Yersinia pestis: still a plague in the 21st century.

Yersinia pestis, the causative agent of plague, is an aerobic, non-motile, gram-negative bacillus belonging to the family Enterobacteriacea. It is a zoonotic infection transmitted to humans via the bite of a flea. Three clinical forms of human plague exist: bubonic, pneumonic, and septicemic. Many important virulence factors associated with this organism are responsible for its extreme pathogenicity and high mortality rates. The bubonic form of plague is usually not transmitted human to human but the pneumonic form is--through inhalation of contaminated aerosol droplets. The pneumonic plague would be the form most likely implicated in the event of an intentional attack. Inhalation of aerosols can cause devastating consequences resulting in many casualties. Unless antibiotics are administered within 24 hours of the initial symptoms, death is inevitable. Its potential for use as a biological weapon is of major concern to public health officials.     

Diagnostic analyses of biological agent-caused syndromes: laboratory and technical assistance

The impact of a bioterrorism attack can be greatly reduced by collaboration among primary healthcare providers, laboratories, the veterinary community, public health officials, and emergency response personnel. Improved communication and coordination are essential to make this happen. As a first-line provider, the emergency physician must keep in mind the possibility of bioterrorism and alert the laboratory so that samples can be processed in the correct fashion. New and exciting developments in laboratory organization, communication, and diagnostic capabilities will ensure that all patients receive the best possible care.     

Poinsettia exposures have good outcomes … just as we thought

The poinsettia (Euphorbia pulcherrima) is a much-maligned plant which is thought by the public and some health professionals to be extremely toxic. Despite pronouncements by public health officials to the contrary, the poinsettia continues to be recognized as a poisonous plant. To determine if there was any validity to the toxicity claims, 849,575 plant exposures reported to the American Association of Poison Control Centers were electronically analyzed. Poinsettia exposures accounted for 22,793 cases and formed the subset that was analyzed to critically evaluate the morbidity and mortality associated with poinsettia exposures. There were no fatalities among all poinsettia exposures and 98.9% were accidental in nature, with 93.3% involving children. The majority of exposed patients (96.1%) were not treated in a health care facility and 92.4% did not develop any toxicity related to their exposure to the poinsettia. Most patients do not require any type of therapy and can be treated without referral to a health care facility.     

Pharmacological treatment of acute ischemic stroke

Ischemic stroke is devastating. It is the third leading cause of death in the United States. Each year, 480,000 people fall victim to ischemic stroke, which is estimated to cost 71.8 billion dollars (Hinkle JL, Bowman L. J Neurol Nurs. 2003;35:1-8. New treatment is available. Acute ischemic stroke is no longer considered an accident resulting in damage that must simply be dealt with. Now termed a brain attack, like a heart attack it must be treated immediately. Education is key to improving outcomes. Health care professionals must be trained to recognize early signs and symptoms of stroke. The public must be educated to understand the urgency of early evaluation once symptoms of stroke occur Brown M. Clin Med. 2001; 1:60-65). Television commercials, billboards, and public health lectures can be advantageous in a campaign to educate about stroke and the need to seek help immediately when experiencing symptoms, to halt the ischemic damage Brown M. Clin Med. 2001; 1:60-65.     

Decontamination of mass casualties--re-evaluating existing dogma

The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response. Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.     

Hepatitis C: an update for occupational health nurses.

Hepatitis C is no longer an emerging dilemma. It is a significant public health problem with life altering complications. Occupational health nurses have the responsibility to their employees to be up to date on the latest treatment modalities so they can accurately advise their clients should an exposure occur. Occupational health nursing practice needs to focus on employee education related to Occupational Safety and Health Administration's Blood Borne Pathogens Standard and the latest in safety devices through regular yearly in-services.     

Influencing Genomic Change and Cancer Disparities through Neighborhood Chronic Toxic Stress Exposure: A Research Framework

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood‐level interventions that have the potential to mitigate exposure to neighborhood‐associated chronic toxic stress, improve individual‐level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood‐level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long‐term outcomes can be measured by evaluating population‐level cancer incidence and mortality.     

Terrorism involving cyanide: the prospect of improving preparedness in the prehospital setting

The potential for domestic or international terrorism involving cyanide has not diminished and in fact may have increased in recent years. This paper discusses cyanide as a terrorist weapon and the current state of readiness for a cyanide attack in the United States. Many of the factors that render cyanide appealing to terrorists are difficult to modify sufficiently to decrease the probability of a cyanide attack. For example, the relative ease with which cyanide can be used as a weapon without special training, its versatile means of delivery to intended victims, and to a large degree, its ready availability cannot be significantly modified through preparedness efforts. On the other hand, the impact of an attack can be mitigated through preparedness measures designed to minimize the physical, psychological, and social consequences of cyanide exposure. Although the nation remains ill-equipped to manage a cyanide disaster, significant progress is being realized in some aspects of preparedness. Hydroxocobalamin-a cyanide antidote that may be appropriate for use in the prehospital setting for presumptive cases of cyanide poisoning-currently is under development for potential introduction in the US. If it becomes available in the US, hydroxocobalamin could enhance the role of the prehospital emergency responder in providing care to victims of a cyanide disaster. Additional progress is required in the areas of ensuring local and regional availability of antidotal treatment and supportive interventions, educating emergency healthcare providers about cyanide poisoning and its management, and raising public awareness of the potential for a cyanide attack and how to respond.     

H EALTH C ARE F ACILITY P REPARATION FOR W EAPONS OF M ASS D ESTRUCTION

Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night.     

Health care facility preparation for weapons of mass destruction

Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night. PREHOSPITAL EMERGENCY CARE 2000;4:261-269     

Epidemiology and etiology of chemical ocular injury: A brief review

Chemical ocular injury is one of the common ophthalmologic emergencies that can cause vision loss and serious complications. Despite all protective measures, it continues to be a serious public health problem, especially in young male patients. Although it is known that injuries occur most frequently in the workplace and in young male patients, there is a variable frequency and distribution in different regions around the world. In addition, with the coronavirus disease 2019 pandemic, there are ...     

Diarrheal illnesses: a public health perspective

Diarrheal illnesses remain among the leading causes of morbidity in the United States. Approximately five million diarrheal cases occur annually (Chin, 2000; Ostroff & Leduc, 2000), with an estimated incidence of one diarrheal episode per person per year (Aranda-Michel & Giannella, 1999). Though the causes of diarrheal illnesses vary, infectious agents account for a majority of cases (Aranda-Michel & Giannella, 1999; Chin, 2000; Ostroff & Leduc, 2000). Most diarrhea-causing infectious agents are transmitted through food, water, or person-to-person via the fecal-oral route and are the cause of numerous diarrheal outbreaks. The risk for exposure to such pathogens within the general population is universal; however, persons in pediatric, geriatric, and other immunocompromised populations are at increased risk for subsequent illness and complications (Centers for Disease Control and Prevention, 2001; Ostroff & Leduc, 2000). Moreover, many persons with diarrheal illness do not seek medical care and self-treat with over-the-counter antidiarrheal agents, which have potentially serious side effects among high-risk individuals. The public health impact of diarrheal illness is apparent and emphasizes the need for early diagnosis and appropriate treatment, timely notification of illness with public health implications, and coordination between healthcare professionals and public health officials to prevent and control the spread of infection.     

Increased incidence of syphilis in Tennessee during the 1980s: challenges for a new decade.

Although recent increases in the incidence of syphilis are well known to public health officials, the general medical community is less well informed regarding the dramatic rise in cases. We present trend data from Nashville and Tennessee over the past decade. These statistics emphasize specific factors, such as drug abuse, that contribute to new difficulties in controlling this sexually transmitted disease.     

Recognition and management of bioterrorism infections

Recent events have demonstrated that bioterrorists have the ability to disseminate biologic agents in the United States and cause widespread social panic. Family physicians would play a key role in the initial recognition of a potential bioterrorism attack. Familiarity with the infectious agents of highest priority can expedite diagnosis and initial management, and lead to a successful public health response to such an attack. High-priority infectious agents include anthrax, smallpox, plague, tularemia, botulism, and viral hemorrhagic fever. Anthrax and smallpox must be distinguished from such common infections as influenza and varicella. Anthrax treatment is stratified into postexposure prophylaxis and treatment of confirmed cutaneous, intestinal, or inhalation anthrax. Disease prevention by vaccination and isolation of affected persons is key in preventing widespread smallpox infection. Many resources are available to physicians when a bioterrorism attack is suspected, including local public health agencies and the Centers for Disease Control and Prevention.     

Biosocial bases of aggressive and violent behavior--implications for nursing studies

Although aggression and violence have been increasingly viewed as a major public health problem with a biological and health basis, it has been under-researched in the nursing and health context. This paper reviews early biological risk factors for violence. These factors include pregnancy/birth complications, fetal exposure to nicotine, alcohol, and drugs, low cholesterol, malnutrition, lead and manganese exposure, head injuries and brain dysfunction, low arousal, low serotonin, low cortisol, and high testosterone. A biopsychosocial violence mode is proposed. Finally, the paper argues that nursing is ideally placed to develop a new body of knowledge based on a biosocial perspective that can lead to more effective prevention programs for violence.     

Reporting of interaction

Interaction is the situation whereby the association of one risk factor with a certain outcome variable differs across strata of another risk factor. From a public health perspective, the assessment of interaction on an additive scale may be most relevant. Although additive models exist, logistic and Cox regression models are the most commonly used models in epidemiology. The resulting relative risks can be translated to an additive scale. The present paper presents surrogate measures to evaluate the presence of additive interaction when dealing with data on a multiplicative scale (relative risks). For a transparent presentation of interaction effects it is recommended to report the separate effect of each exposure as well as their joint effect compared to the unexposed group as joint reference category to permit evaluation of interaction on both an additive and multiplicative scale.     

Public opinion and smoke-free laws

Public support for Lexington-Fayette County, Kentucky's smoke-free law, perception of health risks from exposure to secondhand smoke (SHS), smoking behaviors, and frequency of visiting restaurants, bars, and entertainment venues were assessed pre- and post-law. Two cohorts of noninstitutionalized adults (N = 2,146) were randomly selected and invited to participate in a 10- to 15-min telephone survey. Public support for the smoke-free law increased from 56% to 63%, and respondents were 1.3 times more likely to perceive SHS exposure as a health risk after the law took effect. Although adult smoking and home smoking policy did not change post-law, adults frequented public venues at least as much as before the law. Lexington adults favored the smoke-free legislation despite living in a traditionally protobacco climate. The smoke-free law acted as a public health intervention as it increased perception of risk of heart disease and cancer from SHS exposure.     

Kelly West Lecture. Primary prevention of type II diabetes mellitus

A useful paradigm for developing a public health strategy for combating chronic diseases consists of three phases: observational epidemiological studies, first cross-sectional and then prospective; intervention trials; and, finally, public health action. Although the field of cardiovascular epidemiology is well advanced into the third phase, i.e., public health action, the field of diabetes epidemiology is at least a generation behind and has only recently entered the phase of prospective observational studies. Part of the reason for this lag may be that, unlike cardiovascular disease, non-insulin-dependent (type II) diabetes has not been traditionally viewed as an epidemic, thereby detracting from a sense of urgency about the disease. Although this perspective may be appropriate for white populations, data from around the world make it increasingly apparent that type II diabetes has indeed reached epidemic proportions in non-white populations. Prospective studies are needed to firmly establish risk factors on which public health actions can be confidently based. Although anthropometric and metabolic risk factors such as obesity, body fat distribution, and circulating glucose and insulin concentrations are becoming well established as risk factors for type II diabetes, much less is known about behavioral risk factors. These latter risk factors are especially important because they are often amenable to public health action. There are preliminary data suggesting that decreased physical activity and increased fat consumption may be behavioral risk factors for diabetes. Decreased total energy intake, reflecting either low levels of physical activity or an intrinsically low metabolic rate, perhaps genetic in origin, may also be a diabetes risk factor. Unlike the field of cardiovascular epidemiology, in which there is already a critical mass of intervention trials on primary prevention, such trials are essentially nonexistent in the field of diabetes epidemiology; they are urgently needed. Although the notion of a single gene causing diabetes is clearly simplistic, there is a reasonable expectation that genetic markers can be identified that would be useful in screening for genetic susceptibles, at least in selected predisposed populations. Such markers could then be used to identify target populations for primary-prevention trials and public health action. Although primary-prevention trials should not be deferred until genetic markers are available, these two research paths may someday converge and genetic markers may come to play an important role in screening individuals as part of a comprehensive public health strategy. Numerous trial designs should be considered for testing hypotheses about the primary prevention of type II diabetes. These include single risk factor, multiple risk factor, and factorial designs.(ABSTRACT TRUNCATED AT 400 WORDS)     

Air pollution,vascular disease and thrombosis: linking clinical data and pathogenic mechanisms

Summary. The public health burden of air pollution has been increasingly recognized over the last decades. Following the first assessed adverse effects on respiratory diseases and lung cancer, a large body of epidemiologic and clinical studies definitely documented an even stronger association of air pollution exposure with cardiovascular mortality and morbidity, particularly related to atherothrombotic (coronary and cerebrovascular) disease. Particulate matter (PM), mainly that with lower aerodynamic diameter (fine and ultrafine PM), is responsible for the most severe effects, due to its capacity to transport toxic substances deep into the lower airways. These effects have been shown to occur not only after short‐term exposure to elevated concentrations of pollutants, but even after long‐term relatively low levels of exposure. Vulnerable subjects (elderly persons and those with preexisting cardiopulmonary diseases) show the highest impact. Fewer and conflicting data also suggest an association with venous thromboembolism. Although not completely elucidated, a series of mechanisms have been hypothesized and tested in experimental settings. These phenomena, including vasomotor and cardiac autonomic dysfunction, hemostatic unbalance, oxidative stress and inflammatory response, have been shown to change over time and differently contribute to the short‐term and long‐term adverse effects of pollution exposure. Beyond environmental health policies, crucial for improving air quality and reducing the impact of such an elusive threat to public health, the recognition and assessment of the individual risk, together with specific advice, should be routinely implemented in the strategies of primary and secondary cardiovascular prevention.