Europe. The threat of covert deliberate releases against civilians has become a reality. In Europe, despite the growing number of criminal hoaxes, no cases of anthrax linked to deliberate releases have been reported, and the only contaminated letters were addressed to American embassies abroad. Nevertheless, the time has come for Europe to set up efficient and timely plans to respond to bioterrorism, under the coordination of the European Commission.

Anthrax↗
PubMed2001

The use of smallpox virus as a biological weapon: the vaccination situation in France.

In the context of its plan to fight against bioterrorism, the Ministry of Health asked the Institut de Veille Sanitaire to evaluate the epidemic risk from a release of the small pox virus, and to make recommendations on potential vaccination strategies to be implemented. A benefit/risk assessment of various vaccination scenarios, including vaccination of the whole French population, was carried out to evaluate the severity of a terrorist action threat. This analysis concludes that at this stage, vaccination action does not seem to be justified. Even in the case of a real threat, the vaccination of frontline healthcare personnel, and in particular of contacts of cases, must be given priority.

Age Factors↗
PubMed2003

Molecular weapons against agricultural vulnerability and the war on terror.

The multiple reports in this issue of the Journal from the Agenda for Action conference, coupled with the analysis by the National Academy of Sciences, the National Research Council, and the Auditor General (UK) on bioterror preparedness and homeland security, highlight the immediate need for rapid disease detection and advanced diagnostic capabilities to protect the public health, animal agriculture, and the numerous associated economies in the United States. In response to the potentially devastating consequences that could arise, there is an acute need for rapid detection of a variety of the lethal foreign animal diseases, such as foot-and-mouth disease virus (FMDV), highly pathogenic strains of avian influenza, classical swine fever, rinderpest, exotic Newcastle disease virus (END), and domestic, vesicular look-alike diseases that include bluetongue, epizootic hemorrhagic disease, vesicular stomatitis, bovine herpes IBR, contagious ecthyma, bovine herpes mammilitis virus, vesicular exanthema, malignant catarrhal fever, and papular stomatitis. Some striking advances are occurring in the creation of rapid technology, including microfluidics, robotics, miniaturization, and biostabilization that are quickly being applied to the development of rapid microbial detection assays. These are now providing important weapons to combat this agricultural vulnerability.

Animal Diseases↗
PubMed2006

Academic food-supply veterinarians: future demand and likely shortages.

The future demand for and potential shortages of food-supply veterinarians have been the subject of much concern. Using the Delphi forecasting method in a three-phase Web-based survey process, a panel of experts identified the trends and issues shaping the demand for and supply of academic food-animal veterinarians, then forecasted the likely future demand and shortages of food-supply veterinarians employed in academic institutions in the United States and Canada through 2016. The results indicate that there will be increasing future demand and persistent shortages of academic food-supply veterinarians unless current trends are countered with targeted, strategic action. The Delphi panel also evaluated the effectiveness of several strategies for reversing current trends and increasing the number of food-supply veterinarians entering into academic careers. Academic food-supply veterinarians are a key link in the system that produces food-supply veterinarians for all sectors (private practice, government service, etc.); shortages in the academic sector will amplify shortages wherever food-supply veterinarians are needed. Even fairly small shortages have significant public-health, food-safety, animal-welfare, and bio-security implications. Recent events demonstrate that in an increasingly interconnected global economic food supply system, national economies and public health are at risk unless an adequate supply of appropriately trained food-supply veterinarians is available to counter a wide variety of threats ranging from animal and zoonotic diseases to bioterrorism.

Animals↗