Diarrhea in U.S. troops deployed to Thailand.

Ninety-five (28%) of 333 U.S. military personnel deployed to Ubonratchathani, Thailand, for 1 month in February 1993 developed diarrhea. Campylobacter jejuni was identified in 6 (25%), attaching and effacing Escherichia coli was identified in 3 (13%), nontyphoidal Salmonella spp. were identified in 2 (8%), and rotavirus was identified in 1 (4%) of 24 persons who had diarrhea and submitted specimens.     

Mitochondrial and nuclear variants in a U.S. Black population: origins of a hybrid population

The maternal transmission of mitochondria in higher eukaryotes makes it possible to distinguish between reciprocal matings, since offspring possess the mitochondrial DNA variants received from the mother. This possibility can be extended to hybrid populations, the mitochondrial frequencies reflecting the relative maternal contributions from the parental populations. Nuclear variations reflect the relative genetic contributions of the parental populations, irrespective of parental sex. The U.S. Black population is a hybrid of West African and European populations. The African-European matings that contributed to the present Black population are traditionally considered to have been almost exclusively between African females and European males. We have studied nuclear and mitochondrial variants in a sample of U.S. Blacks, comparing them with published frequencies from African and Caucasian groups. Our results suggest that the mitochondria of present-day American Blacks are derived from Caucasians to an extent similar to nuclear genes. In contrast to traditional beliefs, the contribution from Caucasian females is of the same magnitude as that from Caucasian males.     

Prevalence of overweight and obesity in a U.S. pediatric surgical population

OBJECTIVE: To describe the prevalence of overweight and obesity in a pediatric surgical population from a large teaching hospital in the United States. METHODS AND PROCEDURES: We carried out a retrospective review of the perioperative database for the period January 2000 to December 2004 at the University of Michigan. Using directly measured height and weight, we computed body mass index (BMI) on 6,017 children. Overweight and obesity were defined using age- and gender-specific cut-off according to the National Center for Health Statistics (NCHS)/Centers for Disease Control and Prevention (CDC) (2000) growth charts. We also examined the type of surgical procedures most commonly performed on overweight and obese children, and the distribution of overweight and obese patients by preoperative American Society of Anesthesiologist (ASA) classification. RESULTS: We found a somewhat "heavy" pediatric population with a mean BMI of 21.6kg/m(2). The mean BMI in males was 21.7 kg/m(2) and 21.6 kg/m(2) in females. BMI showed a positive correlation with age overall (r=0.48, p < 0.01), and in both males and females. The overall prevalence of overweight and obesity using age-specific criteria was 14.4% and 17.2%, respectively. Approximately 10% of the children met adult criterion for obesity (BMI > or =30 kg/m(2)). Orthopedic and otolaryngological procedures were the most common surgeries in this cohort of overweight and obese children. We further found that 35.3% of obese and 20.6% of morbidly obese children were classified as ASA I. CONCLUSION: The prevalence of overweight and obesity is high in this pediatric surgical population. Follow-up studies examining the impact of overweight and obesity on perioperative outcome are needed.     

Effects of a tailored inhaler use education program for chronic obstructive pulmonary disease patients

ObjectivesThis study compared the effects of a tailored inhaler use education program with routine clinical practice in asthma and chronic obstructive pulmonary disease patients treated with inhalers.MethodsThe participants included 59 patients from a ≥900-bed university hospital in J city. Participants were divided into two groups and received either the tailored inhaler use education program (n = 29) or routine clinical care (n = 30). Disease knowledge and correct inhaler use were assessed using a questionnaire and observational checklists at admission and discharge. Chi-square and Mann-Whitney U tests were used for data analysis.ResultsDisease knowledge (asthmaz = −2.69, p = .007; chronic obstructive pulmonary disease z = −6.08, p < .001) and correct inhaler use (z = −5.51, p < .001) were significantly higher in the tailored inhaler use education program group compared to the control group.ConclusionsNurses play a pivotal role in educating patients. Our results indicate that nurses are needed to identify diseases and inhaler types and to provide patients with individually tailored education that includes demonstration and feedback.Practice implicationsOne-on-one health literacy education tailored to inhaler type and patient age shows promise for chronic disease interventions provided by nurses, physicians, and pharmacists--all the parties involved in patient care.     

Characterization of enterotoxigenic Escherichia coli isolated from U.S. troops deployed to the Middle East.

Enterotoxigenic Escherichia coli (ETEC) was a common cause of traveler's diarrhea in U.S. soldiers in the Middle East in 1989 and 1990. To determine which bacterial components would be useful in a vaccine, potential protective antigens (toxin, colonization factor antigen [CFA], and serotype) from 189 ETEC isolates were examined. Nearly half of the isolates expressed both ETEC toxins, 39% had only heat-stable enterotoxin (ST), and 17% had heat-labile enterotoxin (LT). CFA/I was the least common colonization factor antigen (11%), CFA/II was common (34%), as was CFA/IV (31%), and 24% expressed none of these CFAs. Fifty-seven O:H serotypes were found. Serotype O6:H16 was the most common, occurring in 29% of the ETEC isolates, usually with LT-ST and CFA/II. Generally, CFA/II was associated with expression of both toxins, CFA/IV was associated with expression of ST, and none of the CFAs was routinely found with LT. We conclude that ETEC from soldiers in the Middle East expressed a variety of antigens and that an effective vaccine will require multiple protective antigens.     

Spouse abuse recidivism in the U.S. Army by gender and military status

Recidivism by spouse abusers was investigated using records of offenders in the U.S. Army Central Registry. Recidivism by gender and military status (active-duty or civilian spouse) was compared over a 70-month period. Between fiscal years 1989-1997, 48,330 offenders were identified in initial and recidivist incidents. Recidivism was analyzed by means of a Cox proportional hazard rate model, controlling for age, race, number of dependents, education, and substance abuse. Two different sets of survival curves were obtained: (a) Men were much more likely than women to have a recurrence and (b) within gender, civilians were more likely to have a recurrence than were active-duty military personnel. At 70 months, 30% of the male civilian offenders and 27% of the male active-duty offenders had committed a subsequent spouse abuse incident compared with 20% of the female civilian offenders and 18% of the female active-duty offenders, controlling for other variables.     

Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

PURPOSE: Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. METHOD: A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. RESULTS: All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. CONCLUSION: Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.     

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.     

Usability and feasibility of smartphone video capabilities for telehealth care in the U.S. military

The two-way audio/visual capabilities on the latest smartphone platforms bring new possibilities for the delivery of healthcare services to users. Because this technology is so new, the feasibility and the basic usability of the technology need to be evaluated before more research is conducted on its application in the telehealth field. The purpose of this study was to conduct preliminary usability testing of smartphone two-way video capabilities for potential telehealth use for U.S. military service members. Seven service member volunteers communicated with research staff at a large military installation via Apple's (Cupertino, CA) FaceTime? app on the iPhone? 4 smartphone platform and conducted basic usability testing of the technology. Preferences for potential use of the technology were also assessed. The results showed that the technology has both limitations as well as potential for telehealth applications that warrant additional research.     

Genetic epidemiological studies of early-onset deafness in the U.S. school-age population

Profound, early-onset deafness is present in 4–11 per 10,000 children, and is attributable to genetic causes in at least 50% of cases. Family history questionnaires were sent to 26,152 families of children with profound, early-onset deafness not known to be related to an environmental cause. The probands were ascertained through the 1988–89 Gallaudet University Annual Survey of Hearing Impaired Children and Youth. The analysis is based on the responses that were received from 8,756 families. Classical segregation analysis was used to analyze the family data, and to estimate the proportions of sporadic, recessive and dominant causes of deafness in the families. These data were consistent with 37.2% of the cases due to sporadic causes, and 62.8% due to genetic causes (47.1% recessive, and 15.7% dominant). An earlier study using the 1969–70 Annual Survey found 49.3% sporadic cases and 50.6% genetic, demonstrating that the proportion of sporadic cases of early-onset deafness has significantly decreased since 1970. © 1993 Wiley-Liss, Inc.     

The impact of tailored interventions on a community health center population

We conducted a 4-year randomized study in a community health center that serves primarily low income Blacks in Durham, North Carolina. Patients (1318 at baseline) were assigned randomly to one of three study groups: provider prompting intervention alone, provider prompting and tailored print materials or the previous group and tailored telephone counseling. The purpose of the study was to determine whether increasingly intensive, tailored print and telephone interventions also were increasingly effective in promoting adherence to mammograms, Pap tests and overall cancer screening compliance. Thus, the combination of tailored print interventions (print and telephone) should have been more effective than the provider prompting intervention alone, or the print intervention and prompting combination. This is one of the few studies to examine a measure of overall cancer screening compliance and to assess the benefit of combinations of tailored interventions in promoting adherence to cancer screening. Patients gave extremely high ratings to the interventions. At the bivariate level, we found a significant effect of the most intensive group (provider prompting intervention, tailored print communications and tailored telephone counseling) on Pap test compliance (P = 0.05) and borderline significance at the multivariate level (P = 0.06) as well on overall screening compliance (P = 0.06). There was not a significant effect on mammography, probably because a majority of the patients were receiving regular mammograms. We also found some important subgroup differences. For example, a larger proportion of women reported Pap tests in the tailored print and counseling group when they believed the materials were 'meant for me.' These results show that a combination of tailored interventions may have potential for reaching the women who have too often been labeled the 'hard to reach.'     

The chemoprophylaxis of cerebrospinal meningitis using rifampin in a military population.

Since February 5th 1990, the prevention of secondary cases of cerebrospinal meningitis (CSM) in France has been obtained by the use of rifampin. Following the detection of a case of N. meningitidis of antigenic formula B:NT:P1.15,16 in a military population, 89 contacts subjects received 600 mg rifampin twice a day during 2 days. Meningococcal carriage rate was investigated by nasopharyngeal swab sampling of the 89 subjects and 62 non-contact controls from the same community. Twenty-three days after the initial case of meningitis, carriage rate was 5.6% for treated subjects and 37.1 for controls. Sero-grouping, serotyping and subtyping failed to detect the initial virulent strain; it demonstrated the heterogeneity of circulating strains. Since rifampin-resistant mutants may occur, two strains in the treated group, it is essential that chemoprophylaxis in a community be limited strictly to the contact subjects.     

Case series study of traveler's diarrhea in U.S. military personnel at Incirlik Air Base, Turkey

Military personnel with traveler's diarrhea (n = 202) while deployed to Incirlik Air Base, Turkey, from June to September 2002 were evaluated for pathogen-specific immune responses. Serologic and fecal immunoglobulin A (IgA) titers to enterotoxigenic Escherichia coli antigens (CS6, CS3, and LT) were quite low. In contrast, subjects with Campylobacter infections had high serologic and fecal IgA responses.